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DH Theory 1 > Prevention of Disease Transmission > Flashcards

Prevention of Disease Transmission Flashcards

1
Q

Define standard precautions (2)

A
  • standard of care to protect healthcare providers and patients from pathogens spread by bodily fluids
  • ALL bodily fluids of all patients are treated as if they are infectious, expect sweat > people lie about carrying diseases/having an infection
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2
Q

Describe the origin of microorganisms of the oral cavity (3)

A
  • oral cavity is sterile in the uterus; after birth microorganisms are transmitted from mother/other people to baby
  • biofilm becomes more complex as infant grows
  • microbiota of an adult harbors 50-100 billion bacteria represented by over 700 different organisms
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3
Q

Describe the infection potential of MO in oral cavity 2

A
  • the intact mucous membrane provides SOME protection against infection
  • pathogenic, potentially pathogenic, or nonpathogenic microorganisms may be present in the oral cavity of each patient
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4
Q

what are “carriers”

A

patients that have certain diseases but are asymptomatic

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5
Q

pathogenic organisms may be ______ or _______?

A

permanent or transient

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6
Q

describe cross contamination of MO’s

A
  • person to person
  • person to inanimate object > inanimate object to person
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7
Q

what are some inappropriate work practices that may permit transmission (4)

A
  • careless handwashing
  • unhygienic personal habits
  • inadequate sterilization and handling of sterile instruments and materials
  • inadequate personal protective equipment (PPE), ventilation, and overall infection control practices
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8
Q

what are the 6 essential features for the chain of disease transmission; describe and EX

A
  1. infectious agent > invading organism that has its own specific reaction in an infected host: bacteria, virus, fungi, protozoa
  2. reservoir> where the organism lives and multiples: inanimate matter, insect, human cells/blood, Clostridium tetani lives in soil, herpetic infections live in humans
  3. port of exit > exit through various modes: respiratory tract, bloodstream through skin abrasions, needles, or dental instruments
  4. mode of transmission > direct or indirect: transmissions by aerosol can be direct from the respiratory tract of one person and spread to another via coughing/sneezing/speaking. Droplets can pass indirectly to inanimate objects and spread to the next person.
  5. port of entry > entry on new host: similar to modes of exit, respiratory tract, eyes, mucous membranes, needlestick, break in skin
  6. susceptible host > someone who doesnt have immunity to invading agent: immunosuppressed, non vaccinated, elderly, medically compromised
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9
Q

What is the number one intervention to break the chain of disease transmission, name others

A
  1. STANDARD PRECAUTIONS
    - immunization
    - maintain good aerosols (like the ventilation in DM room)
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10
Q

types of airborne infections

A

aerosols and spatter

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11
Q

describe aerosols (4)

A
  • solids or liquid
  • may remain suspended in air (hot air balloon)
  • may contain infectious agents
  • range in size 1-100μm microns
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12
Q

how are aerosols classified based on particle size

A

droplet nuclei: < 5μm
droplets: 5-100μm
spatter: >100μm

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13
Q

describe precautions for aerosols in the ODU facility; ex of AGP

A
  • high volume evacuation must be used (HVE) during all aerosol-generating procedures (AGP) to help control aerosols
  • EX: air polishing, ultrasonic scaling, laser
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14
Q

describe spatter (4)

A
  • heavier, larger particles (greater than 100 μm)
  • may remain airborne only for a short time because of size and weight
    -drops on objects, people, floor, etc.
  • may be visible; (saliva, blood, snot)
  • may come in direct contact with mucous membranes of eyes, nose, and mouth
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15
Q

at ODU we wear a face shield for operations with heavy spatter, give 3 examples

A
  • ultrasonic scaling
  • air polishing
  • rubber cup polishing
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16
Q

describe the CONTENTS of aerosols and spatter (5)

