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TIENT M N GEMENT LEGEND

opic

ards opic

ards

behavioral sciences

1 19

OSHA 51 76

infection control

20 50

public he lth 77 99

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BS

Arrange the following steps of the educational process in correct order.

1.

expressing needs

2.

stimulating motivation

3.

recognizing needs

4.

evaluating results

5.

reinforcing learning

6.

setting goals

7.

acting to achieve goals

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3 1 2 6 7 5 4

Step 4

setting goals

short-range or long-range guides to ac-

tivity

must be meaningful, attractive & at-

tainable

Step 5


activity is needed for learning

must be directed at spec ific goals

Step 6


review repetition aid in learning re-

tention

Step 7

evaluating results

aid in judging what patient has learned

aid in determining how effective

dentist's teaching has been

can help clarify or redefine goals

Although each learning situation will not fol-

low these steps in exact sequence, most situa-

tions will include all of these seven steps in

some form:

recognizing needs

expressing needs


setting goals



evaluating results

Step 1

recognizing needs

dentist recognizes educational needs as treat-

ment needs are determined

dentist helps patient recognize needs

Step 2

expressing needs

dentist records educational needs

dentist helps patient state needs

Step 3


motivation arouses & maintains interest

dentist may appeal to inner needs or use arti-

ficial stimuli

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BS

Identify each of the following statements that are true concerning needs and

learning.

needs are driving forces that prompt a person to act

the process of learning is continuous

learning occurs as a person attempts to satisfy needs

expressing needs helps to pinpoint them for the patient and dentist

recording educational needs can be as important as recording treatment needs

all of the above statements are true

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all of the above statements are true

Needs &

Learning

needs & goals may provide motiva-

tion

motivation arouses & maintains in-

terest

motivation may be artificial or built-

in

patients rarely learn without motiva-

tion

learning is continuous and occurs

when a person attempts to satisfy

needs

motivation stimulates a person to act

on needs

motivation is a fundamental part of

every learning situation

short-range goals are less remote &

more easily attained

goals should be attractive & attain-

able in order to be meaningful

goal-directed activity is necessary

for learning

Assessment of behavior

in order to change behavior, assess-

ment of the behavior is needed

how to assess behavior

- identify problem

- consider motivation

- consider readiness

- consider willingness to change

- consider ability to change

- collect baseline data

-

reassess behavior after imple-

memtation

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BS

Most researchers believe that changes in behavior are a prerequisite to

changes in attitude.

Behavior can be defined as a determined, purposeful unit of activity.

both statements are true

both statements are false

the first statement is true, the second is false

the first statement is false, the second is true

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Behavior

changes in behavior are a prerequisite

to changes in attitude

behavior is defined as a determined,

purposefu l unit of activity

-

determined

the assumption that the behavior

is lawful & has determinants

-

purposeful

the assumption that the

behavior is goal-oriented, that it

seeks to achieve positive and re-

duce negative need or motivated

states

-

unit of activity

what a person does that can be re-

ported or described as discrete

elements

Behavior examples

a common behavior for a dentist

is

to observe that a problem exists

(e.g., tooth decay)

a common behavior for a

patient

is to

avoid the dentist

even though a

need exists & treatment is required

both of the above examples mee t the

criteria of being determined, pur-

poseful units of human activity

Behavior management

as described by the ADA, tech-

niques or therapies used to alter or

control the actions of a patient who

is receiving dental treatment; exam-

ples include education or anxiety

relief techniques

the means by w hich the dental

health team effectively and effici-

ently performs treatment for the

patient, and, at the same time, instills

a positive attitude

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BS

The principal nonverbal cue that two or more persons can use to regulate ver-

bal communication is:

posture

facial expression

eye contact

gestures

proximity

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eye contact

Communication

the process by which information is

exchanged between 2 or more persons

communication is essential in the

dentist-patient relationship

acceptable verbal non-verbal

communication varies with the age, sex,

ethnicity and culture of the patient

communication is both

verbal

non-verbal; also includes listening

Verbal communication

involves use of language

choice of words is important

delivery of speech is important

(fast vs. slow, loud vs. soft)

Non-verbal communication

involves use of body language

conveyed by eye contact, posture, body

movement, hand gestures & expressions

Empathy

& Rapport

empathy

is the ability to experience the

feelings of another person

rapport

is a mutual sense of trust and

openness between individuals

Listening

receiving understanding messages

a good listener shows attention

interest

listening techniques include

-

paraphrasing

(repeating in own

words)

- interpretation

(identify ing the

underlying reason)

-

preparation

(allowing time for dis-

cussion & eliminating distractions)

Eye contact

is the

principle non-verbal cue used to

regulate verbal comm unication

when listening to a patient, a dentist

should maintain eye contact

a dentist should engage the patient's

eyes as often as is comfortable for both

parties

Facilitative skills

facilitative skills make comm unication

easier and help to develop trust

include encouraging patient questions,

answering questions, responding to re-

quests & communicating with warmth

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BS

Which term describes a behavioral response that operates by the simple

process of association of one stimulus w ith another?

operant conditioning

classical conditioning

observational learning

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Classical conditioning

a

stimulus

leads to a response

a.k.a. pavlovian or respondent condi-

tioning

a process of behavior modification by

which a subject comes to respond in a

desired manner to a previously neutral

stimulus that has been repeatedly pre-

sented along with an unconditioned

stimulus that elicits the desired response

Operant conditioning

process of behavior modification in

which the likelihood of a specific be-

havior is increased or decreased through

positive or negative reinforcement each

time the behavior is exhibited, so that

the subject comes to associate the pleas-

ure or displeasure of the reinforcement

with the behavior

four types:

positive reinforcement,

negative reinforcement, punishment

&

extinction


Observational learning

or modeling, is a type of learning that

occurs as a function of observing, re-

taining and replicating behavior exe-

cuted by others in a social context

two phases: acquisition of the behavior

& performance of the behavior

Example

Classical conditioning

before conditioning,

a painful injection

(unconditioned stimulus)

would elicit a

fear reaction

(unconditioned response)

during conditioning, the dentist with

syringe (neutral stimulus)

is linked

with the painful injection and elicits a

fear reaction

after conditioning, the dentist with a

syringe

(conditioned stimulus)

will en-

courage a fear reaction

(conditioned

response)

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BS

Which type of aggression is an act of hostility unnecessary for self-protection

or preservation that is d irected toward an external object or person?

destructive aggression

inward aggression

constructive aggression

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Destructive aggression

act of

hostility

unnecessary for self-protection or

preservation

directed toward external object or

person

Constructive aggression

act of

self-assertiveness

in response to a threatening action

for purpose of self-protection and

preservation

Inward aggression

destructive behavior

directed

against oneself

destructive aggression

Aggressive personality

personality with behavior patterns

characterized by irritability,

tantrums, destructiveness or vio-

lence in response to frustration

aggressive personalities are individ-

uals whose overall style of inter-

acting involves

considerable, per-

sistent, maladaptive aggression

expressed in a variety of ways and

in a w ide range of circumstances

characteristics include the

following:

-

seek a superior position in any

relationship or encounter

-

abhor subm ission

- self-advancing at expense of

others

-

have d isdain for truth

-

lack internal brakes

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BS

Match the type of question on the left to the correct example on the right.

direct

1

ou're not afraid of needles, are you?

probing

.

ow are you doing with brushing flossing?

laundry list

.

ow are you?

open-ended

.

s it easier to hold the brush this way?

leading

.

hat else did you notice about your gums?

facilitating

.

s the pain sharp, dull, or throbbing?


