Infection Control and safety Flashcards
Sterilisation: 82 Sharp Awareness: 83-
1
Q
All medical devices that have been used on patients must be considered as?
A
Contaminated
2
Q
a combination of processes, including cleaning, rinsing, disinfection (if WD used), drying, inspection and sterilisation can be defined as?
A
Decontamination/ (Reprocessing)
3
Q
Dental Instruments are classed as?
A
Medical devices
4
Q
Decontamination is required to?
A
minimize the risk of transmission of infective agents including bacteria, viruses and prions between patients and staff.
5
Q
a process by which reusable items are rendered safe for further use on patients and safe for staff to handle is known as?
A
Decontamination
6
Q
Instrument or medical device decontamination or reprocessing of instruments is a complex?
A
Multistage process.
7
Q
There are three methods of cleaning reusable dental instruments, what are they?
A
manual cleaning or using an ultrasonic bath or a washer-disinfector.
8
Q
Any organic or adherent materials left on an instrument will inhibit these processes of decontamination, what else can this lead to?
A
- Corrosion
- Impair function
- Transmission of infection
9
Q
Levels of resistance to disinfection and sterilisation vary between?
A
Different microorganisms
10
Q
Disinfection describes a process that?
A
a process which eliminates many pathogenic microorganisms (except bacterial spores)
11
Q
Sterilization is a term referring to any process that?
A
eliminates (removes) or kills all forms of microbial life, including transmissible agents such as fungi, bacteria, viruses and spore forms present on a surface
12
Q
An instrument is defined as sterile when the theoretical probability of a viable microorganism being present in or on a device following a validated sterilisation process is less than one in a?
A
million
13
Q
What is the most resistance microorganism to disinfect and sterilise?
A
- Prions
- Bacterial spores
- Mycobacteria
- Small non-enveloped viruses
- Gram-negative bacteria
- Fungi
- Large non-enveloped viruses
- Gram-positive bacteria
- Lipid enveloped viruses
14
Q
What must be done before buying an equipment?
A
Check the manufacturers decontamination instructions, so that you know whether they can be decontaminated by the facilities present.
15
Q
What symbol is indicated for single use instruments
A
= circle with the number 2 crossed out.
16
Q
What happens if you use a single use device twice
A
= if you reprocess a single use device you become legally liable if the product fails. You also take the manufactures liability.
17
Q
Preference should be given to instruments that can be sterilised through which method and why
A
= Give preference to instruments that can be cleaned using an ultrasonic bath or a washer-disinfector as these are automated processes which can be validated. This method includes a thermal disinfection and drying stage.
18
Q
What is the MDD (manufacturers device directive)
A
This defines the information manufacturers are obliged to provide for the users of their products
19
Q
The manufactures device directive information is presented in the form of?
A
Symbols on packaging so that it can be understood in any language.
20
Q
The C E – European Commission mark indicates what?
A
that a medical device satisfies the requirement of the MDD, making it fit for use
21
Q
By having the C E logo, where can these products be traded?
A
Only then can this product be traded on the European economic area market.
22
Q
Staff working in a local decontamination unit must be vaccinated for what =
A
hep B
23
Q
Local decontamination unit users (LDU) should all be trained in the standards of infection prevention and control (SIPCs), including:
A
- How infections are transmitted
- Hoe to prevent transmission of infections
- What to do in the event of an accident/near misses
- Local policies on infection prevention and control
24
Q
COSHH (control of substances hazardous to health) is the law that requires employers to control substances that are?
A
hazardous to health.
25
Substances hazardous to health examples:
* Biological agents- bacteria, viruses, fungi and other microoganisms
* Chemicals
* Fumes
* Dust
* Vapours
26
If space allows what is desirable in a local decontamination unit?
Two rooms desirable for a local decontamination unit
27
If space allows, then it would be desirable to have two rooms in a local decontamination unit, what function would each room have?
1. one for dirty activity (the washroom)
2. one for clean activity (inspection, wrapping of instruments and sterilisation)
28
a single room is acceptable in a local decontamination unit (LDU) however tight procedural controls are required, what must you ensure?
1. You must ensure a dirty to clean workflow is maintained.
2. Dirty instruments, splashes or aerosols generated during cleaning must not encounter clean instruments
29
In a local decontamination unit, there needs to be the following:
1. separate hand-washing sink
2. storage for PPE (plastic apron, eye protection, face mask, household gloves
3. containers for transporting dirty instruments.
