BAMS Patient Safety Flashcards
What colour waste stream for amalgam waste?
Red
Three main categories of waste generated as a result of health and social care activities?
Special (or hazardous) waste
Domestic waste
Healthcare (including clinical) waste
Which waste stream for flowers and styrofoam coffee cups?
Black or clear bag
What technique is used for tying waste bags at the neck before uplift, and why?
Swan neck tie
To prevent leaking and make it easy to carry from the top
What types of waste must be labelled with a point of origin?
Special (hazardous) waste
Healthcare (including clinical) waste
Orange waste bag has to have what information included on the label?
Ward or department
Care area name
Date waste sealed
Examples of healthcare (including clinical) waste
Soiled dressings
Sharps
Swabs
Which waste bag for PPE used in a clinical setting?
Orange
If you are carrying a waste bag and it bursts in the corridor what is the first thing you should do?
Cordon off the area
Which blood borne virus can you be vaccinated against to help reduce the risk of you getting the virus through an occupational exposure?
Hepatitis B
A significant occupational exposure
When a staff member’s broken skin or mucous membranes come into contact with blood or body fluids from someone who has a BBV
Aerosol
Collection of solid or liquid particles of any size suspended in a gas
Dominant mode of transmission for covid 19
Aerosol inhalation
Variant of concern
Changes within a virus structure that have a clinical or public health significance that affects one or more of
Transmissibility
Virulence
Vaccine effectiveness
Diagnostic testing
Virulence
Severity of disease caused by a virus
Superspreader
Individual associated with a higher than average amount of infectious material, in exhaled breath or skim squames
Why are <5 micron particles of particular interest in virology?
There are more likely to be airborne, and they are the size of particles that can get right down into the alveoli
10 SICP must dos to prevent infection
Patient placement/assessment for infection risk
Hand hygiene
Respiratory and cough hygiene
Personal protective equipment
Safe management of care equipment
Safe management of care environment
Safe management of linen
Safe management of blood and body fluid spillages
Safe disposal of waste (including sharps)
Occupational safety - prevention and exposure management (including sharps)
Patient placement SICP
Patients must be promptly assessed for infection risk on arrival at the care area or if possible, before.
Isolation for those who present a particular cross-infection risk
When to carry out hand hygiene?
5 moments
Before touching a patient
Before a procedure
After a procedure or body fluid exposure risk
After touching a patient
After touching a patient’s surroundings
In healthcare settings, maintain CO2 concentrations below..
800ppm (typically 10-15 l/s/person)
Box for transport to LDU requirements
Rigid sides
Leak proof
Tight fitting lid
Colour coded
Where should a box of used instruments be brought to?
An agreed set down area within the LDU, which might be the same as the unload area
What PPE and why is worn in the LDU?
Gloves to protect from substances adhering to hands
Apron to prevent ourselves/our clothes becoming contaminated
A face shield or visor to protect face and eyes from splashes
(Can also wear a mask to protect from aerosols)
What additional PPE is worn for manual washing and why?
Heavy duty rubber gloves as they protect a bit more from sharps injuries
When should handwashing be carried out in the LDU?
When entering and leaving the unit
Between clean and dirty processes
What is SOP in an LDU?
Standard Operating Procedures
Allow us to make our activities reproducible and consistent. Easy for other members of staff to follow.
Used for example for the daily checks.
First step of decontamination process after transporting instruments and PPE/hand hygiene)
Washer disinfector
Daily checks must be done before processing instruments
We must follow any directions for loading the machine
Directions for proper loading of the washer disinfector
No overlapping, hinges open, disassemble assemblies, do not overload
What is done following washer disinfector in the LDU?
Inspection of processed instrumentation
We use an illuminated magnifier to identify any biological matter that might still be present
If there is any contamination on the surface of the instrument at all they must be further processed
Most important parts of instrumentation to inspect following washer-disinfector
Hinges, joints, textured or threaded surfaces
What is done if biological matter is still present on instruments after washer-disinfector?
Manual cleaning and ultrasonic bath
How is manual cleaning done?
Long handled, soft bristled, non metallic brush is used for physical scrubbing
Why is manual cleaning useful?
Physical scrubbing with the recommended brush can exert more forces than the jets of water within the WD chamber
What is the recommended brush for manual cleaning?
Long handled, soft bristled, non metallic brush
What is done after manual cleaning and ultrasonic bath?
