LO 5 Flashcards
(80 cards)
1
Q
A total office infection control program is designed to _______
A
Prevent or reduce the spread of disease
2
Q
What are the six pathways for cross-contamination?
A
- Patient to dental team
- Dental team to patient
- Patient patient
- Dental office to community, including the dental teams families
- Community to patient
- Dental team to family
3
Q
What are the three factors for infectious disease to develop?
A
- Virulence
- Dose
- Resistance
4
Q
What are the goals of infection control?
A
- The goal of infection control is to reduce the dose of microorganisms that may be shared between individuals or between individuals and contaminated surfaces
- The more the dose is reduced, the better the chance of preventing disease spread
5
Q
Where do infection control recommendations come from?
A
- Center for disease control (CDC) and health Canada - provide infection control recommendations
- Royal college of dental surgeons of Ontario (RCDSO) regulates the practice of dentists under the regulated Health professions act (RHPA)
- The regulatory college for dental hygienists (CDHO)
6
Q
Routine practices are based on the concept that ________
A
All patients are potentially infective
7
Q
Are routine infection control practices required by law?
A
Yes, occupational health and safety is regulated in Canada in each of the 14 jurisdictions (provincial, territorial, and Federal)
8
Q
What are the five principles inherent in routine practices?
A
- Risk assessment
- Hand hygiene
- Use of PPE
- Environmental controls
- Administrative controls
9
Q
Define universal precautions
A
The concept that all human blood and certain body fluids that may contain blood are treated as if known to be infectious for HIV and HBV and other bloodborne pathogens
10
Q
According to the CDC, an infection control program should include _______
A
A written program
11
Q
Describe general dental office CDC guidelines
A
- All personnel should be tested for antibody hep B surface antigen
- Standard precautions / routine practices are to be used
- Proper hand hygiene must be followed
- PPE should include clean eyewear or face Shields
- Dental office personnel are to be educated about skin reactions that occur with frequent hand hygiene and the use of gloves (availability of latex-free gloves and emergency kits)
12
Q
Describe CDC guidelines for Central instrument processing area
A
- Designated into receiving, cleaning, decontamination, preparation, packaging, sterilization, and storage
- Includes use of automated equipment (ultrasonic)
- Use of barriers / puncture resistant gloves
- Critical / semi critical instruments packaged and heat sterilized (use of chemical indicators and sterilization monitors)
13
Q
Describes CDC guidelines for dental unit water lines/biofilms
A
- Use water that meets environmental protection agency drinking standard (500 CFU/ml) for dental care
- Flushing of handpiece, air water syringe, and ultrasonic scalers with water and air for 30 seconds after use and prior to removal from water lines between clients
14
Q
Describe CDC guidelines for dental handpieces
A
- Follow manufacturer’s guidelines for proper sterilization
- Do not advise patients to close their lips around low-volume suction
15
Q
Describe CDC guidelines for dental radiology
A
Use of heat tolerant/disposable film holding devices including use of barriers and proper disinfection of digital sensors
16
Q
Describe the CDC guidelines for the dental laboratory
A
Need proper PPE and proper documentation
17
Q
What should a dental hygienist know about immunizations?
A
- Optimal use of vaccines to prevent transmission of disease and illness (cost effective)
- Important vaccines missing for dental professionals include: hepatitis C, HIV, tuberculosis, and some forms of human herpes viruses
18
Q
Describe tetanus
A
- Lockjaw
- Infectious complication of a cut/puncture wound caused by clostidium tatini (proliferation in anaerobic environment)
- Painful muscular contraction / spasms, death often and expected outcome of infection
- Tetanus endospores are present continually in environment and are resistant to disinfection efforts
- Boosters every 10 years after two inoculations at 4 to 6 years and 11 to 12 years - recommended for all those over 7 years of age
19
Q
Describe influenza
A
- Acute respiratory disease
- Influenza type A or B typically infect humans
- Virus changes frequently and typically new vaccines are developed two times a year
- Individuals at high risk or persons over 50 should be vaccinated yearly
- CDC advises all health care workers to vaccinate yearly
- Vaccine is grown in eggs; cannot be administered to those with hypersensitivity to eggs
20
Q
________ is one of the most frequently reported vaccine preventable diseases in North America (the need for a booster is still debated)
A
Hepatitis B
21
Q
What are the purposes of PPE?
A
- Protect the operator
- Reduce direct contact
- Minimize indirect transmission
- Minimize exposure to spatter
- Minimize exposure to aerosols
22
Q
What is included in personal protective equipment?
