LAW/COMMUNICATION/SHARPS/DECONTAMINATION

Question 1

What is the function of the GDC?

Answer 1

Protect patient safety and maintain public confidence in dental service

Question 2

Who are the three categories in the register for the GDC?

Answer 2

Dentist, dental care professionals and specialist.

Question 3

Registration for dentists runs on a calendar year basis, when must you pay the fee by to be on the register?

Answer 3

31^st of December each year.

Question 4

What are the three things that you must do be placed on the dental register?

Answer 4

1. Pay the fee before 31^st of December
2. Declare enhanced CPD hours
3. Fill in an indemnity declaration

Question 5

Written consent form is not the actual valid consent itself. It is simply evidence that an attempt at consent has been undertaken. What Anaesthesia procedure do you need written consent to perform?

Answer 5

General anaesthesia.

Question 6

Offering your arm for blood samples, is an example of which type of consent?

Answer 6

Implied consent.

Question 7

At which age in Scotland is age of legal capacity?

Answer 7

16

Question 8

Buckman proposes the communication protocol?To break bad news

Answer 8

spikes

Question 9

What does spikes stand for?

Answer 9

S – setting and listening skills

P – patients’ perception of condition and seriousness

I – invitation from the patient to give information

K – knowledge, giving the facts

E – explore emotions and empathise as patient responds

S – strategy and summary

Question 10

Goal setting can be tailored in to two groups, what are they?

Answer 10

Armpits

A – Appropriate

R – Realistic

M – Measurable

P – Positive

I – Important

T – Time – related

S – Specific

Smart

S – Specific

M – Measurable

A – Attainable

R – Relevant

T - Time-bound

Question 11

Aggression is said to exist in two forms, what are they?

Answer 11

Active aggression and passive aggression

Question 12

What are the four forms of passive aggression?

Answer 12

1. Sulking
2. Withdrawing
3. Being stubborn
4. Being resentful

Question 13

Injuries from needles, instruments, bone fragments, or bites which break or penetrate the skin is known as a?

Answer 13

percutaneous injury (sharps injury)

Question 14

A significant exposure is one where the source is known to be?

Answer 14

BBV infected

Question 15

An injury with a non-contaminated sharps, is not classified as a significant exposure but should it still be reported?

Answer 15

Yes

Question 16

What qualifies as a sharp in the dental setting?

Answer 16

1. Needles
2. Human teeth
3. Bone fragments
4. Instruments

Question 17

The transmission of infection depends on a number of factors, including?

Answer 17

1. The persons natural immune system
2. The depth of the injury
3. The type of sharp used e.g. hollow/solid bore
4. Where the sharp enters the body
5. If the source, if known, has BBV

Question 18

Which BBV has the greatest risk of transmission?

Answer 18

Hepatitis B (1 in 3)

Question 19

Which BBV has the second greatest risk of transmission?

Answer 19

Hepatitis C 1 in 30

Question 20

Is there a vaccination against Hep C?

Answer 20

No

Question 21

Which BBV has the least risk of transmission?

Answer 21

HIV 1 in 300

Question 22

• All medical devices used on patients = contaminated
• Decontamination/reprocessing = cleaning, rinsing, disinfection, drying, inspection, and sterilisation
• The above will make contaminated products safe to re-use.

Question 23

Reprocessing RMD’s

• Complex multistage process

Question 24

Disinfection and sterilisation

• Disinfection: a process which eliminates many pathogenic microorganisms (except bacterial spores)
• Sterilisation: a process that removes or kills all forms of microbial life
• An instrument is sterile = theoretical probability of a viable microorganism being present in or on a device following a validated sterilisation process is less than one in a million.

Question 25

What is the most resistance microorganism to disinfect and sterilise?

Answer 25

1. Prions
2. Bacterial spores
3. Mycobacteria
4. Small non-enveloped viruses
5. Gram-negative bacteria
6. Fungi
7. Large non-enveloped viruses
8. Gram-positive bacteria
9. Lipid enveloped viruses

Question 26

What must be done before buying an equipment?

Answer 26

Check the manufacturers decontamination instructions, so that you know whether they can be decontaminated by the facilities present.

Question 27

What symbol is indicated for single use instruments

Answer 27

= circle with the number 2 crossed out.

Question 28

What happens if you use a single use device twice =

Answer 28

if you reprocess a single use device you become legally liable if the product fails. You also take the manufactures liability.

Question 29

Preference should be given to instruments that can be sterilised through which method and why =

Answer 29

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.

Question 30

Staff working in a local decontamination unit must be vaccinated for what =

Answer 30

hep B

Question 31

COSHH (control of substances hazardous to health) is the law that requires employers to control substances that are hazardous to health.

Question 32

Two sinks desirable for a local decontamination unit

Question 33

What does a dental handpiece lubricator do

Answer 33

= prolong handpiece

Question 34

Manual cleaning = increase sharps injury, cannot also be validated.

Question 35

What does fairy liquid do to proteins

Answer 35

= make proteins stick to the instruments.

Question 36

At what temperature should the water not exceed to and why not? =

Answer 36

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.

Question 37

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.

Question 38

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.

Question 39

Place instruments in a suspended basket, ensuring that they are not overloaded or overlapped as 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.

Question 40

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

Question 41

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.

Question 42

After the cycle is complete, drain the basket of instruments before rinsing. Each cycle must be recorded as satisfactory, sign and retain print outs.

Question 43

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.

Question 44

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.

Question 45

Ultrasonic cleaner testing

• 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

Question 46

After the cleaning process either manually or using an ultrasonic cleaner, all instruments must be dried thoroughly.

Question 47

Do not allow instruments to air dry as this can enable moisture to get trapped and also promote microbial growth and corrosion.

Question 48

Dry with low-linting towels to reduce any cloth fibres from sticking to the instruments which can increase risk of contamination. Make sure all instruments are fully dried before packaging or prior to sterilisation as any moisture will inhibit steam from contacting all surfaces

Question 49

Washer-disinfector

Using a WD requires several resources including staff training, space, compatible instruments and cassettes. You need to ensure that you have sufficient quantity of instruments as the process takes much longer. It needs to be installed and validated on site prior to use by an engineer. It needs regular testing and maintenance.

Question 50

Using a washer-disinfector is the preferred method for cleaning dental instruments because it offers the best option for the control and reproducibility of cleaning, and the cleaning process can be validated. WDs are used to carry out the processes of cleaning and disinfection consecutively. There are two methods of disinfection. Thermal being the preferred method as Chemical disinfection has disadvantages such as toxic reactions.

Question 51

Washer-disinfector

5 stages in the WD stage

1. Flush
2. Wash
3. Rinse
4. Thermal disinfection 80 degrees for 10 minutes 90 degrees for 1 min
5. Drying