Micro Clinical Test 3

Front 1

General Duty Clause

Back 1

Employers are to "furnish to each of his employees, employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.

Front 2

Law requires that attending physicians of pts with communicable diseases or conditions give control measures for the diseases to pts as prescribed by Commission for Health Service rules (T/F)

Back 2

True

Front 3

What are the std. precautions for doing invasive procedures?

Back 3

-Adopt a written infection control policy
-Conduct a training programs for HCWs
-Monitor compliance w/ infection control requirements
-Designate a staff member to be trained in infection control by completing a state approved course

Front 4

Example of Bloodborne viruses?

Back 4

-HBV
-HCV
-HIV

Front 5

Copy of complete NC communicable disease laws can be obtained from

Back 5

-Communicable Disease Control Branch Epidemiology and Communicable Disease Section

Front 6

Two revisions affecting dentistry in OSHA Bloodborne Pathogen std. revisions?

Back 6

-Recordkeeping: Injury and illness records
-Safety device evaluation: OSHA Needlestick Safety and Prevention Act

Front 7

Which of the following devices does OSHA approved or endorse?
-Local anesthetic needles
-Scalpels
-Needless IV ports
-OSHA does not approved or endorse any product

Back 7

-D: OSHA does not approved or endorse any product

Front 8

Describe Exposure Control Plan.

Back 8

-Must be developed, reviewed, updated annually
-Whenever necessary to reflect changes in code and employee risk
-Personnel and OSHA representative must be access to a copy.

Front 9

Purpose of Exposure Control Plan?

Back 9

-To define and provide the training, equipment, procedures, vaccination, and other requirements specified by the standard to reduce the likelihood of exposure.

Front 10

When implemented, the current CDC and OSHA infeciton control practices for dentistry should reduce the risk of transmitting infections by which route?
-Dental personnel to pts
-Pts to pts
-Pts to dental personnel
-a,b,c
-b, c

Back 10

-a,b,c

Front 11

Using plastic utility drapes or bags can be more effective and economical than thorough disinfection of operatory and equipment surfaces (T/F)

Back 11

False

Front 12

PPE (Personal Protective Equipment) must be bo cost to employee and cloths must be appropriate. (T/F)

Back 12

True

Front 13

Percent of HSV infection.

Back 13

-2-9% of adults shedding in saliva
-5-8% in children
-Prodromal period: very infectious.

Front 14

Spatter is capable of transmitting which of the following:
-HIV
-TB
-HB
-All of the above

Back 14

-All of the above

Front 15

Employer shall ensure the employee uses appropriate PPE.

Back 15

-Accessible
-Cleaned, laundered and disposed
-Repaired and or replaced as needed
-Removed prior to leaving the work area

Front 16

Clean reusable face protection between patients; if visibly soiled, clean and disinfect (T/F)

Back 16

True

Front 17

Example of Enginnering Controls (Isolation or remove the hazard)

Back 17

-Sharps containers
-Medical devices with injury protection features (self-sheathing needles)

Front 18

Handwashing facilities must be provided and readily accessible (Antiseptic hand cleanser) (T/F)

Back 18

True

Front 19

-Wash hands before putting on and immediately afer removing gloves or other PPE (T/F)
-Wash hands and any other skin as soon as possible after and exposure (T/F)

Back 19

True

Front 20

Benefits and Limitations of Alcohol-basd Preparations?

Back 20

-Benefits: fast, effective antimicrobial action, improved skin condition, more accessible than sinks
-Limitations: Can't be used if hands are visibly soiled, sotre away from high temp. or flames, hand softeners and glove powders may "build-up".

Front 21

Contaminated needles and sharps shall not be

Back 21

-Bent
-Recapped
-Removed or broken

Front 22

Contaminatd needles and sharps placed in appropiate container

Back 22

-Puncture resistant
-Labeled or color-coded
-Leakproof on the sides and bottoms
-Closable

Front 23

Mouth pipetting of blood and OPIM is prohibited (T/F)

Back 23

True

Front 24

A written schedule for cleaning and method of decontamination shall be determined and implemented by the employer based upon what

Back 24

-Location w/in the facility
-Type of surface to be cleaned
-Type of soil present
-Task procedure performed in that area.

