test 3 & 4 Flashcards
Surfaces that are touched frequently
can act as __________ for microorganisms.
Reservoirs
What is the primary source of contamination?
When a member of the dental team
touches surfaces with contaminated
gloves
What is the definition of
environmental surfaces?
surface within a healthcare facility that is not directly
involved in patient care, but that may become
contaminated during the course of treatment
What are some examples of
an environmental surface?
Countertops, floors, instrument
control panels, walls
Is it possible to predict accurately the
life span of microorganisms on the
surface of dental equipment?
No
What is the safest approach
for avoiding contamination?
Assuming the surface has
potentially infectious material on it
According to the CDC Guidelines for infection
control in dental healthcare settings, what are
the two categories of environmental surfaces?
clinical contact surfaces and
housekeeping surfaces
What does housekeeping
surfaces include?
Floors, walls, and sinks
Which category of environmental
surfaces has the lower risk of disease
transmission?
Housekeeping
What are the three categories
of clinical contact surfaces?
touch, transfer, and
splash/spatter/and droplet
What are touch surfaces?
Surfaces that are directly touched and
contaminated during procedures
What are some examples of
touch surfaces?
Light handles, dental unit controls, chair
switches, chaired computers, pens, telephones,
containers for dental material, and draw handles
What are transfer surfaces?
Surface not directly touched and
contaminated during procedures
What is an example of transfer
surfaces?
Instrument trays, hand piece
holders
What are splash, splatter, and
droplet surfaces?
Surface that does not contact members
of the dental team or contaminated
instruments or supplies
What is an example of splash,
splatter and droplet surfaces?
Countertops
Which of the three types of clinical
contact surfaces should be barrier
protected?
Touch and Transfer surfaces
At least how many times should splash,
splatter, droplet surfaces be cleaned?
At least once a day
What are the two methods to
dealing with contamination?
Surface barriers or preclean
and disinfect between patients
What type of surfaces should be
cleaned and not barrier protected?
Smooth, hard surfaces such as
countertops, trays, and supply
containers
If a surface has crevices or knobs, how
should it be protected from
contamination?
Barriers
Whose responsibility is it to make sure
the equipment and treatment room
surfaces are properly managed?
Dental Assistant
What is an important
characteristic in surface barriers?
Fluid resistant
When and how should you
remove barriers?
In-between patients and while
you are still gloved
Do surfaces with barriers ever need to
be disinfected, or are the barriers
enough?
Surfaces that are barriered still need to
be disinfected/ cleaned at the
beginning and end of each day
What are single use items?
aka disposable items, used only once
and then discarded (not intended to be
sterilized)
Why are single use items
recommended?
They reduce the chance of
patient to patient contamination
What should you do if a
surface barrier tears?
Take it off and prequel and
disinfect replace barrier
What regulation requires the
use of a surface disinfectant?
OSHA Blood Borne Pathogens
Why must surfaces be
precleaned?
Remove Bioburden, disinfectant’s
effectiveness can be decreased if even the
smallest amount of saliva is still present
What is disinfection intended
to do
Kill disease-causing microorganisms that
remain on the surface after precleaning
What is the term disinfectant
used for?
chemicals that are applied to inanimate
surfaces such as countertops and dental
equipment.
What are antiseptics used for?
antimicrobial agents applied
to living tissue
Why should disinfectants and antiseptics
never be used interchangeably?
Tissue toxicity and damage to
equipment
What kills all microorganisms?
sterilant
Who regulates disinfectants and
chemical sterilants according to
chemical classification?
Environmental Protection
Agency EPA
What does the word
pathogenic mean?
Disease causing
What are the only types of products that
should be used to disinfect treatment
rooms in dental offices ?
products registered by the EPA such as
hospital disinfectants and tuberculocidal
What type of bacteria is highly
resistant to disinfectants?
Mycobacterium Tuberculosis
What label would be given to
a product that can kill spores?
Sporicidal
What label would be given to a
product that can kill some viruses?
Virucidal
What label would be given to
a product that can kill fungi?
Fungicidal
What is the ideal surface disinfectant?
And is there any product on the market
that meets all of these expectations?
Rapidly kills broad spectrum of bacteria, minimal
toxicity, exhibit residual activity, not damage surface
being treated. No there is not one product that meets
all of these expectations
What are iodophors?
EPA registered intermediate level
hospital disinfectants with tuberculocidal
action
During patient treatment, surfaces in
equipment and treatment rooms are likely to
become what with blood and saliva?