A
- Gloves
- Hand hygiene
- Masks - bacterial filtration efficiency: standard masks block particles greater than three micrometers with 95% filtration. Need to be removed by loops
- Protective eyewear - remove by ear rests
- Protective clothing
- Use of barriers
23
Q
Why is it so vital to wear gloves?
A
- Client’s blood has been found to be retained under the fingernails of dental team members for several days even with hand washing!
24
Q
What are factors that affect gloves?
A
- Length of time worn (approximately 1 hour)
- Procedures that perforate gloves
- Packaging
- Fit
- Storage
- Alcohol
- Rings
- Washing of gloves
25
What are the types of gloves typically worn in a dental office?
1. Client care gloves
2. Utility gloves (chemical and puncture resistance)
26
What are the proper use procedures dental hygienists should follow regarding gloves?
1. Disposable gloves should be worn during all patient care activities
2. These disposable gloves should not be reused
3. Never wash patient care gloves with detergents or chemicals (will weaken them and enhance penetration/wicking)
4. Remove if punctured or defective
5. Proper fit important reduced fatigue
6. Change gloves if leaving chairside
27
Latex gloves are made from _______ and _______ of the population and _____ of healthcare workers are sensitive to latex
1. Hevea brasiliensis (rubber tree)
2. 1-6%
3. 8-12%
28
What are the three types of reactions to gloves?
1. Irritant contact dermatitis
2. Allergic contact dermatitis
3. Latex allergy
29
What products in the dental office may include latex?
Gloves, masks, profecups, rubber dams, blood pressure cuffs, carpule stoppers, Ortho rubber bands, impression materials
30
Who is at high risk of developing latex allergy?
1. Healthcare workers
2. Increased risk of developing due to multiple medical surgeries, food allergies (avocado, banana, kiwi, chestnut, papaya)
31
What is instrument processing?
1. Collection of procedures to prepare contaminated instruments for reuse
2. Must be performed carefully to ensure that disease agents are not transferred and to keep instrument damage at a minimum
32
What are the considerations for design of an instrument processing area?
1. The instrument processing area should be as far away as possible from the dental chairs
2. Store sterile packets, trays, and cassettes enclosed cabinets or drawers
3. Do not process instruments or handle sterile packages during client care
4. Proper placement of signage - e. G. Contaminated items only, clean items only, sterile items only, etc
33
What are workflow design considerations for dental processing areas?
1. Recommended designs include a u-shaped workflow pattern in a room with a single door
2. Key aspect and design of the processing area is to separate the three main areas of activity, to prevent cross-contamination - decontamination area, preparation and packaging area, sterilizing and storage area
34
What should you remember to do before any cleaning procedure?
1. Handle contaminated instruments carefully to prevent cuts and punctures from sharp items
2. PPE such as mask, gloves, protective eyewear, and clothing should always be worn
35
How should you transport instruments to the sterilization area?
In closed cassettes covered with a plastic lid
36
What should dental hygienists know about single use devices?
1. They are not heat tolerant and cannot be reliably cleaned or disinfected therefore they must be disposed of appropriately after use
2. Single-use items will be labeled with icons showing a two with a circle around it and a line through it
37
What are the seven steps to instrument processing?
1. Holding (pre-soaking)
2. Pre-cleaning
3. Corrosion control, drawing, lubrication
4. Packaging
5. Sterilization or high level disinfection
6. Sterilization monitoring
7. Handling processed instruments
38
Describe holding (pre-soaking)
1. To prevent drying of saliva and blood
2. For contaminated instruments that cannot be cleaned right away
3. Discard / change solution once per day or when visibly soiled
4. Extended pre-soaking (more than a few hours) is not recommended - may cause instruments to corrode
5. Always read and follow the manufacturer's instructions for cleaning
39
Describe precleaning
1. A client's microbes are called **bioburden**
2. Organic components of the blood in saliva (fats and protein) protects bioburden from sterilization agents
3. Precleaning contaminated instruments reduces bio burden and increases effectiveness of sterilization or disinfection
40
There are three basic types of cleaning systems but only two that have been approved by the FDA for safety and effectiveness, what are they?
1. Approved - ultrasonic cleaning, instrument washers or washer disinfectors
2. Not approved - manual scrubbing of instruments
41
Describe ultrasonic cleaning
1. Excellent cleaning mechanism
2. Ultrasonic energy produces millions of tiny bubbles in the cleaning solution that collapse and create high turbulence at the surface of the instruments
3. This turbulence dislodges the debris
4. Use of cleaning basket or cassette rack to eliminate the need to scoop up the instruments by hand at the end of the cycle
5. Lid should be closed
6. Always use cleaning solution designed for use on the dental instruments and recommended for use in ultrasonic cleaners
7. Fill the solution to an appropriate level
8. Solution that contains antimicrobial will help to reduce the buildup of microorganisms in the solution as it is used repeatedly
42
What does ultrasonic cleaning time depend on?
