Infection Control Flashcards
OSHA
occupational safety and health administration
OSHA is a US government agency under the
department of labor
what is OSHAs mission
to ensure safety in the workplace
1986 OSHA began to develop
the new blood borne pathogens standards
in 1991,
mandatory blood borne pathogen standards were made
CDC
center for disease control and prevention
CDC is the – — — agency
US public health
what does the CDC review
current scientific information
CDC creates
recommendations
what trends does the CDC track?
disease trends across the country
what does the CDC serve as a primary investigator for?
when disease outbreak threatens public health
infection prevention and control refers to the policies and procedures used to
minimize the risk of spreading infections in the healthcare setting
chain of infection
process by which infectious diseases are transmitted
three opponents of a chain of infection
a causative agent
a susceptible host
a mode of transmission
all three components are necessary for infection to spread. infection control strategies are intended to break one or more of the links, thereby preventing disease transmission
causative agent
any microorganism in sufficient numbers capable of causing disease (pathogen)
causative agents can include a variety of (4)
viruses
bacteria
protozoa
fungi
pathogens can be present in
blood or OPIM
blood borne pathogens of concern in dentistry (3)
not typical of a blood borne pathogen (1)
hep B virus: HBV
hep C virus: HCV
human immunodeficiency virus: HIV
Sars CoV 2
susceptible host
a person who lacks the effective resistance to a particular pathogen
factors that influence a persons level of susceptibility (5)
age physical conditions medications immunization underlying medical conditions
mode of transmission
the mechanism by which the pathogen makes its way to the host
types of mode of transmission (3)
direction contact: occurs when a pathogen is transmitted directly from an infected person to you
indirect contact: occurs when an inanimate object serves as a temporary reservoir for the pathogen
airborne: when the pathogen is airborne via droplet spatter or aerosols
three main ways in which covid 19 is spread
breathing in air when close to an infected person who is exhaling small droplets and particles that contain the virus
having these small droplets and particles that contain virus land of the eyes, nose, or mouth, especially through splashes and sprays like a cough
touching eyes, nose, or mouth with hands that have the virus on them
droplet transmission
coughs and sneezes can spread droplets of saliva and mucus
airborne transmission
tiny particles possibly produced by talking, are suspended in the air for longer and travel further
potential routes of transmission (3)
patient to DHCP
DHCP to patient
patient to patient
standard precautions are the minimum infection control practices that apply to all patient care in any setting where health care is delivered, whether or not a patient is suspected or confirmed as having an infection. the purpose of standard precautions is to
decrease the risk of transmission of blood borne and other pathogens from both known and unknown sources
transmission based precautions are used in addition to standard precautions for patients with
known or suspected infection
what is an essential part of a disease prevention and infectious control program?
immunizations
ACIP provide national guidelines for immunization of
health care providers
ACIP recommend the all health care providers be vaccinated or have documented immunity to these diseases (6)
HBV influenza measles mumps rubella chicken pox (varicella)
hep B vaccination is required of all employees who will have
patient contact and employees working with infectious instruments and or materials that are exposed to blood, saliva, OPIM
OSHAs blood borne pathogen standard in 1991 mandated that all employers must offer the
hep B vaccine to employees without cost within 10 working days if they are potentially exposed at work to blood or OPIM
what if the DHCP provider declines the hep B vaccination?
must sign a declination statement and educate on the risk of exposure
overall, the risk of exposure to TB for the DHCP is low; however, both the CDC and ADA agree dental practices should have a
TB control program appropriate for their level of risk
covid 19 CDC recommendations (4)
- assessment: is the DHCP or the patient at risk
- availability of PPEs
- stay informed (changes daily)
- provide care in the safest way
elements of standard precautions (5)
hand hygiene personal protective equipment safe injection practices safe handling of potentially contaminated equipment or surfaces in the patient area respiratory hygiene/cough etiquette
single most important way t reduce the risk of disease transmission
hand hygiene
according to the CDC, when do hands need to be cleaned? (3)
when visibly dirty
after touching contaminated objects with bare hands
before and after patient treatment (before glove placement and after glove removal)
how should you wash your hands?
