CDA Infection Control Exam 2021

Terms

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oral surgery procedures

involve the incision, excision, or reflection of tissue that exposes the normally sterile areas of the oral cavity

EXAMPLES

~biopsy

~periodontal surgery

~apical surgery

~implant surgery

~surgical extractions of teeth

Droplet nuclei

Particles <5 µm in diameter formed by dehydration of airborne droplets containing microorganisms that can remain suspended in the air for long periods of time

engineering controls

removes & isolates a hazard

~primary method to reduce exposures to blood & OPIM from sharps

~frequently technology based & often incorporate safer designs of instruments & devices

Droplets

Small particles of moisture (e.g., spatter) generated when a person coughs or sneezes, or when water is converted to a fine mist by an aerator or shower head. These particles, intermediate in size between drops and droplet nuclei, can contain infectious microorganisms and tend to quickly settle from the air such that risk of disease transmission is usually limited to persons in close proximity to the droplet source

Germicide

An agent that destroys microorganisms, especially pathogenic organisms. Terms with the same suffix (e.g., virucide, fungicide, bactericide, tuberculocide, and sporicide) indicate agents that destroy the specific microorganism identified by the prefix. Germicides can be used to inactivate microorganisms in or on living tissue (i.e., antiseptics) or on environmental surfaces (i.e., disinfectants)

Hepatitis B immune globulin (HBIG)

Product used for prophylaxis against HBV infection. HBIG is prepared from plasma containing high titers of hepatitis B surface antibody (anti-HBs) and provides protection for 3--6 mos

Hepatitis B surface antigen (HBsAg)

Serologic marker on the surface of HBV detected in high levels during acute or chronic hepatitis. The body normally produces antibodies to surface antigen as a normal immune response to infection

Hepatitis B e antigen (HBeAg)

Secreted product of the nucleocapsid gene of HBV found in serum during acute and chronic HBV infection. Its presence indicates that the virus is replicating and serves as a marker of increased infectivity

Hepatitis B surface antibody (anti-HBs)

Protective antibody against HBsAg. Presence in the blood can indicate past infection with, and immunity to, HBV, or immune response from hepatitis B vaccine

Heterotrophic bacteria

Those bacteria requiring an organic carbon source for growth (i.e., deriving energy and carbon from organic compounds)

Hospital disinfectant

Germicide registered by EPA for use on inanimate objects in hospitals, clinics, dental offices, and other medical-related facilities. Efficacy is demonstrated against Salmonella choleraesuis, Staphylococcus aureus, and Pseudomonas aeruginos

Independent water reservoir

Container used to hold water or other solutions and supply it to handpieces and air and water syringes attached to a dental unit. The independent reservoir, which isolates the unit from the public water system, can be provided as original equipment or as a retrofitted device

Microfilter

Membrane filter used to trap microorganisms suspended in water. Filters are usually installed on dental unit waterlines as a retrofit device. Microfiltration commonly occurs at a filter pore size of 0.03--10 µm. Sediment filters commonly found in dental unit water regulators have pore sizes of 20--90 µm and do not function as microbiological filters

Nosocomial

Infection acquired in a hospital as a result of medical care

Sterile

Free from all living microorganisms; usually described as a probability (e.g., the probability of a surviving microorganism being 1 in 1 million)

Surfactants

Surface-active agents that reduce surface tension and help cleaning by loosening, emulsifying, and holding soil in suspension, to be more readily rinsed away

Washer-disinfector

Automatic unit that cleans and thermally disinfects instruments, by using a high-temperature cycle rather than a chemical bath

Wicking

Absorption of a liquid by capillary action along a thread or through the material (e.g., penetration of liquids through undetected holes in a glove)

Seroconversion

The change of a serological test from negative to positive indicating the development of antibodies in response to infection or immunization

Endotoxin

The lipopolysaccharide of gram-negative bacteria, the toxic character of which resides in the lipid protein. Endotoxins can produce pyrogenic reactions in persons exposed to their bacterial component

Dental healthcare personal (DHCP)

individuals who work in a dental practice who may be exposed to body fluids such as blood or saliva

3 types of bacteria & their shape

Cocci (spherical), bacilli (rod), spirochetes (spiral)

Links in the chain of infection

~an infectious agent

~reservoir

~portal of exit

~mode of transmission

~portal of entry

~susceptible host

oral candidiasis

Caused by yeast & can be found in the oral cavity

Aerobes

Require oxygen to grow

Anaerobes

Do not require oxygen to grow

Facilitative anaerobes

Can grow in the presence or absence of oxygen

Clinical contact surfaces

Those that are touched w/contaminated hands, instruments, or spatter during routine patient care

Clinical touch surfaces

Surfaces that are directly touched and contaminated during procedures

INCLUDES

~dental light handles

~dental unit controls

~chair switches

~chairside computers

~pens

~phones

~dental materials containers

~drawer handles

****uses barrier protection OR cleaned between patients

clinical transfer surfaces

not directly touched but often touched by contaminated instruments

INCLUDES

~instrument trays

~handpiece holders

***uses barrier protection OR cleaned between patients

clinical splash, spatter, & droplet surfaces

don't actually contact members of the dental team orr contaminated instruments or supplies