4. setting down area for dirty instruments.
30
What type of brush do you need to clean in a washing sink for manual cleaning?
Long-handled soft bristle brush
31
What are the requirements for washing sink for manual cleaning instruments?
* Long-handled soft bristle brush
* thermometer
* water level indicator
32
it is only desirable to have an automated dental handpiece lubricator. These machines are not validated for cleaning and do not disinfect, however their use may?
prolong the life of a handpiece.
33
What are the biggest issue with manual cleaning?
1. Manual cleaning cannot be validated as it’s difficult to ensure that it is being carried out effectively every occasion.
2. Compared to other methods of cleaning it presents a higher risk of sharps injury to staff.
34
With manual cleaning it is important measure volume of tap water to correct volume of enzymatic detergent to achieve exact concentration specified by manufacturer, why can we not use detergent like fairy liquid or Chlorhexidine?
Make proteins stick to the instruments. Also, you must be able to see instruments under the water, so its important to not using foaming solutions.
35
At what temperature should the water not exceed to and why not?
= water temp should remain at 30-35, should not exceed 45. Prion proteins start to coagulate at 45 making it more difficult to clean instruments.
36
what does this image show?
This picture shows water level indicator and a thermometer to ensure the correct temperature is maintained.
37
When washing and rinsing what must you do?
1. Fully immerse instruments under water, disassemble if required to prevent aerosols
2. Use long-handled bristle brush
3. If instruments are heavily soiled, drain sink and repeat process.
4. Preferred to rinse instruments in second sink, if not possible drain and refill to rinse.
5. Fully immerse instruments to rinse thoroughly removing any residual soil and detergent
38
What are the pros and cons to manual cleaning?
Pros
1. Inexpensive
2. Less risk of wear and tear
3. Quicker process
4. Less instruments to purchase
Cons
1. Not an automated process
2. Cannot be validated
3. Not reproducible
4. Less effective processes
5. Increased risk of sharps injury
6. No disinfection stage
39
Ultrasonic cleaning uses high frequency sound waves, transmitted through a?
liquid medium.
40
These sound waves create an activity in the liquid called?
cavitation.
41
Ultrasonic cleaner devices need to comply with the requirements of?
SHTM 2030
42
What are the following features found in an ultrasonic cleaner?
* Interlocking lid to prevent operation with lid open and prevents aerosols
* Suspended baskets for instruments
* Drain-tap to enable chamber being emptied
* Control of process variables such as temperatures and time (6 - 10 minute cycle)
* A printer to provide a retainable record of each cleaning cycle
43
How often should the solution be changed in an ultrasonic cleaner?
* The solution must be changed every 4 hours or after use if visibly contaminated as debris will inhibit the cleaning process
44
Ultrasonic cleaning uses high frequency sound waves, transmitted through a liquid medium. These sound waves create an activity in the liquid called cavitation. This occurs as the sound waves pass through the liquid, causing the formation of microscopic bubbles which are forced to expand. Once they reach a size where they can no longer support they implode. The cavitational process creates a scrubbing effect within in the liquid which gently agitates any debris off the surface of any instrument immersed in the tank.
45
Fill the ultrasonic cleaner tank with cleaning solution Run the first cycle without any instruments to de-gas the solution on start up and on subsequent re fills. Ensure that joints and hinges are opened fully and instruments that need taking apart are fully disassembled before they are immersed in the solution.
this will prevent the solution contacting all surfaces of the instruments which will result in poor cleaning and can also cause wear to the instruments.
46
Do not place instruments on the floor of the ultrasonic cleaner as excessive instrument movement can damage to them. To avoid damage to delicate instruments a modified basket might be necessary. Remember handpieces cannot be cleaned in an ultrasonic bath
47
Submerge the baskets, close the lid and do not open until the cycle is complete. Select cycle setting for the validated cleaning procedure ensuring that temperature is not above 40°C.
48
After the cycle is complete, drain the basket of instruments before rinsing. Each cycle must be recorded as satisfactory, sign and retain print outs
49
The solution must be changed when it becomes visibly contaminated or otherwise every 4 hours because the build-up of debris will reduce the effectiveness of cleaning.
50
Keep a record of each change of solution. Rinse out the tank after emptying the solution to remove any soil before refilling. Drain, clean with a neutral solution, rinse and dry the cleaner when not in use and overnight.
