Study GuideInfection Control and Safety

OHR 801 Summer 2016

● Know the definition of infection.○ Growth and survival of a microorganism on or in the body

● Know the definition of infection control.○ Controlling the spread and increase of disease agents by

performing specific procedures (same as infection prevention).

● Understand examples of direct and indirect modes of transmission.

○ Direct:■ through intact or non-intact skin in contact with blood, oral

fluids, or other potentially infectious patient materials (OPIM)

■ inhalation; coughing, spatter, droplets (sneezing, talking) into mucous membranes

○ Indirect:■ through contact with contaminated objects like

instruments, operatory equipment, or environmental surfaces

■ droplets, etc on objects

● Know the elements of the chain of infection.○ Pathogen ○ Source ○ Mode of transmission ○ Portal of entry ○ Susceptible host

● Know the goal of infection control as it relates to (virulence, dose and resistance).

○ Eliminate cross infection and reduce potential exposure○ Health or disease = virulence X dose body resistance...high or

low immune system or high or low pathogens

● Know the definition of antibodies.○ Proteins produced in response to an antigen that are capable of

binding specifically to that antigen

● Know the definition of incubation stage.

○ In a disease, the time between infection and the appearance of signs and symptoms

● Know the definition of standard precautions and be able to differentiate when it is not being practiced.

○ Consideration of blood and all body fluids, including secretions and excretions (except sweat), nonintact skin, and mucous membranes, as potentially infectious in all patients who may not be symptomatic

○ Treating every patient as if they have a potentially infectious disease

● Understand the difference between airborne and droplets and diseases associated with each.

Airborne infections are caused by smaller infectious particlesTB, Flu -- airborne

Droplet infections are caused by larger infectious particlesHep B, Hep C, HIV

● Know the risk of contracting Hepatitis B, if you are not vaccinated, and you have a percutaneous exposure.You are at a high risk for transmission when handling sharps.Only ~⅓ have recognizable symptomsVaccine may also prevent type D (type D requires type B to be virulent)Risk of Transmission after percutaneous exposureHep B: 6% vs. 30% (HBeAG- vs HBeAG+)Hep C:1.8%HIV:0.3%

● How many injections are involved in the Hep B vaccine? When should they be given (healthcare setting)? When should titer be drawn after vaccine? Who pays for all of this?

○ Have to get within ten days of employment ○ 3 injections. ○ Immediately. 1st shot, then wait a month, second shot, then wait

6 months for 3rd shot, then 30 days till titer (the notes say 4-8 weeks after 3rd dose for titer).

○ Employer pays for this

● Hep C – if contracted, what percent become chronic carriers? ○ 75-85%

● What happens to the immune system during the process of HIV→Aids?HIV can be spread percutaneously, sexually, or maternally.HIV causes AIDS by destroying the body’s defenses against diseases.

Most people who develop HIV are + within 6-12 weeks.

● Approximately when do the antibodies form (if infected with HIV) and how long can it take before one may show serious symptoms?

Approximately 4 weeks till symptoms. The antibodies form between 6 to 12 weeks after initial exposure.

● Know which diseases are bloodborne vs. airborne○ HEP B/C/D vs. TB/chickenpox/pneumonia

● Know the sequence of steps to take if you have an occupational exposure.

○ Wash location of exposure○ contact supervisor○ call exposure number Campus Health○ then talk to patient about testing. ○ Document exposure○ Testing should be done within 2 hours for best results

● Know why is it CRITICAL to report an exposure ASAP.○ Critical period of 1-2 hours to prevent conversion… start

treatment ASAP

● Know the factors the healthcare professional will consider when evaluating your exposure.

Your current immunity state to Hep B, Patient’s current viral content (Hep B carrier, HIV record, or anything: tested by blood samples), extent and mode of exposure (open wound, slight graze, transmission of blood, injection.)

● Know what herpetic whitlow is and where it is commonly found.

○ A lesion on a finger or thumb caused by the herpes virus.

