Mandated, Highly Recommended, and Other Vaccines

for Oral Healthcare Personnel Workers

MCQ Model:

1 d
2 c
3 c
4 b
5 d
6 d
7 d
8 b
9 c
10 c
11 b
12 d
13 b
14 d
15 d
16 d
17 c
18 d
19 d
Personal Protective Equipment
20 d

1.Which of the following statements is correct with respect to personal protective equipment (PPE)?

A. The wearing of PPE is mandated by Standard and Transmission-Based Precautions.

 B. PPE are medical devices designed to protect healthcare personnel from acquiring healthcare-
associated infections (HAIs).
C. In healthcare settings PPE include the use of surgical gowns, surgical masks, respirators, goggles, face
shields, and gloves.
D. All of the above are correct.

2.Which of the following federal agencies is the nation’s health protection agency that makes
evidence-based recommendations related to the prevention and control of disease, injury, and
disability?

A. CDC
B. NIOSH
C. OSHA
D. FDA

3.Which of the following federal agencies is responsible for setting and enforcing regulations to assure
safe and healthy working conditions?

A. CDC
B. NIOSH
C. OSHA
D. FDA

4.A medical device for which general regulatory controls alone cannot assure safety and effectiveness
is categorized by the FDA as a ____________________.

A. Class I medical device

B. Class II medical device
C. Class III medical device
D. All of the above are correct.

5.Which of the following statements is correct with respect to PPE?

A. The CDC issues recommendations for when, what, and how PPE should be used to prevent exposure
to infectious pathogens.
B. OSHA regulations require that employers provide their employees with appropriate PPE.
C. Key elements to consider when selecting PPE include the type of anticipated exposure, the durability
and appropriateness of the PPE for the task, and the fit.
D. All of the above are correct.

6.All of the following statements related to protective clothing are correct except which one?
 A. Surgical gowns must be worn by OHCP whenever splash, spatter, spray, and aerosols of blood or
OPIM are anticipated during the clinical process.
B. Scrubs, or clinical and laboratory coats or jackets worn for comfort and/or purposes of identity are
considered appropriate PPE.
C. Surgical gowns should have long sleeves to protect the wrists and forearms.
D. Surgical gowns should cover the torso from neck to knees and wrap around the back to prevent
contamination of street the clothes.

7.All of the following statements are correct with respect to surgical gowns except which one?

A. Disposable and reusable surgical gowns are Class I medical devices.

B. Repellency and pore size of the fabric affect blood and OPIM penetration of the barrier and
contribute to gown performance.
C. Regardless of the material used to manufacture surgical gowns, they must be resistant to liquid and
microbial penetration.
D. Several gown sizes should be available in oral healthcare settings to ensure appropriate coverage for
all staff members.

8. Which of the following statements is correct with respect to the use of surgical gowns?

A. Surgical gowns should be changed between patients.

B. When penetrated by blood or OPIM, even intra-procedure, surgical gowns should be changed as
soon as possible.
C. Surgical gowns should be changed before leaving patient-care areas.
D. All of the above are correct.

9. Which of the following statements is correct with respect to surgical masks?

A. Surgical masks must be worn by all OHCP during clinical activities likely to generate splash, spatter,
spray, and aerosols.
B. Surgical masks, which are Class II medical devices, are labeled according to their performance level
on testing standards developed by the American Society for Testing and Materials (ASTM).
C. Fluid resistance, bacterial filtration efficiency (BFE), particulate filtration efficiency (PFE), breathability
(P-Δ), and flammability of the mask material determine surgical mask performance.
D. All of the above are correct.

10. Which of the following ASTM level surgical face mask has a high level of barrier effectiveness
in the presence of splash, spatter, spray and aerosols?
A. Level 1
B. Level 2
C. Level 3
D. Particulate respirator

11. All of the following statements are correct with respect to particulate respirators except which
one?

A. When Airborne Precautions are necessary (i.e., Transmission-based Precautions), NIOSH-certified, fit-
checked particulate-filter respirator, a class II medical device, must be worn.
B. NIOSH-certified N95, N99, or N100 particulate-filter respirators, which have the ability to filter
particles in the range of 0.1 to 1.0 micron, have a filtration efficiency of 95, 99, and 99.8% respectively.
C. Currently, the CDC recommends the use of a N95 or higher level respirator by OHCP exposed to
patients with suspected or confirmed tuberculosis.
D. All of the above are correct.