A
  • single or clumps of infectious agents such as streptococcus species, staphylococcus species, M. tuberculosis, and viruses
  • tooth and restoration fragments
  • microorganisms from saliva, tissue, biofilm, and blood
  • oil from a handpiece
  • water from dental unit waterlines
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17
Q

describe the concentration/distribution aspects of aerosols and spatter 4

A
  • occur in greater concentration closer to the site of instrumentation/origin
  • aerosols travel with air currents and can move from room to room which is why we preclean and disinfect prior to seeing patients
  • both can settle in dust and be a source of contamination
  • when doors open/close dust is set into motion and can settle onto surfaces/instruments/people
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18
Q

EX of organisms that may travel in dust

A

Clostridium tetani (tetanus) and enteric bacteria

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19
Q

what helps control the spread of dust borne pathogens

A

surface disinfection of all equipment

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20
Q

what transmissible diseases are of concern to dental healthcare personal (5 given in lecture)

list the others (11)

A
  • coronavirus-2 (SARS-CoV-2)
  • tuberculosis
  • viral hepatitis
  • herpetic infections
    -HIV/AIDS

adenoviruses (50+ of them)
NPEVs > hand-foot-mouth, respiratory
poliovirus
rotaviruses
influenza A,B,C
measles
rubella
group A streptococci
candida albicans
streptococcus pneumoniae
mycobacterium > tuberculosis

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21
Q

out of the 20 bloodborne pathogens known to cause disease, which are the most of concern for DHCP (based on book)

A

HBV, HCV, and HIV

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22
Q

how does ODU go about patients with transmissible diseases (3)

A
  • clients reporting active infection of tuberculosis, Hep A, B, C, D, or E, may not be seen until a physician clearance is received
  • clients with active herpetic lesions will not be seen until extraoral herpetic lesions have crusted over and intraorally when the ulcer is no longer present
  • clients with HIV need a medical consultation prior to treatment
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23
Q

what are the recommended immunizations for personal protection of the dental team (6)

A
  • Hepatitis B
  • influenza
  • MMR (measles, mumps, and rubella)
  • tetanus, diphtheria, pertussis
  • varicella
  • COVID-19
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24
Q

for personal protection, describe clinical attire 3

A
  • fully enclosed wipable shoes
  • solid color scrubs or professional attire
  • long socks to cover the ankle
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25
Q

What protective clothing do we wear to clinics and why? 5

A
  • worn over clinic attire to protect the skin and prevent cross-contamination form splash, spatter, aerosols, and patient contact
  • clinic barrier gown
  • gloves
  • if soaked or soiled by infectious materials, change protective clothing immediately
  • during protective clothing removal, turn inside out to prevent exposure to infectious material
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26
Q

describe the barrier gown we wear 4

A
  • only to be worn IN clinic
  • launder after every patient
  • must cover the knees while sitting for patient treatment
  • has long sleeves with fitted cuffs to permit protective gloves to extent over the cuffs
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27
Q

T/F its ok to wear a lab coat to clinic

A

FALSE - never wear a lab coat in clinic

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28
Q

how should your hair be during clinic 2

A
  • hair pulled up and off the shoulders
  • no facial hair to allow seal of respirator mask
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29
Q

the type of mask we wear depends on?

what is filtration?

what BFE does our mask need?

name the type of masks we wear

A
  • the type of procedure
  • Bacterial filtration efficiency (BFE) the measurement of the masks resistance to bacteria
  • must wear masks with >95% BFE
  • surgical masks level 1, 2, and 3 differ on BFE, we use level 3; respirator mask (N95 mask)
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30
Q

Why do we use a respirator mask when dealing with aerosols 2

A
  • aerosols are the dispersion of particles/debris, polishing agents, and water, all of which are contaminated by the patients oral flora which occurs during aerosol generating procedures (AGP)
  • it’s recommended to use a N95 mask or a respirator that offers an equivalent or higher protection during AGP
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31
Q

people who wear N95 respirators must get: 3

A
  • medical clearance
  • training
  • fit tested
32
Q

describe what/why we wear protective eyewear for personal protection 5

A
  • eye protection is necessary for patients and the DHCP
  • eye involvement leads to pain, discomfort, loss of work time, and sometimes permanent injury
  • eye infections can occur following the dropping of an instrument or from splashing of various materials from the oral cavity to the eye
  • contamination can be introduced from saliva, biofilm, carious materials, pieces of old restorative materials (cavity prep), bacteria-laden calculous (scaling), microorganisms from aerosols or spatter
  • protective eyewear is the most effective defense
33
Q

what are the types of eyewear you can use? 4

A
  • safety glasses
  • loupes
  • prescription glasses with side shields (suggest to get contacts)
  • goggles
34
Q

what is worn in addition to eyewear during high spatter procedures?

what do we have incase something enters the eye during procedure

A

face shield

eye wash station

35
Q

how do you clean eyewear? how do you clean face shields?