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4,5,6,2,1,3

#

Type

Example

4 direct

question

Is it easier to hold the brush this way?

direct questions asked for a specific bit of information

C

probing

question

What else did you notice about your gums?

probing questions ask for more specific information that the

Patient offers spontaneously

6

laundry list

question

Is the

pain sharp, dull, or throbbing?

laundry list questions give the patient a list of choices

2

open-ended

question

How are you doing with brushing &

flossing?

open-ended questions request information in the patient's

own words and specify a content area

leading

question

You're not

afraid of needles, are you?

leading questions

entice a patient to answer in a

specific way;

leading questions should not he used with patients

3

facilitating

question

How are

you?

facilitating questions encourage the patient to say

more

without specifying an area or topic

Comm unication hints

ask questions/never presume

carefully inquire/never interrogate

be specific/avoid being vague or abstract

provide information educate/instead of giving advice

provide accurate information/fully discuss concerns & offer support

exhibit professionalism/it is an essential component of dentist-patient relationships

exhibit confidence, care warmth

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BS

Which one of the following types of patients is usually considered to be the

most difficult?

the know-it-all patient

the anxious patient

the shy patient

the talkative patient

the stubborn patient

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Anxious patient

is the

most difficult patient to manage

in dentistry

anxiety is defined as unpleasant nega-

tive emotional state

without identifi-

able cause

anxiety is the feeling of apprehension,

uneasiness, agitation or uncertainty re-

sulting from the anticipation of a threat

of danger whose source is unknown

most anxious patients have had a trau-

matic experience in a healthcare setting

anxiety causes patients to avoid dental

treatment & interferes with treatment

anxiety may cause problems with pain

Indicators of anxiety

affective patient is emotional, talks a

lot, talks fast

cognitive

patient is not listening &

does not follow instructions

motor

increase in body movement

& muscle tension

psychological increase in heart rate,

respiration, sweating & dry mouth

the anxious patient

Management of the

anxious patient

be friendly

be calm

& patient

build trust; use

empathy & respect

create a relaxing environment

make the patient feel welcome

convey a sincere concern for patient's

well-being

explain procedures before doing them

encourage the patient

to ask questions

use understandable words

pay attention to what the patient is

saying

and

how it is said

forewarn patient about possible pain

watch a patient's eyes eyebrows to

see if the patient is feeling pain

give patient control by giving option

to raise your hand if you feel any-

thing

provide

moral support

during proce-

dure

use headphones or TV as a

distraction

use SUDS (the subjective unit of dis-

tress scale) to assess the level of pat-

ient anxiety

throughout treatment; ask

the patient to rate their level of anxiety

from 0 none) to 10 (highest level)

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BS

Which type of parent has an excessively demanding attitude?

neglectful parent

overprotective parent

manipulative parent

hostile parent


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Manipulative parent

is demanding

demands usually start with appoint-

ment times

may try to provide diagnosis and di-

rect the course of treatment

Overprotective parent

insists on remaining with child in

operatory regardless of situation or

age of child

usually has a child who is shy,

docile and manageable

by pointing out the lack of appre-

hension of the child and the impor-

tance of establishing a one-on-one

relationship between the dentist and

child, this will usually satisfy most

overprotective parents

manipulative parent

Hostile parent

questions the necessity of treatment

questions stem from d istrust and not

curiosity

Neglectful parent

fails to keep appointments

misses recall visits

does not oversee oral hygiene of

child

the uncooperative child

may be described as stubborn or

spoiled & is usually a child with

defiant behavior

may be hostile or angry; with this

child, the dentist must try to iden-

tify the underlying source of these

emotions

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BS

Dental fear is an unpleasant m ental, emotional or physiologic sensation de-

rived from a specific dental related stimulus.

Someone who experiences fear w ill not necessarily be anticipating a negative

event, their response will occur at the moment the unpleasant event e.g.,

pain

occurs.





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Dental fear

refers to the fear of den tistry and

receiving dental care

is defined as an

unpleasant

mental,

emotional or physiologic sensation

derived from a specific dental-re-

lated stimulus

elements common to all fears

- fear of unknown

- fear of pain/bod ily injury

- fear of loss of control

-

fear of helplessness dependency

understanding the above elements of

fear allows for effective planning for

the treatment of fearful anxious

patients

when evaluating a patient's dental

fear, take note of

what the patient

says

and how

the patient behaves

appears

while in

the dental office

Dental anxiety

is defined as a non-specific uneasiness,

apprehension or negative thoughts about

what may happen during a dental

appointment

patients who are fearful or anxious

avoid dental appointments

Stress

is defined as the

body's reaction to a

change that requires a physical, men-

tal or emotional adjustment or

response

stress can be caused by physical, emo-

tional or psychological influences

Stress, anxiety,

&

fear

of stress, fear & anxiety ---

stress is

associated w ith a response

stress

is the body's response to danger

fear

is a feeling of uneasiness in

response to imminent danger

anxiety is a feeling of uneasiness when

no danger is present

the interaction of the intensity of an

emotional response with threat appraisal

determines

the

behavior that w ill follow

--- whether to show up to a dental

appointment, submit to an injection,

accept the need for extraction etc.

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BS

A 32-year-old woman visits the dental office for a routine dental cleaning. The

dental hygienist discovers that the patient has not been following the hom e

care program that was recomm ended six months ago. The hygienist believes

that the problem is not a skills deficiency but a management deficiency in-

stead. What is the best course of action for the hygienist?

accept that the patient might never change her habits

provide the patient with a pamphlet on periodontal disease

collaborate w ith the dentist to determine the course of action

go over brushing & flossing techniques

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collaborate with the dentist to determine course of action

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Motivating the patient

reviewing home care instructions will

not solve the problem, since this is

not

a skills

deficiency;

a plan must be

determined to motivate this patient

if the patient knows what to do, and

how to do it, members of the dental

team must collaborate and find a way to

motivate the patient

to embrace the

recommended home care regimen

Stages of change model (SCM)

1 pre-contemplation

(no admission of

problem )

2 contemplation (considering problem

& change)

3 preparation

(getting ready to change)

4

action / willpower

(changing

behavior)

5

maintenance

(maintain behavior

change)

6 relapse

(abandon change)