Contaminated
What have laboratory studies shown
about the time microorganisms may
survive on environmental surfaces?
Period of time varies
What 4 things do we consider when
cleaning and disinfecting patient
treatment areas?
- )Amount of direct patient contact
- ) Type and frequency of hand contact
- ) Potential amount of contamination by aerosol and or spray
- ) Other sources of microorganisms (dust, water, soil etc.)
What can be directly contaminated either by spray or spatter generated during dental procedures or by contact with the dental professional’s gloved hands?
Contact Surfaces
Which organization recommended that
clinical surfaces be classified and
maintained under three categories?
OSAP
What are some common uses
for plastic barrier tape?
touch pads on equipment, electrical
switches on chairs, and X-ray equipment
What can be used instead of
barriers? Why?
Aluminum foil because it is formed easily around any shape
According to CDC guidelines, what
should be done if barriers can not be
used?
Pre-cleaning and disinfecting
What PPE should be worn when cleaning
and and disinfecting environmental
surfaces?
puncture resistant gloves, protective
eyewear, face shield, masks
why should you always wear PPE whiny are exposed to chemical disinfectants
Because of the risks associated with exposure to
chemicals and to prevent occupational exposure
to infectious materials.
What is bioburden?
Blood, saliva, and other body
fluids
Can regular soap and water
be used for precleaning?
yes
Can regular soap and water
be used for disinfecting?
no
What is not killed during
disinfection procedures?
Spores
What is the term disinfectant
used for?
inanimate surfaces
What is the term antiseptic
used for?
antimicrobial agents used on
living tissue
What is the process in which
all life forms are destroyed?
Sterliization
What are disinfectants?
chemicals that destroy or inactivate
most species of pathogenic
microorganisms
What are the only types of
disinfectants used in dentistry?
Ones that are registered with the EPA as
hospital disinfectants with tuberculocidal
claims
What kills all microorganisms?
sterilants
What is residual activity?
Action that continues long after initial
application, as with disinfectant
What recommendations from a
manufacturer should you follow?
Mixing and diluting, application
technique, shelf life, activated use life,
and all safety warnings
What is the difference between
disinfection and sterilization?
Disinfection only kills most
microorganisms while sterilization kills all
forms of life
How resistant is
mycrobacterium tuberculosis?
Very resistant (that is why it is the benchmark
for disinfectants: if the disinfectant can kill it,
it can kill ALMOST everything else)
What does iodophors contain that
causes them to discolor certain metals,
clothing, and other surfaces?
Iodine
What are synthetic phenol
compounds?
EPA - registered intermediate level
hospital disinfectant with broad-spectrum
disinfecting action
What can we use Phenols on?
metal, glass, rubber, or plastic
Can Phenols be used as a
holding solution for instruments?
yes
What is a disadvantage of
phenols?
They leave a residue film on treated
surfaces and they have to be prepared
daily to reduce battery growth
What is another name for
Sodium Hypochlorite?
Household bleach
What is sodium hypochlorite
classified as?
intermediate level disinfectant
What are some advantages of
sodium hypochlorite?
fast acting, economical, and
broad spectrum
What are some disadvantages
to sodium hypochlorite?
unstable, must be prepared daily, has a strong odor, and is
corrosive to metals, destructive to fabrics, irritating to eyes and
skin, may eventually cause plastic chairs to crack, NO LONGER
RECOMMENDED BY THE CDC AND IS NOT EPA REGISTERED
Why is alcohol not effective as
disinfectant?
Its rapid rate of evaporation limits
antimicrobial activity, can be damaging to
certain surfaces
Although alcohol is not a
disinfectant? What is it used as?
An antiseptic
Who does not recommend
alcohol as disinfectant?
ADA, CDC, OSAP
What is an immersion
disinfectant?
can be used for high level
disinfection or for sterilization
What is an advantage of immersion
disinfectants when it is used as a
sterilant?
It kills all microbial life including
bacterial endospores
What is an advantage of immersion
disinfectants when it is used as a high
level disinfectant?
It inactivates all microorganisms
except bacterial endospores
What is a disadvantage of
immersion disinfectant?
toxic chemicals and can
irritate eyes, skin and lungs.
What are immersion
disinfectants used for?
Heat sensitive items
Can immersion disinfectants be
used as a surface disinfectant?
no
How do you minimize the fumes
of immersion disinfectants?
Close the lid on the container in
which the materials are soaking in
Depending on the type, what is the time
for sterilization of immersion
disinfectants?