12. All of the following statements are correct with respect to goggles except which one?

A. Goggles must be worn by OHCP and patients to prevent the transmission of pathogens through the
conjunctival mucosa either directly (e.g., splash, spatter, spray, or aerosols) or by touching the eyes with
contaminated hands or other objects.
B. Goggles, which are Class I medical devices, must fit snugly from the corners of the eyes across the
brow.
C. Indirectly-vented goggles with anti-fog coating provide the most reliable eye protection.
D. Personal eyeglasses and contact lenses are considered adequate eye protection.

13. All of the following statements are correct with respect to face masks except which one?

A. Face shields with high crowns and chin protection that wrap around the face to the point of the ears
are recommended for infection control purposes.

B. Face masks should fit snugly and the foam brow-band contoured to the wearer.

C. Face shields can be worn without surgical masks.

D. Eye protective devices should be cleaned with soap and water, disinfected with a hospital level
disinfectant, rinsed with water, and air dried before reuse.

14. Task-specific gloves should be worn by all OHCP to prevent contamination of the hands when
_______________.

A. anticipating direct contact with blood, mucous membranes, nonintact skin, and OPIM.
 B. having direct contact with patients who are colonized or infected with pathogens transmitted by the
contact route.
C. handling visibly or potentially contaminated patient care items and environmental surfaces.
D. All of the above are correct.

15. All of the following statements are correct with respect to gloves except which one?

A. Patient examination gloves, classified as Class I medical devices, should be worn during dental
cleaning, restorative, and other non-surgical dental procedures.
B. Sterile surgeon’s gloves are intended for use during surgical procedures to protect the provider and
the wound from contamination.
C. Surgeon’s gloves are subject to design control requirements and are classified as Class II medical
devices.
D. Surgeon’s gloves must be sterile when offered for sale to end-users.

16. All of the following statements are correct with respect to patient examination and surgeon’s
gloves except which one?

A. Patient examination gloves and surgeon’s gloves are made primarily of latex, nitrile, or vinyl.
B. There are significant differences in the barrier properties of unused intact gloves.
C. Vinyl gloves have higher failure rates than latex or nitrile gloves.
D. To reduce the risk of latex-related allergies, low-allergen latex gloves or nitrile gloves should be used.

17. Which of the following statements is correct with respect to gloves?

A. Patient examination gloves and surgeon’s gloves may not be washed for subsequent reuse because
microorganisms cannot be removed reliably and continued glove integrity cannot be ensured.
B. Washing gloves can lead to wicking (penetration of liquids through undetectable holes in the gloves)
and subsequent hand contamination.
C. To prevent transmission of infectious pathogens, it may be necessary to change gloves when during
the course of treatment radiographs, dental charts, computer keyboards, or other equipment are
touched.
D. All of the above are correct.

18. Which of the following statements is correct with respect to cleaning (utility or general
purpose) gloves?

A. The FDA does not regulate cleaning (utility or general purpose) gloves used for routine janitorial
functions in healthcare facilities.
 B. It is illegal for manufacturers to label or to suggest that such gloves as suitable for medical use.
C. Gloves used for cleaning patients, or cleaning or handling surfaces or items contaminated with
patient waste or fluids and patient-care devices contaminated with blood or OPIM should meet the
requirements for patient examination gloves.
D. All of the above are correct.

19. Which of the following statements is correct with respect to putting on and for the safe
removal of PPE?

A. The CDC recommends a hierarchical sequence of steps for putting on PPE and for the safe removal of
PPE that will prevent skin, mucosal, clothing, or environmental contamination.
B. Designated containers for used disposable or reusable PPE should be placed in a location convenient
to the site of removal to facilitate containment of contaminants.
C. Putting on PPE begins with the gown and progresses sequentially to the mask or respirator, goggles
or face shield, and, finally, the gloves.
D. All of the above are correct.