M otivating pat ients

use good communication techniques

express

empathy and engage the

patient

identify the patient's current oral

hygiene status and the agree on

achievable goals for improvement

avoid arguing;

gently challenge the

thought that underlies the behavior

support self-eff icacy;

encourage the

patient to believe that they can change

the behavior and they will achieve their

desired goals

develop a partnership

with the patient

consult your patient

& elicit their

views ,

the patient will feel that their

voice is heard & their needs are

considered

ultimately, the

patient must believe

that the decision to follow a partic-

ular course of action is theirs

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Behavior shaping is also called:

aversive conditioning

successive approximation

restraining

hypnodontics

BS

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successive approximation

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Behavior shaping

a.k.a. successive approximation

shaping

is used when an existing

behavior needs to be changed into a

more appropriate or new behavior

the strategy involves use of reinforce-

ment of

successive approximations of

a desired behavior

immediate positive reinforcement

includes verbal praise and nonverbal

indications of approval

each approximate desired behavior that

is demonstrated is reinforced, while

behaviors that are not approximations of

the desired behavior are not reinforced

examples

of behavior shaping methods

include tell-show-do and modeling

Aversive conditioning

using a punishment or something u

pleasant to stop an unwanted behavior

like all forms of punishment, it may

work but is less effective than reinforc-

ement

an example is the HOME technique

(Hand-Over-Mouth)

Hypnodontics

the application of hypnosis and

controlled suggestion in dentistry

Restraining

a dental restraint

is defined as any

form of restriction of movement by a

patient in the dental environment

a dental restraint includes the following

characteristics :

-

short duration

- limits movement of head body

- prevents injury to the patient and/or

dental staff during the procedure

- provides physical control to allow

dental staff to complete treatment

- is usually well tolerated by patient

an example is

papoose board

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BS

Which one of the following is a conceptual framework that describes a per-

son s health behavior as an expression of his or her health beliefs?

health maintenance model

health role model

health belief model

leading circle model

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he lth belief m odel

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MODIFYING

Age, sex, ethnicity

Personality

So do economics

Knowledge

Health belief model

(HBM)

is a psychological model that a

attempts to explain and predict

health behaviors

by

focusing on

the attitudes beliefs of indivi-

duals

developed in the 1950s by social

psychologists working in the U.S.

Public Health Services

INDIVIDUAL PERCEPTIONS

Perceived susceptibilty/

seriousness of disease

developed in response to the failure

of a free tuberculosis

(TB) health

screening program

has been adapted to explore a

variety of long- and short-term

health behaviors, including sexua l

risk behaviors and the transmission

of HIV/AIDS

suggests that individuals act to

prevent disease only when they are

susceptible to it

FACTORS

IKELIHOOD OF ACTION

Perceived bene Its

versus

barriers to behavioural

change

Likelihood of be

change

erceived threat of

disease

Cues to action

education

s yrrpto rrts

media into ration

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Behavior modification is also known as:

behavior evaluation

behavior therapy

behavior shaping

behavior training

BS

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behavior therapy

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Behavior modification

a.k.a. behavior therapy

type of psychotherapy that attempts to

modify observable, maladjusted patterns

of behavior by the substitution of a new

response to a given stimulus

mostly used in pediatric dentistry

Techniques

for modifying behavior




modeling

systemic desensitization


a.k.a. pavlovian or respondent condition-

ing

a naturally occurring

stimulus is paired

with a

response

-

next, a previously neutral stimulus is

paired with the naturally occurring

stimulus

- eventually, the previously neutral stim-

ulus comes to evoke the response with

out the presence of the naturally occur-

ring stimulus

the two elements are known as condi-

tioned stimulus & conditioned response


a.k.a. instrumental conditioning

a method of learning

that occurs

through rewards & punishments for

behavior

positive

&

negative reinforcement

strengthen behavior

punishment & extinction

weaken

behavior


using a

punishment or something

unpleasant to stop unwanted behavior

is less effective than reinforcement

an example is the HO ME technique

(Hand-Over-Mouth)

modeling

form of learning where individuals

ascertain how to act by observing

another individual

systemic desensitization

therapy for phobias, fears & aversions

premise is to reduce a person's anxiety

responses through counter conditioning

teaches a

person to replace

the feelings

of anxiety with

feelings of relaxation

when the object or behavior is present

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BS

Five techniques are used to facilitate patient dialogue: em pathy, respect, re-

flection, interpretation and silence.

Reflection is the explanation and understanding of the patient s com ments.





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Facilitation

Five techniques are used to facilitate patient

dialogue: empathy,

respect, reflection, in-

terpretation

and silence.

empathy

is the ability to accurately understand

the patient s feelings

empathy also involves being able to

communicate this understanding

when properly done, empathy increases

rapport, encourages expression and

promotes trust

the dentist must actively listen and con-

centrate on what the patient is trying to

say both verbally and nonverbal ly

when communicating empathically, it

is helpful to respond with the same

feeling as the patient's statement

respect

respect promotes rapport, open

expression trust

respect is communicated via the way

the dentist works with the patient

communicate respect by regarding each

patient as an individual

reflection

is a

response that restates or

repeats a segment of the patient s

statement

reflection encourages the patient to

continue comm unicating

reflection is a subtle way of asking a

question and is less intimidating than

asking a direct question

interpretation

is the dentist's explanation and

understanding of the patient s

comments

an interpretation may stimulate dialogue

by requiring the patient to agree or to

disagree with the statement

an interpretation does not need to be

correct in order to stimulate dialogue

silence

is used

to facilitate dialogue

by

stimulating the patient to comment

and therefore break the silence

when using silence, it is very important

to communicate interest by nodding the

head yes , leaning toward the patient,

and/or maintaining eye contact

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BS

Each of the following are ways to communicate effectively with patients

EXCEPT

one. Which one is the

EXCEPTION?

describe

evaluate

be specific

be responsive

pay attention

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evaluate

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Do

Don't

Describe

Evaluate

Be specific

Be general

Be responsive

Be evasive

Pat attention Be distracted

Listen carefully Interrupt

Make eye contact

Let eyes wander

Use lay terms

Use jargon

Lean forward

Lean back

Use gestures Fold arms

Use expression

Show disinterest

Ask questions

Presume

Suggestions

from Patients

How to Reduce Anxiety

Prevent pain

Be reassuring

Have a calm demeanor

Provide moral support

Work efficiently

Be friendly

Communications Effectively

with Patients

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BS

Each o f the following are considered to be aversive conditions of interaction

between the dentist arid patient

EXCEPT

one. Which one is the

EXCEPTION?

psychophysiological reactions

stress, anxiety & fear

preventive oral health behavior

pain

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Aversive conditions

any negative condition to which a per-

son will learn to make a response to

avoid it

the dentist-patient interaction

seeks to

minimize

conditions that are perceived

as aversive

aversive conditions

- psychophysiological reactions

-

stress, anxiety & fear

- pain

Non-aversive conditions

non-aversive conditions

-


- com munication

- gathering information

- identifying problem s

- giving information

the dentist-patient interaction

seeks to

maximize the conditions that arc

perceived as non-aversive

Dental fear, anxiety &

pain

dental fear

is an unpleasant emotional

or physiologic sensation derived from a

specific dental-related stimulus

dental anxiety

is a non-specific uneasi-

ness, apprehension or negative thoughts

about what may happen during dental

treatment

dental phobia

is when dental treatment

is avoided or endured with intense

anxiety

dental fear anxiety

can come from

different sources

dental fear anxiety are often from a

previous bad experience, or, from

hearing of a bad experience , or a gen-

eral fear of needles

dental fear happens during childhood

or adolescence in approximately 50-

85% of cases

dental fear, anxiety

&

pain

are all

interrelated

fear

may cause a person to endure pain

and not seek treatment

pain & anxiety

-

as pain increases, anxiety increases

-

as anxiety increases, pain is enhanced

& is less tolerable

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BS

Which of the following suggests that change does not happen in one step and

people tend to progress through different stages on their way to successful

change.

