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Infection Control for Dental Professionals

Course #54051 - $45 -

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  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
  1. The Occupational Safety and Health Administration (OSHA) adopted the Bloodborne Pathogens Standard in

    OSHA REGULATIONS

    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]. The OSHA Standard requires employers whose employees have exposure to blood or other potentially infectious material to implement safe work practices, education, and barriers to exposure. The Standard was later amended to cover the safe use of sharps.

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  2. The OSHA Bloodborne Pathogens Standard requires employers whose employees have exposure to blood or other potentially infectious material to implement safe work practices, education, and barriers to exposure.

    OSHA REGULATIONS

    The OSHA Bloodborne Pathogens Standard requires that every healthcare worker who may have contact on the job with blood or other bodily fluids (referred to as other potentially infectious material or OPIM) 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 Contact Precautions.

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  3. Of the following, which generally poses the greatest risk for airborne infection?

    MODES OF TRANSMISSION

    Aerosols, droplets (produced by the respiratory tract), and splatter contaminated with blood and bacteria are produced during many dental procedures [9]. 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.

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  4. Which of the following diseases is known to spread by aerosols or droplet?

    MODES OF TRANSMISSION

    Diseases known to spread by aerosols or droplet include:

    • TB

    • Pneumonic Yersinia pestis infection (plague)

    • Influenza

    • Legionellosis (Legionnaires' disease)

    • Severe acute respiratory syndrome corona­virus (SARS and COVID)

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  5. The average risk for infection after a needlestick or cut exposure to hepatitis C virus-infected blood is approximately

    BLOODBORNE PATHOGENS

    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% [11]. 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 [11]. 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 [9]. 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.

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  6. Standard Precautions apply to contact with all of the following, EXCEPT:

    PREVENTION STRATEGIES

    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

    • All bodily fluids, secretions, and excretions (except sweat), regardless of whether they contain blood

    • Intact or nonintact skin

    • Mucous membranes

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  7. A central tenet of Standard Precautions is to

    PREVENTION STRATEGIES

    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.

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  8. To avoid contamination and maintain aseptic technique, medications should be drawn

    PREVENTION STRATEGIES

    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 other potentially infectious material should be kept separate from medications.

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  9. The OSHA Bloodborne Pathogens Standard mandates the wearing of masks, eye protection, and face shields

    PREVENTION STRATEGIES

    Procedures that 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 other potentially infectious material 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.

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  10. Studies have shown that which of the following types of gloves have the highest failure rates?

    PREVENTION STRATEGIES

    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 [19].

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  11. Which of the following is NOT a regulated waste found in dental practice settings?

    ENVIRONMENTAL CONTROL MEASURES

    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].

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  12. Devices connected to the dental water system that enter the patient's mouth should be flushed for how long after each patient?

    ENVIRONMENTAL CONTROL MEASURES

    Patient material, such as oral micro-organisms, blood, and saliva, can enter the dental water system during treatment. Devices connected to the dental water system that enter the patient's mouth should be flushed to discharge water and air for a minimum of 20 to 30 seconds after each patient to remove patient material that might have entered the turbine, air, or waterlines.

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  13. Which of the following statements regarding handling of sharps is TRUE?

    ENGINEERING AND WORK PRACTICE CONTROLS

    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:

    • 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

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  14. Cleaning is defined as

    ENGINEERING AND WORK PRACTICE CONTROLS

    Cleaning is defined as the removal of visible soil (organic and inorganic material) from objects and surfaces; normally, it is accomplished manually or mechanically using water with detergents or enzymatic products. Decontamination reduces the number of pathogenic micro-organisms on objects, usually with a 0.5% chlorine solution [21]. Thorough cleaning and decontamination are essential before high-level disinfection and sterilization because inorganic and organic materials that remain on the surfaces of instruments interfere with the effectiveness of these processes.

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  15. According to the Spaulding classification system, critical items

    ENGINEERING AND WORK PRACTICE CONTROLS

    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. Critical items are those items that enter sterile spaces, such as soft tissue or bone. These items pose the greatest risk of transmitting infection and require sterilization.

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  16. The risk of infection following occupational exposure depends on

    PROTECTING DENTAL HEALTHCARE WORKERS

    An occupational exposure is defined as a percutaneous injury or contact of mucous membrane or nonintact skin with blood, tissue, or other potentially infectious material, most commonly a needlestick injury. The risk of infection depends on several factors, including:

    • 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

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  17. Postexposure prophylaxis, or the provision of medications after a substantial exposure in order to reduce the likelihood of infection, is available for

    PROTECTING DENTAL HEALTHCARE WORKERS

    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 [36]. 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 [36].

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  18. All of the following statements regarding TB prevention are true, EXCEPT:

    PROTECTING DENTAL HEALTHCARE WORKERS

    The CDC recommends that all dental care providers be screened for TB upon hire, using either a tuberculin skin test or blood test [25]. 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.

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  19. The hepatitis B vaccine is given

    PROTECTING DENTAL HEALTHCARE WORKERS

    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 [33]. 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.

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  20. Retraining on bloodborne pathogens is required

    PROTECTING DENTAL HEALTHCARE WORKERS

    Dental professionals 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 other potentially infectious material, 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.

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  • Back to Course Home
  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.