Clinical Foundations - Outcome 5

Question 1

Patient Examining Gloves

Answer 1

Used for routine patient care, examination, and other nonsurgical procedures involving contact with mucous membranes and skin, as well as laboratory duties. These are typically latex, nitrile or nitrile blends, polyurethane, or styrene-based copolymers. Plastic (polyvinyl chloride) or vinyl gloves may also be used, however, gloves from these materials tend to tear easily and contain more defects from manufacturing. All of these gloves are for use on one patient only and are discarded after use (CDSA, 2023).

Question 2

Gloves

Answer 2

Gloves are used in addition to hand washing and protect dental team members from direct contact with microorganisms in patients’ mouths and on contaminated surfaces. They also protect patients from microorganisms on the hands of the dental team. Dental assistant must wear new single-use exam gloves for patient care, whenever the hands might be contaminated with blood, saliva, or other bodily fluid, or will be in contact with contaminated instruments or devices. (CDSA, 2023).

Question 3

Sterile Surgical Gloves

Answer 3

Must be used whenever invasive surgical procedures are performed; such as whenever intentional gingival, mucosal or dermal flaps are raised, or whenever the cutting or sectioning of bone is anticipated. These are sterile, incorrect hand size, and made of latex, nitrile or nitrile blends, polyurethane, or styrene-based copolymers. All of these gloves are for use on one patient only and are discarded after use (CDSA, 2023). Whenever invasive surgical procedures are performed, sterile gloves are required. Example: Whenever the cutting or sectioning of bone is anticipated; and whenever a simple procedure becomes a surgical procedure; (e.g., a tooth breaking that then requires surgical extraction) (CDSA, 2023).

Question 4

Overgloves

Answer 4

Overgloves are worn over contaminated treatment gloves (over-gloving) to prevent the contamination of clean objects handled during treatment.

Over gloves are not acceptable alone as a hand barrier or for intraoral procedures.
Over gloves must be worn carefully to avoid contamination during handling with contaminated procedure gloves.
Over gloves are donned before the secondary procedure is performed and removed before the patient’s treatment that was in progress is resumed.
Over gloves are discarded after a single-use.

Question 5

Utility gloves

Answer 5

Utility gloves are not used for patient care (CDSA, 2023)

Used for cleaning and disinfection procedures, such as during operatory cleanup and instrument reprocessing.
Must be chemical resistant, puncture proof.
Selection and use of PPE, including gloves, must provide proper Standard of Practice: Infection Prevention and Control Standards and Risk Management for Dentistry College of Dental Surgeons of Alberta 8 | Page protection and be appropriate to the task considering necessary dexterity for cleaning
Made with nitrile or latex-nitrile blends, chloroprene/neoprene, butyl rubber, fluoro-elastomer, polyethylene, or other vinyl copolymers.
Commonly referred to as utility, industrial, or general-purpose gloves, these are not for patient care and should be puncture and chemical resistant.
They are relatively thick and should be cleaned and disinfected after each use.

Question 6

Face masks

Answer 6

Masks are worn to protect the one who wears the mask from disease agents that might be present in sprays, splashes, or aerosol particles from body fluids or other potentially infectious materials. Face masks do not provide a perfect seal around the edges causing unfiltered exhaled and inhaled air to pass through these sites. It is important to select a mask that fits the face well to minimize the passage of unfiltered air. A mask with at least 95 percent filtration efficiency should be worn.

Mask should cover the nose and mouth during dental procedures whenever splashes, sprays or spatter of blood, saliva, other body fluids, or water contaminated with blood, saliva or other body fluids may be produced. The mask must be changed whenever it becomes contaminated or wet or according to (CDSA, 2023).

Question 7

Use of surgical masks beyond their shelf life

Answer 7

Masks can still be used beyond their shelf life to protect health care providers. Health care providers should check that the straps are intact and there are no visible signs of damage. There is no specific timeframe beyond the expiry dates for masks at which they would no longer be considered suitable for use. (Health Canada, 2020)

Question 8

Protective Eye Wear

Answer 8

DHCP must wear protective eyewear (e.g., safety glasses, safety googles, or face shields as determined by a point-of-care risk assessment) during dental procedures whenever splashes, sprays or spatter of blood, saliva, other body fluids, or water contaminated with blood, saliva or other body fluids may be produced(CDSA, 2023)

Protective eyewear must have front and side shield protection. (MDA, 14th ed 2024)

Question 9

Clothing

Answer 9

Protective clothing must be worn whenever there is a chance for contamination of skin or other clothing with spray or splashes of saliva, blood, or other potentially infectious materials. If this clothing becomes visibly soiled, it needs to be changed before caring for the next patient, and fresh protective clothing is required to be put on before surgery. Protective clothing must be removed when leaving clinical areas and should not be worn to lunchrooms or outside the office.