ABC m odel behavior theory model)

stages of change model

SCM)

social cognitive theory

contemporary public health model

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stages of change model (SCM)

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Stages of change model

SCM)

behavior change does not happen in

one step

a person will progress through dif-

ferent stages

on the way to successful

change

each person will progress at their own

rate

Stages of change

1 pre-contemplation

not acknowledging there is a prob-

lem that needs to be changed

2

contemplation

acknowledging problem but not

ready or sure of wanting to make a

change

3 preparation

getting ready to change

4

action/willpower

changing behavior

5

maintenance

maintaining behavior change

6 relapse

abandoning change, returning to old

behavior

Social cognitive theory

behaviors are learned through obser-

vation, modeling & motivation such

as positive reinforcement

learning is strengthened if the observer

identifies with their mod el

learning is strengthened if someone

models a behavior he or she has seen

rewarded; this motivates the person

to model the behavior to get a reward

ABC model

behavior theory)

behavior has 3 components :

A= antecedents trigger)

B = behaviors

C = consequences

B comes between A and C

rather than occurring in isolation,

behavior is preceded by an antecedent

that sets off the behavior and is

followed by

a consequence

Contemporary community

public)

health model

a prevention model that

considers so-

cial, cultural, economical

&

enviro-

nmental factors as having significant

influence

on a person's health behaviors

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BS

Which of the following is an essential part of risk management?

veracity

documentation

autonomy

negligence

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PATIENT MANAGEMENT

document tion

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Risk management

refers to the policies and procedures the

dentist should follow in order to reduce

the chance that a patient will file legal

action against him or her

includes issues of

legal competence,

informed

consent, liability, confiden-

tiality and

documentation

Informed consent

informed consent

(written or oral)

must he obtained by the dentist from

adult patients prior to treatment

informed consent components

-

WHO

will render treatment

-

WHA T are the treatment options

-

WH AT treatment will be done

-

WHEN will the treatment occur

- WHERE (if referring the patient)

- WHY

purpose of the procedure and

risks versus benefits

-

QUESTIONS

the opportunity for the

patient to ask questions & obtain info

Patient record

the patient record is the property of the

dentist and must be retained by the dentist

Documentation

is essential to risk management

dental records must be thorough, con-

sistent & complete

must include ac tual visits, missed visits

& evidence of noncompliance

Documentation tips

inform the insurance carrier if an

incident with a patient occurs

remem ber that everything

written in

the record can be used in court

always document informed consent

never change any written entry -

add

an addendum / separate entry instead

if a mistake is made -

draw a single

line through the error, mark it error

and initial & date it

be

specific - write facts only, not opinions

be objective -

avoid personal charac-

terizations, state behaviors

be complete

be timely

write legibly

maintain integrity

of the patient record

never sign a patient record entry for

someone else, or vice versa

countersign carefully - you are as

responsible as original person who signed

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IC

Identify which one of the following is a false statement concerning personal

protective equipment

PPE):

1. protective clothing must be worn by dental professionals when contact with

blood or other bodily fluids is anticipated

2. gloves must be worn to prevent contact with blood, saliva or mucous membranes

3.

wearing gloves replaces the need for handwashing

4.

protective clothing must be removed before leaving the dental office

5.

masks must be changed between patients

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wearing gloves replaces the need for hand washing

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Protective clothing

protective clothing includes

gowns,

lab coats

& jackets

may be

disposable

is worn over ex isting clothing

street

clothes or scrubs)

is

used to prevent skin & mucous

membrane exposure

when contact

with blood or other body fluids is

anticipated

must be changed daily or more often

if visibly soiled

protective clothing must be removed

before leaving the dental office

Masks protective eyewear

if spatter

& aerosolized sprays are

likely, surgical masks & protective

eyewear, or chin-length plastic face

shields must be used

a mask must be changed between

patients

or more often if it becomes

wet or moist

face shields & protective eyewear

must be washed/disinfected with

appropriate cleaning agents

Gloves

wearing gloves does not replace the

need for handwashing

dental professionals must wear gloves

to prevent skin contact with blood,

saliva or mucous membranes

new gloves must be worn for each

patient

gloves must be worn

when touching

contaminated items or surfaces

non-sterile gloves

are recommended

for examinations & nonsurgical

procedures

sterile gloves are recommended for

all surgical procedures

utility gloves are recommended for

cleaning and instrument processing

gloves must be changed whenever

they are torn, cut or punctured during

treatment

gloves should

never be washed

before use, or, disinfected for reuse

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IC

Identify each of the following that is a true statement regarding the launder

ing of contaminated laundry in the dental setting:

1.

contaminated laundry must be handled as little as possible

2. the dentist may choose to use an outside laundry service

3.

the dentist or assigned office personnel may launder the clothes on-site

4. contaminated laundry should be bagged at the location of use

5. contaminated laundry should be handled with appropriate PPE

6.

if contaminated laundry is transported to a laundromat, the employee must be

trained in the handling of contaminated laundry

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all statements are true

Protective clothing

Laundry choices

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for optimal protection gowns, jackets

or coats are required to be long

sleeved

and high necked

such clothin

g

,

minimizes the potential

for exposed skin

to contact blood,

saliva or other potentially infectious

material

Disposable gowns

if used,

eliminates the need to launder

contaminated protective clothing

Contaminated laundry

defined as laundry

that has been

soiled with blood or OPIM other

potentially infectious material)

handling of contaminated laundry

includes the following:

-

handle as little as possible

- handle with appropriate PPE

-

bag at location of use

- do not sort or rinse at location of use

- label transport bags with a biohazard

sign

in the dental office contaminated

laundry includes protective clothing

that is

used to cover street clothes or

scrubs

the dentist may choose to

use an out-

side laundry service

the dentist or assigned office personnel

may launder the clothes in a washer

and dryer on-site

if contaminated laundry is trans-

ported to

a

laundromat the

employee or dentist must use PPE, be

trained in handling of contaminated

laundry and transport the laundry in a

red/orange bag that is labelled with a

biohazard symbol

a dentist who is unincorporated and is

the owner may take laundry home; if

the owner is unincorporated, the owner

is not subject to OSHA regulations

IC

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Match each term with the correct definition:

clinical contact surface

disinfectant

disinfection

hospital disinfectant

intermediate level disinfectant

low level disinfectant

tuberculocidal

1.

a disinfectant that makes the label claim

tuberculocidal

2.

a germicide effective against HIV and HBV

3. an agent capable of inactivating Mycobac-

terium tuberculosis

4.

any surface directly contaminated from

patient materials,

gloved hands, blood, or OPIM

5.

a process which destroys a majority of, but

not all, microorganisms

6.

a chemical agent used to destroy recognized

pathogens; kills some but not all microorgan-

isms

7.

