Cleanliness champions/Decon/CPD/GDC Flashcards
You are working at a dental practice as a dentist, you arrived exceptionally early and saw 2 nurses getting off the bus in their uniforms.
Name 2 concerns you would raise with the nurses?
Infection control – wearing uniform out-with the practice
Practice and profession reputation as the nurses have uniform that shows where they work
Name 6 key learning outcomes from a learning session on PPE?
Always wear PPE when carrying out procedures
Wear fresh PPE when cleaning
Change PPE between patients and cleaning
Correct disposal of PPE in orange stream waste Protection of hands, eyes, clothing with PPE Protect the patient with glasses and apron
How would you ensure staff follow instructions on PPE?
Clinical audits
Regular inspections Reflections
Decontamination
Why do we need to do manual cleaning (4 examples)
To remove gross contamination
Contamination with deposits prevents direct contact between the steam and surfaces of the instruments that is necessary for effective sterilisation
To remove organic material
- Any material left on instruments may become fixed during sterilisation and be more difficult to remove later and they can encourage growth of microorganisms.
Remove restorative materials Aid Disinfection and sterilisation Mexico-legal requirement Restore function
Why do we need to test the washer disinfector/steriliser?
To ensure it is working correctly and to its optimum
Testing ensures validity of the machine and warranty
Testing helps detect procedural errors and equipment malfunctions
Chemical indicators verify that sterilising agent has penetrated the package and reached the instruments inside.
Describe the 5 steps of the washer disinfector
- Pre-wash/flush
<45oC to remove gross contamination- Washing
Physical force of water, chemical action of detergents, thermal heat which activates and facilitates action of detergent to remove any
remaining soil - Rinsing
4. DisinfectingTemperature only with holding time 1-10minutes
5. Drying
Circulation air heated to 90oC for 20 minutes to clear chamber of remaining moisture - Washing
Decontamination
What are the differences between type B and type N sterilisers?
- Type N (non-vacuum):Cycle intended for sterilisation of non-wrapped solid products such as small metallic items that aren’t lumened.
Air is displaced passively from the chamber and load by gravity displacement, as steam is generated within the chamber.
Items aren’t wrapped and should be used immediately after processing and not stored-Type B (vacuum):Cycle intended for sterilisation of wrapped solid, hallow and porous productsVacuum pump actively removes air from the chamber and load.Products are vacuumed packaged and are sterile at point of use and can be stored before use.
Decontamination
Name 4 key personnel involved in the decontamination process and give a description of each of their roles
Decontamination user:
Person responsible for the day-to-day management of the steriliser (dental practitioner, senior nurse, recycle manger)
They maintain records, ensure tests and maintenance are carried out.
Operator:
Trained in the operation of all equipment and practices, simple housekeeping and maintenance
Manager: Person who is ultimately responsible for decontamination Generally the practice owner
Authorising engineers:
Provide expert advice and perform independent audits quarterly and annually, advises validation, maintenance and testing ‘
Test person:
Conducts and reports on validation and periodic tests, must be qualified >2year experience
Maintenance person: Routine and requested maintenance, qualified personnel.
What type of water is used for the final rinse cycle and why use this as opposed to mains water?
Demineralised water – reverse osmosis water; distilled water sterile water for irrigation or deionised water
SHTM 2010 states that we need to use clean steam for sterilisation which rules out the use of mains water as it contains organic and mineral compounds.
Demineralised water types do not contain bacterial endotoxins which means it is safe for humans and there will be no mineral deposits present which reduces the formation of limescale on the instruments and cleaner.
As a member of the dental profession, CPD is one of the standards of practice
What is CPD?
Continuing professional development:
It refers to the process of tracking and documenting the skills, knowledge and experience that you gain both formally and informally throughout your career, beyond any initial training to advance your professional development.
It is a requirement by the GDC that a registered member must adhere to specific CPD training every 5 years to stay registered.
CPD supports dentists and dental care professionals in maintaining and updating their skills, knowledge and behaviour throughout their working life, contributing to delivery of good quality care and service provision, that patients and the public trust if sage and the best it can be.
How many hours of CPD are to be done in a 5 year cycle and how many are to be verifiable?
At least 250 hours of CPD every 5 years
75 hours must be verifiable CPD
Give 3 suggested CPD topics and the hours per cycle
Medical emergencies – atleast 10 hours in every CPD cycle; 2 hours per year
Disinfection and decontamination – atleast 5 hours every CPD cycle Radiography and radiation protection – atleast 5 hours every CPD cycle
What are the 7 components of clinical governance?