“Laundry in a dental office may include gowns/lab coats, uniforms/scrubs, contaminated textiles, and fabrics often contain high numbers of microorganisms from body substances, including blood other body tissues and fluids. Laundry services for dental offices are provided either onsite or by off-site commercial laundries. To minimize transmission of infectious disease while handling linen, general good hygiene measures and consistent use of appropriate personal protective equipment is recommended. When laundry services are possible onsite, utilize the following guidelines. At home laundry of contaminated PPE must not be performed.” (CDSA, 2023)

Question 10

Order for Donning PPE
Aerosol Generated Procedures

Answer 10

• perform hand hygiene
  -place gown
  -put on mask
  -place eye protection
  -place cap/bouffant
  -perform hand hygiene
  -place exam gloves

Question 11

Order for Doffing PPE
Aerosol Generated Procedures

Answer 11

-remove gloves
-perform hand hygiene
-remove gown
-perform hand hygiene
-remove cap/bouffant
-remove glasses
-remove mask
- perform hand hygiene

Question 12

Order for Donning PPE
Non-Aerosol Generated Procedures

Answer 12

-perform hand hygiene
-place mask
-place glasses
-place gloves

Question 13

Order for Doffing PPE
Non-Aerosol Generated Procedures

Answer 13

-remove gloves
-perform hand hygiene
-remove glasses
-remove mask
-perform hand hygiene

Question 14

Surface Barriers

Answer 14

The use of surface barriers in dental treatment rooms can reduce disease transmission, reduce operatory turn-around time between patients, and reduce office time and expenses associated with infection control. Barrier techniques are considered appropriate for non-critical patient care items.

Question 15

Where & Why Barriers are placed

Answer 15

Barriers are placed over equipment and surfaces that will be exposed to bodily fluids during dental procedures. Placing them provides a physical barrier between the body and a source of contamination as well as prevents microorganisms from accumulating on equipment. If a surface cannot be easily and thoroughly cleaned and disinfected, it should have barrier protection

Question 16

Variety of Barriers Used…

Answer 16

All should be resistant to fluids to keep microorganisms in saliva, blood, or other liquids from soaking through to the surface underneath.

Some plastic bags are designed in the shape of items such as the dental chair, air-water syringe, hoses, pens, and light handles.

Plastic-barrier tape is frequently used to protect smooth surfaces such as touchpad equipment, electrical switches on chairs, and x-ray equipment.

Aluminum foil can also be used because it is easily formed around any surface barrier.

Question 17

IPC Standards apply to…

Answer 17

reception and business office areas

clinical settings

laboratory areas

remote locations and mobile clinics

Alternate clinical settings require policies and procedures regarding:

loading the vehicle

decontamination of the operatory in a mobile setting air handling systems

unloading contaminated dental devices/instruments from container pre-cleaning holding (enzymatic) solutions reprocessing

closing down the operatory in a mobile setting end of day unloading of the vehicle at the reprocessing location

Question 18

According to CDSA Standards of Practice The dental office or clinic must have written IPC policies and procedures. These policies and procedures must include but are not limited to:

Answer 18

Individual assigned to maintaining and implementing IPC

Hand hygiene policy

The selection, acquisition, transportation, receiving, handling, processing, and disposal of new, loaned, shared, and leased dental instruments and devices

Manufacturer’s Instructions for Use (MIFU) regarding maintenance and reprocessing;

Sterilization processes following IPC principles as set out in the CDSA Standards; and

The protection and safety of personnel in accordance with the Alberta Occupational Health and Safety Act (OHS).

The dentist must ensure that the Dental Health Care Personnel (DHCP) employed by the dentist are aware and comply with the documentation required for IPC and OHS purposes.

The dental clinic owner and dentists working in each facility must review all policies annually to ensure policies are kept up-to-date with all current CDSA Standards of Practice.

IPC training and continuing education must be in accordance with the CDSA Standards of Practice.

Question 19

The dental assistant must follow safe practice procedures…

Answer 19

Avoiding or using extreme caution when passing sharps during four-handed dentistry;

Removing burs before removing the handpiece from the dental unit;

Not using fingers in tissue retraction or palpation during suturing and administration of anesthesia;

Identifying and removing all sharps at the point of use from an instrument tray prior to instrument cleaning.

Question 20

Sources of Contamination in Dental Waterline

Answer 20

Biofilm: Refers to a thin layer of micro-organisms that stick to surfaces and form a protective slime layer. Biofilm can be found on many surfaces where there is constant moisture and the inside of dental tubing is an ideal environment.

Suck-Back: The term “suck-back’ or ‘backflow’, meaning reverse flow, can occur if a patient closes their lips around the saliva ejector tip and ‘sucks back’ biofilm into their own oral cavity. Based on this theory, research studies have suggested that there is indeed a risk for transferring pathogenic biofilm between patients during suck-back creating a risk for an infection to occur. There is a higher risk for infection if open wounds or sores are present and/or if the patient is immune- suppressed.