a germicide effective against

Salmonella

choleraesuis, Staphylococcal aureus and

Pseudomonas aeruginosa

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PATIENT MANAGEMENT

4 6 5 7 1 2 3

Clinical contact surface

Intermediate level disinfectant

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any surface directly contaminated from

patient materials, gloved hands, blood

or OPIM

other potentially infectious

material)

these surfaces can then cross contam-

inate other instruments, devices, hands,

gloves & other items

Disinfectant

chemical agent used to destroy recog-

nized pathogens; kills some but not all

microorganisms

Disinfection

a process which destroys a majority of,

but not all, microorganisms

while disinfection is lethal to some

organisms, only sterilization kills all

organisms

Hospital disinfectant

germicide effective against Salmonella

choleraesuis, Staphylococcal aureus

and Pseudomonas aeruginosa on non-

living objects

disinfectant that makes the label claim

`tuberculocidaP

Low level disinfectant

germicide effective against HIV &

HBV

Tuberculocidal

agent capable of inactivating Mycobac-

terium tuberculosis

Disinfectant selection

factors to consider

ability to inactivate TB, HIV and Hepa-

titis B

suitability for use as a cleaner and disin-

fectant

health hazards and precautions

contact time requirements

compatibility with equipment, devices

and ma terials

shelf life and storage

sensitivity to temperature

IC

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antiseptic

asepsis

bloodborne pathogens

exposure incident

infectious waste

personal protective equipment

standard precautions

1.

pathogens present in blood that cause disease

in humans

2.

includes protective attire, gloves, mask and

eyewear

3.

involves contact with blood or other poten-

tially infectious materials and that results from

dental procedures

4.

the absence of disease-causing microorgan-

isms

5.

measures designed to protect operators pa-

tients from pathogens spread by blood or any

other body fluid, excretion, or secretion

6.

a substance that inhibits the growth of bacte-

ria

7.

waste that consists of blood, blood products,

contaminated sharps or other microbiologic

23

products

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6, 4, 1, 3, 7, 2, 5

Basic terminology

infectious waste

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an understanding of the terminology related

to infection control is important for the den-

tal professional

antiseptic

a substance that inhibits the growth of

bacteria

asepsis

the absence of pathogens, or disease-

causing microorganisms

bloodborne pathogens

pathogens present in blood that cause

disease in humans

disinfect

the use of a chemical or physical proce-

dure to inhibit or destroy pathogens;

highly resistant bacterial and mycotic

spores are not killed during disinfection

disinfection

the act of disinfecting

exposure incident

a specific incident that involves contact

with blood or other potentially infec-

tious materials that results from proce-

dures performed by the dental profes-

sional

waste that consists of blood, blood

products, contaminated sharps, or other

microbiologic products

occupational exposure

contact with blood or other infectious

materials that involves the skin, eye, or

mucous membranes and that results

from procedures performed by the den-

tal professional

parenteral exposure

exposure to blood or other infectious

materials that results from piercing or

puncturing the skin barrier

personal protective equipment

PPE)

protective attire, gloves, mask and eye

wear

sharp

any object that can penetrate skin, in-

cluding, but not limited to, needles and

scalpels

standard precautions

measures designed to protect health care

IC

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The interpretation of the Centers for Disease C ontrol

& Prevention (CDC) rec-

ommended infection control practices in dental healthcare settings varies

from state to state; not all guidelines apply in all states.

The CDC recommended infection control practices in dental healthcare set

tings are stand-alone guidelines and are not required to be used in conjunc-

tion with OSHA practices procedures.





24

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CDC recommended infection control

Recommendations

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practices in dental health care set-

tings

primary purpose of infection control

procedures is to

prevent the trans-

mission of infectious diseases

infectious diseases may be trans-

mitted

-

from patient to dental professional

-

from dental professional to patient

-

from one patient to another patient

use of recommended infection con-

trol guidelines greatly reduces the

transmission of infectious diseases

recommended infection control

practices are applicable to all set-

tings in which dental treatment is

provided and must be observed

in conjunction with required

OSHA Occupational S afety and

Health Administration)

practices

and procedures for worker protec-

tion

vaccination

of dental professionals

use of

protective attire and barrier

techniques

hand washing and care of hands

proper

use and care of sharps

instrum ents and needles)

sterilization

of instruments

cleaning & disinfection of the

dental unit and environmental

surfaces

disinfection of the dental laboratory

use and care of hand pieces, anti-

retraction valves, and other devices

attached to air & water lines of dental

units

single use of disposable instruments

proper

handling of biopsy specimens

proper use of extracted teeth in

dental educational settings

proper

disposal of waste materials

implementation of recommendations

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Instruments in the dental practice can all be classified as e ither critical or non-

critical.

For infection to occur, these three conditions must be present:

a susceptible host a pathogen with sufficient infectivity and numbers to

cause infection, and, a portal of entry through which the pathogen m ay enter

the host.





25


PATIENT MANAGEMENT

the first statement is false the second is true

Disease transmission

critical instruments

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for an infection to occur by one of

these routes of transmission,

the fol-

lowing three conditions must be

present:

- a

susceptible host

-

a pathogen

with sufficient infecti-

vity and numbers to cause infection

-

a portal of entry through which the

pathogen may enter the host

effective infection control practices

are intended to alter one of these

three conditions and prevent disease

transmission

Classification

all instruments in the dental practice

can be classified as

critical, semi-

critical or noncritical

instruments are classified depend-

ing on the risk of transmitting infec-

tion the need to sterilize between

uses

penetrate soft tissue or bone

must be sterilized after each use

examples

include forceps, scalpels,

bone ch isels, scalers and surgical

burs

semicritical instruments

contact but do not penetrate soft

tissue or bone

must be sterilized after each use

if the instrument can be damag ed by

heat and sterilization is not feasible,

a disposable one-use item is

required

examples

include x-ray beam align-

ment d evices, mirrors, amalgam

condensers and burs

noncritical instruments

do not come in contact with mu-

cous membranes

because there is little risk of trans-

mitting infection, an

intermediate

level or low-level disinfectant is

required

between uses in different

patients

IC

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pasteurization

sanitization

antiseptic

disinfectant

bacteriostatic

bactericidal

1.

pathogens present in blood that cause disease

in humans

2. an agent that prevents further growth of bac-

teria

3.

an agent capable of killing bacteria

4.

to expose food to an elevated temperature for

a period of time sufficient to destroy certain dis-

ease-causing microorganisms

5.

a chemical agent used on inanimate objects to

destroy or inhibit the growth of harmful organ-

isms

6. treatment of water to reduce microbial counts

to safe levels

7. an antimicrobial agent that can be safely

applied to living tissues

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PATIENT MANAGEMENT

4, 6, 7, 5, 2, 3

Definitions disinfectant

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antiseptic

an antimicrobial agent that can

be safely applied to living tissues

(e.g.,

alcohol);

inhibits but does not

necessarily destroy microorganisms

bactericidal

an agent that is capable of killing

bacteria; bactericidal agents are

preferable over those which are

bacteriostatic

bacteriostatic

an agent that prevents the further

growth of bacteria

a chem ical agent used on inanimate

objects to destroy or inhibit the

growth of harm ful organisms; not

considered safe for use on hu man

tissues (e.g.,

bleach); a disinfec-

tant kills some, but not all microor-

ganisms

pasteurization

to expose food to an elevated tem-

perature for a period of time suffi-

cient to destroy certain disease-

causing microorganisms; the target

of pasteurization is the destruction

of M ycobacterium tuberculosis

sanitization

treatment of water supplies to

reduce microbial counts to safe

public health levels

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Identify each of the following that is a true statement regarding the pur-

pose of cleaning prior to disinfection:

