Unit 303 Flashcards
What does cross - infection mean?
a patient being contaminated by another patient/member of staff (infection), or from a dirty instrument.
The guidelines in regards to decontamination in general dental practice are covered by what regulations?
Department of health publication
Health technical memorandum
HTM 01-05
HTM01-05 is a working document, what does a working document mean?
it will be updated as evidence of better techniques and systems when they become available.
Essential quality requirements are:
the basic level of decontamination standards that all workplaces should have implemented within the first year of the publication of the document.
Best practice is:
gold standard to be aimed for in the future
-use of a washer disinfector
-separate facility for decontamination tasks- away from clinical area
-separate storage area for sterilised instruments - away from clinical area
Who oversees dental practice in regards to patient safety and decontamination?
CQC
The code of practice on the prevention and control of infections was introduced under what regulation?
health and social care act 2008
-CQC use this criteria to decide if a dental workplace is compliant with all infection control requirements.
What is direct cross infection?
the transfer of infection from person to person
What is indirect cross infection?
from person to equipment and onto a second person
What is the system of standard precautions designed to do?
protect staff from inoculation and contamination risks and also to protect patients from being exposed to the risk of cross infection.
Routine procedure for all patients
The basic principle of cross infection is to?
assume that any patient may be infected with any micro-organism and could pose a risk to patients and staff.
What type of people are called carriers?
patient who is infected with a micro-organism but not showing any signs of disease - unaware of the risk they pose to others.
Best practice dictates that good general infection control is achieved by what, list examples:
- up to date written infection control policy in place
- standard precautions are used for all patients
- correct cleaning and disposal
-validation, maintenance and testing of all decontamination equipment in accordance with the manufacturers instructions.
What are the current personal infection control protocol procedures to be followed by staff?
- Hepatitis B vaccination
- Immunised against current common illnesses
- correct hand cleaning procedure`s
- PPE
HTM 01-05 infection control policy update, what does the clinical governance require use to do?
written infection control policy
Examples of how we can minimise blood borne virus transmission to ourselves as nurses:
-Hepatitis B vaccination
-Safer sharps are used where reasonably practicable
-sharps injury policy
Examples of cleaning machines:
washer disinfector
ultrasonic bath
rinsing
manual cleaning
How are instruments inspected after cleaning?
illuminated magnifier
Examples of sterilisation machines:
- vacuum autoclave B or S type
- non vacuum autoclave n type
unwrapped instruments can be stored in a non clinical area for how long?
1 week
What does social cleanliness mean?
clean to a socially acceptable standard for personal hygiene purposes.
NOT disinfected or sterilised
What does disinfection mean?
process used to kill or inactive bacteria and fungi but not spores
What does sterilisation mean?
process of killing all micro-organisms and spores to produce asepsis
What does Asepsis mean?
The absence of all living pathogenic micro-organisms
What does decontamination mean?
the combination of processes used to remove contamination from reusable items
Also referred to as “reprocessing”
Dedicated hand washing sinks must be available in practice and have taps that are operated by either.. and why?
elbow or foot to avoid contamination from dirty hands.
What does “WHO`S” mean?
five moments of hand hygiene
What are the 5 moments of hand hygiene (whos)?
- before touching a patient
-before undertaking a clinical procedure
-after exposure to a bodily fluid
-after touching a patient
-after touching a patients surroundings
Hand wash with soap and water (clinical) should take how long to complete?
40-60 seconds
How should hands be dried after washing with hand wash and soap?
disposable paper towels
Hand rub with gel (social) should take how long to complete?
20-30 seconds
Should hands be dried after using hand rub with gel?
No - dry naturally
When should hand gels be used?
visibly clean hands between patients during surgery sessions
Can hand cream be used before putting on gloves and why?
No
encourage the growth of any micro-organisms present on the skin
Why is PPE worn?
to prevent staff from coming into contact with blood and other bodily fluids.
Examples of PPE:
gloves, uniform, plastic apron, safety glasses and facemasks
Why should alcohol gel not be used with clinical gloves?
damage the nitrile or vinyl material allowing leakage to occur.
What is the guidance that insists cleaning equipment should be colour coded?
NPSA
National patient safety agency
Red coloured cleaning items are used where in the dental practice?
toilet and washrooms
Yellow coloured cleaning items are used where in the dental practice?
clinical and decontamination areas
Green coloured cleaning items are used where in the dental practice?