****should be cleaned 1x per day

EXAMPLE

countertops

Glutaraldehydes

~have a high toxicity

~tend to discolor & erode surfaces

single use items

items that are only used once on one patient

EXAMPLES

patient napkins, surface barriers, syringe needles, plastic orthodontic brackets, and sterilization pouches

sterilant

Destroys all microorganisms including high numbers of bacterial spores

high level disinfectant

Destroys all microorganisms but not necessarily high numbers of bacterial spores

intermediate level disinfectant

Destroys vegetative bacteria, most fungi and most viruses, inactivates mycobacterium tuberculosis var. bovis (is tuberculocidal)

EXAMPLES

~EPA hospital disinfectant w/label claim of tuberculocidal activity

~chlorine based products

~phenolics

~iodophors

~quaternary ammonium compounds w/alcohol

~bromides

USE

~clinical contact surfaces

~non-critical surfaces w/visible blood

low level disinfectant

Destroys vegetative bacteria, some fungi and some viruses, doesn't inactivate M. Tuberculosis var. bois (isn't tuberculocidal)

EXAMPLES

EPA registered hospital disinfectants w/no label claim of tuberculocidal activity (quaternary ammonium compounds)

USE

~housekeeping surfaces

~noncritical surfaces w/o visible blood

~clinical contact surfaces

The strength of an organism to produce disease is

Virulence

Biologic monitor

Ensures sterilization has occurred

Process indicators, integrators, gauge readings

Provide visual control of sterilization conditions

Type IV reaction

Delayed reaction that invokes the immune system

****reactions are limited to area of contact

Enteral

A technique of administration in which the agent is ABSORBED through the gastrointestinal tract or oral mucosa such as w/ oral, rectal, or sublingual administration

parenteral

a technique of administration in which the drug bypasses the gastrointestinal tract such as w/intramuscular, intravenous, intranasal, submucosal, subcutaneous, or intraocular administration

blood borne disease

diseases that are spread through the exposure to, inoculation of, or injection of blood; or exposure to blood contained in body fluids, tissues, or organs; include infections caused by agents such as the human immunodeficiency virus (HIV) & hepatitis B (HBV)

infection control

Programs, procedures, & methods to reduce the transmission of agents of infection for the purpose of preventing or decreasing the incidence of infectious diseases

clinical practice location

site at which a regulated person practices

contaminated

the presence or the reasonably anticipated presence of potentially infectious materials on an item or surface

decontamination

the removal, inactivation, or destruction of HBV & HIV on a surface or item to the point where HBV &/or HIV are no longer capable of causing infection & the surface or item is rendered safe for barehanded touching, use, or disposal

disinfection

~destroys MOST pathogenic and other microorganisms by physical or chemical means

~does not ensure the degree of safety associated with sterilization processes

sterilization

destroys ALL microorganisms, including substantial numbers of resistant bacterial spores, by heat (steam autoclave, dry heat, and unsaturated chemical vapor) or liquid chemical sterilants

use surface barriers on

light handles, back of patient chair, keyboards, drawer handles, radiograph equipment or any other surface thats hard to clean

The ______________ regulates LOW & INTERMEDIATE LEVEL disinfectants

Environmental protection agency (EPA)

The _________________ regulates CHEMICAL STERILANTS/HIGH LEVEL disinfectants

food & drug administration (FDA)

exposure incident

a person has eye, mucous membrane, non intact skin, or parenteral contact w/potentially infectious material at a clinical practice location

high level disinfection

the elimination of viability of all microorganisms except bacterial spores

commissioner

commissioner of health

regulated person

a licensed dentist, DH, dentist physician (dentist w/ medical license), or a registered dental assistant who currently practices

HBV

the hepatitis B virus with the e antigen present in the most recent blood test

HCV

the hepatitis C virus

HIV

the human immunodeficiency virus

transmission based precautions

2nd tier of infection prevention

~used when patients have diseases that can spread through contact, droplet, or airborne routes

~ALWAYS used in addition to standard precautions

PPE

any equipment or overclothes that reduce the risk of a persons clothing, skin, eyes, mouth, or other mucous membranes coming into contact w/ potentially infectious materials (PIM) at. a clinical practice location

INCLUDES BUT NOT LIMITED TO

~aprons

~clinic jackets

~eyewear/safety glasses w/ side shield

~face shields

~foot & leg coverings

~gloves

~gowns

~lab coats

~masks

critical instruments

those that touch bone or penetrate soft tissue

EXAMPLES

~surgical instruments, forceps, scalpels, bone chisels, scalars, and burs

STERILIZATION METHOD

sterilization

semi critical instruments

touch mucous membranes but won't touch bone or penetrate soft tissue

EXAMPLES

mouth mirrors, amalgam condenser

STERILIZATION METHOD

sterilization OR high level disinfectant

Dental treatment water

Nonsterile water used during dental treatment, including irrigation of nonsurgical operative sites and cooling of high-speed rotary and ultrasonic instruments

non critical instruments

ontact only with intact skin

EXAMPLE

dental radiograph sensor

STERILIZATION METHOD

intermediate to a low level disinfectant or basic cleaning

Potentially infectious materials

1) human blood, human blood components, products made from human blood

2) semantic, vaginal secretions, cerebrospinal fluid, pleural fluid, pericardial fluid, amniotic fluid, saliva in dental procedures, any body fluid thats visibly contaminated w/blood & all body fluid in secretions where its difficult or impossible to differentiate body fluids