1.

cleaning destroys all pathogens

2.

cleaning reduces the concentration of pathogens

3.

cleaning removes blood and debris which can interfere with disinfection

4.

cleaning is optional prior to disinfection

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2, 3

Cleaning

Cleaning

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is defined as the

physical removal

of debris

with aseptic technique,

you must

clean before you d isinfect

the cleaning step is

not optional, it

is required

all disinfectant products include

specific instructions for cleaning

prior to disinfection

Results in

a reduction in the number of

microorganisms present

the removal of blood, tissue biobur-

den and other debris that can

interfere with disinfection

IC

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Identify the term that BEST describes the complete destruction of all forms

of microbial life, including heat-resistant bacterial spores:

pasteurization

sanitization

sterilization

disinfection

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PATIENT MANAGEMENT

sterilization

Sterilization

destruction of all forms

Biological mon itoring

sterilizers must be monitored for

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defined as the

of microbial life

limiting

requirement is the inactiva-

tion of b acterial spores

proof of such destruction is the ultimate

criteria for sterilization because

spores

are the most heat-resistant microbial

forms

per the Centers for Disease Control and

Prevention

(CDC),

sterilization is

required for all instruments and

items that are placed in the patient's

mouth

if an item cannot withstand heat sterili-

zation, a disposable

one-tim e use)

item should be used instead

heat is the most efficient and depend

able physical mode of achieving

sterilization

of dental instruments;

the heat may be moist or dry

three equipment options for heat

sterilization include the

autoclave, the

chemical vapor sterilizer and the dry

heat oven

proper functioning.

his is done via

the use of biological indicators

BI)

or

spore tests

both the CDC and ADA

recommend

weekly spore testing of all sterilizers

Other definitions

disinfection

the inhibition or killing of pathogens;

spores are not killed during disinfection

pasteurization

to expose food to an elevated tempera-

ture for a period of time sufficient to

destroy certain disease-causing

microorganisms; the target of pasteur-

ization is the destruction of

M ycob acterium tuberculosis

sanitization

treatment of water supplies to reduce

microbial counts to safe public health

levels

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Identify the type of pathogen that provides the ultimate test for efficacy of

sterilization:

fungal organisms

HIV

hepatitis B virus

bacterial spores

29


PATIENT MANAGEMENT

bacterial spores

Biological monitoring

involves the processing of highly

Spore testing

after a spore strip is processed in a

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resistant

bacterial spores

to determine

if they have been killed

a biological indicator BI)

or spore

strip

contains the spores

used in

biological monitoring

a spore strip is a

small piece of paper

that contains one or more types of

spores Bacillus atrophaes spores are

used for testing dry heat oven units and

Geobacillus stearothermophilus

spores are used for testing steam and

chemical vapor units

the spore strip is enclosed in a

protective glassine envelope

sterilizer, it is mailed to a monitoring

service

in a laboratory setting,

the spore strip

is aseptically placed in a test tube of

culture media for 7 days

for each of the 7 days, the tube of

culture media is inspected for cloudi-

ness

if spores are

viable have

not been

killed, the culture m edia appears

cloudy

if no cloudiness is noted in the culture

media, then sterilization is confirmed

cloudiness in the culture media indi-

cates

a

failed test

spores were not

killed),

also known as a positive biolog-

ical spore test

to rule out contamination during testing,

a

Gram stain

is prepared to identify the

bacteria in the failed test

when

the gram-positive Bacillus

organism is observed on the test slide,

sterilization failure is confirmed

I

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For a steam autoclave, identify each of the following that lists the correct tem-

perature, pressure and time that must be used for sterilization.

250 F, 15 psi, 20 minutes




30


PATIENT MANAGEMENT

250 F, 15 psi, 20

minutes or

270

F, 30

psi

8 minutes

Autoclave

the use of

steam heat under pre

Advantages

Disadvantages

advantages

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sure remains the oldest, most com-

mon and most acceptable method

for instrument sterilization

the typical autoclave uses

- a temperature of

121 C (250 F)

-

a pressure of

15 psi

- cycle time of

20 minutes

r

-

a temperature of 132 C (270 F)

- a pressure of

30 psi

- cycle time of

8 minutes

- a short

efficient cycle time

-

good penetration

- a wide range of

materials can he

processed without destruction

disadvantages

- corrosion

of unprotected carbon

steel instruments

-

dulling

of unprotected cutting edges

-

packages

may remain wet at the

end of a cycle

- use of

hard water may leave

deposits

- possible destruction

of heat-

sensitive materials

Autoclave problems

that may result in a failed spore test

faulty temperature gauge

faulty pressure gauge

faulty timer

faulty or dirty gasket / seal

faulty heating coil, exhaust line

faulty or clogged bleeder valve

mineral deposit build-up

IC

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For a dry heat oven, identify the correct temperature and time that must be

used for sterilization.

375 F, 60 minutes

375 F, 120 minutes

320 F, 60 minutes

320 F, 120 minutes

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PATIENT MANAGEMENT

320 F 120

minut s

Dry heat oven

in the absence of moisture,

destruction

Advantages & Disadvantages

advantages

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of all forms of microbial life requires

conditions very different from the auto-

clave

dry heat sterilizes much less

efficiently than moist heat

a HIGHER TEMPERATURE &

LONG ER CY CLE TIME is required

for sterilization to occur

the typical dry heat oven uses

- a temperature of

160 C (320 F)

-

cycle time of 120 minutes

r

- a temperature of

170 C (340 F)

-

cycle time of

60 minutes

the use of a commercial cooking oven

is not a substitute for an FDA -app-

proved sterilizer

- no dulling

of cutting edges

- no corrosion

of metal instruments

disadvantages

-

the long cycle time

-

poor penetration

- may

discolor or char items

- destroys heat-labile items

- cannot sterilize liquids

- not suitable for hand pieces

Forced air convection ovens

a.k.a.

rapid heat transfer ovens

another option for dry heat sterilization

use a HIGHER TEM PERATURE \

and a CONTROLLED INTERNAL

AIRFLOW

uses a temperature of 190 C (375F)

and a cycle time of

12 minutes for

wrapped items and 6 minutes for

unwrapped items

Dry heat oven problems



faulty timer

IC

For a chem ical vapor sterilizer, identify the correct temperature, pressure and

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time that must be used for s terilization.

