clinic theory 1 exam

dental hygiene process of care

• ADPIE

• Assessment

• Diagnosis

• Plan

• Implement

• Evaluate

• Document

purpose of ADPIE

• components are integrated with each other

• procedures are continual, may overlap or occur simultaneously

• provides framework for individualized care

• identifies risk factors

assessment

• foundation of patient care

• collection of subjective and objective data

diagnose

• interpret assessment data using critical thinking skills

• identify health behaviors and actual or potential oral health problems within scope of practice

• provide basis how the DH care plan is designed, implemented, and evaluated

• justify proposed treatment to patient

plan

• is a set of strategies and interventions needed to help patient attain oral health

• presented to dentist and patient

why do we need DH care plans for the dentist?

• for a part of the comprehensive dental care plan

why do we need a DH care plan for patients?

• for what treatment is needed

• for how many appointments it will take

• and to obtain the patient’s consent

implementation

• this phase is activation of the care plan

• the treatment

evaluation

• This phase determines if:

  • A specific area needs to be treated again

  • If the patient needs to be referred

  • If the patient can be placed into a regular schedule of continuing care

documentation

• in a condensed, consistent format, __ details:

  • all assessment data

  • diagnosis

  • care plan

  • treatments

  • patient education

  • evaluation

if you didnt document it, IT DIDNT HAPPEN!!

6 As

• assess

• ask (PICO - patient/problem, intervention, comparison, outcome)

• acquire

• appraise

• apply

• audit

qualitative research

• understand and subjectively interpret complex social interactions

• smaller sample sizes, not random

• observations, interviews, open-ended questions, field notations, and narrative reflections

quantitative data

• test hypotheses, view correlational relationships, make predictions

• large sample sizes, randomly selected

• data collected and reported as quantifiable numbers or statistics

mixed method

• combine the best of both qualitative and quantitative research approaches

• data are collected and reported as both qualitative insight and quantitative analysis

highest levels of evidence

• Meta-analysis (MA) - platinum standard

• systematic reviews SRs- diamond standard

gold standard of evidence

• high-level/ primary studies

• randomized controlled clinical trials

• case studies and case reports, narrative reviews

• editorials and SME opinions

lowest level evidence sources

• case studies, case reports, and narrative reports

• editorials and SME opinions

• preclinical trials (in vitro or vivo)

infection control

• A comprehensive, systematic program that, when applied, prevents the transmission of infectious agents among persons who are in direct contact with the healthcare environment.

safety

• The condition of being protected from or unlikely to cause danger, risk or injury

bloodborne pathogens

• pathogenic microorganisms that are present in human blood and can cause disease in humans.

• These pathogens include but are not limited to

  • hepatitis B virus (HBV)

  • human immunodeficiency virus (HIV).¹

CDC

• increases the health security of our nation as the nation’s health protection agency

• addresses all aspects of infection control in healthcare settings

• CDC guidelines cover broad infection control practices

• Guidelines are recommendations that health care facilities are encouraged to follow

OSHA

• to assure America’s workers have safe and healthful working conditions free from unlawful retaliation

• sets and enforces standards

• national system of worker safety and health protections

• standards focus on specific topic

• legal authority to enforce standards through inspection and pentaltie$

standard of care

• level of care that a reasonable prudent practitioner would exercise

• minimum acceptable level of care in all aspects of client care

principles of infection control

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 other potentially infectious body substances

the most important measure to avoid the transmission of harmful germs and precent healthcare-associated infections is _

hand hygiene

requirements for safety glasses

• high impact plastic

• over entire eye area from eyebrow to cheekbone

• each side of face beyond the temple area

• side shields should be solid rather than slip on or vented

• glasses can be completely sterilized

safe DONNING of PPE

1. gown

2. mask

3. protective eyewear

4. gloves

safe DOFFING of PPE

1. gloves

2. eyewear

3. mask

4. gown

can develop from frequent and repeated use of hand hygiene products, exposure to chemicals, and glove use. dry, tichy, irritated areas on skin

contact dermatitis

Steam Under Pressure Sterilization

• autoclave

• most widely used

• requires exposure of each item to direct steam contact at required temperature and pressure for a specific amount of time

• 30 minutes at 15-40 PSI at 230 degrees Fahrenheit

critical dental instruments

• penetrate soft tissue or bone

• greatest risk of transmitting infection

• heat sterilize

semi-critical dental instruments

• touch mucous membranes or non-intact skin

• lower risk of transmitting infection

• heat sterilize if heat tolerant or process with high-level disinfectant

non critical

• contact only skin

• least risk of transmission

• clean unless visibly soiled; then disinfect with hospital grade disinfectant

• visibly contaminated with blood or OPIM requires intermediate level disinfectant

• requires a barrier if not able to be cleaned

wicking

• Bacteria can contact the instrument through wet paper

• can occur if packages are not dry in the sterilizer before they are handled

• can occur if other substances come into contact with paper such as ink

high level disinfectants

• capable of inactivating high numbers of bacterial spores with high exposure times

• used for heat sensitive items - immersion only

• no longer in practice

intermediate level disinfectants

• destroys M. tuberculosis, vegetative bacteria, and most fungi and viruses

• EPA-registered hospital disinfectant

• MUST BE USED WITH UTILITY GLOVES

low level disinfectants

• inactivate certain viruses such as HIV/HBV, some fungi, and some vegetative bacteria