3) any unfixed tissue or organ (other than intact skin) from a human (dead or living)

4) HIV-containing cell, tissue, or other organ cultures; HIV or HBV-containing culture media or other solns; blood, organs, or other tissues from experimental animals infected w/HIV or HBV

sharps

objects that can penetrate the skin; include but not limited to scalpels, needles, tofflemere bands, broken glass, broken capillary tubes, & exposed ends of dental wires

sharps disposable

must be placed in a typically red leakproof & puncture proof container with a closed lid & biohazard label; place as close to disposable pickup as possible

Acute infections

Severe & rapid display of symptoms

Chronic infection

Microorganism present for a long time or even life

***individual may be asymptomatic or not showing any symptoms

latent infection

persistent infection w/symptoms coming & going

opportunistic infection

Nonpathogenic

**occur in those w/decreased or compromised immune resistance

pathogens

disease producing organisms

*****most common in dentistry is caries

spores

~most resistant form of life known

disinfectant

used for chemicals that are applied to inanimate objects

antiseptic

used for antimicrobial agents that are applied to living tissue

Sporicidal

a product capable of killing spores

virucidal

a product capable of killing viruses

fungicidal

a product capable of killing fungi

high level disinfectant (EPA classification)

has a relatively short contact time & a sterilant when used w/a prolonged contact time

USE

semi critical items that can't tolerate heat sterilization

intermediate level disinfectant (EPA classification)

hospital disinfectant w/tuberculocidal activity

USE

noncritical items or surfaces that have been contaminated w/blood or saliva

low level disinfectant (EPA classification)

nontuberculocidal

USE

surfaces not contaminated w/blood

American Dental Association (ADA)

Provides info on the best practices & emerging issues of interest

American Dental Assistants Association (ADAA)

Encourages education, registration, & certification

American dental hygienists association

Mission is to advance the art & science of DH & to promote the highest standards of education practice

Organization for Safety, Asepsis and Prevention (OSAP)

Promote infection control & related science based health $ safety policies & practices

Center for Disease Control and Prevention (CDC)

Lead fed agency for protecting the health & safety of people at home & abroad

~makes infection control recommendations

***no authority to make laws

work practice controls

result in safer behaviors

EX's: using the one handed scoop method to recap a needle, wearing PPE

administrative controls

policies, procedures, & enforcement measures targeted at reducing the risk of exposure to infectious persons

Alcohol-based hand rub

An alcohol-containing preparation designed for reducing the number of viable microorganisms on the hands

Antimicrobial soap

A detergent containing an antiseptic agent

Bead sterilizer

A device using glass beads 1.2--1.5 mm diameter and temperatures 217ºC--232ºC for brief exposures (e.g., 45 seconds) to inactivate microorganisms

***NOT been cleared by the FDA as a sterilizer

Bioburden

Microbiological load (i.e., number of viable organisms in or on an object or surface) or organic material on a surface or object before decontamination, or sterilization. Also known as bioload or microbial load

Colony-forming unit (CFU)

The minimum number (i.e., tens of millions) of separable cells on the surface of or in semisolid agar medium that give rise to a visible colony of progeny. CFUs can consist of pairs, chains, clusters, or as single cells and are often expressed as colony-forming units per milliliter (CFUs/mL)

inadvertent contamination

When a dental operator has a break in skin (usually don't know) and touch a contaminated surface. Cross-contamination

percutaneous injuries among DHCP usually

1) occur outside the patients mouth & pose less risk for recontact w/patients tissue

2) involve limited amounts of blood

3) caused by burs, syringe needles, lab knives, & other sharp instruments

*****NEEDLESTICKS ARE MOST COMMON

OSHA blood-borne pathogens standard

protects employees who work in occupations where they're at risk to exposure to blood or other potentially infectious materials

OSHA's Hazard Communication Standard

protects employees who may be exposed to hazardous chemicals

~chemical manufacturers & importers are required to evaluate the hazards of the chemicals they produce or report & prepare labels & safety data sheets to convey the info to customers

~all employers w/hazardous chemicals in their workplace must have labels & safety data sheets for their exposed workers & train them to handle chemicals appropriately

~hazard classification -->provides specific criteria for classification of health & physical hazards as well as classification of mixtures

~labels -->chemical manufacturers & importers are required to provide a label that includes a harmonized signal word, pictogram, & hazard statement for each hazard class & category; preliminary statements must be provided

~information & training -->train employees on MSDS & hazard labels