6 hours to 30 hours
How can you make immersion
disinfectants into high level
disinfectants?
Weaker concentration and
increased contact time
What always must be worn while
handling immersion disinfectants?
PPE
What is chlorine dioxide
Effective, rapid-acting environmental
surface disinfectant or chemical sterilant
What is the time for sterilization when
using chlorine dioxide as a chemical
sterilant?
6 hours
What is the time for disinfection when
using chlorine dioxide as a surface
disinfectant?
3 minutes
What is Glutaraldehyde?
high level disinfectant sterilant that can
also be used as a liquid sterilant
registered by the EPA
How can you make
glutaraldehyde a liquid sterilant?
Greatly increasing immersion
time
What is the time for disinfection
using glutaraldehyde?
10-90 minutes
What happens if contact of certain types
of instruments and glutaraldehyde are
prolonged?
Discoloration or corrosion of
instrument’s surfaces and cutting edges
What is Orthojphthala Dehyde
or OPA?
chemical used as a high level
disinfectant (immersion disinfectant)
At room temperature, how long does it
take for high level disinfection to occur
using OPA?
12 minutes
What are some advantages of
Ortho Phthala Dehyde?
good alternative for individuals with a
sensitivity to glutaraldehydes, very little
odor, does not require mixing or activation
What are some disadvantages
of Ortho Phthala Dehyde?
More expensive, can only be used half as long as most
glutaraldehydes, it may stain fabrics, plastics turn bluegreen color when proteins have been removed, and it
would require more than 30 hours to secure sterilization
There is no scientific evidence showing
that housekeeping surfaces (e.g. floors,
walls, and sinks) pose a risk for what?
Disease transmission in dental
healthcare settings
What are the majority of housekeeping
surfaces cleaned with?
Only a detergent and water or EPA
registered hospital
disinfectant/detergent
Do you need to make fresh cleaning
solution each day or can you keep
leftovers for the next day?
You should discard of any remaining disinfectant
and allow the container to dry until the next day
when you make a fresh cleaning solution
What should you try to avoid doing
while cleaning patient care areas?
Try to to produce mists, aerosols, or
disperse dust in patient care areas
Can carpet be reliably
disinfected?
no
What have studies found in
carpeting
Fungi and bacteria
What does the CDC
recommend on carpeting?
Avoid using carpeting and cloth upholstered
furniture in dental operators, laboratories, and
instrument processing areas
What causes the majority of
blood contamination in dentistry?
Spatter from procedures using
ultrasonic instruments
Has it been proved that housekeeping
surfaces can lead to HIV, HBV, and
HCV?
No, but it is still important to use
good infection control practices
What does OSHA require when it
comes to blood spills and other bodily
fluids?
It needs to be removed from the surface
and the surface should be properly
disinfected
What should you aways wear when
cleaning up spills of blood or other
body fluid?
Gloves and other PPE
What is greener infection
control?
Minimizing the environmental impact of
infection control products and
procedures
What does going greener
require?
thoughtful planning, research,
and experimentation
Are infection control procedures
usually environmentally friendly?
no
How can we reduce paper use
in the office?
Using electronic records instead of
paper records that require 12.8 pages per
person
How can we reduce radiology
in the office?
Using digital radiology instead of film
based radiology that requires the use of
chemicals and lead foil
Which regulation requires the use
of surface disinfectant?
OSHA Blood borne pathogens
standard
Why do you need to read all
labels carefully?
Statements may contradict each other,
you do not want to misuse product
Autoclave
Instrument to sterilize by moist heat
under pressure.
Biologic indicator
Vials or strips (spore test) that contains
harmless bacteria used to determine
whether sterilization has occured.
Biologic monitoring
Verifies sterilization
All spore-forming microorganisms have
been destroyed.
Chemical vapor sterilization
Hot formaldehyde vapors under
pressure.
Clean area
Place where sterilized instruments, fresh
disposable supplies, & prepared trays are
stored.
Contaminated area
Place where items are brought for
precleaning.
Critical instrument
Sterilization
Instruments used to penetrate soft tissue
& bone.
Dry heat sterilizer
heated air
Noncritical instrument
Intermediate to low-level disinfection.
Contacts only intact skin.
Semicritical instrument
Sterilization or high-level disinfection.
Come in contact with the oral tissues but
do not penetrate soft tissue or bone
Ultrasonic cleaner
Instrument that loosens & removes
debris by sound waves traveling through
a liquid.