51
o not use ultrasonic to clean? Dental handpieces
Do not use ultrasonic to clean? Dental handpieces
52
What is the ultrasonic procedure?
* Submerge baskets and close lid
* Select cycle for validating cleaning process and do not open lid until cycle is complete
* Cycle normally lasts between 6 -10 minutes depending on cycle and temperature selected (between 25° - 40°C)
* Once cycle is complete drain instruments before rinsing
* Record each cycle (check print out and sign)
* Change solution if visibly contaminated or every 4 hours to ensure effective cleaning recording every change
53
What are the ultrasonic cleaner testing procedures?
* Foil Ablation Test – determines the pattern of erosion on aluminium foil strips suspended in the cleaner
* Cleaning Efficacy Test – determines if the ultrasonic is functioning correctly by checking if any residual proteins are left on the instruments
* Soil Test – involves removal of artificial soil from a test device
* N.B - record all information as recommended by manufacturer in a logbook which can be downloaded from Health Facilities website
54
After the cleaning process either manually or using an ultrasonic cleaner, all instruments must be?
dried thoroughly.
55
Do not allow instruments to air dry as this can?
enable moisture to get trapped and also promote microbial growth and corrosion.
56
Dry with low-linting towels to reduce any cloth fibres from sticking to the instruments which can increase risk of?
Contamination
57
Make sure all instruments are fully dried before packaging or prior to sterilisation as any moisture will inhibit steam from?
contacting all surfaces
58
Using a washer-disinfector is the?
preferred method for the cleaning of dental instruments
59
Why is using a washer-disinfector preferred to other cleaning methods?
It’s an automated process that can be validated.
60
What stage does a washer-disinfector include?
It includes a disinfection stage (renders instruments safe for handling and inspection):
61
Using a WD requires several resources including?
1. staff training
2. space
3. compatible instruments and cassettes
62
why must you ensure that you have quantity of instruments in the washer-disinfector?
as the process takes much longer.
63
WDs are used to carry out the processes of cleaning and disinfection consecutively.
There are two methods of disinfection, what are they?
Thermal being the preferred method as Chemical disinfection has disadvantages such as toxic reactions.
64
What are the 5 stages in the WD stage?
1. Flush – removes gross contamination including blood and bone fragments. Water temperature ˂45°C to prevent proteins from coagulating
2. Wash - removes any remaining debris. Mechanical and chemical processes loosen and break up any contamination adhering to instruments. Detergents used must be specified by manufacturer as suitable for WD
3. Rinse - removes detergent, may have several sub-stages
4. Thermal disinfection - 80 degrees for 10 minutes 90 degrees for 1 min
5. Drying - purges the load and chamber with heated air to remove any residual moisture
65
What considerations should you take for handpieces?
1. Check instructions regarding cleaning
2. Handpieces have symbols indicating cleaning method
3. WD may remove lubricant
4. Consider use of automated lubrication equipment
66
What are the main benefits of a Washer-disinfector?
* Automated/validated process
* Reduces risk of sharps injuries
* Minimal human contact with instruments
* Cleaning cycle is reproducible
* Disinfects as well as cleans
* Has a drying cycle
67
Washer-disinfector housekeeping requires you to daily check what?
* Check the spray nozzles for blockages
* Ensure spray arms are freely rotating
* Check door seals
* Remove and clean strainers and filters
68
What are the washer-disinfector testing and validation?
1. Automatic control test (ACT) - ensures WD functions properly
- Involves checking readings and timings are within required parameters
- Printers record this information and will notify is cycle has failed
2. Efficacy test – demonstrates the WD ability for removing contamination
69
All instruments regardless of method of cleaning must be inspected using an?
illuminated magnifier
70
Packaging instruments prior to sterilisation maintains their sterility, these can therefore be labelled what?
Sterile
71
Packaging material for pre-sterilisation should be?
1. Allow steam penetration
2. Allow steam to penetrate around the instrument
3. Be able to withstand the sterilisation process
4. Prevent recontamination after sterilisation
5. Maintain sterility of instrument
6. Be made of non-shredding material
7. Only a single layer of wrapping material used
8. Allow placement of adhesive labelling
72
Package labelling should include the following information?
