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BDS3 > Patient Safety > Flashcards

Patient Safety Flashcards

1
Q

What is Spaulding classification?

A

Classifies instruments as critical (must be sterile), semi-critical (ideally sterile/high level disinfected) or non-critical (disinfect or clean)

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2
Q

Dental mirror Spaulding classifictation

A

Semi-critical

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3
Q

Dental handpieces challenge of sterilisation

A

Sterilising inside the instrument, getting steam to penetrate

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4
Q

What type of sterilisers for lumened instruments?

A

Type B vacuum

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5
Q

Why must instruments be sterilised?

A

Reduces probability of infection transmission
International standard for surgical instruments
Legislative and professional standards
Maintaining high quality patient care

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6
Q

Do type N sterilisers sterilise dental handpieces?

A

No, they are non-vacuum

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7
Q

Sterile definition

A

For a terminally sterilised medical device to be designated STERILE the theoretical probability of there being a viable micro organism present on/in the device should be equal to or less than 1 x 10^-6

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8
Q

Lifecycle of re-usable surgical instrument

A

(acquisition)- cleaning - disinfection - inspection - (disposal) - packaging - sterilisation - transport - storage - use - transport - cleaning

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9
Q

What is a good tip to keep sterilisation guidelines simple?

A

Single use devices where possible

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10
Q

What is the next step after disinfection and inspection?

A

Packaging

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11
Q

What is the next step after packaging of instruments?

A

Sterilisation

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12
Q

Three main factors in the reduce of spread of hepatitis B in dentistry?

A

Modern sterilisation requirements
PPE
Vaccination

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13
Q

Reasons to be concerned about CJVD

A

Prions more difficult to inactivate on surgical devices
Infectivity can survive steam sterilisation at 134C for 18 minutes
Asymptomatic carriage may be relatively high

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14
Q

Possible bacterial cause of post-op infection

A

Staph aureus

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15
Q

How is the inside of a handpiece sterilised?

A

Type B vacuum steriliser

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16
Q

What is a critical device by Spaulding classification?

A

A device that penetrates soft tissues, makes contact with broken skin and enters or contacts the bloodstream or normally sterile tissue

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17
Q

What is a semi-critical device by Spaulding classification?

A

A device that comes into contact with non-intact skin or mucous membrane, but does not penetrate soft tissue or make contact with the bloodstream, bone, or normally sterile tissue

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18
Q

What is a non-critical device by Spaulding classification?

A

A device that only comes into contact with the skin and intact mucous membrane

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19
Q

What are the Standards of decontamination that must be achieved?

A

BS EN

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20
Q

What are the guidance documents used for decontamination standards called?

A

SHTM

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21
Q

What does the cleaning stage of the decontamination cycle do?

A

Removes all of the biological matter from the surface of the instruments following use

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22
Q

Reasons instruments must be cleaned (5)

A

Functionality of instrument
To minimise spread of contamination
To prevents failed procedures such as biopsy
To achieve steam contact - can’t sterilise through bacterial matter
It is a legal requirement

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23
Q

Which machine is recommended for cleaning?

A

Washer disinfector

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24
Q

What is the second most preferred method of cleaning?

A

Ultrasonic Bath

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25
Q

When can manual cleaning be carried out?

A

If it is the only option
It is specifically recommended by the manufacturer’s instructions
Washer disinfector automated process has failed to remove the contamination

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26
Q

What is the difference between Type B/Type N sterilisers?

A

Vacuum/non vacuum

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27
Q

First 3 things to do upon entering decontamination room?

A

Set down dirty instruments
Hand hygiene
PPE

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28
Q

What is the next stage after using the washer disinfector?

A

Inspection

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29
Q

3 methods for cleaning stage, and what this stage is designed to do

A

Washer disinfector
Ultrasonic bath
Manual

Remove biological matter

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30
Q

What PPE should be worn in the LDU?

A

Apron
Face shield
Gloves

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31
Q

What PPE is worn for manual cleaning specifically, and why?

A

Heavy duty rubber gloves
Risk of sharps injury

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32
Q

What does LDU stand for?

A

Local decontamination unit

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33
Q

Requirements for manual cleaning

A

There must be a dedicated sink
Another sink is required for rinsing
Standard potable water or tap water can be used
Water must be 30-35C
(Temp in excess of 35 can cause proteins to coagulate)
Chemical detergents must be used in the process
Detergents should be formulated specifically for manual cleaning, generally an enzymatic or pH neutral detergent
Manufacturers instructions always followed for dosing levels of chemicals

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34
Q

Two manual cleaning methods

A

Immersion
Non-immersion

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35
Q

Why is important to scrub below the surface of the water in manual cleaning?