Clinical effectiveness and research
Audit Risk management Education and training Service user, carer and public involvement Clinical information and IT Staffing and staff management
What are the 6 dimensions of healthcare quality?
Safe – avoiding harm to patients from the dare that is intended to help them
Effective – providing services based on scientific knowledge to all who could
benefit and reframing from providing services to those not likely to benefit
Patient centred – providing care that is respectful of and responsive to individual patient preferences, needs and values Timely – reducing waits and delays for both those who receive and those who give care Efficient – avoiding waste, equipment, supplies, ideas and energy Equitable – providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, location and socioeconomic status.
Give 6 members of the dental team that have to be registered with the GDC
Dentists
Dental nurses
Dental hygienists
Dental therapist
Orthodontic therapists Dental technicians Clinical dental technicians
What is a clinical audit, what is it for?
It is a quality improvement process that seeks to improve patient care and outcome through systematic review of care against explicit criteria and the
implantation of change
It is used to observe gaps in knowledge, learning, attitudes, protocols and training.
What is the audit cycle?
Identify problem or issue
Set criteria and standards
Observe practice/data collection
Compare performance with criteria and standards
Implementing change
What are the stages of significant event analysis (SEA)?
Step 1 – identify significant event
Step 2 – collect and collate as much information as possible relating to the event Step 3 – convene a meeting – non-threatening, no blame – educational focus Step 4 – undertake a structured analysis Step 5 – monitor progress of all actions agreed upon Step 6 – write up event analysis Step 7 – seek educational feedback – peer review
Cleanliness champions
List stages in the chain of infection
Infectious agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host
Name and concentration of chlorine releasing agent(s)
Sodium hypochlorite (Actichlor) 10,000ppm
Sodium DiChloroisocyanurate 10,000ppm
How long is the agent left for?
5 minutes
Give waste streams and an example for each?
Black – domestic waste
Orange low risk – PPE
Yellow hazardous – teeth, sharps, needles
Red hazardous – amalgam
Brown confidential – confidential documents
Tooth with extracted amalgam what stream does it go into
Red stream special hazardous waste labelled amalgam
What are the principles of waste disposal?
Segregation
Storage
Disposal
Document
What do you legally need to keep and for how long?
Description of waste
Quantity of waste Destination of waste Origin of waste Transport of waste
Clinical governance
What is clinical governance?
It is a systematic approach to maintain hand improving patient care in the health system.
What are the dimensions of healthcare quality?
Safe – avoiding harm to patients from the dare that is intended to help them
Effective – providing services based on scientific knowledge to all who could benefit and reframing from providing services to those not likely to benefit Patient centred – providing care that is respectful of and responsive to individual patient preferences, needs and values Timely – reducing waits and delays for both those who receive and those who give care Efficient – avoiding waste, equipment, supplies, ideas and energy Equitable – providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, location and socioeconomic status.
What are the components of clinical governance?
Clinical effectiveness and research
Audit
Risk management
Education and training
Service user, carer and public involvement o Clinical information and IT
Staffing and staff management
What are the 3 divisions of NHS Scotland dental services?
Primary care – general dental practices
Public dental services – community services
Secondary care – hospital services
List the 9 GDC standards for dental professionals
o Put patient’s interests first
o Communicate effectively with patients o Obtain valid consent
o Maintain and protect patients information
o Have a clear and effective complaints procedure
o Work with colleagues in a way that is in patients best interests
o Maintain, develop, and work within your professional knowledge and skills
o Raise concerns if patients are at risk
o Make sure your personal behaviour maintains patients confidence in you and the dental profession
Chain of infections
List the sinner circle
Time
Temperature
Chemical
Energy/mechanics
Name the 10 SiCPs
Patient placement
Hand hygiene
Respiratory and cough etiquette 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
Ethics
What are the 4 pillars of ethics?
Respect for autonomy
Non-maleficence
Beneficence Justice
What is negligence?
The omission to do something which a reasonable dentist wouldn’t do, or, doing something which a reasonable dentist would not do.
Dentist fails to meet standards of ordinary care which can ultimately result in harm.
What is the criteria for clinical negligence?
The dentist owed a duty of care
The duty standard of care was breached
The breach caused or materially contributed to damage
The damage was responsible foreseeable and had negative consequences and effects
How long should Notes be kept for?
Minimum 2 years after end of treatment but ideally 11 years or until age 25 for children
What should Notes be?
Confidential
Concise
Accurate
Legible
Complete Current Retrievable Retained
Who is on the GDC board?
12 members – 6 registrants (including chair) and 6 lay members
Studies
What type of study provides the highest level of evidence?
Cochrane reviews which are systematic assessments of all the relevant randomised controlled trials (RCTs) which give the highest level of evidence.
