2. Infection Control in Dentistry Flashcards
Importance of Infection Control in Dentistry
Following the ____ can prevent transmission of infections among patients and dental care professionals
Potential for transmission of pathogens by exposure to ____ (saliva, blood, respiratory secretions, and excretions EXCEPT ____) and injury from ____ (burs, scalpel or needle-stick injuries)
universal precautions
body fluids
sweat
sharps
How can pathogen transmission occur?
____ contact with blood or other body fluids
____ contact with a contaminated instrument or surface
Contact of mucosa of the eyes, nose or mouth with droplets or splatter
____ of airborne microorganism
Indirectly could be touching with lacerated skin or inhalation of airborne micro like microbacterium tuberculous
direct
indirect
inhalation
Chain of infection
Pathogen > ____ > Mode > ____ > ____ > pathogen
____ one of the links of the above chain will prevent the transmission of the pathogen
source
entry
susceptible host
removing
Universal Precautions to be followed
____
The use of ____, such as gloves, masks, eye protection, and gowns, that are intended to prevent the exposure of skin and mucous membranes to blood and other potentially infectious materials
____ of contaminated instruments
____ of environmental surfaces with disinfectant wipes
Injury prevention through safer ____ and ____
handwashing personal protective equipment sterilization cleaning and disinfection work practices engineering controls
Clean hands
- types of bacteria on hands!
- Showing microbial flora of our hands and if not washed properly can be transferred from ourselves to the ____
- Proper washing saves lives and like ____ for ourselves
patients
vaccine
Handwashing
- As per CDC, handwashing is like a “____” vaccine
- Involves five simple steps - ____, Lather, ____, Rinse, ____
- Removes germs from your own hands as well as their ____ in the dental office
do-it-yourself wet scrub dry spread
Hand Sanitizing
- If hands are not visibly soiled and if water and soap are not available, only ____ could be used. If hands are visibly soiled, then they must be washed first with ____, before using hand sanitizer.
- Alcohol based sanitizers that contain at least ____ alcohol are recommended.
- One should use enough sanitizer to apply to all surfaces of ____ and ____. Then rub hands against one another until all surfaces are ____.
• If not visibility soiled can use the hand sanitizer that have 60-70% alcohol and need to be rubbed dry
hand sanitizers water and soap 60% hands fingers dry
How to handwash
- wet hands with ____
- apply enough soap to cover all ____ surfaces
- rub hands palm to palm
- right palm over left dorsum with interlaced fingers and vice versa
- palm to palm with fingers interlaced
- backs of fingers to opposing palms with fingers interlocked
- rotational rubbing of left thumb clasped in right palm and vice versa
- rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa
- rinse hands with water
- dry thoroughly with a single use towel
- use towel to turn off faucet
- … and your hands are safe
Wash for ____ seconds if visibility soiled and if not visibly soiled then ____ seconds is enough
water
hand
40-60
30
How to handrub?
duration: ____
- apply a palmful of the product ina . cupped hand, covering all surface
- rub hands palm to palm
- right palm over left dorsum with interlaced fingers and vice versa
- palm to palm with fingers interlaced
- backs of finger to opposing palms with fingers interocked
- ____ rubbing of left thumb clasped in right palm and vice versa
- rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa
- once dry, your hands are safe
20-30 seconds
rotational
Efficacy of Hand Hygiene
Good: ____
Better: ____
Best: ____
plain soap
antimicrobial soap (4% CHX)
alcohol-based handrub (70% isopropanol)
• Sequence of putting on the equipment, first the ____, then ____, then ____ and then the ____ which put on in front of the patients
gown
mask
eye protection
glove
• Sequence of removing the equipment is the ____, ____, ____ and then ____
gloves
goggles
gown
mask
Gloves
Provider Patient
- To ____ the risk of health care personnel acquiring ____ from patients
- To ____ microbes from being transmitted from health care personnel to ____ by microbial flora
However, gloves are NOT a substitute for ____!
minimze infections prevent patients handwashing
Steps in Gloving
Wear gloves when contact with blood, saliva, and mucous membranes is possible
Remove gloves after each ____
Wear a new pair of gloves for each ____
If gloves tear during treatment or get nicked, they must be changed
____
•____ may develop in the gloves if you wash and reuse contaminated
gloves, leading to fluid and bacteria penetration
•Once gloves are removed, hands should be immediately ____
•Hands should be washed ____ putting gloves on and immediately ____
removing them.
patient care patient immediately micropores washed before after
Protective gown
• Protective gowns are used to fully cover torso from ____ to ____, arms to end of wrists and wrap around the back
• Be sure to ____ behind the neck and waist
• Gowns help to prevent contamination by eliminating body exposure to fluids like blood, splatter, aerosol or droplets of infectious material
• Gowns are ____ in certain areas of PDM (Atrium, Levy Bldg, Adm. Offices, ____, eating areas, elevators, ____).