A

Can create aerosols and splash environment
Instruments in contact with water and detergent - better cleaning

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36
Q

Two reasons that you must follow the recommended temperature of water for manual cleaning

A

Temperatures above 35C can cause protein coagulation process to start
Recommended temperature for chemicals must be used as this could damage the efficacy of the chemicals, especially enzymatic

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37
Q

What type of brush should be used for manual cleaning?

A

Long handled soft bristled, preferably one that can be cleaned through a washer disinfector

NEVER metallic - could scratch passivation layer

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38
Q

What is the passivation layer?

A

Layer on surface of instruments that prevents corrosion

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39
Q

How does the ultrasonic bath work?

A

It uses soundwaves at very high frequencies to produce bubbles, then fluctuations in pressure produced by the sound waves cause the bubbles to rapidly expand and collapse, having a scouring effect on instrument surface

(has potential to damage instruments so always check manufacturers instructions)

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40
Q

What is cavitation?

A

The process in ultrasonic bath where soundwaves are used to produce bubbles, then fluctuations in pressure which cause the bubbles to rapidly expand then collapse

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41
Q

Operating temperature of ultrasonic bath

A

20-30C

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42
Q

Can tap water be used in the ultrasonic bath?

A

Yes

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43
Q

Should a chemical be added to the water in the ultrasonic bath?

A

Yes

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44
Q

What must be done to ultrasonic bath before it can be used to clean instruments?

A

Degas cycle must be run - If pre existing bubbles, any produced by the cavitation process will collapse into them

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45
Q

How is a degas cycle carried out

A

Chamber filled with water and detergent
Standard production cycle ran with empty chamber (except for the load carrier)

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46
Q

Information recorded following use of ultrasonic bath

A

Date
Cycle number
Detergent added
Temperature
Time
Operator name

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47
Q

What must be carried out immediately after use of the ultrasonic bath?

A

Rinsing - separate sink, below surface of the water

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48
Q

If washer disinfector process fails, so manual and ultrasonic cleaning are used, what must be done next?

A

Rinsed, then run through washer disinfector again

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49
Q

Advantages of manual and ultrasonic cleaning

A

Manually scrubbing exerts greater force than WD is capable of
Some pieces of equipment can not be run through the WD in-line with manufacturer’s instructions
Ultrasonic baths are very good at removing contamination

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50
Q

Reasons against manual and ultrasonic cleaning

A

A member of staff must be present the whole time
Risk of aerosol production
Risk of contaminating surrounding environment
Potential for inconsistency due to human error
High risk of sharps injury
Ultrasonic process is ferocious and could potentially damage equipment
No automated water changes in ultrasonic bath - could recontaminate as removed from chamber

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51
Q

Stages of washer disinfector cycle

A

Flush/prewash - saturate the contamination and removes gross contamination
Main wash - supplemented by detergent to more effectively remove biological matter
Rinse - removes any remaining biological or chemical residue
Thermal disinfection - actively kills microorganisms with use of heated water
Drying - hot air used to remove any remaining moisture from the surface

52
Q

What happens between each stage in the washer disinfector cycle?

A

Water is changed (automatically)

53
Q

When are proteins/prions removed from instruments?

A

During the cleaning stage of the decontamination cycle, ideally in washer disinfector, but manual washing and ultrasonic bath can be used if this does not remove all biological matter

54
Q

Why is important to remove proteins and prions in the washer disinfector?

A

They can survive high temperatures for long periods of time so will not be removed during sterilisation stage

55
Q

Temperatures of WD stages

A

Prewash - <35C
Main wash - dependent on detergent
Rinse - <65C
Thermal disinfection - 90-95C for min 1minute
Drying - not specific but generally 100C

56
Q

Why is washer disinfector the first step?

A

Save bother/staff for manual cleaning if WD works well to remove all contamination
There is fresh water for each stage
Thermal disinfection makes instrumentation safe for staff to handle so that inspection can take place before steam sterilisation
Consistency
Traceability

57
Q

Daily checks for the washer disinfector

A

Check that spray arms spin freely without obstruction
Check spray jets on arms are not blocked
Make sure there is not debris on the strainer/filter and no parts of instruments or other potential blockages
Check door seal and wipe clean if necessary
Verify there is a suitable amount of chemical in reservoir
Record disinfection temp of the first cycle daily (ACT automatic control test)

58
Q

Where are the spray arms in a washer disinfector?