A

eyewear > clean frames with disinfectant wipe, soap and water for the glass

face shield > soap and water

36
Q

describe heavy duty utility gloves 4

A
  • used for ALL infection control procedures except when removing PPE at the end of the day
  • puncture resistant
  • cleaned after each use but is ALWAYS considered a dirty item
  • can be autoclaved up to 5 times if it’s getting stinky
37
Q

what order do we DON in?

A

clinic gown, name tag, face mask, protective eyewear, face shield, gloves

38
Q

symptoms for latex allergy:

treatment:

most frequent item containing latex:

A
  • symptoms range from a dermatitis to a life-threatening anaphylactic shock
  • the only available treatment for a latex allergy is avoiding all contact
  • gloves
39
Q

Latex hypersensitivity in ODU’s DH care facility

A

only uses latex in the face shrouds on the simulators used in the clinic; if you have a latex allergy let your instructors know

40
Q

methods of exposure for latex hypersensitivity 3

A
  • direct exposure
  • inhalation of the allergen when the powder (cornstarch) from the gloves becomes airborne
  • mucosal contact
41
Q

type 1 hypersensitivity (immediate reaction) 7

A
  • Urticaria (hives)
  • Dermatitis (rash, itchy)
  • nasal problems (sneezing, itchy, runny)
  • eyes (watery, itchy)
  • respiratory reaction (breathing difficulty, asthma/wheezing, coughing)
  • drop in BP (shock)
  • anaphylaxis
42
Q

Type IV hypersensitivity (delayed reaction) 1

A

contact dermatitis - develops 8hrs-5days after contact

43
Q

what is resident bacteria 3

A
  • relatively stable bacteria that inhabits surface epithelium or deeper areas in the ducts of skin glands or depths of hair follicles
  • ultimately shed with the exfoliated surface cells/excretions of the skin glands
  • tend to be less susceptible to destruction by disinfection procedures (harder to remove, lives on skin surface > resident of the body)
44
Q

what is transient bacteria? 2

A
  • can be washed away or may cause infection if a break in the skin exists
  • most can be removed with soap and water or antiseptic hand rub
45
Q

how should our hands look during clinic? 3

A
  • fingernails trimmed short, no polish
  • can wear one wristwatch and one ring, no bracelets
  • always be wearing the correct gloves for the procedure you’re doing
46
Q

what is the most important single procedure for the prevention of cross contamination

A

hand washing

  • Routine handwash > uses nonantimicrobial soap.
  • Antiseptic handwash > (used in clinic) uses antimicrobial soap
  • Antiseptic hand rub > used in surgical antisepsis (surgical scrub)
47
Q

An optimal treatment room includes? 10

A
  • supplies that are sterilized or disposable
  • sharps disposal
    -biohazard waste w/ foot control opener and sealable liner
  • regular waste bin with a large opening and heavy duty liner
  • deep stainless steel sink with electronic foot controls for washing up to elbows
  • client chair with foot controls, easy-to-clean surface, and no seams
  • barriers covers
  • light with an autoclavable handle or barrier cover
  • unit with easy-to-clean surfaces, removable hoses that are straight and not coiled, with autoclavable handpieces
  • floor should be smooth, easy to clean, nonabsorbent, no carpet
48
Q

describe instrument processing

A

effective/safe system W/ specific routine that must be followed without exception to prevent cross contamination

49
Q

what is the recirculation process of instruments

A
  1. clinical use
  2. instrument cleaning and decontamination using a thermal disinfector or ultrasonic
  3. rinse and dry
  4. instrument packaging and management
  5. seal
  6. sterilize
  7. store packages
50
Q

what are the 3 types of precleaning methods used before sterilization of instruments