Wet your hands with clean running water (warm or cold) and apply soap.Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.Scrubyour hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.Rinseyour hands well under clean, running water.Dry your hands using a clean towel or air dry them.Turn off water using the paper towel and to open the door as you exit
if hands are visibly soiled with blood or opim (3)
if hands are not visibly soiled (3)
use soap and water
use anti-microbial soap and water
do NOT use an alcohol based hand rub
use soap and water
use anti-microbial soap and water
use an alcohol based hand rub
handwash
washing hands with plain soap and water
antiseptic hand wash
washing hands with water and an antimicrobial soap
ex. chlorhexidine, iodine, iodophors, chloroxylenol, triclosan
alcohol hand rub
rubbing hands with an alcohol containing preparation (at least 60% alcohol)
surgical antisepsis
handwashing with an antiseptic soap and an alcohol-based hand rub before operations by surgical personnel
personal protective equipment protects the skin and mucous membranes from
exposure to infectious materials in spray or splatter
PPE consists of (4)
gloves
surgical masks
protective eyewear/face shields
protective clothing
optimizing the supply of PPE during shortages (3)
- conventional capacity
- contingency capacity
- crisis capacity
masks before covid 19
Should cover both the nose and the mouthShould fit snugly against the faceIf you have facial hair, keep well groomed in order for the mask to be worn effectivelyChange it between patients or immediately if it gets wetRemove it as soon as treatment is overAvoid touching the mask, touch only the elastic or cloth ties
levels of facemarks (3)
ASTM level 1: low risk of fluid exposure
ASTM level 2: moderate risk of fluid exposure
ASTM level 3: high risk of fluid exposure
guidelines for wearing a respirator
Must have a written respiratory protection policyYou must be medically cleared to wear the respiratorMust be fit tested for the respiratorNo facial hairKnow the schedules for cleaning, disinfecting, storing, inspecting, repairing, and discarding Must be properly trained in the proper use of respirators
gloves
Minimize the risk of health care personnel acquiring infections from patientsPrevent microbial flora from being transmitted from health care personnel to patients Reduce contamination of the hands of health care personnel by microbial flora that can be transmitted from one patient to another It is not a substitute for handwashing!
glove considerations
Remove gloves that are torn, cut or punctured Do not wash, disinfect, or sterilize gloves for reuse Use sterile gloves when performing surgical proceduresAllergies to certain glove materialKeep finger nails short, minimize or eliminate jewelryAlways change gloves between patientsUse utility gloves for cleanup and disinfection
protective eyewear and face shields
Shields the eyes of dhcp from spatter and debris generated from dental proceduresprotective eyewear and face shields should be cleaned with soap and water as needed.If visibly soiled, disinfect between patients according to the manufacturer’s instructionBecause many dental procedures produce projectiles from various dental materials used, protective eyewear for the patient is advised
protective clothing
Wear gowns, lab coats, or uniforms that cover skin and personal clothing likely to become soiled with blood, saliva, or infectious material Change if visibly soiled Remove all barriers before leaving the work area
the CDC defines occupational exposure to bloodborne pathogens in dentistry as a
percutaneous injury or contact of mucous membrane or non-intact skin with blood, saliva, tissue, or other body builds that are potentially infectious
ways to prevent occupational exposures (3)
standard precautions
engineering controls
work practice controls
engineering controls
technology based measures that eliminate hazards through safer designs that isolate or remove the blood borne pathogens hazard from the work place
engineering controls rely on the
devices technology, rather than the users technique
work practice controls
procedures that reduce the likelihood of exposure by altering the way in which a task is performed
post exposure management protocols
dental practices should have a comprehensive written plan to facilitate prompt reporting, evaluations, counseling, treatment, and medical follow up of all occupational exposures
post-exposure management protocols should
describe the type of blood or OPIM contact that may place dental members at risk for bloodborne infections
describe procedures for prompt reporting and evaluating such exposures
identify a healthcare professional who is qualified to provide counseling, medical evaluations, and procedures in accordance with the most current recommendations of the US Public Health Service
DHCP with hep B
How is the patient at risk
✓the DHCP must be sufficiently viremic
✓the DHCP must have an open wound that allows exposure to their blood or other infectious bodily fluids
✓the providers blood or infectious bodily fluid must come into direct contact with a patients wound
specified exposure-prone procedures
✓Major oral surgery procedures would be overseen
Expert panel
✓Responsible for providing oversight of the infected DHCP’s practice
notification to patient
no notification necessary
In addition, the Consult Subcommittee determined that there was no scientific or ethical basis for the restrictions that some medical and dental schools have placed on HBV-infected students and concluded that such restrictions were detrimental to the professions as well as to the individual students.