● Know what the major symptoms are for an active TB patient.○ Lung infection caused mycobacterium tuberculosis ○ Malaise (general feeling of discomfort)○ Productive cough for more than 3 weeks ○ Blood in sputum○ Fever, night sweats○ Weight loss

● Know what ULSD, as well as a dental office policy should be for handling this patient.

○ TB in the active state = we cannot handle, send to the hospital for proper care

○ TB in the latent state = we can work on these patients

● Know the 2 types of FLORA reduced from our hands when hand washing.

○ Resident Skin Flora = attaches to deeper layers of skin but less likely to be associated with infections

○ Transient Skin Flora (more likely to cause disease)

● Where is MRSA most often found? Can it be spread in the dental office?

○ Skin. Oh yeah. ;)

● Know the #1 means of preventing disease transmission. Proper washing-hands technique. (15 seconds)

● Know 2 major criteria when looking for an intermediate disinfectant?

1. TB kill time = Contact time (too long may not be practical)2. EPA #

● 3. Compatibility with equipment

● Know the purpose of using the intermediate disinfectant on contaminated surfaces.Kills nearly everything, but spores.

● Know the rationale for wrapping instruments before placing in the sterilizer.

There are chemical indicators on the package that show if the instruments are sterile or not. Also, the packaging allows people to handle the instruments while maintaining the integrity of the sterile environment.

● Know the spore test for heat.○ Biological indicator→ to measure spore forming bacteria;

To be demonstrated weekly with biological testing○ Chemical indicator -- changes color once the temperature is

reached (integrated chemical indicators that change color or form slowly, responding to a combination of time and temperature)

● Define mechanical indicators.○ Monitor sterilization parameters such as time, temperature, and

autoclave pressure. ○ Slow change

● Define chemical indicators.○ Materials containing a chemical that changes color or foams with

exposure to heat/steam, are used to monitor exposure of items to heat- or gas-sterilizing agents

○ Rapid change

● Biological indicators ○ Measures spore forming bacteria, performed once weekly

● Know reasons for sterilization failure.○ Improper loading○ Improper packaging○ Improper timing○ Improper Unit Operation○ Unit malfunction○ Improper maintenance of equipment

● Know the first thing to do if sterilizer fails.○ Repeat the spore test immediately using the same procedure

that produced the positive biological indicator ○ If it passes, proceed as normal○ If another failure occurs, the sterilizer should be removed from

service and sterilization operating procedures reviewed to determine whether operator error could be responsible. Call in manufacture/expert.

■ Don’t use until three consecutive empty chamber sterilization cycles test negative

● Know the purpose of sterilization vs. disinfection.○ Sterilization destroys or eliminates all forms of microbial life (i.e.

spores) and is carried out by physical or chemical methods

○ Disinfection destroys all disease-producing microbes but not high levels of bacterial spores

○ Disinfection kills more microorganisms and sterilization kills endospores(but sterilization kills most everything… except for that crazy ass bacteria that lives like at deep sea vents or volcanos… like woah man)

● Know the difference between critical, semi-critical and non-critical items.

○ Critical- heat-sterilize or use disposables between patients; have high risk of transmitting infection

■ Penetrate mucous membranes or contact bone/bloodstream (surgical instruments, scalpel blades, periodontal scalers, dental burs)

○ Semicritical- heat-sterilize or high-level disinfection (for heat-sensitive instruments); lower risk of transmission, most items are heat-tolerant

■ Contact mucous membranes but doesn’t penetrate soft tissue (dental mouth mirrors, amalgam condensers, dental handpieces)

○ Noncritical items- clean with intermediate-level disinfectant (if visibly bloody)/low-level disinfectant for everything else; needs to have a label claim for killing HIV and HBV

■ Contact intact skin (x-ray heads, facebows, pulse oximeter, blood pressure cuff)

● Know the rationale for precleaning instruments.○ Must clean before disinfecting/sanitizing because if there's blood,

cement, or other stuff then there sanitation won't be 100% effective. Also to prevent the spread of infection outside the cubicle.