Instruments must go back through the washer-disinfector
(the reason for this is the high temperatures and contact achieved during the disinfection part of the automated cycle).
What do we reinforce the washer disinfector process with if necessary? Why is this?
Manual cleaning and ultrasonic processes as it is essential that all biological matter/proteins/bodily fluids are removed entirely
What % of contamination is removed once the washer disinfector stage is completed?
95%
What temperatures are reached in the washer-disinfector, and for how long?
90-95 degrees celsius, for a minimum stage hold time of one minute, allowing the minimum contact rate of 12 seconds
Why is it necessary to sterilise after washer disinfector?
There are still pathogens that can survive the 90-95 degrees held for a minimum of 1 minute in the WD, and we need to sterilise all of our instrumentation through a piece of equipment that has the capability to achieve all of the recognised standards and set points, internationally agreed, to constitute sufficient sterilisation
What are the guidance documents we should follow for decontamination?
Scottish Health Technical Memorandum
These direct us to the BS EN standards
When purchasing equipment, what must it be in compliance with?
Medical device regulation MDR
What is the series of events if an instrument is found to be contaminated at inspection?
WASHER DISINFECTOR
ILLUMINATED MAGNIFIED
(If contaminated,
ULTRASONIC BATH
WASHER DISINFECTOR)
STEAM STERILISER
What are the two types of steam steriliser?
Type N
Type B
Which type of steriliser can sterilise wrapped instruments?
Type B
Vacuum capable
If the sterilisation temperature of a cycle achieves 135.2 degrees celsius what is the corresponding pressure range and minimum hold time?
3.05-3.35 bar
3 minutes
If instruments need to be sterile at the point of use, how should they be prepared for processing and what equipment must be used?
They should be wrapped in paper packaging before processing in vacuum capable type B steriliser
On a daily basis, what 4 things must be recorded from the first production cycle of the day?
Temperature
Cycle number
Hold time at required sterilisation temperature
Pressure
What is the name of the PCD that is used for the first cycle of the day on a vacuum steriliser?
Bowie Dick test
What does Bowie Dick PCD test for?
Steam penetration
4 kinds of purified water that can be used for sterilisation
Reverse osmosis
De-ionised water
Distilled water
Sterile water
What part of the SHTM 01-01 provides guidance for operating and testing sterilisers?
Part C
What is the symbol for a male in a family tree?
Square
What is the symbol for a female in a family tree?
Circle
What does a shaded in symbol mean in a family tree?
That person is affected by the condition
What does a diagonal line through a symbol on a family tree mean?
The person in dead
How might you show carriers of a disease in a family tree?
Shade half of the symbol vertically
What does it mean if a condition is autosomal?
Affects chromosomes that aren’t the sex chromosomes
How many chromosomes in human DNA?
46 chromosomes (2 of them are sex chromosomes)
What does it mean if a condition is autosomal dominant?
Having one faulty copy of the gene is enough to give you the disorder
What is the role of RNA polymerase?
DNA transcription
What is the function of ribosomes?
Translation - protein synthesis
What does it mean if a condition is autosomal recessive?
Need to have two faulty copies of the gene to be affected
How can we describe the genotype of “carriers”?
Heterozygous
How many genes are in the mitochondrial chromosome?
37 - much smaller
Who passes on their mitochondrial DNA
Only mothers
If mother has a fault on her mitochondrial chromosome, this would be passed on to all children she has
Example of a autosomal dominant condition
Myotonic dystrophy
Myotonic dystrophy
Condition affecting muscles, thinking, eyes, swallowing
Risk of sudden death from cardiac rhythm disturbance
Affects all age groups but usually adult onset
What can we tell about a condition if we see affected Dads passing on the affected sons?
Not X linked (Dad passes on Y chromosome)
Cystic Fibrosis
Autosomal recessive condition
Childhood onset
Affects males and females
Horizontal pattern - you will see siblings with it but tends to occur where parents are carriers, not affected
Problems in dentistry encountered with CF
Breathing difficulties
Antibiotic resistance due to tx for repeated URTIs
Affected salivary ducts
How is cystic fibrosis diagnosed?
