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level: Level 1

Questions and Answers List

level questions: Level 1

QuestionAnswer
The first link in the chain of infection– infectious agent: virulence strength or degree of pathogenicity
Links of infection–infectious agent –resevoir –portal of exit –transmission –entry –susceptible host Virulence -Numbers -Susceptible host -Portal of entry
Bioburdenblood saliva and other body fluids
Acute infectionan infection of short duration that is often severe
chronic infectionan infection of long duration
percutaneousthrough the skin such as needles stick cut or human bite
direct transmissionwhen someone comes into direct contact with the infectious lesion or infected body fluids –person–to–person contact
Mist–like aerosols–has the finest droplets –can remain suspended in the air for extended periods of time –can only spread resp. infections not HIV and HBV inhaled
Bloodborne–BB pathogens are organisms transferred through contact with bodily fluids. EX. blood –common BBP of concern are HCV, HBV, HIV
know all the different types of immunity–Active natural: contact with the disease and produce memory cells – Passive natural: receive maternal antibodies through the placenta or breast milk –Active artificial: vaccination to produce memory cells –Passive artificial: receive antiserum with antibodies from another host
Know all the different types of transmission of diseases and the most common route in the dental office– airborne transmission: the spread of disease through droplets of moisture containing bacteria or viruses –Parenteral transmission: needlestick injuries, human bites, etc. – Bloodborne transmission: direct or indirect contact with blood and other body fluids
Know all the different types of transmission of diseases and the most common route in the dental office PART 2– Food and water transmission: contaminated food is consumes – Fecal oral transmission: improper hygiene and handwashing and a person ingests fecal material – most common route is through direct contact with patients blood or saliva
Role of CDC– Federal agency –Not regulatory – issues specific recommendations based on scientific evidence
Role of OSHA– Federal agency –Not regulatory – Issues specific standards to protect the health of employees
Purpose of the BBP and how often it needs to be updatedBBP standard is designed to protect employees against occupational exposure to BBP
Standard precautionsall human blood, body fluids, nonintact skin, and mucous membranes are to be treated as if they are infectious
Protocol if there is an exposure incident–Has to be a written plan –explains exactly what steps the employee must follow after the exposure incident occurs and the type of medical follow up that will be provided to the employee at no charge – counseling, HIV test series 0,6,12 weeks and 6 months, a tanus booster, HEP B, documentation
What is recommended by CDC after HBV vaccine– Dentist must offer vaccine within days of employment – Dentist must obtain proof\n– An employee can refuse by signing an informed refusal form – 3 series dosses 0,1, and 6 months in the deltoid muscle –blood test should be performed to ensure immunity after 1–2 months – if immunity isn't there talk to the doctor –after the second round of 3–dose series don't take another, must be given counseling
Sequence of PPE's– protective clothing –surgical mask – protective eyewear – gloves
What should the employer supplyall appropriate PPE's –protective clothing –surgical masks – face shields – eyewear –disposable gloves – heavy duty utility gloves
Latex allergyNo cure – if one person in the office is allergic no one can wear latex –3 types: – irritant dermatitis –Type IV allergic reaction – Type I allergic reaction
Irritant Dermatitisnon immunologic –contact with a substance that produces chemical irratation
Type IV allergic reactionmost common– –delayed contact reaction, can take 48–72 hrs for rash to appear –involves the immune system –immune response is produced by the chemicals used to process latex
Type I allergic reactionmost dangerous – severe immunologic response, takes 2–3 mins to react – the reaction is in response to the latex protein in the gloves
General Waste– non–hazardous, non–regulated should be discarded in covered containers -EX. paper towels, empty food containers
contaminated wastehas made contact with blood or other body fluids -EX. used barriers and patient napkins
hazardous wasterisk to humans and environment, toxic chemicals –EX. amalgam, x–ray film, fixer solution
infectious or regulated waste(biohazard)contaminated capable or transmitting disease – some items like extracted teeth might be both hazardous(amalgum) and infectious –extracted teeth are regulated waste unless they contain amalgam