1. Allow tracking of instruments
2. Contents – sterile or sterilised
3. Name of department or clinic
4. Individual instrument identifier
5. Sterilisation cycle number
6. Steriliser number
7. Method of sterilisation – steam
8. Use of chemical process indicator that is either printed on the pouch or available as a label or tape
73
What are the methods of sterilisation?
1. Heat
2. Chemical
3. Radiation
74
To kill micro-organisms, the instruments need to be exposed to steam at the required temperature-pressure-hold of?
134-137 degrees Celcius for a minimum of 3 minutes at 2.1 - 2.25 bar gauge pressure.
75
What are the types of sterilisers available?
1. Type N Cycle: designed for non-wrapped solid instruments (no vacuum)
2. Type B Cycle: preferred method, used to sterilise wrapped/packaged instruments
3. Type S Cycle: only suitable for loads specified by steriliser manufacturer.
76
What are the advantages of steam sterilising
1. Rapid heating
2. Rapid penetration of the load
3. Rapid destruction of microorganisms including bacterial spores
4. Cost effective
5. Practical
6. No toxic residues produced
7. Readily controlled and monitored
77
Before you use the steriliser, what must the instruments be?
Clean, dry and inspected beforehand.
78
The water used in the steriliser reservoir should be low in what?
1. Mineral
2. Pathogen
3. Endotoxin free
79
Automatic control test for all steriliser types should be carried out when?
Carry out at beginning of each day
80
Weekly safety checks include?
* Examine the door seal for signs of wear or damage
* Examine the security and performance of the door safety features including the hinges and the locking mechanism
* If a fault detected in the door seal or safety features, ensure this is corrected before carrying out weekly tests or using the steriliser
* Record satisfactory completion of weekly safety checks in logbook
81
What are the two types of traceability test?
1. Through the decontamination process
2. Directly to the patient
82
Dentistry is currently classified as low risk regarding the transmission of vCJD but high risk of what?
Blood-borne viruses
83
What is a percutaneous injury?
(sharps injury) e.g. injuries from needles, instruments, bone fragments, or bites which break or penetrate the skin.
84
What would be considered as a significant exposure with a sharps injury?
Exposure with known BBV infected
85
An injury with a non-contaminated sharps e.g. unused needle, is not classed as a?
significant exposure (but should still be reported)
86
What is a classified as a sharp in the dental placement?
1. Needles
2. Human teeth
3. Bone fragments
4. Instruments
87
What causes sharps injuries? Most commonly they are caused by:
* Lack of personal/environmental awareness
* Anxiety (personal and/or patients)
* Poor Technique
* Not following the proper procedure/protocol
* Lapse of concentration
88
Injuries with no direct patient contact are due to inappropriately discarded needles.
Studies have shown that injuries commonly occur when:
* Taking needles off syringes or other devices
* Re-sheathing needles
* Taking sharps to a disposal point (sharps container)
* Not disposing of sharp at all
* Over-filling sharps containers.
89
Whose responsibility is it to dispose the sharps?
It is ALWAYS the responsibility of the person using the sharp to dispose of it
90
The transmission of infection depends on a number of factors, after a sharps injury including:
* The persons natural immune system
* The depth of the injury
* The type of sharp used e.g. hollow/solid bore
* Where the sharp enters the body
* If the source, if known, has BBV
91
Which BBV has the greatest risk of transmission via sharps injury?
* Hepatitis B – has the greatest risk of transmission
* Estimated risk of transmission following a sharps injury (deep penetrating injury involving hollow bore needle or device visibly contaminated with blood) is 1 in 3
92
How can the risk of hepatitis b transmission be lower after a sharps injury?
* Risk may be lower if you are protected by getting your Hepatitis B vaccination.
* If the person who has Hepatitis B is on treatment, the risk of transmission to you may be even lower
93
Which BBV has the second greatest risk of transmission?
* Hepatitis C – has the second greatest risk of transmission
* Estimated risk of transmission flowing a sharps injury (deep penetrating injury involving hollow bore needle or device visibly contaminated with blood) is 1 in 30
94
Is there a vaccination against hepatitis C?
no, however treatments are available with good success rates
95
Which BBV has the least risk of transmission?
* HIV (human immunodeficiency virus) - has the least risk of transmission
* Estimated risk of transmission following a sharps injury (deep penetrating injury involving hollow bore needle or other device visibly contaminated with blood) is 1 in 300
96
Is there a vaccine against HIV?
