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165 Cards in this Set
- Front
- Back
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What are quaternary ammonium compounds that are used for skin antisepsis classified as?
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Cationic detergents
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Surface active agents composed of a long-chain, lipid-soluble, hydrophobic portion and a polar hydrophilic group, which can be cation, anion, or nonionic.
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Detergents
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What do the surfactants of detergents interact with?
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Lipids in cell membrane via hydrophobic chain to disrupt the membrane
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What are the quaternary ammonium compounds used for?
What type of bacteria is most susceptible? |
Disinfectants / Antiseptics
gram+ |
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What are the negatives against using cationic detergents?
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Not sporicidal
Not tuberculocidal Not Virocidal Inactivated by anionic detergents |
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What is a good example of an anionic surface-acting substance?
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Soaps
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Substances that alter the nature of interfaces to lower surface tension and increase cleaning.
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Anionic detergents
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What is the primary value of an anionic detergent?
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Remove microorganisms mechanically from skin
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_____ _____ do not possess any antimicrobial properties
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Nonionic chemicals
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_____ destroys all the microorganisms in a certain environment except for _____.
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Disinfection / Spores
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The complete elimination of all organisms including spores.
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Sterilization
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What is a powerful oxidizing agent that inactivates bacteria and most viruses by oxidizing free sulfhydryl groups?
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Chlorine
(active component of hypochlorite or bleach) |
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Antimicrobial agents that kill (germicide) or prevent the growth (microbiostatic) of pathogenic microorganisms. Not considered safe for tissue. Used only on surfaces
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Disinfectants
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What disinfectant was originally used in hospitals but is now discontinued due to it being caustic?
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Phenol
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What disinfectant denatures protein and nucleic acids?
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Formaldehyde
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_____ and _____ _____ are critical factors that determine the effectiveness of an antimicrobial agent against a particular microorganism.
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Concentration, Contact time
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What parts of a microbial cell can be affected by an antimicrobial agent?
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Cell membrane
cytoplasmic contents (esp. enzymes) nuclear material |
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How long does it take to kill bacterial spores when a dental instrument is placed in a 2% solution of glutaraldehyde?
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10 hours
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An alkalizing agent highly lethal to essentially all microorganisms if sufficient contact time is provided with an absence of extraneous organic material?
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2% Glutaraldehyde
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What are the advantages of glutaraldehyde?
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Most potent chemical germicide
Kills spores after 10 hours EPA - Immersion sterilant used on heat sensitive materials |
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What are the disadvantages of glutaraldehydes?
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Long time sterilization
Allergenic Not environmental disinfectant Toxic to tissues |
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What is glutaraldehyde used to disinfect in hospitals?
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respiratory therapy equipment
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What is the proper time and temp. for autoclaving?
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250 F (121 C) for 15-20 min.
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What is the amount of pressure behind autoclaving?
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15 lbs. of pressure of steam per square inch
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How does the moist heat of autoclaving destroy bacterias?
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Denatures high protein containing bacteria
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What speeds up the heating process while autoclaving?
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heat under pressure
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If it only takes ten minutes to destroy the required bacteria in autoclaving why is the time 15-20 min?
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Allows for penetration when the instruments are wrapped in towels
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How is the effectiveness of autoclaving best determined?
How often is this recommended? |
Culturing bacterial spores
Recommended weekly |
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What is the most important step in instrument sterilization?
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Precleaning
Debris is a barrier to sterilant |
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What is the safest and most effective method of precleaning?
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Ultrasonic instrument cleaning
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What is the proper time and temp for dry heat sterilization?
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320 F (160 C) for 2 hours
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How does dry heat destroy microorganisms?
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Causing coagulation of proteins
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Why should you immediately remove items from the Autoclaving?
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Diminish the possibility of corrosion of the instruments
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What are the advantages of dry heat?
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Effective and safe sterilazation for metal
Does not dull / corrode instruments |
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What are the disadvantages of dry heat?
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Long cycle
poor penetration ruin heat sensitive materials |
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What interferes with the sterilization process?
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Water
Instruments must be dry before process |
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Why do spores have to be subjected to heat at high pressure?
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They are resistant to boiling (100 C at sea level)
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What is the most heat resistant spores?
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Clostridium botulinum (Botulism)
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What is the flash cycle of steam autoclaves?
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134 F (270 C) at 30 psi for minimum 3 min.
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What is the minimum required temperature to destroy all organisms?
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121 F (250 C)
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The _____ _____ will vary directly with the type of load placed into the chamber.
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Autoclaving time
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What is the flash cycle of the autoclave most useful for?
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Unwrapped instruments
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How long does sterilization of ethylene oxide take place?
