|
| A) | 1981. | ||
| B) | 1991. | ||
| C) | 2003. | ||
| D) | 2009. |
Legal issues first began to impact infection control practices at the beginning of the acquired immunodeficiency syndrome (AIDS) epidemic in the early 1980s. The need to protect healthcare workers from bloodborne exposures resulted in the publication of the Bloodborne Pathogens Standard by OSHA in 1991 [3].
| A) | education. | ||
| B) | safe work practices. | ||
| C) | barriers to exposure. | ||
| D) | All of the above |
The OSHA Bloodborne Pathogens Standard requires that every healthcare worker who may have contact on the job with blood or other bodily fluids must receive specific annual education, which includes instruction in the basics of infection control and prevention. Training must also cover bloodborne pathogens, modes of transmission, the proper use of needles, and Transmission-Based Precautions [2,3].
| 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) | Plague | ||
| B) | COVID | ||
| C) | Influenza | ||
| D) | All of the above |
Diseases known to spread by aerosols or droplet include:
TB
Pneumonic Yersinia pestis infection (plague)
Influenza
Legionellosis (Legionnaires disease)
Measles
Chickenpox
Disseminated shingles
Severe acute respiratory syndrome and coronavirus (SARS and COVID)
| A) | Blood | ||
| B) | Sweat | ||
| C) | Intact skin | ||
| D) | Mucous membranes |
Since the 1980s, regulatory and legislative activity has focused on implementing a hierarchy of prevention and control measures to improve infection control in healthcare settings. The gradual acceptance of various infection prevention standards has changed the way we work in the provision of dental care. 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) | change gloves only if they become heavily soiled. | ||
| B) | reuse devices as much as possible to reduce waste. | ||
| C) | isolate all patients regardless of the disease/condition. | ||
| D) | consider all patients to be potentially infected with a bloodborne pathogen. |
Since the 1980s, regulatory and legislative activity has focused on implementing a hierarchy of prevention and control measures to improve infection control in healthcare settings. The gradual acceptance of various infection prevention standards has changed the way we work in the provision of dental care. 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) | Surgeical 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 |
Contaminated needles and other contaminated sharps should not be bent, recapped, or removed unless the employer can demonstrate that there is no alternative or that such action is required by a specific procedure. Necessary bending, recapping, or needle removal must be accomplished through the use of a mechanical device or a one-handed scoop technique. Shearing or breaking of contaminated needles is prohibited. Immediately, or as soon as possible after use, contaminated reusable sharps (e.g., scalpels, dental knives) must be placed in appropriate containers until properly reprocessed. These containers must be [9,10]:
Puncture resistant
Labeled or color-coded
Leak-proof on the sides and bottom
Maintained in accordance with OSHA requirements for reusable sharps
Designed so personnel are not required to reach by hand into the container
Located as close as possible to the point of use
| A) | Extracted teeth | ||
| B) | Contaminated sharp items | ||
| C) | Gauze saturated with blood | ||
| D) | Disposable gloves, masks, and gowns |
To ensure safe injection practices, use aseptic technique throughout all aspects of injection preparation and administration. Aseptic technique involves the handling, preparation, and storage of medications in a manner that prevents microbial contamination. It also applies to the handling of all supplies used for injections and infusions. To avoid contamination, medications should be drawn in a clean medication preparation area. Any item that may have come in contact with blood or OPIM should be kept separate from medications. In addition, eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure. Food and drink should not be kept in refrigerators, freezers, shelves, or cabinets or on countertops where blood or OPIM is present.
| A) | Shearing or breaking of contaminated needles is preferred. | ||
| B) | Contaminated reusable sharps should be placed in appropriate containers once per hour. | ||
| C) | All contaminated needles and other contaminated sharps should be bent, recapped, or removed. | ||
| D) | Necessary bending, recapping, or needle removal must be accomplished through the use of a mechanical device or a one-handed scoop technique. |
Cleaning is defined as the removal of visible soil (organic and inorganic material) debris and OPIM from objects and surfaces; normally, it is accomplished manually or mechanically using water with detergents or enzymatic products [9]. Cleaning must precede any disinfection or sterilization process.
| A) | chairside. | ||
| B) | in a clean medication preparation area. | ||
| C) | only while wearing a gown and face shield. | ||
| D) | by designated "clean" individuals who have been tested and cleared. |
Patient-care items (e.g., dental instruments, devices, and equipment) are categorized using the Spaulding classification system as critical, semicritical, or noncritical, depending on the potential risk for infection associated with their intended use.
| A) | the removal of visible soil (organic and inorganic) debris and OPIM from objects and surfaces. | ||
| B) | a process that destroys vegetative bacteria and most fungi and viruses. | ||
| C) | a process that eliminates many or all pathogenic micro-organisms, except bacterial spores, on inanimate objects. | ||
| D) | a process that destroys or eliminates all forms of microbial life and is carried out in healthcare facilities by physical or chemical methods. |
Manufactured dental units are now engineered to be anti-retractive to prevent patient material, such as oral micro-organisms, blood, and saliva, from entering a dental water system during treatment. These dental unit lines and devices should be purged with air or flushed with water at the beginning of the clinic day for at least two minutes prior to attaching handpieces, scalers, air water syringe tips, or other devices [9,10]. The dental unit lines and devices should be flushed between each patient for a minimum of 20 seconds [9].