A

One on the bottom of chamber one on the top

59
Q

Why is loading the washer disinfector correctly important?

A

For sufficient cleaning the water and detergent must contact every surface of every instrument

60
Q

Loading of washer disinfector requirements (5)

A

Load carrier must be used
Clip trays must be used and positioned correctly
No overlapping or shadowing of equipment
Hinged instruments must be open at hinger
All assemblies should be disassembled before hand

61
Q

What must be carried out after using the washer disinfector and for what 2 reasons?

A

Inspection under illuminated magnifier - for damage to instruments and to check there is no contamination still present

62
Q

Why is steam used for sterilisation?

A

Steam carries a massive amount of energy
Non-toxic component in the sterilisation process
For certain applications it can be recondensed and used again
The main ingredient is water - readily available
There is no waste product except water

63
Q

What must be used for steam production for sterilisation?

A

Purified water - had organics, minerals and microorganisms removed from it

64
Q

Why is it useful that steam, compared with the amount of water used to create it, has a much bigger volume?

A

Can flood the chamber with small amount of water
High pressure, helps with permeability of steam

65
Q

Three types of steriliser

A

Type N
Type B
Type S

66
Q

What is a type N steriliser?

A

Most basic
Autoclave
Also called gravity displacement

67
Q

What is a type B steriliser?

A

Most robust cycle
Vacuum

68
Q

What is a type S steriliser?

A

Specialised piece of equipment for a specific piece of equipment

69
Q

Process of type N sterilisation

A

Machine heats water in chamber
Turns to steam and passively forces air out (not entirely efficient and can leave pockets of air in chamber)
Not favourable for high quality sterilisation and wrapped or lumened instruments can’t be processed

70
Q

Which instruments can not be processed in type N steriliser?

A

Wrapped or lumened

71
Q

What are the problems associated with air pockets in sterilisers?

A

Air pockets are always colder than the steam - not heated or maintained in the same way
If instrument is in air pocket it is not contacting the steam, might not reach sterilisation temperature for the minimum required time

72
Q

What instruments are recommended to be sterilised in type N?

A

Only rigid steel/solid instruments with no pockets, channels or lumens, unwrapped

73
Q

Required temperature and pressure of type N, and how long must this be maintained?

A

134-137C
2.05-2.45 bar gauge
3 min

74
Q

Process of type B steriliser

A

Empty chamber of all air with vacuum pump
Fill chamber with steam

75
Q

Advantages of type B steriliser

A

Vacuum so more effective at having steam contact all instrument surfaces at all times
Can penetrate wrapped instruments allowing them to be sterile at the point of use

76
Q

Required temperature and pressure for type B steriliser, and how long must this be maintained?

A

134-137C
2.05-2.35 bar gauge
3 min

77
Q

Extra stage of type B steriliser

A

Drying stage to remove moisture

78
Q

Process of type S steriliser

A

Washes and lubricates hand pieces as well as sterilising them
Has a vacuum process but can not process wrapped instruments
Same temperature, pressure and hold time
Only used for instrument it is designed for

79
Q

When do instruments get wrapped if they are sterilised in type N?

A

Immediately after

80
Q

What stage in the disinfection process should instruments be wrapped?

A

Before sterilisation (type B)
Immediately after sterilisation (Type N)

81
Q

Suitable environment for storage of wrapped instruments

A

Clean and free from aerosol contamination, dry, temperature controlled, away from direct sunlight, first in first out

82
Q

Daily tests for sterilisers

A

Check door seals, clean if necessary
Verify chamber is free from damage, debris, contamination, instruments
Verify condition of load carrier
Fill and drain the feedwater reservoir
Drain the used water reservoir
(steam penetration test for type B)

83
Q

What daily test must be carried out on specifically type B sterilisers?

A

Steam penetration test using Bowie Dick test pack or Helix

84
Q

Weekly tests for type B sterilisers

A

An air leakage test
Air detector function test
Both cycles on the machine

85
Q

Guidance for sterilisation documents

A

SHTM 01 - 01 part c
referencing BS EN 285 and BS EN 13060

86
Q

Why is sterilisation carried out?

A

Destroy all viable microorganisms

87
Q

Requirements for instrument transport container

A

Rigid sided
Tight fitting lid
Leak proof
Colour coded or clearly marked

88
Q

Requirements for washer disinfector

A

Validated to establish cycle parameters
Loading patterns followed
Daily and weekly testing carried out

89
Q

Requirements of the inspection stage

A

A lit magnifier used to identify any damage and identify any spots or residual contamination

90
Q

What is ultrasonic bath used for?