Kitchen
Blue coloured cleaning items are used where in the dental practice?
office and reception
What standard should be achieved in the clinical dental environment?
disinfection
Bleach based cleaners:
contain sodium hypochlorite
used to disinfect all NON-METALLIC and NON-TEXTILE surfaces + labwork
Aldehyde based cleaners:
used on metallic surfaces and soak lab items
Isopropyl alcohol wipes:
disinfect items
such as exposed x-ray film packets
for safe handling during processing
Chlorhexidine gluconate:
irrigating disinfectant during rct treatment + skin cleanser
Alcohol/detergent combinations:
as wipes for use on HARD surfaces
Hypochlorous acid products:
surface sprays and for use in DUWLs
Other than surface sprays and DUWLS what can hypochlorus acid products be used for?
Impression disinfectant, instrument holding solution, ultrasonic bath, mouth rinse, root canal irrigant
Special precautions are required to ensure that the air conditioning unit does not become contaminated with the waterborne micro-organism - legionella
What is zoning?
areas should be designated as clean and dirty
What are protective barriers?
equipment’s likely to be contaminated should be covered with impervious plastic sheets and changed between patients.
What should aspirators be flushed daily with?
non-foaming disinfectant
Bleach has to be made up on a daily basis as a fresh solution
Bleach solution: 1% fresh solution should be made for?
disinfecting all non-metallic, non-fabric surfaces and for disinfecting lab impressions and removable prosthesis
Bleach solution: 10% fresh solution should be made for?
blood spillages
If disinfectants are ingested, what are their manufacture and usage strictly controlled by which legislation?
COSHH
What hand soap should be used for clinical hand washing?
antibacterial or antimicrobial hand wash
What hand soap should be used for surgical/aseptic hand washing?
chlorhexidine
How long should we wash our hands with chlorhexidine during a surgical/aseptic hand wash?
2 minutes
120 seconds
When cleaning the clinical area after use what should be used to do this?
Disposable cloths
water to wet the cloths
detergent
Spray bottles should be considered as…
single use items
Where should items be stored if they are not in use?
cupboards and drawers
When decontaminating a surgery after use, what should be done first?
the most contaminated items removed first
What should be available to work of when decontaminating a surgery after use?
written cleaning schedule
DUWL`S can become contaminated with micro-organisms such as what bacteria?
Legionella
Micro-organism contamination of micro-organism can come from what sources?
Water supply - main system
proliferation within the water system if temp is not maintained
bacteria from the mouth of a patient “suck back”
Biofilm contamination of the bottle or water line
The risk assessment and written scheme for legionella risk assessment must be undertaken by whom in the practice?
competent person
a water engineering specialist e.g. legionella control association
Reservoir bottles should contain what type of water?
freshly distilled
reverse osmosis generated water
Specialist biocide chemicals (disinfectants) are available for use within the reservoir bottles while carrying out dental treatment. What do they help to reduce?
The build up of biofilm within the system
In regards to reservoir bottles what other solution can be used in the water bottles?
hypochlorous acid solution
At the start of a session DUWL`S should be flushed for how long?
2 minutes
Between patients DUWL`s should be flushed for how long?
20-30 seconds
During surgical procedures what source should be used (DUWLS)?
Single use sterile water or saline
Micro-organims in water will grow at what temperature?
20-40`C
How is water temperature checked (what do we use?) and how often?
Thermometer
stop watch system
- Recorded on a MONTHLY basis
Infection with legionella in any person due to the workplace water supply system should be reported under?
RIDDOR
What are the 3 main techniques available for cleaning reusable dental equipment, hand pieces, instruments:
Manual cleaning
Manual cleaning with ultrasonic decontamination
Decontamination and cleaning with washer disinfector
What is the correct way to clean a curing light?
Wiped down with a suitable cleaning agent
Fibre optic tip - single use barrier cover
What is the correct way to clean a aspirator tubing?
wiped down externally with a suitable cleaning agent
single use barrier cover
What is the correct way to clean a x-ray unit tube?
wiped down with suitable cleaning agent after use
With sterilising hand pieces what is the main aim?
reduce the risk of cross infection rather than completely eliminating it.
What is the correct name for inner hallow surfaces of instruments?