● Know 3 bacteria most common in dental unit water lines that can cause infection in immunocompromised persons.

○ Pseudomonas Aerigunosa○ Legionella○ Mycobacterium Tuberculosis

● Know the factors contributing to biofilm growth. (DAFSA) or what about (SAD..AF) ? hehe

○ Diameter of tubing (tiny=more)○ Ability to attach○ Flow rates (slow=more)○ Stagnant water

○ Amount of bacteria present in incoming water

● Know reasonable approaches to improving the quality of dental unit water.

○ Being on a CLOSED system!! Using bottles and iodine strips, getting plumbing checked (CFU count), periodic flushing with cleaner, and frequent flushing of water lines (2 min in the morning) before and after patients (30 sec btwn).

● Know the acceptable level of CFU/ml for dental unit water.200 CFU/ml or less - Drinking water is at 500 CFU/mL, dental water lines have a higher standard that coincide with CDC protocol.

●

Know what type of water must be used in surgeries. ○ Sterile water

● Know which particle of oral fluids can be inhaled into the lung air sacs.

○ Aerosols, droplets

● Rubber dams will not reduce what?○ Biofilm that has been grown in the dental unit waterlines

● Once an impression is taken, what is the first thing you should do with it?

○ Rinse it off with water, disinfect, then remove the carrier attachment (Metal: sterilize. Plastic: dispose)

● What should be done to any work being sent to a lab (in office of outside office)?

○ Wash, disinfect, label, transport in appropriate container

● Are all disinfectants compatible with all impression materials?○ No way Jose

● Know the difference between regulated and non-regulated waste.

○ Regulated: bio-hazard (for things saturated w/ bodily fluids) & sharpsNon-regulated: normal trash

● Know the criteria for sharps containers.Only sharp objects (needles, blades), and carpules go in.Empty before it gets too full (¾-full)

● Know the purpose of personal protective equipment.It serves as the first physical barrier protecting the doctor from

exposure to patient viri/bacteria. Also protects the patient from exposure to doctor’s germs. Proper sequence of use when dressing: Gown, mask (pinch nose), eyewear, gloves (always last on and first off)

● Know the definition/examples of work practice controls.○ Work practice controls: procedures that reduce the likelihood of

exposure by altering the way in which a task is performed. Examples include: one handed scoop technique (https://www.youtube.com/watch?v=AYUbpBLceTg), do not pass needles unsheathed, do not recap needles using two hands, never bend a needle or cavitron tip, use a blade remover (not ya hand)

● Know the definition/examples of engineering controls.○ Engineering controls: needle sheath, scalpel blade remover

shown in class, technology, idk

● Know that OSHA regulates and enforces laws for the safety of the employee.

○ OK

● Know the purpose of OSHA’s Bloodborne Pathogen Standard.○ To protect employees from exposure to blood/saliva

● Know the purpose of CDC’s Recommendations.To protect the patient.

● Know that FDA regulates sterilizers and gloves (& drugs).○ Yes ma’am. Need to be FDA approved to limit liability.

● Know the purpose of OSHA’s Hazard Communication Standard.○ To ensure that the hazards of all chemicals produced or imported

are evaluated and details regarding their hazards are transmitted to employers and employees.

● Know the 5 main elements of the Hazard Communication Standard.

○ Inventory of hazardous chemicals and hazard assessment ○ System for maintaining MSDSs (Material Safety Data Sheets)○ Chemical labels and warning signs ○ Training programs ○ Written Hazard Communication Program

● Know the purpose of an SDS (Safety Data Sheets). ○ It describes the physical and chemical properties of the product

efficiently for reference in an emergency. SDSs contain useful

information such as toxicity, flash point, procedures for spills and leaks, storage guidelines, and exposure control

● Know 2-3 products that are flammable that dental offices work with on a regular basis.

○ Alcohol○ Envirocide○ ..hair gel & mousse ○ Monomers! ○ Acetone○ My mixtape

● Know where the Safety Data Sheets are located at UL. ○ Hallway to the right of the elevator on each floor.

Patricia is the LOL