1. The instruments, the amount and type of material on the instruments, the efficiency of the ultrasonic unit
2. Time ranges from 4 to 16 minutes
3. Time determined by the visible cleanliness of the instruments
4. Instruments in plastic / resin cassettes require longer cleaning times because the plastic / resin absorb some of the ultrasonic energy
43
What should you do with instruments after cleaning?
1. The rinsed and cleaned instruments are still contaminated, so it must be handled with gloves
2. Thoroughly rinse the instruments under tap water with a minimum of splashing
3. Rinsing removes residual cleaning solution and reduces the bioburden
44
Describe instrument washers
1. Remove bioburden, without direct handling of instruments
2. Automatically clean and rinse
3. Do not use household detergent
4. Cnih has instrument washers
45
Describe manual scrubbing
1. Effective in removing debris but is dangerous due to the risk of cuts and punctures during the procedure - not recommended
2. To prevent injury while handling contaminated and sharp instruments, the following precautions should be taken:
1. Using puncture resistant utility gloves
2. Not reaching into trays or containers that are holding sharp instruments that cannot be seen (for example, soap filled sinks)
3. Using a long-handled brush if manually scrubbing instruments
4. Wearing a mask, protective eyewear, and gown to protect from sprays, splashes, and splatter
46
Describe corrosion control, drying, and lubrication
1. After rinsing, allowed to drain
2. Hinged type instruments require lubrication
3. Rust inhibiting solutions can be sprayed on instruments prior to processing in a steam autoclave
47
Describe packaging for sterilization
1. Maintains the sterility
2. Prevents contamination after sterilization during storage or one being distributed to chairside
3. Unpackaged instruments - exposed to environment immediately after the sterilizer door is opened
4. Each package must be labeled before sterilization with the date processed, sterilizer used, cycler load number, initials of the healthcare worker who packaged the instruments
5. Labels must be placed on the transparent side of a plastic / paper pouch or directly on the closure tape of wrapped packages, taking care not to block the breathable area of the package
6. Permanent soft tipped markers that have been validated for the sterilizer should be used, ensuring they do not puncture or damage the packaging
7. The inside contents of the package need to be labeled if the instruments are not visible (for example, in a wrapped cassette)
8. All packages must include both external and internal chemical indicators
48
Describe the use of cassettes in sterilization
1. Reduces direct handling of contaminated instruments
2. Keeps instruments together
3. Requires planning to ensure that the proper size of ultrasonic cleaner and sterilizer are used
4. Numerous styles
5. It is important to follow cassettes manufacturers recommendations and always wrap cassettes before processing them through a sterilizer
49
Describe sterilization of unwrapped instruments
1. Sterilizing unwrapped instruments is called flash sterilization
2. For emergency purposes only
3. Allows unnecessary contamination
4. Unwrapped item is placed in an open tray or is placed in a specially designed, covered, rigid container to allow for rapid penetration of steam. Flash sterilization should only be used in urgent emergency situations where the instrument will be used immediately and no other options are available. Client scheduling and or lack of instruments do not qualify as a reason to use Flash sterilization
50
What should be considered regarding the use of Flash sterilization?
1. A log is kept of all particulars when this method is used (i.e. client name, procedure, and instrument used)
2. Instruments must be clean and dry prior to sterilization
3. Every cycle must be monitored using the appropriate indicators
4. Care is taken to prevent contamination of instruments prior to use
5. A log must be kept of immediate use steam sterilization including contents of the load and confirming all physical parameters were met. Equipment/devices sterilized in this manner must be noted in the patient's chart along with the rationale
51
Define microbicidal agent
One that kills microbes
52
Define bactericidal
Kills bacteria but not necessarily the endospores of bacteria
53
Describe fungicidal
A disinfectant that kills fungus
54
Define virucidal
Kills viruses
55
Describe germicidal
A general term used to refer to any agent that destroys germs or harmful microorganisms such an agent might be used in sanitation procedures
56
Define microbiostatic and bacteriostatic agent
1. A drug or chemical or method that inhibits the growth and reproduction of microorganisms
2. Stops the growth of specifically bacteria, but does not kill it
57
Define asepsis
The absence of pathogens on living tissues
58
Define aseptic technique
Disinfection of the environment and cleansing of the body tissue with antiseptics
59
Define sterilization
A process intended to kill all microorganisms - the highest level of microbial kill that can be achieved
60
Define disinfection
Les lethal of a process than sterilization - intended to kill disease producing microorganisms but not bacterial endospores. Usually refers to the use of liquid chemicals to kill microorganisms at room temperature on surfaces
61
Define disinfectants
Chemicals used to disinfect inanimate objects such as operating rooms / dental operatories (kills microorganisms, but is not sporicidal) - destructive to living tissues
62
Define antiseptics
Solutions used to disinfect the skin or other living tissues
63
Define sanitization
Reduces the microbial population to levels considered safe by public health standards, such as those applied to restaurants
64
What is the standard challenge in sterilization?