A
  1. Manual scrubbing, is not recommended
  2. instrument washer/thermal disinfector
    - used at ODU
    - uses hot water and detergent
    - different from household dishwasher
    - NOT CONSIDERED STERILE AFTER USE > unload w heavy duty gloves
  3. Ultrasonic processor
    - uses energy waves in water to disrupt debris attachment (biofilm)
51
Q

describe the process of the instrument packaging and management system 4

A
  1. after cassettes are removed from the washer-disinfector open and inspect instruments to ensure removal of debris (reclean if necessary)
  2. PLACE CHEMICAL INDICATOR STRIP INSIDE EACH CASSETTE
  3. wrap each cassette and label with students name, box#, and date
  4. load autoclave - approx. 12 cassettes per tray
52
Q

list 5 sterilization methods

A
  1. steam under pressure (used at ODU)
  2. Dry heat
  3. chemical vapor
  4. immediate use steam sterilizer (flash)
  5. chemical (cold) sterilizer > not recommended
53
Q

incomplete sterilization frequently occurs due to:
3

A
  1. inadequate preparation (cleaning of debris/packaging)
  2. misuse of equipment (overloading, timing, temperature selection)
  3. inadequate maintenance
54
Q

what 3 tests are used to check if a sterilizer is working properly

A

internal chemical indicator
external chemical indicator
biological monitor

55
Q

what is a chemical indicator 4

A
  • changes color to indicate that the sterilizer reached the required temperature
  • does not indicate that items are sterile
  • placed inside cassette PRIOR to wrapping
  • when processed, color changes from white to black
56
Q

what is a biological monitor 4

A
  • weekly spore test done in EACH sterilizer
  • negative test > purple, sterilization occurred, all forms of life are destroyed
  • positive test > yellow, sterilizer is not working properly
  • record results 1 day after test is run
57
Q

when do we use a biological monitor other than once per week (6)

A
  • when a new type of packaging material/tray is used
  • after training new sterilization worker
  • demonstrate for someone who is new to sterilizing
  • after machine repair
  • with every implantable device/handheld devices
  • after changes in the sterilizing procedure
58
Q

how do we care for sterile instruments 5

A
  • stored with sealed wrappers
  • stored in clean, dry, cabinets/drawers
  • doesn’t need to be re-sterilized for 7-12 months; UNLESS BEING USED; HENCE WHY WE STERILIZE AFTER EVERY USE/ONCE A WEEK
  • plastic/nylon wrap keeps it sterile longer
  • expected shelf life depends on the area surrounding stored packages
59
Q

describe barriers 3

A
  • protect a surface from contaminations
  • moisture resistant, easily removable, disposable
  • changed after every patient
60
Q

barriers placed at ODU: 8

A
  • keyboard, mouse, computer monitoring arm
  • patient chair and bracket table
  • chair control panel
  • assisting arm buttons
  • saliva ejector, air/water syringes, HVE
  • light handles
  • radiology: tube head, control panel, on/off switch
  • additional barriers for specific procedures
61
Q

3 types of waste

A

REGULAR
- most abundant

SHARPS
- ex; needles
- do NOT put w/ regular trash
- red sharps container in cubicle cabinet

BIOHAZARD
- disposable items contaminated with blood; EX blood soaked gauze
- do NOT put w/ regular trash
- separate biohazard waste container near trash cans

62
Q

what are the 4 principles of infection control

A
  1. take action to stay healthy
  2. avoid contact with blood and other infectious body substances
  3. make patient care items safe for use
  4. limit the spread of blood and other infectious body substances
63
Q

how do dental workers “take action to stay healthy” 2

A
  • immunizations for vaccine-preventable diseases
  • work restrictions if DH has an infection or is exposed to disease > consult with CDC guidelines about restrictions
64
Q

how do dental workers “avoid contact with blood and other infectious body substances?” 6