CDC
Centers for Disease Control &
Prevention
Seven steps for Instrument Processing
Transport Cleaning Packaging Sterilization Storage Delivery Quality assurance program
What are the three basics ways to
reduce transfer of organisms between
patients???
Sterilization
Disinfecting
Cleaning/sanitizing
Transport
Transport contaminated instruments to the
processing area in a manner that minimizes the risk of
exposure to persons & the environment.
Use appropriate PPE & a rigid, leak proof container.
cleaning
Clean instruments with a hands-free, mechanical process such an
ultrasonic clean or instrument washer.
If instruments cannot be cleaned immediately, use a holding
solution.
All debris must be removed before disinfecting or sterilizing.
packaging
Packaging
In the clean area, wrap instruments in appropriate materials.
Place a chemical indicator inside the package next to the
instrument.
If an indicator is not visible on the outside of the package, place
an external process indicator on the package.
Sterilization
Load the sterilize according to the manufacturer’s instructions.
Label packages.
Do not overload the sterilizer.
Place packages on their edges insingle layers. or on racks to increase circulation of the
sterilizing agent around the instruments.
Operate the sterilizer according to the manufacturer’s instructions.
Allow packages to cool handling.
storage
Store instruments in a clean, dry environment in a manner that maintains the
integrity of the package.
Rotate packages so that those with the oldest sterilization dates will be used
first.
Do not store sterile instruments on an open tray or in a dental cabinet unless
they are covered.
delivery
Delivery packages to point of use in a manner that
maintains sterility of the instrument until they are used.
Inspect each package for damage.
Open package aseptically.
Quality assurance program
Should incorporate:
Training
Record keeping
Maintenance
Use of biologic indicators
What are the three classification that are
used to determine the method of
sterilization???
Critical Instruments
Semicritical Instruments
Noncritical Instruments
Identify the major sterilization.
Liquid chemical sterilization Glass (hot) bead sterilization Dry heat sterilization Rapid heat sterilization Chemical vapor sterilization Steam under pressure sterilization Steam (flash) autoclave sterilization
Liquid chemical sterilization
Glutaraldehyde
What are the advantages &
disadvantages Glutaraldehyde???
Advantages -Disinfects -Sterilize (6-10) hours -Used for items that cannot endure heat sterilization Disadvantages -Difficult to monitor -Toxic fumes -Stains
Glass (hot) bead sterilization
Small sterilizer-glass beads or salt
Temperature-450 degrees F (234 C
what are the advantages & disadvantages
of Dry heat sterilization???
Advantage -Dried instrumentsndo not corrode or rust. -Easily monitored Disadvantage -20 minutes to preheat -2 hours to sterilize -Solder joints melt -Instruments must be thoroughly dried before placing them in a wrap or bag.
Rapid heat sterilization
Temperature-375 f
What are the advantages &
disadvantages of Rapid heat
sterilization???
Advantages -Sterilizes in 6-12 minutes -No corrosion Disadvantages -Damage to some plastics -Solder joints melt -Pre-dry instruments
Chemical vapor sterilization
Temperature-270 F (132 C)
What are the advantages &
disadvantages of Chemical vapor
sterilization???
Advantages -20 minutes to sterilize -Very reliable & can be easily monitored -No corrosion-carbide & non-stainless steel Disadvantages -Formaldehyde & alcohol -Must be vented -Instruments must be thoroughly dry before placing in this sterilizer
What instruments can go in the Chemical
vapor sterilizer???
Carbon steel/stainless steel
Surgical burs
Surgical instruments
Dental rotary handpieces
Steam under pressure sterilizer
Autoclave
Temperature- 250-273 F (121 C) 15psi
Best method
Sterilize in a short period of time.
What are the advantages & disadvantegs
of Autoclave???
Advantages
-10-30 minutes
-Good penetration of steam
-Easily monitored
Disadvantages
-Distilled water
-Rusts nonstainless (carbibe) steel instruments & burs-main disadvantage.
-15 minute drying cycle door must be cracked open for the drying process to take place at the end of each cycle.
-Has a corrosive effect on anything that is made of carbide steel.
Steam (flash) autoclave sterilization
temperature - 270-273 F (132 C)
What are the advantages &
disadvantages of the Steam (flash)
Autoclave sterilizer???
advantages -Easily monitored -Sterilizes in 3 minutes unwrapped. Disadvantages -Instruments should be used promptly. -Distilled water