List 4 aspects of this type of study? (RANDOMISED CONTROLLED TRIALS)
Randomised double blind reduces bias
Inclusion and exclusion criteria Randomisation facilitates statistical analysis Compares one treatment over placebo to investigate any statistical significance
Give 3 other study designs
Randomised control trials – effectiveness and efficacy of treatments
Cohort studies – prospective study
Case control studies – retrospective study
Case study – one patient report
What is incidence?
Is the number of new disease cases developing over a specific period of time in a defined population,
Incidence rate = no of new cases of disease in a period/no of individuals in population at risk Incidence estimates are obtained from longitudinal studies or derived from registers
What is prevalence?
Is the number of disease cases in a population at a given time
Prevalence – no of affected individuals/total no of persons in population Prevalence estimates are obtained from cross-sectional studies or derived from registers which can relate to attributes to absence or presence of disease
What is SiMD?
Scottish index of multiple deprivation which is an area based index which use a range of data to decide which neighbourhoods are most deprived by ranking data zones in order of deprivation from quantile 1 – most deprived to quantile 5-10 – least deprived
Give 7 factors influencing deprivation?
Employment status
Income Health and health care services Geographic access to services Crime Housing, living and working conditions Education, skills and training
Split mouth study designs
What are the advantages of a split mouth study design?
Both control and intervention group are exposed to same environment.
Each of 2 treatments are randomly assigned to either the right or left halves of the dentition on the same environment.
What are the disadvantages? (SPLIT MOUTH STUDY DESIGN)
Patient can not be blinded
Adds more bias into the reporting
Incorrect reporting risk
What are the advantages? (SPLIT MOUTH STUDY DESIGN)
It removes inter-individual variability from the estimates of treatment effect
No carry over effect for intervention or outcome
What is confidence intervals?
The range of values the absolute risk difference will take in the population
95 out of 100; the CL will contain the true population ARD
CL should not overlap 0 = sufficient evidence
CL overlaps 0 = null hypothesis (insufficient evidence) A narrow CL is better as the larger the sample the narrower the CL
What is a P value?
Used to determine the significance of your results
P value <0.05 means you reject the null hypothesis and your results are statistically significant
Alzheimer’s and Parkinson’s
What are the signs and symptoms of Alzheimer’s?
Confusion
Memory and cognition problems
Communication difficulties Muddled over every day activities Mood swings Being withdrawn Loss of confidence
What are the signs and symptoms of Parkinson’s?
Mask like face
Bradykinesia
Rigidity
Postural instability and loss of balance Resting tremor Shuffling gait Loss of protective reflexes Cog wheel rigidity
What complications are there for dental treatment and these conditions? (ALZHEIMERS/PARKINSONS)
Loss of protective reflexes
Tremor in resting gave Reduce ability to self care – poor OH and dental care Reduced manual dexterity Reduced communication – pain unrecognised Assessing capacity to consent Access to surgery may be difficult
What are the principles of the adults with incapacity act 2000?
Act refers to the consent and capacity issues and ensures that no one can make decisions for you if you can make decisions for yourself:
Principles:
The benefits of the adult
Minimum intervention – least restrictive option Take account Present and past wishes of the adult Consultation with the adult and relevant others Encourage the adult to use/exercise their skills and further development of these
What is capacity?
Someone has the capacity to consent when they can:
Retain the memory of a decision
They can act (decide) Can make a reasoned decision Can communicate a decision Can understand a decision – repeat back in own words
Who can consent under the AWI2000?
Power of attorney
Someone had capacity and make the decision to appoint someone to make decision about their welfare medically and financially while they still have capacity which is then passed through the court system so that
the person makes decisions on their behalf when capacity is lost.
Welfare Guardianship
Someone who had never had the capacity; court will appoint someone to look after persons welfare and make decisions for them
. Decontamination
What is the decontamination cycle?
Acquisition (purchase or loan)
Cleaning
Disinfection o Inspection
Disposal (scrap or return to lender)
Packaging
Sterilisation o Transport o Storage
Use
Transport
Name 4 legislations for decontamination
The health and safety at work act 1974
The medical device directive 2007/47/EC
The national health service (Scotland) regulations 2010 COSHH Consumer protection act
Give 5 reasons for cleaning?