• In the labs, ____ gowns should be worn. Clinical gowns are restricted in lab areas.
• Long hair must be ____ back
- There are some areas where restricted to be worn, continues to read slide blue the whole levy building and remember all of these areas, she has seen D1 coming with gown in these and in the labs we have disposable with gowns that should be worn not the ones form clinic to protect from spray
- With long hair need to tie back
neck knees fasten restricted restrooms library white tied
• CDC recommends use of ____ or ____ mouth mask by dental care personnel, since there is close contact with patients and body fluids
• Mouth mask should cover ____ and ____ during any dental procedure and patient care activities that can generate splashes or sprays of blood or body fluids.
• Masks should be changed between ____
• Masks should be changed if ____ or visibly ____.
• Masks should either be ____ – they should not dangle under the neck
or from the ear. Nor should they be placed in pockets for later use.
• ____: ideal protection for treatment of TB patients.
surgical procedural nose mouth patients wet soiled on or off N95 respirator
• CDC recommends use of ____ or ____ mouth mask by dental care personnel, since there is close contact with patients and body fluids
• Mouth mask should cover ____ and ____ during any dental procedure and patient care activities that can generate splashes or sprays of blood or body fluids.
• Masks should be changed between ____
• Masks should be changed if ____ or visibly ____.
• Masks should either be ____ – they should not dangle under the neck
or from the ear. Nor should they be placed in pockets for later use.
• ____: ideal protection for treatment of TB patients.
surgical procedural nose mouth patients wet soiled on or off N95 respirator
Protective eyewear
• Dental health care personnel should wear protective eyewear with side shields during procedures that can generate splashes or sprays of blood or body fluids
• Protective eyewear protects the mucous membranes of the eyes from contact with microorganisms and also protects ____ eyes from splatter or any debris
• Reusable protective eyewear should be cleaned with ____, and when visibly soiled, ____ between patients (disinfectant ____ or ____)
patient's soap and water disinfected wipes spray
Disinfection and Sterilization
• Disinfection: Reduction of pathogens on objects to decrease potential of infection. Will not destroy ____.
• Sterilization: Destruction of all microbial life including ____.
bacterial spores
bacterial spores
Cleaning & Disinfection of impressions & surfaces
Impressions should be disinfected with spray and remain wet for ____ mins, then rinsed with ____ and dried, before sending to the lab. They should be placed in a sealed bag with a sticker stating they have been ____.
Use disinfectant wipes ____ to clean surfaces First wipe to remove gross debris
Second wipe to disinfect the surface
• Disinfectant spray have to follow the instructions of the ____
10 water disinfected twice manufacturers
Devices used for cleaning instruments
- ____
- autoclave
- ____
- dry heat sterilization
• Used to remove the gross debris form the instruments which is the ____ and ____
ultrasonic cleaner
instrument washer
ultrasonic cleaner
instrument washer
Types of sterilization
Heat-based sterilization
Steam under pressure (autoclaving) - (____ mins. @ ____ °F/ 121 °C / ____ psi)
Dry heat – (____ min. @ ____ °F/ 160 °C)
Unsaturated chemical vapor - (____ min. @ ____ °F/ 132 °C / ____ psi) (Hot ____ vapor under pressure)
Liquid cold chemical based sterilants:
• Only for heat-sensitive instruments like ____ equipment (such as mirrors), cheek retractors, non-disposable plastic trays which are immersed for average ____ hours per day
15-30 250 15 60-120 320 20 270 20 formaldehyde
photography
8-12
Sterilization Monitoring
____- Measure time, temperature, pressure (print-out for every cycle)
____- Change in color when physical parameter is reached (for every ____, every pouch/instrument cassette)
Biological (____) - Use biological spores to assess the sterilization process directly. Most ____ method because it uses heat ____ micro-organisms and not just indicators that test physical or chemical parameters for sterilization (____)
For autoclave: use ____ (Spore test strip)
For dry heat ovens: use ____ (Spore test strip)
These methods are all being used by PDM’s ____.