after covid related exposure, you cannot return until
at least 10 days have passed since symptoms first appeared and at least 24 hours have passed since last fever without the use of fever-reducing medicine
oral surgical procedures present a risk for
microorganisms to enter the body
oral surgical procedures involve the
incision, excision, or reflection of tissue that exposes normally sterile areas of the oral cavity
the ADA considers these procedures as surgical and therefore require surgical gloves (5)
biopsy periodontal surgery apical surgery implant surgery surgical extractions
for surgical hand antisepsis, you must use
an antimicrobial soap or if you use a non-antimicrobial soap you must follow up with an alcohol based hand rub
must scrub the hands, fingers, and forearms
alcohol-based hand rubs should contain chlorhexidine, quaternary ammonium compounds, octenidine, or triclosan to achieve germincidal persistent activity
use sterile saline or sterile water as a —/— when performing surgical procedures
coolant/irrigator
how to deliver sterile irrigating fluids
use devices designed for the delivery of sterile irrigating fluids
cleansing
reduces the number or microorganisms present
disinfection
less lethal to pathogenic organisms than sterilization
sterilization
the process that kills all types and forms of microorganisms
classification of patient care items (3)
critical
semi-critical
non-critical
sterilization process (4)
decontamination
inspection and packaging
sterilization
storage
decontamination
Make safe by removing or reducing contamination by infectious organisms or other harmful substances; the reduction of contamination to an acceptable level.
an item that has been disinfected is less likely to transmit infection than
one that hasn’t
there is only a reduction in the number of microorganisms. therefore you still need to
wear your PPE
Without thorough cleaning, any — matter remaining on the instruments can protect microorganisms during the sterilization process; sterilization cannot be assured, even with longer sterilization times.
organic
packaging after inspection is the final step before the instruments
go into sterilization
wraps
porous material that allow steam to penetrate
pouches
special medical grade bag that allows steam to penetrate
steam is achieved by
exposing products to saturated steam at high temperatures
dry utilizes
hot air that is either free from water vapor, or has very little of it
chemical refers to a technique of sterilization making use of a
chemical agent
where to store sterilized packages
behind closed doors or inside drawers to prevent packages being compromised
use event related practices
sterilization monitoring (3)
mechanical
chemical
biological
1 reason for a failed spore test
overloading
have the machine inspected
take it out of service
repeat the spore test
go over proper loading
types of environmental surfaces (2)
clinical contact
housekeeping
cleaning clinical contact surfaces
Risk of transmitting infections greater than for housekeeping surfacesSurface barriers can be used and changed between patientsORClean then disinfect using an EPA-registered low-(HIV/HBV claim) to intermediate-level (tuberculocidal claim) hospital disinfectantMust wear appropriate ppe
cleaning housekeeping surfaces
Routinely clean with soap and water or an EPA-registered hospital disinfectant / detergentClean mops and cloths and allow to dry thoroughly before re-usingPrepare fresh cleaning and disinfecting solutions daily and per manufacturer recommendations
general cleaning recommendations
Use barrier precautions (e.g., heavy-duty utility gloves, masks, protective eyewear) when cleaning and disinfecting environmental surfacesPhysical removal of microorganisms by cleaning is as important as the disinfection processFollow manufacturer’s instructions for proper use of EPA-registered hospital disinfectantsDo not use sterilant/high-level disinfectants on environmental surfaces
medical waste
not considered infectious, thus can be discarded in regular trash
regulated medical waste
poses a potential risk of infection during handling and disposal
the processes for regulated waste include
autoclaving and incineration
are extracted teeth considered regulated medical waste?
yes
do not incinerate extracted teeth containing amalgam
Clean and disinfect before sending to lab for shade comparison
can extracted teeth be given back to the patient?
yes
handling extracted teeth in educational settings (4)
Remove visible blood and debris
Maintain hydration
Autoclave (teeth with no amalgam)
Use Standard Precautions
dental water quality for routine dental treatment
water should be regulatory standards for drinking water
<500 CFU/mL of heterotrophic water bacteria
Waterlines are the narrow-bore plastic tubing that carries the water to the
high speed handpiece, air/water syringe, and the ultrasonic scaler
biofilm
thin, slimy film of microorganisms that adhere to the interior surface of waterlines
dental unit waster systems must bar regularly maintained to minimize
microorganisms and biofilm colonizing
urge manufacturers to continue to develop accessory components, retrofitted for current
dental units
urge manufacturers in the US to have future units, equipped with
separate water reservoir independent of the public water supply
how to improve water quality (4)
independent water reservoirs
chemical treatment
daily draining and air purging
and point of use filters