Front 25

Medical waste?

Back 25

-Any waste which is generated in the DX, TX, or immunization of human beings or animals, in research thereto, or in the production or testing of biologicals.

Front 26

Only medical waste associated with infectious diease transmission is

Back 26

-Contaminated sharps

Front 27

Handling Biopsy Specimens

Back 27

-Place biopsy in sturdy, leakproof container
-Avoid contaminating the outside of the container
-Label with a biohazard symbol

Front 28

Describe Hep B Vaccination?

Back 28

-After required training
-W/in 10 working days of initial assignment
-Exemptions: vaccination series already completed (immune: Ab testing, contraindication for medical reasons)

Front 29

Information provided to the HCP, post-exposure evaluation and Follow-up.

Back 29

-Copy of this regulation
-Description of exposed employee's duties
-Documentation of route of exposure
-Results of source individual's blood test
-Relevant medical records of employee

Front 30

If blood status known for HIV, HBV no blood test required (T/F)

Back 30

True

Front 31

Post-exposure must store blood for 90 days if employee refuses HIV testing (T/F)

Back 31

True

Front 32

Describe the Healthcare professional's written opinion

Back 32

-Employer to provide professional's written opinion w/in 15 days to employee concerning
-Hep B vaccination and post-exposure evaluation
-Employee has been informed of results and possible consequences of exposure

Front 33

Post-exposure evaluation and follow-up (Medical records kept for duration of employment plus 30 years) (T/F)

Back 33

True

Front 34

Goals of Exposure incident evaluation?

Back 34

-Goal of evaulation is to identify and correct problems in order to prevent recurrence of similar incidents.

Front 35

Biohazard labels

Back 35

-Biohazard sign: fluorescent orange, orange-red
-Labels are close as possible to container
-Red bags or containers may be substituted for labels

Front 36

Post-exposure must store blood for 90 days if employee refuses HIV testing (T/F)

Back 36

True

Front 37

Describe the Healthcare professional's written opinion

Back 37

-Employer to provide professional's written opinion w/in 15 days to employee concerning
-Hep B vaccination and post-exposure evaluation
-Employee has been informed of results and possible consequences of exposure

Front 38

Post-exposure evaluation and follow-up (Medical records kept for duration of employment plus 30 years) (T/F)

Back 38

True

Front 39

Goals of Exposure incident evaluation?

Back 39

-Goal of evaulation is to identify and correct problems in order to prevent recurrence of similar incidents.

Front 40

Biohazard labels

Back 40

-Biohazard sign: fluorescent orange, orange-red
-Labels are close as possible to container
-Red bags or containers may be substituted for labels

Front 41

Decontaminated regulated waste need not be labeled (T/F)

Back 41

True

Front 42

All employees w/ occupational exposure must participate in a training program-

Back 42

-During working hours
-No cost to employees
-At initial assignment (10 days)
-At least annually

Front 43

Formal annual training session are required in training program (T/F)

Back 43

True

Front 44

OSHA Form 200 is used for record keeping (T/F)

Back 44

True

Front 45

Medical record should include?

Back 45

-Name
-SSN
-Copy of Hep B vaccination status
-Copy of all results of examinations, med. testings, follow-up
-Employer's copy for healthcare professional written opinion.

Front 46

Availability of medical records is made available to who?