Lumens
How are the hallow surfaces of instruments correctly sterilised?
Vaccum autoclaves Type B and S
NOT N TYPE
When should soft bristled brushes be replaced?
Follow manufacturers instructions
Before if bristles become splayed
The procedure within the dental practice for cleaning instruments should be written down and included in what policy?
Infection control policy document
In regards to best practice guidance manual cleaning should only be done when…
the manufacturer has instructed automatic cleaning is unsuitable
What temperature should the water be during manual cleaning?
cold
Why are wire bristle brushes not allowed during manual cleaning?
scratch the metal surfaces and allow corrosion and rustling to occur
What should be used to check that all contamination has been removed during manual cleaning?
illuminated magnifier
What do ultrasonic baths remove?
debris from items
How do ultrasonic baths remove debris?
vibrating at an ultrasonic frequency and transmitting that vibration onto the instruments
If an ultrasonic bath is overloaded with instruments what will not be effective?
Debridement
Who is the ultra-sonic bath maintained by?
service engineer
delegated person competent in decontamination
What are the 3 Daily duties of ultrasonic baths?
Strainer/filter cleaning
Tank draining
cleaning check
What are the 2 weekly duties of ultrasonic baths?
Safety checks
Protein residue test
What is the test called that should be done every 3 months with ultrasonic baths?
activity test - aluminium foil
What is a washer disinfector similar too?
traditional dishwasher machine
What are the 5 cycles called in a washer disinfector?
Flush, wash, rinse, thermal disinfection, drying
What 3 in house tests should be carried out every 6 months for washer disinfectors?
Automatic control test
chemical dosing
thermometric disinfection test
N-type autoclave:
134`C 3 minutes 2.25 bar
cycle is 15-20 mins
Unwrapped items
B-Type/S Type autoclave:
BEST PRACTICE
134`C 3 minutes 2.25 bar
Cycle can last 45 mins
Wrapped items and instruments with hollow lumen e.g surgical items
Date logging device
What are N-type autoclave instruments dried with after sterilisation?
single use cloth or towel
N-type autoclave post sterilisation: when they are stored unwrapped in a clinical area when should they be used?
Within the day
N-type autoclave post sterilisation: when they are stored unwrapped in a lidded box in a non-clinical area when should they be used?
1 week
N-type autoclave post sterilisation: when they are placed in a sealed window pouch how long do you have to reuse?
1 year
Autoclaves are..
pressure vessels
N -type autoclave test
Non-vacuum
TST strip
B-type autoclave test
Vacuum
Helix test
bowie dick test
How often should an authorised engineer carry out an inspection on autoclaves?
yearly/annually
What instruments are industrially sterilised by exposure to gamma rays?
single use items
The correct order of cleaning B-TYPE instruments:
clean
inspect
seal
autoclave
The correct order of cleaning N-TYPE instruments:
clean
inspect
autoclave
why is zoning done within a decontamination area?
to avoid cross contamination
Airflow system (extractor fan) within the decontamination room to comply with dirty/clean zoning - best practice guidelines.
What is the best method of avoiding indirect cross infection?
Single use items
What instrument has changed on the HTM 01-05 guide that can now be reused ONLY on the same patient?
endodontic files and reamers
What are the 3 categories of hazardous waste?
- non-hazardous
-hazardous infectious
-hazardous chemical
What colour is the container that non-cytotoxic medicines are put in?
blue-lidded yellow containers
What colour is the bin that soft infectious waste is put in?
orange sacks
Offensive waste is
non infectious but may cause offence to those who come in contact with it.
e.g. PPE, cleaning towels, x-ray films
Not been contaminated with bodily fluids etc
Trade waste is
dental equipment e.g. chairs, curing lights
Commercial electronic waste e.g. computer screens, TV
What are the 3 main occupational hazards in dentistry?
mercury poisoning
radiation
cross infection
Pathogenic micro-organisms that are transmitted by contact (indirect/direct) with bodily fluids and secretions raise concern to the dental team.
