[TEST] Sterilization and disinfection of patient care items in oral healthcare settings

Which statement is inaccurate with respect to sterilization and levels of disinfection?

A. Sterilization is a validated process that destroys all forms of microbial life.

B. High-level disinfection kills all pathogens but not all bacterial spores.

C. Intermediate-level disinfection kills mycobacteria, viruses, fungi, all vegetative bacteria, including bacterial spores.

D. Low-level disinfection kills lipid or medium-sized viruses, some fungi, and vegetative bacteria.

Which component is not included in the Spaulding’s approach to sterilization and disinfection?

A. During the course of their intended use, critical items penetrate soft and hard tissues or the vascular system.

B. During the course of their intended use, semi-critical items contact, but do not penetrate nonintact skin or mucous membranes.

C. During the course of their intended use, non-critical items come in contact with intact skin, but not mucous membranes.

D. During the delivery of care, the most important factor determining the risk of infection from contaminated instruments is the duration of exposure.

Which statement inaccurately describes the sterilizing process for heat tolerant patient-care items?

A. Heat-tolerant critical patient-care items must be sterilized by an FDA cleared heat sterilizer.

B. Heat-tolerant semi-critical patient-care items, including all dental handpieces, must be heat sterilized.

C. Heat-tolerant semi-critical items must undergo disinfection with an FDA-registered chemical sterilant used as a high level disinfectant.

D. Heat tolerant critical and semi-critical items must be sterilized by steam, unsaturated chemical vapor, or dry heat.

Which technique is incorrect when disinfecting heat sensitive critical or semi-critical, or non-critical patient-care items?

A. Heat-sensitive critical items must undergo intermediate-level disinfection using an FDA-registered chemical sterilant.
(low temp ethylene oxide)

B. Non-critical items, when visibly soiled, must be disinfected with an EPA-registered hospital level intermediate-level disinfectant.

C. Heat-sensitive critical items can be sterilized by ethylene oxide or by immersing them in liquid chemical germicides registered by the FDA as chemical sterilants.

D. Unless visibly soiled, disposable barrier protection is the preferred infection control method for non-critical items.

Which statement incorrectly describes the use of steam sterilizers?

A. Steam sterilization is the most widely used method for critical and semi-critical items that are heat and moisture tolerant.

B. Steam sterilization requires exposure to direct steam contact at a specified temperature and pressure for a defined period of time.

C. Gravity displacement steam sterilizers should be tested daily for adequate air removal.

D. The majority of tabletop sterilizers used in oral healthcare settings are gravity displacement sterilizers.

Which is not a characteristic of unsaturated chemical-vapor sterilization?

A. Unsaturated chemical-vapor sterilization involves heating a chemical solution in a closed pressurized chamber.

B. The advantage of using unsaturated chemical-vapor sterilization is that the instruments do not have to be dry before sterilization.

C. When using an unsaturated chemical-vapor sterilizer federal, state and local authorities must be consulted for hazardous waste disposal requirements.

D. Unsaturated chemical-vapor sterilization causes less corrosion of carbon steel instruments than steam sterilization.

Which is an inaccurate description of the characteristics of dry heat sterilization?

A. Dry heat may be used to sterilize patient-care items that might be damaged by moist heat.

B. Dry heat has the advantages of low operating cost and being noncorrosive.

C. The high temperatures required for this prolonged sterilization process are not suitable for many instruments and devices.

D. The static-air type has the advantage a shorter sterilization cycle time compared to the forced-air type.

Which procedure is inaccurate when using chemical sterilants and disinfectants?

A. Heat-sensitive critical items must be cleaned and sterilized by immersing them for 3-12 hours in liquid germicides registered by the FDA as chemical sterilants.

B. Heat-sensitive semi-critical items must minimally undergo high-level disinfection by immersing in an FDA-registered chemical sterilant for 10-12 minutes.

C. Non-critical patient-care items, when visibly soiled, must be cleaned using an EPA-registered intermediate-level disinfectant with tuberculocidal claim.

D. Environmental surfaces in the dental office, when soiled with blood, must be cleaned using an EPA-registered intermediate-level disinfectant.

Which is not involved with the processing of contaminated reusable patient-care items?

A. There should be a central processing area (CPA) of adequate size with four successive stations for cleaning, packaging, sterilization and storage.

B. Within the CPA, each station should be physically separated to control traffic flow and to contain contaminants during the process.

C. If physical separation between stations is not practical, barriers must be installed to isolate the stations.

D. Reusable contaminated patient-care items must be transported from the point of use to the CPA in sealed, leak proof containers displaying a biohazard symbol.

Which cleaning approach for reusable instruments and other devices is inaccurate?

A. If visible organic and inorganic debris is not removed, it will interfere with microbial inactivation and compromise the sterilization and disinfection processes.

B. Factors to consider in selecting a cleaning method include efficacy, compatibility and occupational health and exposure risks.

C. Manual cleaning of instruments is preferred over the use of automated equipment (e.g., ultrasonic cleaner or washer/disinfector) because it is more efficient.

D. During manual cleaning, the instruments must be placed in a leak proof, puncture-resistant container and soaked with a detergent, a disinfectant/detergent, or an enzymatic cleaner.

Which is not a characteristic of detergents and enzymatic cleaners for reusable instruments?

A. Detergents with an acidic pH generally provide the best material compatibility profile and good soil removal.

B. Enzymes, usually proteases, sometimes are added to neutralize pH solutions to assist in removing organic material.

C. Some cleaning solutions also contain lipases (enzymes that inactivate fat) and amylases (enzymes that inactivate starches).

D. After cleaning, detergent and enzyme residues must be removed by washing the instruments.

Which is not recommended when preparing and packaging instruments?

A. Individual instruments should be placed in self-sealed or heat-sealed plastic and paper pouches or arranged in rigid or perforated trays/cassettes and wrapped.

B. Hinged instruments placed in various packs must be in a closed, locked position.

C. Each instrument unit must have an internal indicator placed on the inside and, if the internal indicator cannot be seen, an external indicator must be applied to the outside.

D. The packing material must maintain the sterility of instruments during transport and storage.

Which approach should be avoided when loading and uploading wrapped instruments for sterilization?

A. Perforated trays/cassettes should be placed so that they are parallel to the shelf.

B. Non-perforated containers should be placed on their edge.

C. Peel-packs should be placed on edge and small items should be loosely placed in wire baskets.

D. Once the sterilization cycle is complete, remove the packs to cool and dry outside the chamber.

Which is incorrect with respect to sterilizing and storing unwrapped instruments?

A. Unwrapped instruments must be thoroughly cleaned and dried prior to sterilization.

B. When sterilizing unwrapped instruments mechanical indicators must be checked, but there is no requirement to place a chemical indicator with the items.

C. Critical items sterilized unwrapped must be transferred from the sterilizer to the point of use by an aseptic method for immediate use.

D. Unwrapped sterile instruments can become contaminated with dust, airborne organisms, and other contaminants and should never be stored.

Which statement inaccurately describes sterilizing and high-level disinfecting with germicides?

A. Patient-care items must be rinsed with sterile water after immersion to remove toxic or irritating residues.

B. Patient-care items must be handled using sterile gloves, dried with sterile towels, and delivered to the point of use in an aseptic manner for immediate use.

C. The efficacy of the sterilization or high-level disinfection process using germicides is readily verifiable.

D. Federal law requires that label instructions on FDA and EPA-registered products be followed.

Which is an inaccurate statement regarding the storage of sterilized items?

A. After the sterilization cycle is completed and the instrument units are dry and cool, inspect all packages for proper color change by visible chemical indicators.

B. Instruments units should be stored in a clean, dry, closed cabinet.

C. Storage practices for wrapped sterilized instruments are time-related, i.e., wrapped instruments maintain their sterility for a specified time.

D. When the packaging is compromised (i.e., torn, wet, or open), the instruments should be re-cleaned, re-packaged in a new wrap, and re-sterilized.

Which statement does not accurately describe the quality assurance indicators of the sterilization process?

A. Monitoring physical indicators involves observing the gauges or displays on the sterilizer and recording the time, temperature, and pressure associated with each sterilization cycle for each load.

B. Chemical indicators use sensitive chemicals to assess critical variables (i.e., time, temperature, steam saturation) during a sterilization cycle and validate that sterilization has been achieved.

C. Biological indicators (BIs), or spore tests, assess directly the killing of known highly resistant, nonpathogenic bacterial spores.

D. The results of physical, chemical and biological monitoring must be documented in a sterilization monitoring record.

Which biological monitoring of the sterilization process is not recommended?

A. In oral healthcare facilities, BIs should be processed with a load in all sterilizers at least weekly.

B. A BI must be processed in every load containing an implant and the implant should be quarantined until the result of the spore test is known.

C. When biological testing is done in-office, the test BI must be incubated within two hours or refrigerated.

D. Bacillus atrophaeus are the types of spores that should be used to test steam sterilizers.

Which statement inaccurately describes the sterilization monitoring record (SMR)?

A. Documentation, in the form of a log, is an absolute requirement of quality assurance.

B. Mail-in biological monitoring reports are maintained by the testing agency and there is no requirement for separate recordkeeping in the dental office.

C. The SMR provides a mechanism for determining if a recall is indicated and, in combination with the date and sterilizer number on each pack, the extent of the recall.

D. The sterilization monitoring record and the sterilizer maintenance record shall be maintained for a specified period of time (state dental board requirements may vary).

Which procedure would be unnecessary in the event of a positive spore test?

A. In case of a positive spore test, the sterilizer should be removed from service and all records of physical and chemical monitoring since the last negative BI test should be reviewed.

B. If the physical and chemical indicators reveal the sterilizer is functioning correctly consider possible operator error, and using the same cycle that produced the failure, repeat the spore test immediately after correctly loading the sterilizer.

C. If packaging, loading, and operating procedures have been confirmed as performed correctly and the repeat BI test is negative, the sterilizer must remain out of service until it has been inspected, repaired, and re-tested with a confirmatory BI test.

D. All items sterilized from suspect loads dating back to the last negative BI test should be re-cleaned, wrapped, and re-sterilized.