250 F, 20 psi, 20-40 minutes

250 F, 30 psi, 40-60 minutes

270 F, 15 psi, 40-60 minutes

270 F 20

psi, 20-40

minutes

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PATIENT MANAGEMENT

Chemical vapor sterilizer

requires the use of

organic solvents

270 F, 20

psi, 20-40

minutes

Advantages

Disadvantages

advantages

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chemicals) instead of water to

produce the sterilizing vapor

the typical chemical vapor sterilizer

uses

- a temperature of 132 C (270 F)

- a pressure of

20 psi

-

cycle time of

20-40 minutes

instead of distilled water used in

steam autoclaves),

a solution of

alcohol, formaldehyde, ketone,

acetone and water is used to produce

the sterilizing vapor

- no corrosion of metal instruments

including carbon steel

- no dulling of cutting edges

- suitable for orthodontic stainless

wires

disadvantages

- instruments must be completely

dried

before processing

- special chemical solutions must be

used

- destroys heat sensitive plastics

-

produces a

strong chemical odor in

poorly ventilated areas

-

cannot sterilize liquids

Chemical vapor sterilizer problems



faulty timer

faulty or dirty gasket/seal

faulty or clogged metering valve

IC

How many hours are required to kill bacterial spores when a dental instru-

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ment is placed in a 2

solution of glutaraldehyde?

8 hours

10 hours

12 hours

24 hours

33


PATIENT MANAGEMENT

10 hours

Glutaraldehyde 2

is a liquid chemical sterilant

Advantages

Disadvantages

advantages

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capable of killing spores if

sufficient contact time is provided

and there is absence of extraneous

organic material required contact

time is

10 hours

a.k.a.

cold sterilization

if this method is used to sterilized

an instrument, after 10 hours, it

must be rinsed w ith sterile water,

dried and placed in a sterile

container (if

not used im m ediately)

Important note

use of a chemical sterilant in

dentistry is no longer considered

appropriate

for sterilizing heat-

stable instruments

- most potent

category of chemical

germicide

- EPA registered as

chemical

sterilant

disadvantages

- long time

period required for

sterilization

-

allergenic

-

highly toxic to tissues

-

no way to monitor efficacy

Reminders

CDC refers to

heat sterilization as

the method of choice when

sterilizing instruments and devices

dental instruments must be

appropriately cleaned, packaged &

sterilized between uses with a heat-

based, biologically m onitored

process

if heat sensitive, a heat-stable

alternative or disposable item

must be used

IC

Identify which one of the following is the m ost efficient way to kill microbes:

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cold sterilization

heat sterilization

glutaraldehyde

all of the above

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PATIENT MANAGEMENT

heat sterilization

Heat sterilization

use of heat has long been recog-

heat sterilization as the method of

choice

when sterilizing instruments

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nized as the

most efficient and

reliable method of sterilization

using a steam autoclave, chemical

vapor sterilizer or dry heat oven

cell death is accomplished via

heat inactivation of critical

enzymes and other proteins

within cells

moist heat

destroys bacteria by

denaturation; the denaturation

process is quickened by the use of

pressure

dry heat

destroys m icroorganisms

by causing

coagulation

of proteins

and devices

dental instruments must be appro-

priately cleaned, packaged steril-

ized between uses with a heat-

based, biologically monitored

process

if heat sensitive, it is preferable to

use a heat-stable alternative or

disposable item

IC

Identify which one of the following is a false statement concerning infection

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control in the dental setting:

exposure is not synonymous with infection

do not disinfect what you can sterilize

environmental surfaces must be sterilized between patients

all dental patients can be treated using standard bloodborne precautions

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PATIENT MANAGEMENT

environmental surfaces must be sterilized

it is

not possible to sterilize the

environmental surfaces

that

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become con taminated during

patient care

thorough cleaning of the

surfaces is sufficient to break the

cycles of cross-contamination and

cross-infection

chemical disinfectants used on sur-

faces should:

- kill as many microbes as possible

in the shortest time possible

- not damage the surface being

decontaminated

-

not be harmful to humans or

animals

- not be affected by presence of

organic material

- be compatible with soap,

detergents and other chem icals

- be inexpensive

- be stable during storage

is

Identify which one of the following is a false statement regarding potential

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operator errors that may cause the failure of a spore test:

the sterilizer was overloaded

the sterilizer cycle was interrupted

improper packaging was used

inadequate time, temperature and/or pressure was used

inadequate warm up time was completed

mineral deposit build up

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PATIENT MANAGEMENT

mineral deposit build up

Operator errors

overloading

interrupting sterilization cycle

Errors

Problems

A number of conditions may cause a

spore test to fa il - overloading the steril-

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using inadequate time

using inadequate wane up time

using inadequate temperature

using inadequate pressure

using improper packaging

using expired chemical solution

Equipment problems


faulty pressure gauge

faulty timer

faulty or dirty gasket/seal

faulty heating co il, exhaust line

faulty or clogged bleeder valve

mineral deposit build-up

faulty or clogged metering valve

izer, inadequate temperature and/or pres-

sure, inadequate time or improper

packaging of instruments.

In the majority of cases, OPERATOR

ERRO R is responsible for the failure.

Of all the errors listed in the question,

only one is not an operator error it

is an

EQUIPMENT PROBLEM

mineral deposit build up .

IC

Identify which one of the following is a true statement concerning chemical

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monitoring:

chemical monitoring is a definitive means of determining sterilization

chemical monitoring determines if critical pressure has been reached

chemical monitoring uses heat sensitive chemicals

when a chemical indicator changes color, sterilization is complete

a chemical indicator is part of the spore strip glassine envelope

37


PATIENT MANAGEMENT

chemical monitoring uses heat sensitive chemicals

Chemical monitoring

uses

heat sensitive chemicals

not

weekly testing of the sterilizer

via

biological indicators is the ONL Y

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spores)

to assess the physical condi-

tions during the sterilization process

involves the use of

indicators that

change color when exposed to

certain temperatures

examples include

autoclave tape,

special markings on bags and

pouches, chemical indicator

strips, tabs or packets

a color change only indicates that

the sterilizer reached the proper

temperature

but does not indicate

how long the temperature was

maintained or what pressure was

reached and maintained

confusion often exists between

biological monitoring

spore test-

ing) chemical monitoring

definitive way to verify steriliza-

tion success

a chemical indicator can serve as a

routine check

for all item proce-

ssed in the sterilizer

provides immediate feedback

concerning the critical steriliza-

tion temperature;

identifies if the

sterilizer does not reach critical

temperature

chem ical indicators should be

placed

inside each sterilizer pouch

or wrapped cassette

to verify the

sterilizing parameter for that indica-

tor has been satisfied internally

these indicators should also be

placed on the outside of the

package

IC

Identify which one of the following is a false statement concerning the use

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of alcohol hand gels in the dental setting:

the convenience of alcohol hand gel use helps to increase compliance with hand

washing guidelines

hand washing with an alcohol product takes less time than using soap water

alcohol hand gels can save busy practitioners valuable time between patients

studies have shown that alcohol hand gels reduce microorganisms significantly

better than soap water

alcohol hand gels cause more dryness than soap water hand washing

38


PATIENT MANAGEMENT

hand gels cause more dryness than soap

&

water washing

Hand gels

the

convenience of alcohol hand gel

there is a

misguided belief that

alcohol-based hand gels will dry

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use helps to increase compliance