| A) | contact only intact skin. | ||
| B) | touch intact mucous membranes. | ||
| C) | enter sterile spaces, such as soft tissue or bone. | ||
| D) | None of the above |
Federal, state, and local guidelines and regulations specify the categories of medical waste subject to regulation and outline the requirements associated with treatment and disposal. Regulated medical waste is defined as [10]:
Liquid or semi-liquid blood or OPIM
Contaminated items that would release blood or OPIM in a liquid or semi-liquid state if compressed
Items that are caked with dried blood or OPIM capable of releasing these materials during handling
Contaminated sharps (e.g., needles, burs, scalpel blades, endodontic files)
Pathologic and microbiologic wastes containing blood or OPIM
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) | the amount of blood involved. | ||
| B) | the amount of contagion present in the source person's blood. | ||
| C) | whether the exposure was to nonintact skin or mucous membranes. | ||
| D) | All of the above |
An occupational exposure is defined as a percutaneous injury or contact of mucous membrane or nonintact skin with blood, tissue, or OPIM, most commonly a needlestick injury. The risk of infection depends on several factors, including [27]:
Whether the exposure was from a hollow-bore needle or other sharp instrument
Whether the exposure was to nonintact skin or mucous membranes
The amount of blood involved
The amount of contagion present in the source person's blood
| 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].
| A) | Patients with symptoms of TB should be identified by screening. | ||
| B) | Dental treatment for patients with symptoms of TB should be deferred until their symptoms are mild. | ||
| C) | The patients with potentially active TB should be promptly referred to an appropriate medical setting for evaluation. | ||
| D) | The CDC recommends that all dental care providers be screened for TB upon hire, using either a tuberculin skin test or blood test. |
To prevent the transmission of Mycobacterium tuberculosis in dental care settings, infection-control policies should be developed based on the community TB risk assessment and reviewed annually. The policies should include appropriate screening for latent or active TB disease in dental care providers, education about the risk for TB transmission, and provisions for detection and management of patients who have suspected or confirmed TB disease. The CDC recommends that all dental care providers be screened for TB upon hire, using either a tuberculin skin test or blood test [10].
Patients with symptoms of TB should be identified by screening; dental treatment should be deferred until active TB has been ruled out or the patient is no longer infectious following treatment. The potentially active TB patient should be promptly referred to an appropriate medical setting for evaluation of possible infectiousness and should be kept in the dental care setting only long enough to arrange for referral. Standard Precautions are not sufficient to prevent transmission of active TB [24].
A diagnosis of active respiratory TB should be considered for any patient with the following symptoms:
Coughing for more than three weeks
Loss of appetite
Unexplained weight loss
Night sweats
Bloody sputum or hemoptysis
Hoarseness
Fever
Fatigue
Chest pain
A person with latent TB (positive skin test and no symptoms) can be treated in a dental office using standard infection control precautions [26]. This person has no symptoms and cannot transmit TB to others as there are no spores in his or her sputum.
The American Dental Association recommends that all patients be asked about any history of TB or exposure to TB, including signs and symptoms and medical conditions that increase their risk for TB disease. The Health History Form, developed by the U.S. Department of Health and Human Services, can be used to ask these questions.
If a patient with suspected or confirmed infectious TB disease requires urgent dental care, that care should be provided in a setting that meets the requirements for state, local, and employee standards for airborne infection isolation. Respiratory protection (with a fitted N95 disposable respirator) should be used while performing procedures on such patients. Standard surgical masks are not designed to protect against TB transmission [4,26].
| A) | annually. | ||
| B) | as a single dose. | ||
| C) | in a series of three injections. | ||
| D) | once and followed by a booster after 10 years. |
The hepatitis B vaccine is given in a series of three injections at 0, 1, and 6 months. If one of the injections is missed, the series does not need to be restarted. The CDC recommends if the series is interrupted, the second or third dose should be administered as soon as possible; the second and third doses should be separated by an interval of at least eight weeks [24]. No booster is necessary. Follow-up serologic testing two months after vaccination (to ensure efficacy) is recommended. The provision of employer-supplied hepatitis B vaccination may be delayed until after probable exposure for employees whose sole exposure risk is the provision of first aid.
| A) | for unlicensed staff and personnel only. | ||
| B) | only once when beginning employment at a facility. | ||
| C) | to be presented by a physician or infectious disease specialist. | ||
| D) | annually or when changes in procedures or tasks affecting occupational exposure occur. |
Dental personnel should also fulfill all federal and state requirements for infection control training. New employees, or employees being transferred into jobs involving tasks or activities with potential exposure to blood or OPIM, must receive bloodborne pathogen training before assignment to tasks in which an occupational exposure may occur. Retraining is required annually or when changes in procedures or tasks affecting occupational exposure occur. Employees should be provided access to a qualified trainer to answer questions during the training session [9,10].