Pathogenic micro-organisms: HIV
Viral
destroys the bodies leucocytes, weakening immune system
Eventually develop AIDS
No current vaccination
Pathogenic micro-organisms: Hepatitis B
Viral
liver inflammation - fatal
vaccination needed in dentistry
Pathogenic micro-organisms: Hepatitis C
Viral/virus
Highly likely to prove fatal
No current vaccination
Pathogenic micro-organisms: Herpes simplex type 1
Viral
lips and oral cavity
“cold sores”
Pathogenic micro-organisms: CJD
Rare but fatal
affects the brain and nerve tissues
caused by Prions
Pathogenic micro-organisms: Influenza
Viral
respiratory
similar to a cold but worse
can be fatal with patients who have a low immune system and elderly
Pathogenic micro-organisms: Tuberculosis
Bacterial infection
respiratory and organ damage
spread by droplet contamination and direct contact
vaccination is a must in dentistry
Pathogenic micro-organisms: Ebola virus
Viral haemorrhagic fever
spread direct contact with bodily fluids and secretions
Pathogenic micro-organisms: MRSA
“superbugs”, affect hospitalised patients
MRSA bacteria - spread due to poor infection control procedures
What vaccinations are we given as an infant?
- Pertussis- whooping cough
-MMR - measles, mumps, rubella
What vaccinations are we given in childhood?
-diphtheria
-Poliomyelitis
-tetanus
-chicken pox - if not naturally immune
What vaccinations are we given as a teenager?
- meningitis
–tuberculosis
What vaccination are we given as an adult?
- influenza and swine influenza
What virus is present in saliva before any signs of illness?
MMR
measles, mumps, rubella
If rubella occurs in the first 3 months of pregnancy the unborn child could be affected causing serious physical defects.
Is there a cure for AIDS?
NO
What drugs can be used to pro-long life for a patient who has aids?
antiviral and other drugs that boost the immune system
what is aids caused by?
infection with HIV virus
How is aids transmitted?
contact with blood containing the virus
What are the usual modes of transmission in regards to HIV?
sex, sharing of needles by drug addicts, childbirth, repeated transfusions with contaminated blood
Prevention of AIDS in a dental practice:
same as HEP B
correct sterilisation and surgery hygiene
In regards to washing uniform after being in contact with a known carrier how long and what temp should the wash be?
10 mins
90`C
What can occur as a result of Hepatitis B?
Liver cancer 80%
What disinfectants are used when killing the virus HBV?
hypochlorite
What is the main source of infection in regards to hepatitis B in a dental setting?
direct contact with blood containing HBV
sharps injury, nose, eyes, skin abrasions
What is always present in the blood of patients carrying the virus HEP B?
HBV
All dental nurses should be vaccinated against HBV (hep b virus)
IS hepatitis C more dangerous than hepatitis B?
yes
What is the reason behind hep c being more dangerous than hep B?
no vaccination
What is the main source of transmission for hepatitis C?
Blood to blood contact
sexual transmission is uncommon
What is the pathogenic micro-organism called that is involved with Hepatitis C?
Hepatitis C virus
HCV
How can the virus when dormant be reactivated? (herpes simplex type 1)
general illness, stress, hormonal changes, exposure to sunlight
What is herpes simplex type 1?
virus - cold sores
children - lips, mouth, face
adults - lips
How is herpes simplex type 1 transmitted?
contact with the lesion and infected saliva
What areas during transmission can herpes simplex type 1 virus spread to, that will affect the dental team?
areas of the skin or eyes
What is CJD and new variant CJD similar to…
mad cow disease
What is CJD caused by?
unique non-microbial source of disease
PRION PROTEIN
Where does the CJD infection occur and what does it affect?
nerve tissue, affects both the brain and the nerve tissues
tooth pulp
Prions CANNOT be destroyed by normal sterilisation methods.
How is influenza transmitted?
close contact with an infected person, environmental contamination (sneezing, coughing)
What micro-organism is influenza?
RNA virus
What is an inoculation injury?
SHARPS
contaminated object or substance breaks the skin or mucous membrane or comes into contact with the eyes.
What is the regulation in regards to sharps injuries?
Health and safety (sharps instruments in healthcare regulations) 2013
What is the inoculation injury policy?
Bleed it
Wash it
Cover it
Report it
Within 1 hour of inoculation injury what treatment should the member of staff be given (A&E occupational health)?
prophylaxis treatment
antiretroviral drugs
Where should a sharps injury be reported?
accident book
What regulatory body determines whether each workplace complies with cleanliness and infection control requirements of the health and social care regulations?
CQC
