|
| A) | 1981. | ||
| B) | 1991. | ||
| C) | 2003. | ||
| D) | 2009. |
In 2009, Cal/OSHA adopted the nation's first aerosol transmissible disease (ATD) standard, which remains in effect today. The standard is designed to protect healthcare workers from diseases spread by an airborne or droplet route. The ATD standard requires employers in health care to develop exposure control procedures and train employees to follow those procedures [4]. Basic exposure precautions, such as source screening, infection control, hand hygiene, and cleaning and decontamination procedures, are a fundamental part of the standard. Employees must be included in the periodic review and assessment of these procedures.
| A) | do not treat patients with identified ATD cases. | ||
| B) | treat patients with suspected or confirmed illnesses that require Airborne or Droplet Precautions. | ||
| C) | refrain from performing aerosol-generating dental procedures on patients identified as a possible ATD transmission risk. | ||
| D) | All of the above |
According to the California ATD Standard, California dental offices whose patients have suspected or confirmed illnesses that require Airborne or Droplet Precautions, such as tuberculosis (TB) or other respiratory illnesses, must comply with the ATD standards [4]. Key points include:
Dental employees must be trained to screen patients for ATDs.
The screening process must be described in a written office procedure.
Screening must be consistently implemented.
Elective dental treatment should be deferred until the patient is non- infectious for TB or other diseases requiring Airborne or Droplet Precautions.
| A) | 0.3%. | ||
| B) | 1.8%. | ||
| C) | 3%. | ||
| D) | 18%. |
Hepatitis C is transmitted primarily through percutaneous exposure to infected blood. The average risk for infection after a needlestick or cut exposure to hepatitis C virus-infected blood is approximately 1.8%. The risk following a blood exposure to the eye, nose, or mouth is unknown but is believed to be very small; however, hepatitis C virus infection from blood splashes to the eye has been reported. There also has been a report of hepatitis C virus transmission that may have resulted from exposure to nonintact skin, but there is no known risk from exposure to intact skin. Documented transmission of hepatitis C or hepatitis B virus has resulted from using the same syringe or vial to administer medication to more than one patient, even if the needle was changed [5,10].
| A) | Splatter | ||
| B) | Droplets | ||
| C) | Aerosols | ||
| D) | Unwashed hands |
Aerosols, droplets (produced by the respiratory tract), and splatter contaminated with blood and bacteria are produced during many dental procedures. Devices such as dental handpieces, ultrasonic and sonic scalers, air polishers, air-water syringes, and air abrasion units produce visible aerosol clouds and possible airborne contamination. Splatter generated by dental procedures such as drilling is a primary risk for transmission of bloodborne pathogens. In general, because of their smaller size, aerosols pose the greatest risk for airborne infection [9].
| A) | Blood | ||
| B) | Sweat | ||
| C) | Intact skin | ||
| D) | Mucous membranes |
The gradual acceptance of various infection prevention standards has changed the way we work in the provision of dental care. The DBC defines Standard Precautions as "a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered" [9]. The DBC mandates that Standard Precautions must be practiced in the care of all patients, and all body fluids, except sweat, are considered potentially infectious [9]. The use of Standard Precautions reduces the risk of infection to staff and patients and ensures that the right precautions are used with both known and unknown carriers of diseases due to bloodborne pathogens. Standard Precautions apply to contact with blood, intact or nonintact skin, mucous membranes, and all bodily fluids, secretions, and excretions (except sweat), regardless of whether they contain blood. A central tenet of Standard Precautions is to consider all patients to be potentially infected with a bloodborne pathogen. Saliva has always been considered a potentially infectious material in dental infection control; thus, no operational difference exists in clinical dental practice between Universal Precautions and Standard Precautions. For organisms other than bloodborne pathogens, early identification and prompt isolation are critical.
| A) | without removal all day for all patients. | ||
| B) | only for invasive procedures, such as surgery. | ||
| C) | for all forms of patient contact, regardless of risk. | ||
| D) | when blood or other potentially infectious material exposures are likely. |
Procedures that can generate splashes or sprays of blood, bodily fluids, secretions, excretions, or chemical agents require either a face shield (disposable or reusable) or mask and goggles. The wearing of masks, eye protection, and face shields in specified circumstances (when blood or OPIM exposures are likely to occur) is mandated by the OSHA Bloodborne Pathogens Standard. Sterile barriers for invasive procedures and masks or respirators for the prevention of droplet contamination are also required [2].
| A) | Vinyl | ||
| B) | Latex | ||
| C) | Nitrile | ||
| D) | Surgical gloves |
Studies have repeatedly shown that vinyl gloves have higher failure rates than latex or nitrile gloves. For this reason, either latex or nitrile gloves are preferable for clinical procedures that require manual dexterity or those involving more than brief patient contact. Heavier, reusable utility gloves should be used for non-patient-care activities, such as handling or cleaning contaminated equipment or surfaces, handling chemicals, or disinfecting contaminated tools [9,18].
| A) | No more than 15 seconds | ||
| B) | At least 20 seconds | ||
| C) | At least 90 seconds | ||
| D) | Exactly 2 minutes |
California regulations require that all DHCP wear reusable or disposable protective attire when their clothing or skin is likely to be exposed to aerosol spray or splashing or spattering of blood, OPIM, or chemicals and germicidal agents. Gowns must be changed daily or between patients if they become moist or visibly soiled. All PPE used during patient care shall be removed when leaving laboratories or areas of patient care activities. Reusable gowns should be laundered in accordance with Cal/OSHA Bloodborne Pathogens Standards. In addition, gowns should be worn for disinfection, sterilization, and housekeeping procedures involving the use of germicides or handling contaminated items [9].
| A) | Extracted teeth | ||
| B) | Contaminated sharp items | ||
| C) | Gauze saturated with blood | ||
| D) | Disposable gloves, masks, and gowns |
Regulated medical waste accounts for only 9% to 15% of total waste in hospitals and 1% to 2% of total waste in dental offices [10]. Examples of regulated waste found in dental practice settings are solid waste soaked or saturated with blood or saliva (e.g., gauze saturated with blood after surgery), extracted teeth, surgically removed hard and soft tissues, and contaminated sharp items, such as needles, scalpel blades, and wires [10]. General medical waste, including used gloves, masks, gowns, and lightly soiled gauze or cotton rolls, may be disposed of with ordinary waste.
| A) | HIV. | ||
| B) | hepatitis B. | ||
| C) | hepatitis C. | ||
| D) | Both A and B |
Postexposure prophylaxis (PEP) involves the provision of medications to someone who has had a substantial exposure, usually to blood, in order to reduce the likelihood of infection. PEP is available for HIV and hepatitis B virus. Although there is no PEP recommended for hepatitis C virus, limited data indicate that antiviral therapy might be beneficial when started early in the course of infection [28]. For employees who have not received the hepatitis B vaccine series, the vaccine (and in some circumstances hepatitis B immunoglobulin) should be offered as soon as possible (within seven days) after the exposure incident. The effectiveness of hepatitis B immunoglobulin administered more than seven days after exposure is unknown. PEP has been the standard of care for healthcare providers with substantial occupational exposures since 1996 and must be provided in accordance with the recommendations of the U.S. Public Health Service [28].