Back 46

-To employee and to anyone w/ written permission, to the Director, and to assistant secretary

Front 47

Training records

Back 47

-Dates of training sessions
-Summary of training sessions/topics
-Names and qualifications of persons conducting the training
-Names and job titles of all persons attending the session
-Retained for 3 years

Front 48

GET ANSWERS TO ALL QUESTIONS ON OSHA LECTURES

Back 48

GET ANSWERS TO ALL QUESTIONS ON OSHA LECTURES

Front 49

Treating HIV-infected pts in Private Dental Office

Back 49

Treating HIV-infected pts in Private Dental Office

Front 50

Epidemiological Patterns of Shifting HIV/AIDs

Back 50

-Less homosexual transmission, more heterosexual transmission
-More women and adolescents
-More color people
-Increase in developing countries
-Few perinatal transmission cases in US

Front 51

Male to male sexual contact is highest among Adults and Adolescents (T/F)

Back 51

True

Front 52

Cumulative cases in US and NC and living

Back 52

-US: 817,000 , NC: 23,770
-Living: US: 506 K, 15 K

Front 53

Drainage Water Law

Back 53

Natural Flow - cannot alter flow that would damage other property
Common Enemy - all landowners can take steps to secure against drainage
Reasonable Use - reasonable drainage alterations allowed

Front 54

HIV-1 RNA Level (Viral Load)

Back 54

-Highly sensitive PCR-based tech.
-Indicate magnitude of HIV replication at a given time
-Good prognostic marker of long-term clinical outcome
-Good marker of effectiveness of current anti-retroviral therapy

Front 55

HIV infection = Train in Motion

Back 55

-Viral load tells us how fast the train is traveling
-CD4+ cell count tells us how much railroad track remains ahead

Front 56

Normal CD4+ cell count, and Platelet count

Back 56

-CD4+: 600-1500
-Platelet: 150,000 - 450,000

Front 57

Example of Bleeding Tendencies?

Back 57

-Decreased platelet count (severe thrombocytopenia <50K)
-Decreased production of Coag Factor (PT or APTT > twice normal values)
-Increased Post-op bleeding w/ hepatic disorders (Hep B, C, Med. side effects)

Front 58

Oral Side Effects of Antiretroviral Meds?

Back 58

-Xerotstomia (dry mouth)
-Numbness in mouth
-Nausea and Vomiting

Front 59

What rare cancer can be present in HIV pt?

Back 59

-Kaposi's sarcoma
-Oral lymphoma

Front 60

Describe Gastro-intestinal Disorders

Back 60

-Wasting syndrome and side effect of anti-retroviral medications
-Painful oral lesions, poor dentition, poor food absorption, delayed wound healing.

Front 61

Dental Considerations for the HIV-infected pt?

Back 61

-TX modifications may be needed based on medications, bleeding tendencies and immune status
-Perform clinical exam for oral manifestations, including oral cancers

Front 62

Risk of HIV transmission (moderate risk)

Back 62

-Blood
-Semen
-Vaginal fluids
-Other fluids visibly containing blood

Front 63

Risk of HIV transmission (Minimal Risk)?

Back 63

-Tears
-Cerebrospinal fluid
-Synovial fluid
-Amniotic fluid
-Respiratory secretions
-Saliva

Front 64

Saliva is not considered infectious unless it contains blood (T/F)

Back 64

True

Front 65

Instrument sterilization example?

Back 65

-Steam autoclave
-Prolonged dry heat
-Unsaturated chemical vapor

Front 66

Surface disinfection example?

Back 66

-Spray-wipe-spray technique
-EPA-registered as a "hospital disinfectant" and ADA accepted and labeled "tuberculocidal"

Front 67

Types of Occupational Exposure?

Back 67

-Percutaneous injury: needlestick, cut w/ sharp object
-Permucosal contact: contact w/ mucous membranes
-Non-intact skin: chapped/abraded skin, dermatitis

Front 68

Exposure to non-AIDS patient

Back 68

-Wash exposure site with disinfectant or soap & water
-Ask pt to test for HIV
-Contact physician immediately
-Monitor for HIV seroconversion 3,6,12 months
-Don't give blood or have sex.

Front 69

Exposure to AIDS patient

Back 69

-Initiate anti-retroviral therapy w/in 6 hrs of exposure: Retrovir, Epivir, Crixivan (Zidovudine, Lamivuidine, Indinavir).

Front 70

END OF TXing HIV Patient in Private Practice

Back 70

END OF TXing HIV Patient in Private Practice

Front 71

Infection Control Issues in Hospital Dental Clinic Setting

Back 71

Infection Control Issues in Hospital Dental Clinic Setting

Front 72

Side effects of Chemotherapy?