To remove gross contamination
Contamination with deposits prevents direct contact between the steam
and surfaces of the instruments that is necessary for effective sterilisation
To remove organic material
Any material left on instruments may become fixed during sterilisation and be more difficult to remove later and they can encourage growth of microorganisms. Remove restorative materials Aid Disinfection and sterilisation Mexico-legal requirement
Give 5 common reasons for Handpiece faults
Incorrect compressor settings and lack of maintenance
Damaged or over sized bur fitted damages the chuck Incorrect instrument usage Poor or inadequate cleaning including incorrect processing Incorrect or inadequate lubrication
Decontamination washing
Briefly describe manual washing
Immersion:
Re-usable cleaning brushes used to remove gross contamination of instruments Using sterile, dry, non longing disposable towel to aid drying process.
Non-immersion:
Used for likened hand pieces and such items that would be damaged or inhibit sterilisation by immersion technique Non limiting disposable wipes are used to wipe down instruments Detergent used should be a neural enzymatic 30ml to 8l of water at 30-35oC
Briefly describe ultrasonic bath
Ultrasonic cleaners work by applying a high frequency sound wave. The sound wave produces Miro-bubble which cause cavitation when they implode, the energy released helps remove soil from the surface of the instrument.
Degassing must occur as oxygen will inhibit cavitation and a different bubble is formed with less intensity making it less effective
Ultrasonic cleaners should only be used as a pre treatment to the washer disinfector and should only be used to remove gross contamination or difficult to remove contamination from items before placing them in washer disinfector.
What maintenance and tests are carried out for an AWD?
Daily test – automatic control test to ensure machine is operating as designed.
Used on 1st cycle with instruments,
Weekly test – cleaning efficiency of machine at same time as daily test
Quarterly/annually validation – series of tests carried out and checked against original manufacturers specification by authorised test personnel.
What is the AWD cycle?
Pre-wash
Washing
Rinsing
Disinfecting
Drying
What temp, pressure and time is sterilisation carried out at?
134-137oC for 3 minutes minimum
Give 3 types of sterilisers and compare use
Type S (special) = only used according to manufacturers instructions
Type N (normal) non-vacuum, passive air removal for non-lumened instruments that aren’t wrapped
Type B (better) = vacuum, active air removal for lumened devices which re wrapped and sterile at point of use
What maintenance and tests are carried out for sterilisers?
Daily:
wipe clean door seal and chamber, check door safety device, drain and refill, check printer paper, change water, automatic control test, steam penetration with Bowie-dick or helix devices; chemical colour change from yellow to blue when sterilised
Weekly:
automatic control test, vacuum leak test and air detection testing
Fear and anxiety
Give 4 factors in the aetiology of fear?
Previous adverse dental and medical experiences
Attitude and previous experience of family and peer-groups
Poor understanding of dental procedures/techniques
Emotional development delay Each person’s psychological Make-up Social media influence
How may an anxious patient present?
High neuroticism and trait anxiety
pessimism and negative expectations
Process to somatisation Low pain threshold Withdrawn, depressive, sweating Upset, crying
What is the cycle of behaviour change?
Pre-contemplation
Contemplation Preparation Action Maintenance with progress or relapse at any stage
Give 4 management techniques for anxious patients?
Desensitisation
Acclimatisation o CBT
Progressive relaxation
Tell show do o Distraction o Control Medications – benzodiazepine
Stress
What is primary appraisal in stress?
o Initial assessment of stressor
Irrelevant
Benign Harmful/threat Harmful/challenge
What is secondary appraisal?
Reaction to primary appraisal:
Harm Resistance Exhaustion
Give 4 responses to stress?
Direct action
Seek information Do nothing Coping
What is burnout?
This is the process whereby a previously committed professional disengages from his or her work in response to stress and stain experienced in the job
A person will be exhausted mentally and physically causing them to develop a negative indifferent or cynical attitude towards life,
Give 4 examples of coping mechanisms for stress?
Understanding and managing a good work/life balance
Exercise Education and coping CBT mechanisms on stress Setting own targets and goals Knowing personal limits
Alcohol and smoking use
What are the recommended allowances for alcohol intake for Male and females?
14 units per week with atleast 2 alcohol free days
Spreading units of alcohol but having no more than 3 units in one day
How may you screen for alcohol abuse?
Thorough history after gaining rapport with patient
Cutting down on alcohol intake Annoyed at criticism and makes excuses Guilty Early morning drinking Liver function tests from GDP if concerned
What brief intervention can be used?
Alcohol brief intervention
Raise the issue about if they drink
Screen and give feedback of risks
Listen for readiness to change Suitable referral/information and advice approach
How do you calculate how many cigarettes pack a year?
20/day is 1 pack year = 20/day for 20 years = 20 pack years
How do you offer smoking brief intervention?
5As:
Ask, advice, assist, assess, arrange
3As:
Ask (smoking status), advise (benefits), Act (signpost)
o 2A1R
Ask, advice, refer