A
  • standard precautions
  • transmission based precautions when standards aren’t enough; may need to postpone treatment for nonemergency procedures until patient is noninfectious
  • thorough patient helth history
  • engineering controls > EQUIPMENT to reduce hazards; EX sharps containers, retractable needles, blade guards, disposable items
  • work practice controls > the WAY a task is performed; EX proper patient positioning, using loupes to maintain good distance, using a high-speed evac. rather than a low speed
  • wearing correct PPE
65
Q

what are the additional “transmission based precautions” 4

A

patient isolation
adequate room ventilation
N95 masks
postponing nonemergency procedures

66
Q

how are patient care items safe for use 4

A
  • instrument classification
  • the sterilization process
  • dental water quality
  • general steps for safe dental unit waterlines
67
Q

describe instrument classification

A
  1. critical instruments: penetrate soft tissue/bone, heat sterilized between each use, EX periodontal probes, explorers, scaling and root planing, ultrasonic scaling
  2. semi-critical instruments/items: do NOT penetrate soft tissue or bone, contact oral fluids, heat sterilized between each use, EX mouth mirrors, impression trays, photo retractor, handpiece
  3. non-critical instruments/items: come in contact with skin, not necessarily bodily fluids, use disinfectant, EX chair, countertops, lead apron
67
Q

describe dental water quality and how it’s safe for patient use

A
  • we use water that meets the Environmental Protection Agency’s regulatory standards for drinking water > must contain less than 500 colony forming units per milliliter (CFU)
  • waterlines get flushed for at least 2 minutues at the beginning of the day, 30s in between each patient, and 30s at the end of the day to reduce contamination
68
Q

what do you do with semi-critical items that cant be sterilized?

A

use disinfectant
EX: x-ray sensor

69
Q

what does flushing the waterlines do

A

clears planktonic microorganisms; however the effects are transient

70
Q

what are the general steps for safe dental unit waterlines (DUWLs) 3

A
  • SHOCK > strong disinfection to kill existing contaminants within DUWLs; EX bleach
  • TREAT > ongoing purification of all water entering the DUWLs; filter/trap
  • TEST > measuring bacteria levels of water samples obtained from DUWLs; making sure it’s under 500 CFU
71
Q

describe the “shock” step 3

what do we use at ODU

what is commonly used?

A
  • strong disinfectant designed to kill existing contamination
  • must be done if water content is >500 CFU
  • product is put in water bottle and run through the lines, left to sit, then flushed with plenty of fresh water
  • In ODUs clinic we use Dolfin Pods, 1 tablet in 750 ml of water, flush through the lines, set for 30 min, flush with full bottle of fresh water
  • commonly used is Diluted Bleach, 10 parts water to 1 part bleach, set for 10 min, flush with full bottle of fresh water
72
Q

describe the “treat” step 4

A
  • treated continuously
  • purification of water
  • typically tablets that are added to water or cartridges that draw the water through them to purify
  • ODUs clinic uses BluTube (purification cartridge that attaches directly to the unit > replaced every 6 months)
73
Q

describe the “test” step (6)

A
  • test quarterly
  • organization for safety, asepsis, and prevention (OSAP)
  • if passes (<500 CFU), test again in 3 months
  • if fails (>500 CFU) DUWLs must be shocked and tested again
  • tests can be in office or mailed in for testing
  • ODUs clinic uses Quick-Pass in office testing
74
Q

what is Quick Pass testing 3

A
  • SAMPLE: add equal amounts of water from all lines that dispel water on the unit into clear vial
  • SOAK: insert paddle into vial, let sit white side down for exactly one minute, pour water out and reinsert paddle into vial
  • INCUBATE: white side down for 48-72 hours, compare to the chart to determine safety (<500)
75
Q

how do DHCP limit the spread of blood and other infectious body substances 4

A
  • environmental surface disinfection
  • housekeeping surfaces: walls, floors, sinks cleaned with soap and water unless visibly contaminated then clean and disinfect
  • clinical contact surfaces: clean and disinfect to prevent cross-contamination; EX dental chair, unit, pens, keyboard, monitor, portable equipment
  • use of barriers

DH Theory 1 (9 decks)

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