In regards to chemicals, OHSHA requires employers to __

• disclose/ identify areas and tasks that have potential for chemical exposure

• There are risks involved

• for chemicals to be properly labelled

Instrument Processing area

• must be designated, divided, and labelled into four separate areas

  • receiving, cleaning, and decontamination (dirty)

  • preparation and packaging

  • sterilization

  • storage

• areas should NEVER go in reverse direction and clean instruments should NOT be stored in an area where contaminated instruments are held

personal protecting when cleaning instruments

• wearing puncture-resistant utility gloves for cleaning and decontamination

• wear appropriate PPE when splashing or spraying is anticipated

• use work practice controls that minimize contact with sharp instrument if manual cleaning is necessary (long handled brush)

internal chemical indicator

• should be used inside every package to verify that the sterilizing agent has penetrated the package and reached the instruments inside

• if it cannot be seen from the outside, an external chemical indicator must additionally be used

before sterilization of critical and semi-critical instruments, inspect instruments for __, then wrap or place them in containers designed to maintain sterility during storage

• cleanliness

• for example, if biofilm/ plaque or calculus is left on an instrument before sterilization, it will be cooked onto the instrument.. which is gross

where to place date and locker number on wrapped, sterilized instruments

• label package with date and locker number on plastic surface

• writing on paper can allow for wicking

biological monitors

• ensures sterilization has taken place

• takes 24 hours to process

• directly assesses sterilization process by killing highly resistant spore microorganisms

mechanical monitors

• each sterilization load must be monitors with mechanical monitors

• this includes time, temperature, and pressure

chemical indicators

• are placed on the inside of each package and if not visible from the outside, an external indicator is used as well

• color allows clinician to visualize and confirm instruments have undergone specific heating and pressure required

sterilizers must be monitored AT LEAST __ by using a biological indicator with a matching control

• weekly

in the case of a positive spore test

1. always assume user error and remove sterilizer from service while preforming another test

2. retest the sterilizer by using biological, mechanical and chemical indicators after correcting the procedural problem

3. if repeat test is negative, while mechanical and chemical indicators are normal, put sterilizer back in service

4. if POSITIVE do not use sterilizer until repared or inspected

5. recall and repreocess all items processed since last negative test

6. before placing back in service, run three consecutive times with empty chamber and negative spore tests

sterilization records must be in compliance with __ and __ regulations

• state and local

supplies should be stored a minimum of __ inches from the floor and _ inches from the ceiling

• 8-10 inches from floor

• 5 inches from ceiling

what is the first thing you should do BEFORE opening sterilized instruments?

• examine wrapped packages of sterilized instruments before opening them to ensure the barrier wrap has NOT been compromised during storage

clinical contact surfaces

• surfaces touched by contaminated hands, instruments, devices or other items during patient care; may also be contaminated by direct spray or spatter generated during patient care procedures

• may serve as reservoirs of microbial contamination

• Use intermediate-level disinfectant after each patient on non-barrier-protected clinical surfaces

surface barriers should be used to __

• protect clinical contact surfaces that are difficult to clean (switches on dental chair, light, water/air) and change barriers between patients

examples of clinical contact surfaces

• light handles

• switches

• chair-side computers

• drawer handles

• pens

• countertop

• sink and faucet handles

process for cubicle cleaning and disinfection at end of appointment

• doff PPE

• After removing barriers, wipe all clinical contact surfaces once to clean all surfaces

the necessary first step in any disinfection process is __

• cleaning

• if cleaning is not performed first, the success of the disinfection process can be compromised

• renders environmental surface safe by removing organic matter, salts and visible soils which interfere with microbial inactivation

• we use one product twice for cleaning and disinfection

the 2008 CDC Guidelines for Disinfection and Sterilization in Healthcare Settings …

• Reinforces cleaning required before disinfection

• requires friction by rubbing/scrubbing

housekeeping surfaces

• no evidence to support that these are a risk for disease transmission in dental health care setting but must still be cleaned on a schedule as appropriate with detergent and water

• examples include

  • floors

  • walls

  • base of dental chair

  • operatory partitions

Use of EPA registered intermediate level disinfectant

• obtain new wipe and disinfect all clinical contact surfaces

• leave adequate chemical on surface for designated time to achieve tuberculocidal kill

• follow recommendation for contact time

  • phenols = 10 minute kill time

  • quaternary ammonium chloride with alcohol = 3 minutes

regulated medical waste

• infectious waste that carries a substantial risk of causing infection during handling and disposal

  • solid waste soaked or saturated with blood or OPIM

  • contaminated shaprs

  • extracted teeth

dental devices that are connected to the dental water line and that enter the patient’s mouth should be operated to discharge water and air for __ to __ seconds after each patient

• 20 to 30 seconds

• This includes handpieces, ultrasonic scalers, and air/water syringes

mycobacterium tuberculosis

• respiratory disease

• bacterium carried in airborne droplets through coughing, sneezing, speaking or singing

• particles suspended in air for hours

• transfers through inhalation of droplets

• has a latent infection which makes infected person possibly develop active disease later in life

Exposure incident

• Post exposure management requires you to follow CDC recommendations after percutaneous, mucous membrane, or non-intact skin exposure to blood or OPIM

• Mucous membranes (such as eyes) should be flushed with water, skin injuries washed with soap and water.

hepatitis B vaccination recommendation

• 3 doses

  • 1^st dose

  • 2^nd dose a month following the first

  • the final dose given 5 months after dose 2.

  • Antibody testing must be done to check for immunity and if antibodies are not present after 2^nd round, non-responders should be tested for HBsAg