20. To safely remove PPE begins with

the gloves and progresses sequentially to goggles or face shield, gown, mask or respirator, and
concludes with hand hygiene immediately after removing all PPE

OR

the gown and gloves and progresses sequentially to goggles or face shield, mask or respirator, and
concludes with hand hygiene immediately after removing all PPE.
A. True

B. False

1 d
2 A
3 C
4 B
5 D
6 b
7 a
8 d
9 d
10 c
11 d
12 d
13 c
14 d
15 c
16 B
17 D
18 D
19 D
20 a

Hand Hygiene: Infection Control/Exposure Control Issues

for Oral Healthcare Workers

1. All of the following statements regarding hand hygiene in healthcare settings are true except
which one?

A. The overall adherence of HCWs to fundamental principles of infection control and aseptic technique
(e.g., failure to wear gloves and perform hand hygiene) is low.
B. Poor adherence to hand hygiene practices is a primary contributor to healthcare-associated infection.
C. Hand hygiene is not necessary if gloves are worn.
D. The prevalence of healthcare-associated infections is decreased as adherence to recommended hand
hygiene practices is improved.

2. Intercellular lipids, which form the only continuous domain of the skin essential for a
complete barrier function, e.g., to minimize microbial invasion from the environment, are a basic
component of the ____________.

A. stratum corneum
B. viable epidermis
C. dermis
D. hypodermis

3. Hand hygiene products and procedures can decrease the barrier function of skin by
____________.

A. extracting skin lipids

B. chemically inducing irritation
C. physically stripping the stratum corneum
D. All of the above.

4. Which of the following statements is correct in relation to homeostatic control and the rate of
keratinocyte proliferation?

A. Under basal conditions, differentiated keratinocytes require 2 weeks to exit the nucleated
compartment and an additional 2 weeks to move through the stratum corneum.
B. When stimulated by injury or infection, keratinocytes have the capacity for increased rates of
proliferation and maturation, and 50 to 60% of barrier recovery typically occurs within 6 hours.
C. When stimulated by injury or infection, keratinocytes have the capacity for increased rates of
proliferation and maturation, and complete normalization of barrier function occurs in 5 to 6 days.
D. All of the above.

5. Which of the following statement in relation to the normal skin flora and the acquisition and
transmission of healthcare-associated pathogens is incorrect?

A. One of the largest human-associated microbial habitats is the skin.

B. Transient organisms tend to colonize the superficial layers of skin and since they are amenable to
removal by washing hands with plain soap and water, they are less likely to cause healthcare-associated
infections than resident pathogens.
 C. Organisms are transferred in much larger numbers from wet hands than from hands that are
thoroughly dried.
D. Resident organisms are attached to deeper layers of skin and they are more resistant to removal than
transient pathogens.

6. Which of the following infections can be potentially transmitted from patients to HCWs if
appropriate glove use and hand hygiene are not performed?

A. Herpes simplex virus infections

B. Colonization or infection Staphylococcus aureus
C. Hepatitis B and C virus infection
D. All of the above.

7. Hand hygiene refers to ____________.

A. handwashing, i.e., washing hands with plain soap and water

B. hand antisepsis, i.e., antiseptic hand wash or antiseptic hand rub
C. surgical hand antisepsis
D. All of the above.

8. Handwashing is an inappropriate hand hygiene procedure ____________.

A. when the hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled
with blood or other body fluids
B. to remove or destroy transient microorganisms and reduce the resident hand flora
C. before eating
D. after using the bathroom

9. Antimicrobial-impregnated wipes, i.e., towelettes ____________.

A. might be considered as an alternative to washing hands with plain soap and water
B. are as effective as alcohol-based hand rubs
C. are as effective as washing hands with antimicrobial soap and water
D. B and C

10. Alcohol-based hand rubs have good or excellent antimicrobial activity against which of the
following microorganisms?

A. Viruses and fungi

B. Mycobacteria
C. Gram-positive and gram-negative bacteria
D. All of the above.
11. Each of the following statements regarding alcohol-based hand rubs is true except which one?
Alcohol-based hand rubs ____________.