A

Remove hard to reach contamination
As a secondary or back-up method

91
Q

Requirements for ultrasonic bath

A

Must be degassed and tested before use

92
Q

Requirements for sterilisers

A

Must be tested on daily and weekly basis
Use purified water only
Have an annual insurance test performed

93
Q

Where in the disinfection process must purified water be used?

A

Steriliser

94
Q

Why is time between use and decontamination processing significant?

A

Blood or biological matter dry and adhere to the instruments

95
Q

Elements of Sinner circle

A

Energy
Temperature
Chemicals
Time

96
Q

What does the Sinner circle show?

A

4 key elements that are required for a successful cleaning process
If any component is increased or decreased the efficacy of the cleaning process is changed
(developed by Herbert Sinner in the 1950s)

97
Q

Where can potable/tap water be used?

A

Manual
WD
Ultrasonic

98
Q

What may be present in tap water?

A

Minerals
Silicates
Organics
Metals

99
Q

What is conductivity of water?

A

Total dissolved solids, such as minerals, silicates, organics, metals
Measure in micro-siemens
Soft water has lower conductivity
56.8 micro-siemens in Scotland

100
Q

How is water purified?

A

Distilled
De-ionised
Reverse osmosis
Sterile

101
Q

How is distilled water produced?

A

Boiling and recondensing tap water

102
Q

How is de-ionised water produced?

A

Passing water through an ion exchange that picks up things like sodium, calcium and potassium

103
Q

How is pure water produced by reverse osmosis?

A

A semi permeable membrane filter is used to remove particulate and bacteria from the water

104
Q

How is sterile water produced?

A

Filtered by distillation/deionisiation/reverse osmosis them sterilised

105
Q

Why is it important to only use pure water in the sterilisation stage?

A

Any particulates from water left on instruments when they are dried can leave a residue giving bacteria a place to breed

106
Q

Where are enzymatic detergents used and why?

A

In ultrasonic and for manual washing in order to break proteins down into smaller particles

107
Q

Benefit to pH neutral detergent for the operator?

A

Less harmful for skin

108
Q

Where are high and low alkaline detergents used and why?

A

Enclosed processes - harsh on skin

109
Q

Where is pH neutral detergent used?

A

Manual washing or WD for handpieces

110
Q

How to detergents work?

A

The chemical molecule is designed to have a hydrophilic and a hydrophobic end. The hydrophobic end never contacts water, because of the repulsion
This is where the contamination is drawn to and then flushed away as the hydrophilic end attaches to water molecules

111
Q

What are the important manufacturer’s instructions for detergents?

A

Dosing
Operating temperature

112
Q

What is the energy element in manual/ultrasonic/WD cleaning?

A

Manually - force of scrubbing brush
Ultrasonic - high frequency waves
WD - high pressure (1-1.5 bar)

113
Q

Why does the WD use stronger chemicals that ultrasonic or manual washing?

A

Lower energy process

114
Q

How are times of WD cycles established?

A

At validation by engineer - instruments must be free from biological matter/proteins within the cycle parameters

115
Q

During which stages of the WD must the temperature be below 35C?

A

Flush/prewash (avoid protein coagulation)

116
Q

What temperature is the water for manual or ultrasonic cleaning?

A

<35C

117
Q

Thermal disinfection temperature

A

90-95C
1 minute minimum

118
Q

Steam sterilisation temperature

A

134-137C
3 minutes minimum

119
Q

What temperature is used in the WD for the main wash process?

A

Manufacturer’s instructions

120
Q

What are Scottish Health Technical Memorandum?

A

A series of documents providing information and guidance on testing requirements for decontamination equipment etc.

121
Q

Legislation for decontamination

A

Outlined in government publications such as Acts and Directives, legal obligation to operate any form of decontamination facility in line with the official guidance provided. Also governs production and manufacture of equipment

122
Q

Standards for decontamination

A

A series of highly technical documents (BS EN, BSI, ISO) which govern the way in which facilities and equipment should be operated and amongst other things, the standard to which equipment is produced and processes are tested and verified.

123
Q

Current guidance for sterilisation

A

SHTM 01-01 Part C

124
Q

Current guidance for automated cleaning and disinfection

A

SHTM 01- 01Part D

125
Q

Standards for sterilisers

A

BS EN 285 Sterilisation - Steam sterilisers - Large Sterilisers
BS EN 13060:2014 Small Steam Sterilisers

126
Q

Standards for washer disinfectors

A

BS EN 15883

BDS3 (20 decks)

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