mechanical chemical spore tests valid weekly geobacillus stearothermophilus bacillus atrophaeus IMS
NO food or drinks in the ____ areas!
clincal
Decontaminate environmental surfaces
Cleaning surfaces physically is important. Always use ____ precautions when cleaning and disinfecting environmental surfaces
Risk of transmitting infections is higher in case of ____ contact surfaces
Step 1: Clean the surfaces with a ____ level hospital disinfectant
Step 2: Place ____ where human contact is likely. It is suggested to change barriers between patients
• Need to disinfect equipment ____ and need to also remove the barrier tapes and as extra protection we have to remove these after use and place new ones for the next patient
barrier
clinical
low to intermediate
surface barriers
How to Set up and Break down a Dental Chair
Should watch, no?
YAY!
Barrier tapes must be used in the ____ Room
____ must be disinfected after each use
Patient’s bib must be removed before ____
• If she sees violation and will have iPad with smart seats and will write down these down and these will go towards remediations
• Another area important is the x-ray clinic and the endo microscope in clinics
• When we take radiographs the patients are taking with contaminated bib and placed on them so
this is incorrect
x-ray
lead aprons
radiographs
____ tapes must be used
to prevent pathogen transmission
- Ned to go got the x-ray room and place all of these barriers
- After finishing with radiographs need to remove all of these barriers and disinfect and take patient back to the chair
barrier
Infectious waste disposal
§ Medical Waste: Not considered ____, thus can be discarded in ____ trash. The majority of waste generated in a medical or dental office (~98%–99%) is not considered infectious and can be discarded in the regular trash. Examples include used ____, masks, and ____ bloodied gauze.
• Regulated Medical Waste: Poses a potential risk of infection during handling and disposal
Some waste, such as extracted ____, and gauze soaked in ____ (ability to be squeezed or compressed bodily fluid from item), may pose a potential risk of infection. This requires special precautions during handling and disposal.
• Most of the waste are non infection so they are called medical waste and are placed in the white plastic bags but if soaked with blood or extracted teeth they are medical waste and infectious and disposed in ____ bags that are then disposed in big biohazard boxes
infectious
regular
gloves
lightly
teeth
blood
red biohazard
Regulated waste disposal
Regulated medical waste requires careful containment for treatment or disposal
Single leak-____ biohazard bag is usually adequate to contain ____, regulated medical waste
Puncture-resistant containers with a biohazard label, such as ____ containers, are used to dispose off ____ blades, needles, ____, and ____ sterile sharps
Medical waste should be stored and disposed of in accordance with federal, state, and local EPA regulations
resistant non-sharp sharps scalpel syringes unused
Blood Borne Pathogens
• ____ viruses such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are of concern to dental health care personnel (DHCP).
• Can produce ____ infection.
• Often carried by people ____ of their infection. •Every patient has to be considered as ____.
blood borne
chronic
unaware
infectious
What are the routes of transmission of blood borne pathogens?
Patient > ____
DCP > Patient
____ > Patient
Because Dental Care Personnel are frequently exposed to blood and blood-contaminated saliva during dental procedures, they are at ____ risk of infection by a bloodborne pathogen than are patients.
DCP
patient
greater
Average risk of blood borne virus transmission via needle-stick injury
‘Risk varies by type of ____’
• HBV = ____% to ____% (provided patient’s blood is positive for HBV antigen)
• HCV = ____% (may lead to cirrhosis and ____ cancer)
• HIV = ____%
*Highest rate is for HBV and lowest rate is for HIV transmission
virus 22.0 31.0 1.8 liver 0.3
Prevention of HBV transmission
____ of all dental health care personnel who might be exposed to infected blood
____ must be provided for follow up visits and testing
____ titers for antibody to HBV is indicated for DHCP who have blood or patient contact.
For high transmission of HBV there is a vaccine for this reason
vaccine
access
post-vaccination
Percutaneous injuries among dental health care personnel
Caused by ____, needles, other sharps
Occur outside the patient’s ____
Involve small amounts of ____
Occur form burs by leaving in the handpieces and you can scratch your arm which is body fluid exposures or don’t leave burs in handpieces when finished with them
Occur outside the patients mouth and when taking the instruments to the window and if not placed in right order and there is a n explorer out of the cassette that can prick your finger
And involve small amount of blood, one drop with HBV can be infectious for 1 ____ So be careful
burs
mouth
blood
week
Prevent injuries
Incorporate effective ____ controls and safer ____ of instruments or devices to eliminate or isolate hazard from workers
Using ____ instead of fingers to retract or palpate tissue during suturing and administration of anesthesia
____ needle recapping and not passing an unsheathed needle to another dental personnel
Do not ____ needles
engineering design instruments one-handed bend
Avoid two handed recapping of needle in
PDM clinics.