Creutzfeld–Jakob disease–rapidly progressive and invariably fatal degenerative neurologic disorder – can affect humans and animals, caused by prions –can incubate for years but are usually fatal within 1 year of diagnosis –probably low infection rate
Cleaning surfaces–touch –transfer –splash, spatter and droplet surface –housekeeping
Touch surfaces– directly touched and contaminated during treatments –EX. Light handles, dental unit controls, chair switches, computers
Transfer surfaces–not directly touched but often are touched by contaminated instruments –EX. instrument trays and handpiece holders
Splash, spatter and droplet surfaces– does not come in contact with personnel or contaminated instruments –Ex. countertop
Housekeeping surfaces– no evidence these pose a risk for transission – can be cleaned with a low–level disinfectant -EX. floors, walls and sinks
disinfectants– intended to kill disease–producing microorganisms that remain on the surface after precleaning – spores are not killed
sterilizationall forms of life are killed
Antisepticsare antimicrobial agents that are applied to living tissue
antimicrobialsmore effective at reducing microbial flora –concentrations of 60% to 95% are more effective
Iodophors–EPA registered –intermediate–level hospital disinfectant –tuboricidal action – contain iodine turns metals red or yellow
Synthetic phenol compounds–EPA registered intermediate–level hospital disinfectant – broad–spectrum disinfecting action – phenols leave a residual film –prepare daily
Sodium Hypochlorite–bleach –fast, cheap, broad–spectrum intermediate–level disinfectant –1:100 –unstable, prepared daily, corrosive –causes plastic covers to crack
Alcohol–not effective in precense of blood and saliva –evaporates ad damages plastics and vinyl – ADA and CDC and OSHA donot recomend
Immersion disinfectants–can range from 6–30 hrs to sterilize –used on heat–sensitive instruments
chlorine dioxide immersion disinfectant– effective, fast, surface disinfectant (3 min) –Chemical sterilant (6hrs) –does not penetrate organic debris –prepared daily, fumes, corrosive to aluminum
glutaraldehyde immersion disinfectant–high level –very toxic –thoroughly rinse after us – prolonged contact can lead to discoloration and corrosion of surfaces and cutting edges
Ortho–phthalaldehyde immersion disinfectant–high level (12 min) –more expensive than gluta. –low odor does not require activation or mixing –cant be used for a long time –may stain –plastics turn blue–green – requires more than 3 hrs to secure sterilization
patient care itemscritical – semi–critical –non– critical
critical–penetrate soft tissue or bone –greatest risk for transmission –must be heat sterilized –Ex. scalpels, bone chisels, scalers
semi–critical– touch mucous membranes –lower risk of transmission –must be sterilized by heat if heat resistant or high level disinfection if not heat resistant – Ex. plastic handled brushes, high–volume evacuator tips
Non– critical items–least risk of transmission – only contact with intact skin –cleaned with EPA registered intermediat- level or low–level disinfectant – Ex. lead apron, curing light
High–levelthe process that kills some but not all bacterial endospores and inactivates m. tuberculosis
intermediate levelinactivates m. tuberculosis
low–level–ineffective against m. tuberculosis and should be used only for house keeping
precleaningreducing the number of microorganisms that are present by physically removing debris
sterilizationprocess that inactivates all microbial life including bacterial spores, viruses, bacteria and fungi
disinfectionprocess that kills disease causing microorganism, but not all microbial life
– PPEs requiredutility gloves, mask, eyewear, protective clothing
– The ideal instrument processing areao Centrally located o Dedicated only to instrument processing o Physically separated from the operatories and dental laboratory o Not be a part of a common walkway o No windows open to the outside
Thedifferent methods of precleaning– hand scrubing –ultrasonic – instrument washing machine
Handscrubbingleast desired method, because it requires direct hand contact with contaminated instrument
o Ultrasonicused to loosen and remove debris. Reduce risk of punctures
o Instrument washing machinesimilar to dishwasher, combination of hot circulating water and detergents to remove organic mater (thermal disinfector)
– Flowentrance–> contaminated area–> packaging area–>sterilization/storage
– Reasons for bagging instruments:o Protect instruments from becoming contaminated after sterilization o Can be grouped into special setups for convenience later
Ultrasonicproduces sound waves that travel throughcontainers and form bubbles, they implode. 5–15 minutes until visibly clean.Use appropriate ultrasonic cleaning solution, change solution 2 times a day
Thedifferent sterilizers– steam autoclave – flash –unsaturated chem. vapor –dry heat – static air sterilizers –forced air –ethylene oxide –chemical liquid