Back 72

-Systemic effects: nausea, vomiting
-Oral manifestations: mucositis, ulcerations
-Myelosuppression: leukopenia, neutropenia, thrombocytopenia (decreased platelet count --> hemorrhage)
Medication side effects: Xerostomia -->caries

Front 73

Example of Side effect of Chemotherapy? Infection

Back 73

-Fungal infections: C. albicans
-Viral infections: HSV, CMV
-Bacterial infections: aerobic gram-negative bacilli and gram-positive cocci
-Periodontal and pulpal inflammation.

Front 74

Medical conditions related to End-stage Renal Disease?

Back 74

-Hypertension
-Bleeding tendency-heparin or coumadin, avoid acetaminophen
-Intolerance to drugs cleared by kidney
-restrict fluid intake

Front 75

Medical conditions related to Oral Conditions?

Back 75

-Uremic stomatitis
-Perodontal infections, oral infections

Front 76

Infection control issues-hemodialysis

Back 76

-Depressed immune response
-Vascular fistulae or shunt
-Infectious dieases: HBV, HCV, CMV

Front 77

Infection control issues-renal transplant

Back 77

-Life-long anti-rejection therapy
-Infectious diseases: CMV

Front 78

Example of in-pts hospitalized for

Back 78

-Non-oral care: bure pt, fever-of-unknown-origin, anesthesia trauma
-Oral care: medically compromised, facial/dental trauma, orofacial infection

Front 79

Severe Oro-facial Infection: Infection itself

Back 79

-TX of infection: incision-drainage, antibiotics
-Prevent infection of surgical site

Front 80

Severe Oro-facial infection: Infection control issues?

Back 80

-Over-use or mis-use of antibiotics-resistance
-Prevent spread of infection to hospital personnel and other pt.

Front 81

Distribution of Nosocomial Infections by Major sites

Back 81

-UTI: 33%
-Others: 23%
-Pneumonia: 16%

Front 82

Sources of Hospitalized pt

Back 82

-Acquired from "self" (autogenous)
-Acquired from hospital workers, visitors, other pts, or hospital setting.

Front 83

Hospital-acquired Opportunistic Microorganisms

Back 83

-Coliforms: Klebsiella, E. coli, Enterbacter
-Other aerobic Gram - bacilli, Pseudomonas aeruginosa
-Staphylococci: Staph. aureus, Staph. epidermidis

Front 84

Routes of Microbial Transmission in Clinical Setting

Back 84

-Direct or indirect contact
-Exposure to contaminated droplets
-Aerosolization
-Squames
-Exposure to contaminated water, waterlines

Front 85

Contact: Direct or Indirect: People, Food, Fluids, Equipment

Back 85

-People: Staph. aureus, Gram - bacilli
-Food: Staph. aureus, Salmonellae
-Fluids: Gram-neg bacilli
-Equipments: Staph. aureus, Gram-neg bacilli

Front 86

Airborne Routes: Human Aerosolized Fluids, Dust

Back 86

-Human: Staph. aureus, Tubercle bacilli, Respiratory viruses
-Aerosolized Fluids: Legionella, Gram - bacilli
-Dust: Clostrium tetani, Aspergillus

Front 87

Squames

Back 87

-Exfoliated epithelial cells
-Air-borne by rubbing against clothing, objects
-Main ingredient in dust
-Primarily shed below the waist
-Shedding is greater from males than females
-Contain potentially pathogenic micro-ogranisms

Front 88

Measures to Reduce Nosocomial Infections?

Back 88

-Handwashing
-Disinfection and sterilization protocols
-Personal protective equipment: gown, gloves, mask
-Reverse airflow patterns in operating rooms
-Isolations rooms for highly contagious or susceptiable pts
-Limit movements around hospital

Front 89

Conditions for Medical COnsultations?

Back 89

-Cardiovascular disease or surgery respiratory disease, including asthma diabetes, cancer, Prosthetic joint replacements, liver disease, including hepatitis pregnancy.