Screening of newborns by immunoreactive trypsin level
Confirmation by DNA testing (for CF mutations) and/or sweat testing (for increased chloride conc)
Ectodermal dysplasia
Large group of approx 150 syndromes involving ectodermal structures eg teeth, nails, hair, sweat glands
eg. hypohidrotic dysplasia - reduced ability to sweat, sparse hair, tooth buds may be absent, teeth may be pointed or peg shaped, defective enamel
Chain of infection in order
Infectious agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host
What is the infectious agent in the chain of infection?
Micro organism that can cause infection eg. bacteria, virus etc
What is the reservoir in the chain of infection?
Where the infectious agent lives and grows eg. people, equipment
What is the portal of exit in the chain of infection?
How the IA leaves the reservoir eg bodily fluids
What is the mode of transmission in the chain of infection?
How the IA is spread from one site to another e.g. direct contact
What is the portal of entry in the chain of infection?
How the IA enters the body e.g. innoculation
What is the susceptible host in the chain of infection?
Any person
What is the name of the actions we can use to break the links in the chain of infection?
Standard infection control precautions
When should SICPs be used?
To be used by ALL staff in all care settings at all times for patients whether infection is known to be present or not
Name the SICPs most relevant to dentistry?
Hand hygiene
Personal protective equipment
Safe management of care equipment
Safe management of the care environment
Safe management of blood and bodily fluid spillages
Safe disposal of waste (including sharps)
Occupational safety: prevention and exposure management (including sharps)
Respiratory and cough hygiene
How should blood and bodily fluid spillages be managed?
Local policy must be followed
Appropriate PPE to be worn - apron, mask, gloves and eye protection
Organic matter to be removed using disposable absorbent towels, dispose of in healthcare waste
Apply the appropriate granules or solution to disinfect the area, leave for the required time
Granules to be removed using a scoop, dispose of granules in healthcare waste
Area to be cleaned using water and general-purpose detergent the dried with paper towels or air dried
All waste including PPE disposed of in healthcare waste
Perform hand hygiene
Name the agents used when dealing with a blood spillage
Sodium hypochlorite
Dichloroisocyanurate
What is the required contact time for chlorine releasing granules?
3 minutes
Or
According to manufacturers instruction
What concentration of chlorine releasing granules should be used?
10 000 parts per million available chlorine
Examples of waste disposed of in the orange stream
Gloves
Masks
Bibs
Aprons
Gauze
Contaminated wrapping
Rubber dam
Clinell wipes
Examples of waste disposed of in the black waste stream
Gloves boxes
Hand hygiene paper towels
Paper
Instrument wrapping
When should temporary sharps bin closure be used?
When the container is left unattended or is not in use
How is the temporary closure mechanism engaged?
One click for temporary
Two clicks for permanent closure
What waste is disposed of in blue lid box?
Pharmaceuticals eg 1/2 full LA cartridge
Who is responsible for the disposal of sharps?
The used, operator, creator of the sharp is responsible for the sharp
NO ONE other than the person who used a sharp should be disposing of it
Who is responsible for carrying out a risk assessment following a sharps injury?
Supervising clinician
Clinician
DN team leader
Named nurse
What action should be taken if you receive a sharps injury and your patient refuses to consent for bloods to be taken?
The same protocol is followed whether a patient consents to having bloods taken or if they refuse
Patients must NEVER be pressured into giving consent to have bloods taken
What procedure must be followed if you receive a sharps injury while treating a patient?
IMMEDIATELY stop the procedure - investigate the area
Inform the patient - if injury has occurred
Make the sharp safe
First aid - encourage bleeding, wash injured area, dress with waterproof plaster/dressing
Notify supervising clinician
Risk assessment carried out by appropriate person (not the person injured)
Contact occupational health
Consent pt for bloods
Paperwork
Datix
What happens to a patients risk assessment paperwork after a sharps injury?
Risk assessment must be destroyed after occupational health have been called
All information contained within the risk assessment is strictly confidential
Information from the risk assessment must NOT be written in the patients case notes
What are the 5 WHO moments for hand hygiene?
Before touching a patient
Before a clean/aseptic procedure
After a procedure or body fluid exposure risk
After touching a patient
After touching a patient’s surroundings
Where is a needle disposed of?
Orange lidded sharps box
Where is 1/2 full LA cartridge disposed of?
Blue lidded sharps box
Where are amalgam capsules disposed of?
Red stream waste box
Where are extracted teeth disposed of?
Red stream waste box
Where is arch wire disposed of?
Orange lidded sharps box
Where are paper towels used after hand hygiene to dry hands disposed of?
Black domestic waste bag