Bacterial endospores
65
What are the three common types of sterilizers used in dental offices?
1. Steam sterilization - heating water to generate steam in a closed chamber, producing a moist heat that rapidly kills microorganisms
2. Unsaturated chemical vapor sterilization - heating a special chemical solution in a closed chamber, producing hot chemical vapors that kill microorganisms
3. Dry heat sterilization - heating air with transfer of heat energy from the air to instruments
66
What are the advantages of dry heat sterilization?
1. Does not dull The cutting Edge of instruments
2. Does not rust or corrode as long as the items are dry prior to sterilization
3. Easy to use with very little maintenance required
4. Very reliable
5. Can be monitored for effectiveness
6. Items are dry immediately after cycle
7. Less expensive form of sterilization
67
What are the disadvantages of dry heat sterilization?
1. Usually requires longer cycles for sterilization
2. Damages some plastics
3. May discolor or char fabric
4. Poor penetration
5. Requires careful loading
6. High temperatures May prohibit use with some items and may melt or destroy some metal or solder joints
7. Instruments must be pre-dried
68
Describe steam sterilization
1. Merely boiling water is insufficient
2. Pressurizing steam greatly enhances microbe killing ability
3. Air must be removed from sterilizer chamber so steam can reach all instrument surfaces
69
Describe how a steam autoclave works (**first method of choice**)
1. Moist heat coagulates protein
2. Pressure elevates temperature
3. Steam must be able to penetrate so pack loosely to allow free passage of steam
4. Flash sterilization requires higher than standard temperature and a shorter time
70
What are the advantages of the steam autoclave?
1. Quick and easy to use
2. Allows loads to be packaged
3. Penetrates fabric and paper wrappings
4. Very reliable
5. Can be monitored for effectiveness
71
Describe the disadvantages of a steam autoclave
1. May cause rust or corrosion
2. May damage plastics
3. Made dull sharp instruments
4. May leave items still wet
72
What are the four steps a typical dental office steam sterilizer will go through?
1. Heat upcycle - generates Steam and removes air
2. Sterilizing cycle - sterilization temperature held for a set time
3. Depressurization cycle - steam slowly released, items still wet
4. Drying cycle - drives packages
73
Describe how chemical vapor under pressure works
1. Alcohols, formaldehyde, ketone, water, and acetone are heated under pressure to produce gas that permeates and destroys microbes and viruses
2. Need manufacturers chemical solution
74
What are the advantages of chemical vapor under pressure?
1. Relatively short cycle
2. Does not corrode or rust metal
3. Very reliable
4. Effectiveness can be monitored
5. Items dry quickly
75
What are the disadvantages of using chemical vapor under pressure?
1. Good ventilation is required due to fumes
2. Vapor must penetrate through all materials (fabric packs are incompatible)
3. Damages some materials sensitive to chemicals, temperature, and pressure
4. Requires special solution, increasing the cost
5. Damages plastic / rubber
6. Instruments must be pre-dried
76
Describe liquid chemical sterilization
1. Involves submerging items in liquid sterolin are high level disinfectant at room temperature
2. Good for items sensitive to high heat temperatures (plastics and rubbers)
3. Kill spores within a controlled lab setting but cannot be monitored by a bacterial spore testing routinely, therefore not the most reliable
4. Important to replenish it frequently
5. Items placed in the solution must be free of any visible debris biofilm and blood - these can exhaust the solution causing it to be ineffective
77
What are the characteristics of a good chemical antimicrobial agent?
1. Must kill pathogens within a reasonable period and in specific concentrations
2. Non-toxic to human tissue and non corrosive and non-destructive to materials
3. Easy to apply
4. Inexpensive and easy to prepare
5. Stable - it can be shipped and stored for a reasonable period
6. Stable to pH and temperature changes
78
What is important to remember when loading cassettes or pouches into a sterilizer?
They must be kept separate for each other so steam has access to all services - items should be placed on their edges, not stacked
79
How long is Flash sterilization?
3 minutes exposure at a high temperature
80
What is important to remember about unloading packages from a sterilizer?
Packages should be allowed to dry thoroughly before unload unloading to avoid contamination or "wicking" (the penetration of wet sterilization paper by bacteria or fungi)