o Steam autoclave sterilizationo steam a moist heat rapidly kills microorganism. –As steam fills the chamber the cooler air is pushed from an escape valve. –It isthe heat not the pressure that kills–disadvantage: rust -that kills –disadvantage: rust –Usually operates on four cycles: heat up,sterilizing, depressurization, drying§ Packaging materials may be fabric, but arecommonly film and paper pouches, nylon tubing, –temp: 250–273 –time 3–30
Flashsterilizationrapidheat transfer, steam and unsaturated chemical vapor. Can be used only oninstruments that are placed in the chamber unwrapped. These instruments shouldbe used immediately after sterilization. Compromises sterility
oUnsaturated Chem. Vapor sterilization–similarto autoclave, except chemicals (alcohol, formaldehyde, ketone, acetone andwater) are used instead of water. – OSHA requires MSDS because of chemicaltoxicity. –Does not rust or corrode instruments, wide range of things can besterilized, short cycle time. – Disadvantage: needs ventilation because of fumesor formaldehyde and methyl alcohol are released. Unpleasant odor –Pressure: 20 psi –temp: 270 – time: 20–40 min
unsaurated chem. vapor steriliation part 2Pressure: 20 psi Temperature: 131*c o(270*f) Time: 20–40 minutes
Dryheat sterilization–Hot air on instruments, this requires highertemperatures than steam or chemical vapor sterilization. –Two types: static airand forced air –Temperature: 160*–190*c (320*–375*f) –advantage: instruments don’t rust
Staticair sterilizers– similar to an oven, heating coils are at thebottom and the heat travels up. –Takes 1–2 hrs for heat to transfer ontoinstruments –Disadvantages: time consuming and may not be aseffective if operator calculates the wrong amount of time –Wrapping materials must be heat resistant Ex.Aluminum foil, glass containers
ForcedAir sterilizers–rapid heat transfer, circulates hot air fast. –Transfer of heat happens quickly – Time: after the correct temp has been reached, 6min for unpackaged items. 12 mins for packaged items
Ethyleneoxide sterilization–low temperature –Disadvantage: 4–12 hours and at least 16 hoursof post–sterilization aeration to remove gas molecules attached to plastics. –Itis ineffective on wet items, and toxicity is possible mishandled –These are often used in large clinics orhospitals rarely in private dental offices
Chemicalliquid sterilant–for heat–sensitive items. –Glutaraldehyde: 10 hours of contact time forsterilization –Must have MSDS for the employees
Howto monitor the sterilization process–physical –chemical –biologic
Physical monitoringLookat all the gauges/ readings and record the temp, pressure, and exposure time.(this only shows the temp inside the chamber, if there is crowding the gaugeswont detect that)
Chemical monitoring–external and internal, heat sensitive chemicalthat changes color are used. –Two types of chemical indicators are processindicators and process integrators both don’t indicate sterility –Process indicators: placed outside instrumentpackages (ex. Autoclave tape) only identify if they have been exposed tocertain temperatures – Process integrators: place inside the packages,they respond to
Biologic monitoring–spore testing, the only way to determine ifsterilization has occurred properly. –Must be done weekly –Vials or strips containing bacteria spores. 2are placed inside the packs and 1 is the control –Afterwards all of them are cultured if positivethe sanitation has failed.
Howto prevent rusting–This occurs during steam sterilization –Rust inhibitors such as sodium nitrate (spray ordip) –Dry the instrument with dry heat or unsaturatedchemical vapor sterilization
Bestmethod for hand pieces–Steam and chemical vapor sterilizers arerecommended because sterilization of HP should not exceed 275*f (135*c) –Should be packaged packaged –Never run a handpiece hot our out thesterilizer, no rapid cooldowns –Only rapid cooldown allowed is air fan
Handpiece debris removal process–flushing: –Attach a pressurized handpiece cleaner to intaketube –Flush the head of the handpiece to remove debris –Blow out the handpiece using compressed air toremove debris before sterilization –Running coolant water is insufficient
ADAAoldestand largest group representing dental assistants
OSAPnot for profit, resource for infection control,injury prevention, and occupational health issues
Chemicalhandling–hand protection – eye protection – protective clothing –inhalation protection
Handprotection–utility gloves made of chemical –resistantmaterials like rubber, neoprene, or industrial–grade nitrile. Regular gloves arenot enough, they degrade and allow chemicals to come in contact with skin.
EyeprotectionProtectseyes from fumes and splashes wile pouring chemicals. Ideally googles with softvinyl flanges (rims) at the top and bottom, snugly fitted to the face.
Protectiveclothingwhen caustic or staining chemicals are used userubber or neoprene aprons. The MSDS provides