Question 21

Waterline Asepsis

Answer 21

Maintenance of the air compressor and evacuation systems is an important part of the infection control routines of a dental assistant. Both rotary instruments (handpieces) and suction lines require pressurized air in order to operate. Each dental office has an air compressor on site that is connected to each of the dental units. Dental handpieces use the compressed air to turn the internal rotary mechanisms to spin the bur. The suction lines use the compressed air to create a vacuum to suction debris from the oral cavity. Any large debris that is removed is collected in a suction trap screen within the dental unit.

Question 22

Components of the Oral Evacuation System

Answer 22

Main vacuum pump (compressor)

Vacuum lines that run to each operatory

Evacuation hoses with suction tips that the assistant manipulates to remove oral debris.

Solids/dispose-trap attached to the unit, to prevent objects from flowing into the sewage system.

Question 23

Maintain Operatory Suction and Water Lines - in accordance with CDSA IPC standards

Answer 23

The dental clinic must use a water supply, which is tested for, and free of contaminants, such as from a monitored municipal water supply.

Waterline heaters are not to be used, as these heaters encourage waterline microorganism growth.

All waterlines must be purged at the beginning of each workday by purging the lines thoroughly with water for at least two minutes. (example: air/water syringe line )

All water lines must be flushed at the beginning of each workday by flushing the lines thoroughly with water for at least twenty seconds (example: high and low volume evacuator lines)

Handpieces using water coolant must be run for at least twenty seconds after patient care, in order to purge all potentially contaminated air and water.

Sterile water must be used when irrigating open vascular sites and whenever bone is cut during invasive surgical procedures.

Question 24

Maintaining Closed Water Systems - IPC standards

Answer 24

When closed water systems are used, dental personnel should be careful not to touch the tubing with the fingers or gloved hand when changing the water coolant bottle, as this easily contaminates the entire system. (SAIT clinic closed operatory systems are present in operatory 12 and operatories 20-25)

Manufacturer’s instructions for the dental units and dental equipment must be followed for daily and weekly maintenance whenever closed water systems or other special water delivery systems are used.

Question 25

What is Oral Evacuation?

Answer 25

Oral evacuation is the process used to remove excess fluid and debris from the oral cavity. It is used before, during, and after most dental procedures. It operates on a vacuum system with high and low volume suction hoses – based on the amount of debris present in the oral cavity.

Question 26

The three basic tools used to effectively perform oral evacuation in a restorative procedure are..

Answer 26

High Volume Evacuator (HVE), Low Volume Evacuator, and Air/Water Syringe.

Question 27

High Volume Evacuator (HVE)

Answer 27

The high volume evacuator is used in many dental procedures and often when high-speed handpiece, laser, or ultrasonic scaler is used. It is used to evacuate a large volume of fluid, keep the mouth free of saliva, blood, water, smell, and large debris. It also can retract the tongue and cheek during the procedure and reduces bacterial aerosol caused by the high-speed handpiece. Two types of HVE tips are available.

Question 28

Two types of HVE tips are available..

Answer 28

1. Operative suction tips
   -Designed with a straight or slight angle in the middle
   -Beveled working end
   -Made of disposable material or stainless steel
2. Surgical suction tips
   -Much smaller in circumference to operate in limited space and visibility
   -Made of disposable material or stainless steel

Question 29

Low Volume Evacuator (saliva Ejector)

Answer 29

the saliva ejector removes small amounts of liquid from the mouth, it is not powerful enough to remove large debris. The saliva ejector is made of soft plastic tubing that can be bent or shaped and easily placed in the oral cavity. It can be used in many dental procedures including

-Preventive procedures such as rubber cup polish, fluoride treatments, and sealant placement.
-Restorative procedures to control saliva and moisture accumulation under the dental dam
-Cementation of a crown or bridge (fixed prosthodontics)
-During an orthodontic bonding procedures
-The saliva ejector is generally in all tray/operatory set-ups. It can be considered one of the basic tools for any procedure.

Question 30

Air/Water Syringe (Three-Way syringe)

Answer 30

the air-water syringe is used to rinse and dry the oral cavity. Air-Water Syringe has a removable tip. The tri-syringe is used in conjunction with either the HVE or the saliva ejector to maintain a clear operating field by rinsing and drying the oral cavity. It can direct air, water, or both through a small metal or plastic disposable tip. Water from the tip is used to flush or rinse debris or to freshen the patient mouth after a procedure. The air is used to dry the operative site for better visibility or when placing moisture-sensitive materials. Air is also used to keep the mirror held by the operator clear of moisture when indirect vision is being used.

Question 31

Guideline for use of Air/Water syringe

Answer 31

Direct the tip toward the tooth being treated

Keep a close distance between the operative site and the air/syringe tip

Use air on the mouth mirror continuously when the operator uses indirect vision

When you hear the handpiece stop, rinse and dry the operating site

When completing a limited-area or full-mouth rinse, move the tip while spraying the area