A. reduce bacterial counts on the hands of HCWs more effectively than plain and antiseptic soap and
water
B. kill microorganisms more rapidly than iodophors and other antiseptic containing soaps
C. are only effective if they are applied for ≥60 seconds
D. have been demonstrated to cause less skin irritation and dryness than repeated handwashing (i.e.,
washing hands with plain soap and water) or antiseptic handwash (i.e., washing hands with
antimicrobial soap and water)

12. If hands are not visibly soiled or visibly contaminated with blood or other proteinaceous
material, which of the following regimens is the most effective for reducing the number of pathogenic
organisms on the hands of HCWs?

A. Handwashing, i.e., washing hands with plain soap and water.

B. Antiseptic handwash, i.e., washing hands with an antimicrobial soap and water.
C. Hand antisepsis, i.e., applying an appropriate amount of alcohol-based hand rub to the hands and
rubbing hands together until they feel dry.
D. Using an antimicrobial impregnated wipe, i.e., towelettes.

13. All of the following statements regarding surgical hand antisepsis are true except which one?

A. Antimicrobial counts on hands are reduced as effectively with a 5-minute scrub as with a 10-minute
scrub.
B. A brush or sponge must be used when applying the antiseptic agent to adequately reduce bacterial
counts on hands.
C. The FDA, CDC, and the WHO recommend surgical hand antisepsis using an antimicrobial soap and
water or two-stage surgical hand antisepsis.
D. Handwashing with plain soap and water followed by the application of an alcohol-based hand rub is
an acceptable method of surgical hand antisepsis.

14. According to the CDC, which antiseptic agent is least likely to produce irritant contact
dermatitis or allergic contact dermatitis?

A. Chlorhexidine
B. Ethanol
C. Triclosan
D. Iodophors
15. Compliance with hand hygiene guidelines is substantially improved when a multidimensional
strategy includes ____________.

A. introduction of alcohol-based hand rub

B. educational and behavioral initiatives
C. institutional verification of compliance and feedback
D. All of the above.

1 C

2 A

3 D

4 D

5 B

6 D

7 D

8 B

9 A

10 D

11 C

12 C

13 B

14 B

15 D
Sterilization and Disinfection of Patient-care Items in Oral
Healthcare Settings

1. All of the following statements are correct with respect to sterilization and levels of
disinfection except which one?

A. Sterilization is a validated process that destroys all forms of microbial life.

B. High-level disinfection kills all pathogens but not all bacterial spores.
C. Intermediate-level disinfection kills mycobacteria, all nonlipid or small viruses (e.g., polio), all fungi,
all vegetative bacteria, and all lipid or medium-size viruses (e.g., HBV, HIV), but not bacterial kill spores.
D. Low-level disinfection kills some nonlipid or small viruses (e.g., polio), some fungi, all vegetative
bacteria, and all lipid or medium-size viruses (e.g., HBV, HIV).

2. Which of the following statements best describes Spaulding’s classification of patient-care

items?

A. During the course of their intended use, critical items penetrate soft and hard sterile tissues or the
vascular system.
B. During the course of their intended use, semi-critical items contact, but do not penetrate nonintact
skin or mucous membranes.
C. During the course of their intended use, non-critical items come in contact with intact skin, but not
mucous membranes.
D. All of the above are correct.

3. All of the following statements related to critical or semi-critical, or non-critical patient-care

items are correct except which one?

A. Heat-tolerant critical patient-care items confer a high degree of risk for infection if contaminated
with pathogens and must be sterilized by a U.S. Food and Drug Administration (FDA)-cleared heat
sterilizer.

B. Heat-tolerant semi-critical patient-care items, including all dental handpieces, must be heat
sterilized.

C. Heat-sensitive critical items must minimally undergo high-level disinfection using an FDA-registered
chemical sterilant/high-level disinfectant.

D. Unless visibly soiled, for non-critical items disposable barrier protection is the preferred infection
control method during their use.

4. Which of the following statements related to critical or semi-critical, or non-critical patient-

care items is correct?

A. Heat tolerant critical and semi-critical items must be sterilized by steam, unsaturated chemical vapor,
or dry heat.

B. Heat-sensitive critical items can be sterilized by ethylene oxide or by immersing them in liquid
chemical germicides registered by the FDA as chemical sterilants.

C. Non-critical items, when visibly soiled, must be disinfected with an EPA-registered hospital level
intermediate-level disinfectant.
D. All of the above are correct.

5. All of the following statements with respect to steam sterilizers are correct except which one?

A. