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Chapters 20 & 21
| Term | Definition |
|---|---|
| Bio burden | Saliva, blood, or (OPIMs) other potentially infectious materials |
| CDC Guidelines for Infection Control in Dental Care Settings 2003 | Divide environmental surfaces into clinical contact surfaces and housekeeping surfaces (floors, walls and sinks) |
| Three categories of clinical surfaces of classification | Touch (Directly touched during treatment) Ex: units, chair Transfer (Indirect but touched with contaminated instruments) Ex: Instrument tray Splash, spatter, and droplet ( Not physically touched by employees or supplies) Ex: Overhead light, chair |
| OSAP | Organization Safety and Asepsis Procedures; states the different clinical surfaces based on the intensity of exposure |
| Two Methods of Dealing With Surface Contamination | Surface Barriers Precleaning & Disinfecting surface between patients |
| Why do we use Single Use Items/ Disposables | Regulation Reduce patient to patient contamination |
| OSHA Bloodborne Pathogens Standard | Requires that contaminated work surfaces be disinfected between patient visits |
| Why and how do we pre-clean | We clean to remove and reduce the thin layer of bioburden to increase the effectiveness of the disinfectant by using soap and water |
| What PPE do we wear when precleaning and disinfection | Eyewear, utility gloves, mask, and protective clothing |
| Iodophors | EPA-registered intermediate-level - Tuberculocidal - Contains iodine - Corrode Discolor; yellow stains Used distilled water |
| manufacture's recommendations | - Mixing & diluting - Application & technique - Shelf life - Activated use life All safety warnings |
| Disinfection | kill disease producing microorganisms |
| Disinfectants | A chemical reduce or lower the number of microorganisms on inanimate surfaces Ex: countertops and dental equipment |
| Antiseptics | Antimicrobial agents that are applied on skin |
| Sterilization | Kills all life forms including endospores |
| Ideal disinfectant | EPA registered intermediate level hospital disinfectant that kills Mycobacterium Tuberculosis |
| EPA | Environmental Protection Agency regulates & registers chemical sterilant & disinfectants used and approves which disinfectant should be used in the office based on chemical classification |
| OSHA | Occupational safety & health administration; the agency responsible for the blood born pathogen standards |
| Tuberculosis kill time | 10 minutes |
| House keeping surfaces | Floors, skinks, and walls; need to be cleaned only with detergent, hospital disinfectant or low level |
| Synthetic Phenols | EPA registered intermediate level hospital disinfectants Pro: Broad spectrum: can kill various microorganisms . Used on glass, metal, rubber, or plastic & used as a holding solution Con: Leave residual film and prepared daily |
| Sodium Hypochlorite | Household bleach Pro: fast-acting, economical, and intermediate level Con: Unstable, Prepared daily, Odor, Corrosive, irritating 1: 100 dilution for surface decontamination |
| levels of dilution for surface decontamination | 1-50 high level 1-10 High level with blood 1-100 is intermediate level 1-500 is low level |
| Not effective with blood and saliva | Alcohol |
| Immersion Disinfectants | Contact time: 6 to 30 hours (high level or sterilant) Con: Toxic Can kill all microorganism except endospores |
| Glutaraldehyde | EPA registered high level disinfectant and sterilant (10 hours) Pro: Used in immersion, heat sensitive items, long self life (28 days) Con: unsterile when unpackaged, Blue green discoloration, Harsh, corrosion, fumes, toxic |
| Chlorine Dioxide | Sterilant and disinfectant; rapid-acting environment (3 minutes) with disinfect or 6 hours for chemical sterilant Con: Prepared daily, corrosive, not penetrate organic debris |
| OPA | Ortho-Phthalaldehyde; high level disinfectant and sterilant Pro: disinfects in 12 min at room temp, sensitive people to glutaraldehyde, odorless, doesn't need mixing Con: expensive, stains fabrics blue/green, 30 hrs to sterilize |
| Immersion disinfectants | Ortho phthaladehyde, Glutaraldehyde, iodophors |
| HVE | HIGH VOLUME Evacuation; a suction device that cleans tubs and pipes by flushing with detergent or water weekly or monthly |
| Carpet and Cloth Furniture | Difficult to clean; use tile or nonporous hard surface CDC guideline: Avoid using carpeting and cloth-upholstered furnishing in dental operatories, laboratories, and instrument processing areas |
| Spills of blood and body fluids | CDC guideline: Clean spill of OPIMs and decontaminate the surface with EPA-registered hospital disinfectant with low level to intermediate activity depending on the size of the spill and surface pores (the amount of things they can contain) |
| Greener infection control | Reduce environmental impact of infection control products: Paper Digital patient records Digital Radiology Recyclable PPE Recyclable surface barriers EPA registered chemicals conserve water and water |
| Sterilization | process intended to kill all microorganism and is the highest level of microbial destruction |
| Classification of Patient care items | Critical, semi critical, and noncritical instruments |
| Critical instruments | Items used against soft tissue or bone Scalpel, surgical instrumentation, and any that comes in contact with blood and OPIMs |