No, Post-exposure prophylaxis (PEP) is available
* Must commence within 72 hours (but ideally after 24 hours) after possible exposure to HIV
97
You are accountable for your practice and there are laws to protect you and others.
Be aware of your responsibilities and the legislations, what are they?
* Health and Safety at Work Act 1974
* Management of Health and Safety at Work Regulations Act 1999
* Control of Substances Hazardous to Health Regulations (COSHH)2002
* Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR)2013
* The European Council Directive 2010/32/EU (the Sharps Directive)
* Health and Safety (Sharps Instrument in Healthcare) Regulations 2013(the Sharps Regulations)
98
What does the law say about employers’ responsibility?
EMPLOYERS RESPONSIBILITIES:
* Protecting workers from sharps injuries and occupational exposure
* By providing safer sharps where these are available e.g. safety-plus twist system
* Appropriate waste disposal equipment
* Provide suitable training for all staff/students
* (please be aware this presentation constitutes part of your training)
* Risk assessments
* Investigating the cause of sharps injuries or splash incidences
* Incident reporting pathways
99
What is the procedure when you get a sharps injury?
1. Stop what you are doing immediately
2. Apply first aid:
* Encourage bleeding by gently squeezing under warm water
* (Do NOT suck injured site)
* Wash thoroughly with liquid soap and warm water
* Dry and cover with a waterproof dressing
3. Inform supervising clinician or senior nurse
4. Follow and complete Occupational BBV Exposure Protocol for advice
* N.B. near misses should also be recorded
* Document incindent through local incident reporting system (Datix)
* URGENCY IS IMPORTANT IN THESE SITUATIONS AS PROPHYLAXIS FOR HIV OR OTHER TREATMENTS MAY BE REQUIRED.
100
What are the 10 must do’s to prevent infection?
* Patient Placement/assessment for infection risk
* Hand Hygiene
* Respiratory and Cough Hygiene
* Personal Protective Equipment
* Safe Management of Care of Equipment
* Safe Management of Care of Environment
* Safe Management of Linen
* Safe Management of Blood and Body Fluid Spillages
* Safe Disposal of Waste (including sharps)
101
Occupational Safety: Prevention and Exposure Management (including sharps
Sources of potential infection include what?
1. Blood and other bodily fluid secretions or excretions (excluding sweat)
2. Non intact skin
3. Mucous membrane
102
What must you ensure to have accepted hand hygiene?
1. Bare below elbows
2. Remove all hand/wrist jewellery
3. Ensure fingernails are clean
4. Short and artificial nails or nail products are not worn.
5. Cover all cuts or abrasions with waterproof dressing
103
Micro- organisms found on the skin include two categories, what are they
A – Resident Micro-organisms (normal flora)
B - Transient Micro-organisms (not normal flora)
A - Resident Micro-organisms, these are usually deep seated in the epidermis and not readily removed and do not readily cause infection, however during surgery/invasive procedures, they may enter deep tissues and establish an infection
B – Transient Micro-organisms, these are not part of the normal flora and represent recent contamination. They include most of the organisms responsible for cross infection e.g salmonella, Pseudomonas, E-coli, MRSA and many other viruses
104
Volume of suitable hand hygiene agent, good technique for the duration of time and ensuring your hands are dried properly, these three factors determine what?
The efficacy of hand hygiene.
105
What are WHO’s 5 moments of opportunity for hand hygiene?
1. Before touching a patient
2. Before clean/aseptic procedure
3. After body fluid exposure risk
4. After touching a patient
5. After touching patient surroundings
106
Fluid resistant type 11R surgical face mask are used for what procedures?
Surgical
107
Filtering face pieces FFP3 masks are used for what procedures?
AGP procedures
108
Care equipment is classified as either?
* Single-use
* Single patient use
* Reusable invasive equipment
* Reusable non-invasive equipment (often referred to as communal equipment
109
Uniforms should be transported home in a disposable plastic bag, or a something like a pillowcase which can be laundered.
Uniforms should be laundered in?
* Separately from other household linen
* In a load not more than half the machine capacity
* At the maximum temperature the fabric can tolerate then ironed or tumble-dried
110
What should you apply on to blood and body fluid spillages?
Apply chlorine releasing granules directly on spill
111
Domestic waste – black
Healthcare including clinical – orange/yellow
Special or hazardous waste – red