- Step one- assemble the syringe with ____ needle
- Step two- insert the capped needle through the whole in the____
- Step three- hold on to cap and pull off with the needle ____ but still in the cap
- Step 4- inser the needle into the cap inside the cap
- Step 5- dissemble the syringe with the needle and the cap still in the card and dispose of the needle in the ____ by pushing it out through the card
capped
cap
exposed
sharps
If there is an exposure... • Assessment of infection risk: o \_\_\_\_ and \_\_\_\_ of exposure o Bloodborne status of \_\_\_\_ person o \_\_\_\_ of exposed person
If exposure or injury first thing is to check the type of severity and the bloodborne status of the source and the susceptibility of the exposed person
type
severity
source
susceptibility
In case of exposure: Follow the protocol at PDM
____ treatment and DO NOT ____ the patient
Post-exposure wound management - Obtain immediate First Aid for the Needlestick/BFE on site; wash wound with soap and water for approximately ____ minutes; for splashes to the mucous membrane, the area should be flushed with water for approximately ____ minutes
Advise the ____ / faculty on the clinic floor and the ____ about the Needlestick/BFE and of your need for immediate “____” follow-up care
Either the Clinical Affairs officer or the student will advise the “Source Patient” of the Needlestick/BFE and of the probable need to provide a blood specimen for Hepatitis B, Hepatitis C and HIV testing -at no ____ to him/her. Saliva swab is used to test for ____.
Exposure reporting: Immediate (within ____ hours) “____” reporting to Student Health Center , 3535 Market St. Suite #100
stop dismiss 10 10 supervising dentist same day cost HIV 2 same day
Dental unit waterlines
• Colonies of microorganisms (____) can form on the inside of the small-bore plastic tubing that transports water within the dental unit to handpieces, air-water syringes, and cavitron and Piezo connections
• Once formed, a biofilm serves as a reservoir that may dramatically increase the number of free-floating microorganisms in water used for dental treatment
• CDC recommends that water used for routine dental treatment meet
regulatory standards for ____
• Each day, it is important to flush the waterlines for ____ minutes
before any dental procedures to be performed on that day and for ____ seconds in between patients.
- Another thing we do is check randomly selected chairs and done ____ time a year and checking the quality of the water funning in the dental equipment have to flush the lines for 2 mins for first patient and 30 sec between patients and there are filters in the chairs for the water
- She is collecting all of the clinics from random chairs and they send the vials of water to Colorado and check the microbial count of the sample and measure them to see how much bacteria and there is 0 bacteria in our water form last checking and the water has the standards for drinking water
biofilms drinking water 2 30 4
What resources are provided to dental health providers of Penn to protect them against Hepatitis-C virus? • Vaccine • Post-Exposure Prophylaxis • \_\_\_\_ • \_\_\_\_ • \_\_\_\_
- PPE and annual training (blood borne pathogen)
- Red are the answers
- No ____ for hep c or prophylaxis for post exposure
PPE
annual training
disinfectants
vaccine
Which of these Bloodborne Pathogens does an unvaccinated dental health care provider have the highest risk of acquiring through a percutaneous injury?
• ____
• Hepatitis C Virus
• HIV
HBV
Which items contaminated with body fluids must be disposed off in a sharps container? • \_\_\_\_ • \_\_\_\_ • \_\_\_\_ • \_\_\_\_ • Impression Materials
anesthetic carpules
needles
burs
broken instruments
I was cleaning up after a procedure and picked up a used perio cassette, when one of the scalers cut me.
How could this have happened?
• The student must not have arranged his/her ___ properly
• That typically doesn’t occur
• Nitrile gloves are cut resistant . It must been a defective glove
perio cassette
One of the most important practices to prevent the transmission of diseases is hand washing.
• ___
• FALSE
true