| Semi critical instruments | Touch mucous membranes or oral tissue -> Cheeks and gums |
| noncritical instruments | Only touching skin |
| 7 steps of sterilization | 1. Transport 2. Clean 3. Package 4. Sterilize 5. Quality 6. Storage 7. Delivery |
| Process Indicators | Outside packaging. Single parameter; strips, tabs, and taps with heat sensitive chemicals that change colors when exposed to a certain temp. |
| Process integrators | Inside packaging. Multiparameter; Reacts to time, temperature, and the presence of steam |
| Does indicators state sterilization | no |
| Mechanical/Physical monitoring | Physically record Temp, time, pressure, water level, and packaging, |
| Chemical monitoring | Indicators & integrators. Uses sensitive chemicals that change color when exposed to high temperatures or combinations of time and temperature |
| Storage? | Clean supplies and instruments should be in closed or covered cabinets. |
| Sterilization Area | Linear, good air circulation, away from operatories and labs, large, no doors or windows, deep sink/control free, titles, and multiple outlets |
| Sterilant | agent used to destroy microorganisms; glutaraldehyde, ortho phthalahyde |
| biological monitoring | verifies sterilization with spore test |
| biological indicators | Spore test that contain harmless bacterial spores used to determine whether a sterilizer is operating. |
| Why is kitchen dishwasher not used | not FDA approved |
| Synthetic Phenols compounds | Used on multiple surface, broad spectrum, intermediate level, holding solution |
| Holding solution | keeps blood, saliva, soft to make easier to clean later |
| What is lubricant used for? | To stop from rusting, maintain proper opening, hinged instruments |
| Why are instruments packaged? | To maintain sterility |
| High level disinfectant | relatively short contact time and a sterilant when used with a prolonged contact time use: Semi critical items that cannot tolerate heat sterilization |
| Low level disinfectant | non tuberculocidal; used on housekeeping surfaces use: non critical items or surfaces that have been contaminated with blood or saliva |
| intermediate disinfectant | hospital disinfectant and tuberculocidal; destroys less resistant organisms use: noncritical items or surfaces |
| Workflow | single loop; Dirty to clean to sterile to storage |
| Contaminated area | contaminated items brought for precleaning |
| Cleaned area | Place where sterilized instruments are prepared |
| what needs to be on the Packaging | date and load number |
| Quality insurance | We are insuring that we have quality instruments for patients |
| 3 common forms of heat sterilization | Steam sterilization Chemical vapor Dry heat Ex: autoclave, static and forced air |
| Dry heat forced air | 190 C or 375 F for 12 min |
| Dry heat static air | 160 C or 320F for 60 min |
| Unsaturated chemical vapor | 132 C or 270 F for 20 min must be dry |
| Steam autoclave | 121C or 250F for 30 min |
| Flash sterilization (steam autoclave) | 132 C or 270 for 4 min |
| Four cycles for steam sterilizers (autoclave) | 1. Heat up cycle 2. Sterilizing cycle 3. Depressurization cycle 4. Drying cycle |
| Static air | lower heat and longer time. Hot air to rise inside the chambers and it is just there. |
| Forced air | higher hear, shorter time. Uses a fan to circulates heated air throughout the chamber |
| residual activity | Action after initial application |
| Sporicidal | killing spores |
| fungicidal | killing fungi |
| viricidal | killing viruses |
| Sterilization failures | improper: Cleaning, timing, temp, packaging, wet or punctured, overload, sterilization malfunction, poor quality assurance, no BIs |
| How to clean high speed hand pieces | Steam sterilization and chemicals vapor to clean. 10 to 20 sec to flush water, scrub exterior and oil it |
| Liquid chemical sterilant con | It can not be biologic monitored Most be rinsed with sterile water 10 hours |
| Flash sterilization cons | unsterile = unpackage, most be package before sterilization |
| wicking | process of bacteria & fungi penetrate et sterilization paper |
| Single use items | patient napkins syringes Syringe needles Face mask Surface barriers Gauze Gloves |
| Examples of Barriers | head rest pens control buttons light handles switches x-ray control light curing air-water handles |
| event regulated packaging | packing to remain sterile |
| Chemicals used for chemical vapor sterilization | alcohol, formaldehyde, ketone |
| ultrasonic cleaner | Sound waves traveled though an enzymatic liquid that create cavitation bubbles from the heat and pressure which would hit the debris and bioburden from the instrument resulting in imposion |
| How does an assistant know how to mix, and use disinfectants and sterilant? | By reading the manufacture’s recommendations |
| Immersion or cold sterile | Disinfectant used for soaking heat-sensitive instruments |
| Contact Surface | Directly touched during treatment or procedures for example, units, containers, phones, light handles, chair, or pens |
| Methods of precleaning | handscrubbing, thermal washer or detergent, and ultrasonic cleaner |
| Steps to use an Autoclave | 1. Water in chamber 2. fills 3. heat up 4. steam raises through packet 5. Dry 6. Quality 7. Store 8. Delivery |
Created by:
DentalStudent
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