with hand washing guidelines

increasing popularity of hand gels is

due to flexibility convenience

hand washing w ith an alcohol

product takes less time

than water

washing and

does not require a sink,

water or paper towels for drying

for the busy practitioner who has to

clean their hands often, the quickness

of hand sanitizers can

save valuable

time between patients

studies have also confirmed that alco-

hol hand gels kill more germs; hand

gels with 60 - 70 alcohol

reduce

microorganisms including bacteria,

fungi and viruses

significantly better

than soap and water

out the skin,

particularly with

frequent use

alcohol hand gels on the market

today

contain moisturizers specifi-

cally to prevent such dryness

studies have shown that this new

generation of gels

cause less dryness

and irritation than the traditional

soap and water method of hand

washing

IC

Identify which one of the following is a false statement concerning when to

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use hand hygiene techniques in the dental setting:

before touching a patient

before aseptic procedures

after donning gloves

after touching a patient

after touching patient surroundings

39

copyright

m

2013-2014 - Dental Decks

PATIENT MANAGEMENT

after donning gloves

Hand hygiene recommendations

soap

water hand washing

Techniques

soap

water hand w ashing

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should be used when hands are

dirty or visibly soiled with blood or

other bodily fluids, before eating,

after using a restroom, and, if hands

come in contact with spores

in all other cases, alcohol based

hand gel

can be used for routine

decontamination of hands

once gloves are placed on the

hands,

hand gel or soap

water

should not be used on the gloves

When to clean hands...

before touching a patient

before aseptic procedures

after body fluid exposure or risk

after touching a patient

after touching patient surroundings

-

wet hands

- apply amount of soap recom-

mended by the m anufacturer

-

rub hands togethe r for at least 15

seconds

- rinse with water and dry thoro-

ughly with a disposable towel

-

use towel to turn off faucet

- avoid use of HOT water

alcohol based hand gel

-

apply the amount of gel recom-

mended by the m anufacturer to

one palm

- rub hands togethe r, covering all

surfaces

- continue rubbing hands together

until all surfaces are dry

- if hands feel dry after 10 seconds

or less of rubbing, too little prod-

uct has been used

IC

Identify which one of the following is a false statement concerning the use of

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disinfectants in the dental setting:

the disinfectant used must be registered by the EPA

each practice must maintain a written schedule for surface disinfection

PPE must be used when using disinfectants

when using a disinfectant, the use of vinyl exam gloves is recommended

40


PATIENT MANAGEMENT

when using a disinfectant the use of vinyl exam gloves is recommended

Surface disinfection

surfaces without barriers must be

cleaned and disinfected with an

Housekeeping surface

reusable pails, bins and containers

must be regularly inspected,

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intermediate-level disinfectant

Manufacturer instructions

disinfecting solutions must be

prepared following manufacturer

guidelines

disinfecting solutions must be EPA

registered

manufacturer instructions for

pre-cleaning surfaces must be

followed before disinfection

the disinfectant must be applied to

the surface for the contact time

designated on the product label

Personal protection equipment

puncture and chemical resistant

utility gloves must be used when

cleanin gand disinfecting surfaces

in addition to gloves, protective

clothing, eye protection mask

must be worn when cleaning and

disinfecting surfaces

cleaned and disinfected

housekeeping surfaces contaminated

with body fluids must be cleaned and

disinfected with an EPA-registered

intermediate level disinfectant

Cleaning schedule

the office must have a cleaning

schedule based on the type and

degree of contamination and location

Surface disinfection & OSHA

the office must have a written

schedule for disinfection of surfaces

as required by OSHA

IC

Between patients, all surfaces without protective coverings m ust be cleaned

and disinfected with an intermediate level disinfectant.

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Between patients, all protective coverings used in p lace of surface disinfec-

tion must be changed/replaced.





41

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PATIENT MANAGEMENT


Protective coverings

the use of protective covers on

disinfected surfaces and non-critical

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equipment is acceptable

covers

(barriers)

must be resistant

to fluids and puncture in order to

protect surfaces from contamination

these coverings

may

be used instead

of surface disinfection

between patients

coverings must be replaced/

changed between patients

protective covers eliminate the

need to disinfect the covered

areas between patients

areas covered with barriers during

the treatment day should be

disinfected at the end of the day

s

The Occupational Safety and Health Administration s OSHA)

Bloodborne

Pathogens Standard mandates that all dental healthcare professionals re-

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ceive, at a minimum, the Hepatitis B vaccination series.

The Centers for Disease Control and Prevention (CDC) mandates all other vac-

cinations.





42


PATIENT MANAGEMENT

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IC

All employees with potential exposure to bloodborne pathogens are required

to have the Hepatitis B vaccination.

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The vaccination record of each employee must be kept for 30 years beyond

the employee's last day of employment in the practice.





43


PATIENT MANAGEMENT


In the dental setting, who needs the

Hepatitis B vaccination?

all employees with potential exposure

to bloodborne pathogens

What Hepatitis B vaccination documenta-

tion is required?

according to OSHA, a vaccination

record is part of the employee's

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front office and housekeeping staff

should be assessed as to their exposure

level; if the answer to the following

questions is yes , the vaccination

is needed

- do they handle contaminated laundry?

- do they enter patient treatment areas

where there is potential for exposure?

- are they designated to perform first

aid or CPR?

When should the dentist employer offer

Hepatitis B vaccinations to employees?

employers are required to provide

Hep B vaccinations to all new

employees free of charge after train-

ing and within 10 days of working in

a position where there is potential

exposure to bloodborne pathogens

the only exception is if the employee

has previously received the vaccine

series, and, antibody testing has

revealed the worker is immune

medical record, and

is

required

t

e

kept for 30 years

beyond the employ-

ees last date of employment

all part-

time and temporary employ-

ees are required to provide documenta-

tion of Hep B vaccination which must

be

kept for the same amount of time,

30 years

according to the CDC and OSHA 29

CFR 1910.1030 (h) (1) (ii) (B), employ-

ers are required to keep accurate

copies of each employees Hep B

vaccination status, including the date

of each dose

Is a post vaccination titer required?

post vaccination

titer testing m ust be

done 1 -

2 months after the original

vaccine series is completed

documentation is treated like an

employee medical record

and kept for

30 years from last date of employment

IC

A booster dose of the Hepatitis B vaccine is required.

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The Hepatitis B vaccine series requires that at least 16 weeks elapse between

dose 1 and dose 3.





44


PATIENT MANAGEMENT


What if a new employee

has

been previously

vaccinated but has no documentation?

check with em ployee's previous

employers per OSH A requirements, a

What if a titer, administered within

the

proper amount of time, showed the

employee status to be negative?

repeat the three dose series and test for

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copy of the vaccination records should be

part of the m edical record and retained

if all attempts are unsuccessful, OSHA

requires documentation verifying the

employers attempt to obtain the record

and should include a written statement

from the em ployee about vaccination

status and approximate dates of the

vaccinations

if original documents cannot be obtained

then the Hep B vaccination must be made

available unless the employee has titer

documentation

What if an employee started, but did not

complete the three

doses of the vaccine?

pt mgmt2013-14

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