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20-50 min. depending on material sterilized
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What phase is ethylene oxide used in as a sterilizer?
Why is its use limited? |
Gas
Very toxic and flammable |
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What are the advantages of ethylene oxide sterilization?
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Highly penetrative
No damage to heat labile material Evaporates w/out leaving residue Used for materials that can't be exposed to water |
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How does ethylene oxide function as a disinfectant?
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Alkylating agent
Irreversibly inactivates cellular nucleic acids (DNA) and proteins |
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Process of killing all microorganisms including spores
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Sterilization
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The killing of many, but not all, microorganisms
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Disinfection
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Reserved for chemicals that are used on inanimate surfaces, and are not considered safe for living tissues.
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Sterilization
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Chemical agents similar to disinfectants, but may be applied safely to living tissues.
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Antiseptics
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What is the Doctrine of sterilization?
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Do not disinfect what you sterilze
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What is not destroyed when instruments are immersed in cold disinfectants?
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Spores or the hepatitis viruses
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What are generally sterilized by filtration?
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liquids
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What is the most commonly used filter?
What does it retain? |
Nitrocellulose w/ pore size of .22 um
Retains bacteria and spores |
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What is the most widely used antiseptic that is used to reduce the number of microorganisms on the skin surface in the area of a wound?
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Alcohol
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What does alcohol do to make it an effective antiseptic?
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Denatures proteins
extracts membrane lipids acts as dehydrating agent Inactivates lipophilic viruses |
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What are the drawbacks of alcohol as an antiseptic?
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Evaporates quickly
Diminished activity against viruses in dried blood, saliva, other surface secretions |
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What makes dried blood, saliva and surface secretions so effective at rendering alcohol ineffective?
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Presence of tissue proteins and glycoproteins
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What is the major alcohol used in hospitals?
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Isopropyl alcohol (90-95%)
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What is the alcohol that is widely used to clean the skin prior to immunization or venipuncture?
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Ethanol (70%)
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What is the most effective skin antiseptic used in medical practice and acts as an oxidizing agent and combines irreversibly with proteins?
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Iodine
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What is the greatest occupational health care worker risk for bloodborne infection?
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Hep B
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What percentage of infection in health care professionals were attributed to Hep B before the universal precautions were changed to standard precautions by the CDC in 1987?
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10-30%
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What are the concentrations of HBV in the blood of a chronic carrier?
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1,000,000 to 100,000,000 virions per ml
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What has greater viral loads?
HBV, HIV, AIDS? |
HBV > HIV > AIDS
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Where does the viral concentration of Hep C range?
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Between HBV and HIV
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What can standard precautions for HBV also do with less infectious organisms?
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Prevents cross-infection of other lesser microorganisms
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Has contact with saliva, tears, or sweat ever been shown to result in transmission of HIV?
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No
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What are antimicrobial agents that destroy microorganisms when applied onto inanimate surfaces, such as counter tops or lights?
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Disinfectants
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Defined as the use of physical or chemical procedure to destroy all microbial life, including bacterial endospores
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Sterilization
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Less than lethal sterilization, involves chemical process of microbial inactivation which destroys virtually all pathogenic microorganisms on inanimate surfaces, but not necessarily all microbial forms
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Disinfection
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Involves chemical agents applied onto living tissues to both remove accumulated transient microorganisms, and temporarily lower the concentration of normal, resident flora
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Antiseptics
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What is used as a hand washing agent?
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Chlorohexidine gluconate
Triclosan |
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What does Chlorohexidine gluconate and Triclosan offer as a hand washing agent?
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Broad antimicrobial activity
Substantivity; residual washing action for extended periods |
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What is not used for hand washing but still is called waterless hand hygiene?
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Isopropyl alcohol 60-80% alcohol
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An antibacterial solution which directly kills bacteria is said to be...
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Bactericidal
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The use of bactericidal chemicals is preferable to what?
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Static chemicals
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Why are static chemicals not ideal?
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Don't directly kill or inactivate
Inhibit metabolism and replication |
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When do bactericidal agents work best?
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During the log phase of bacterial growth
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What is the marker microorganism for intermediate surface disinfection?
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Mycobacterium tuberculosis
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Why is tuberculosis used as the intermediate marker for disinfection?
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The morphology and structure of it makes it relatively resistant to penetration by low-level disinfectants
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What are some examples of intermediate level agents?
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Phenols, iodophors, hypochlorite
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What makes an agent an intermediate level one?
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Able to penetrate the wax and lipid outer layers surrounding mycobacteria
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What are the antigens which are most responsible for an immediate type 1 reaction to latex?
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proteins
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What tree does natural rubber latex come from?
What antibody is involved in the reaction? |
Hevea brasiliensis
IgE mediated |
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Why is the cleaning of surfaces prior to disinfection in clinical settings required?
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reduce the concentration of pathogens
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The physical removal of debris
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Cleaning
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What are the two results from efficient cleaning?
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Reduction in # of microorganisms
Removal of: Blood tissue bioburden debris which interferes with infection |
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What is the most efficient way to kill microbes?
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heat sterilization
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What happens to cause microbial cell death in an autoclave, unsaturated chemical vapor, or dry heat unit?
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Heat inactivation of critical enzymes and other proteins
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What must be sterilized using heat?
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Anything that comes into contact with a patient's blood, saliva, or mucous membranes
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What is the most common form of an adverse epithelial reaction noted for health-care professionals?
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Irritation dermatitis
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What is the percentage of health care workers who suffer from chronic or occasional dermatitis on their hands?
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20-30%
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Non-specific immune reaction often caused by contact with a substance that physically or chemically damages the skin.
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irritation dermatitis
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What can aggravate the condition of irritation dermatitis?
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Frequent handwashing
residual glove powder harshness of repeated washing |
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What are some examples of antiseptic agents?
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Chlorohexidine gluconate
parachlorametaxylenol iodophors triclosan |
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What is the acceptible alternative to latex?
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vinyl or nitrile gloves
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What products are not considered an alternative to latex? Why?
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Products with the designation hypoallergenic
contains latex with a chemical coating |
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The treatment of dairy foods, such as milk, for short intervals with heat, to kill certain disease-causing microorganisms; the target is the destruction of mycobacterium tuberculosis
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Pasteurization
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Treatment of water supplies to reduce microbial levels to safe public health levels
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Sanitization
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What is the most infectious target of standard precautions?
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Hep B
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How is the Hep C virus primarily transmitted?
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Through infected blood transfer
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Who is most at risk of receiving Hep C?
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Parenternal Drug abusers
Persons receiving transfusions organ recipient hemophiliacs getting factor VIII and IX Persons receiving tatoos Persons receiving piercings |
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How is a dentist most likely to be infected by a patient that has Hep C?
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Needle stick
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Hep C is a significant risk factor for the development of what?
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Hepatocellular carcinoma
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An infection caused by normally non-pathogenic microorganisms in a host whose resistance has been decreased or compromised is known as what?
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Opportunistic infection
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Infections that originate in a hospital or hospital like setting. Primarily caused by opportunists.
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Nosocomial infection
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What are the particular microorganisms that are responsible for the opportunistic response of nosocomial infections?
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Enterococcus spp.
Escherichia coli. Pseudomonas spp. Staphylococcus aureus |
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Infection which occurs during or after a primary infection. May result from the treatment itself of from alterations in the immune system.
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Secondary infection
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it is recommended that face masks should be changed...
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At least with every patient
More often with heavy spatter |
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What measures the percent efficiency at which the face mask filters bacteria passing through the mask?
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BFE (Bacterial Filtration Efficiency)
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What measures the percent efficiency at which the face mask filters particulate matter passing through the mask?
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PFE (Particulate Filtration Efficiency)
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Defined as the ability of a face masks material construction to minimize fluids from traveling through the material and potentially coming into contact with the user of the face mask.
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Fluid resistance
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Why is fluid resistance important?
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reduces exposure to blood and fluids from spatter
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What does a type IV latex allergy entail?
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Sensitivity to certain chemicals used in the latex manufacturing process
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The genetic tendency to develop the classic allergic diseases (3/4 atopic dermatitis, allergic rhinitis, asthma)
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Atopy
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What antibody does atopy have a capacity to produce in response to common environmental proteins such as house dustmites, grass pollen, and food allergies?
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IgE
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What are the subsets of T-Helper lymphocytes that are involved in cell-mediated immune responses?
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TH1 and TH2
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What does TH1 cells secrete?
What does this do? |
IL-1, Gamma interferon
Enhances: cell-mediated immune response Inhibits: TH2 and humoral immune response |
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What are the functions of TH1
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Inflammatory
B Cells in IgG2 production Activates macrophages and CTL Stimulates Delayed hypersensitivity (Type IV) |
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What does TH1 produce?
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IL2, IFNgamma, TNFbeta
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What does the TH2 secretions cause?
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Inhibit cell-mediated immune response
enhance the humoral response |
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What do TH2 cells produce?
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IL4, IL5, IL6, IL10, IL13
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What help does TH2 cells provide?
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IL's support B cells - Induces switch to IgE and IgG1
Supports eosinophils and mast cells |
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What are the advantages of rapid heat transfer sterilization over dry heat units?
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Fast cycle time
No dulling of cutting instruments Dry instruments after cycle |
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How does a dry heat convection oven differ from other dry heat units?
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Use higher temp.
There is controlled internal air flow within the chamber |
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How fast can a dry heat convection oven sterilize?
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12 min at 375 F (190 C) - Wrapped
6 min. - unwrapped |
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Personal protective equipment clinic jackets should be...
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Long sleeve, high neck
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In healthcare what is the primary disease prevention measure?
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Handwashing
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How long should routine handwashing take place?
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lather for ten seconds followed by a thorough rinse
30 sec |
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What is the aim of handwashing?
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Removal of microorganisms form the hands preventing their potential transfer
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Where can microbes reside that are not easily dislodged in the skin?
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Sweat ducts and hair follicles
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How many medical professionals carry potentially pathogenic antibiotic-resistant pathogens on his or her hands?
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1 in 5
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What is the rate at which hand washing is done amongst medical professionals?
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30% of the ideal rate
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What is the main guarantee of sterilization?
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Calibrated biological indicators (BI)
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What has to happen before an instrument can be disinfected or sterilized?
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Thoroughly cleaned to remove all organic matter and residue.
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Why does Why must organic matter be removed before sterilization?
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It shields organisms from destruction
May inactivate some disinfectants |
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What is defined as entering vascular system or sterile body tissues?
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Critical object
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What are examples of critical objects?
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Scalpels and other surgical instruments
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What type of decontamination is required for critical objects?
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Sterilization and holding in a sterilized state
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What is defined as coming in contact with intact mucous membranes?
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Semi-critical objects
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What are examples of semi-critical objects?
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Thermometer, Vaginal speculum, sigmoid scope
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What kind of decontamination is required for semi-critical objects?
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High level heat or chemicals
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What is defined as something that comes into contact with intact skin?
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Non-critical object
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What are examples of non-critical objects?
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Examining table top, blood pressure cuff, baby weight scale
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What is the decontamination process required for non-critical objects.
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Intermediate or low level disinfection
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What do hand hygiene agents that contain high concentrations of alcohol do instead of removing proteinaceous bioburden?
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They denature and dehydrate proteins
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What is considered infectious and meets the OSHA Bloodborne pathogen standard criteria for regulated waste that requires special handling and disposal
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Blood Saturated gauze used in oral surgical procedure
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Can be initiated by any activity related to the provision of health care, including medical or dental treatments and diagnostic procedures, regardless of whether they are performed properly and regardless of host immunity.
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Iatrogenic Infections
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What can Iatrogenic infections also be called if a patient could not normally develop them without first having a compromised host immunity?
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Opportunistic Infection
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Persons vaccinated against Hep B virus who have developed immunity are also immune to...
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Hep D
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What kind of virus is the Hep D virus (HDV)?
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RNA virus
Incapable of completing its own replication within infected host cells |
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Why is HDV sometimes referred to as the parasite of HBV?
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Uses excess Hep B surface antigen (HBsAg) from existing Hep B virus as the major capsid protein
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What happens when a person is immune to Hep B?
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HBV replication does not occur and HBsAg is undetectable.
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What is still considered to be the gold standard for destruction of microbial pathogens?
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Heat sterilization
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According to the occupational safety and health administration (OSHA) Bloodborne pathogens standard, disposable gloves that have been contaminated shall be replaced...
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As soon as practical
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A set of combined precautions that include the major components of universal precautions or to reduce the risk of bloodborne pathogens and body substance isolation or reducing the risk of transmission of pathogens from moist body surfaces.
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Standard precautions
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What bodily fluids do Standard precautions apply to?
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All bodily fluids except perspiration, and intact skin and mucous membranes
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A set of infection control practices and procedures based on the concept that all blood and other body fluids that might be contaminated with blood should be treated as infectious
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Universal precautions
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What is considered to be items that have contact with blood or other body secretions?
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Contaminated waste
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Whate are exampes of contaminated waste?
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Gloves, masks, disposable guns
Bibs Used gauze w/ saliva and blood Used barriers and covers |
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True false:
Contaminated waste must be placed ina biohazard trash after use? |
False generally not regulated and can be discarded w/ office trash
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What is a subset of medical waste capable of causing an infectious disease?
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Infectious waste
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What are some examples of infectious waste?
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Blood and Blood-saturated materials
Pathological waste: tissue;extracted teeth (no amalgam) sharps used in patient care |
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What is infectious waste that requires special handling, neutralization and disposal?
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Regulated waste
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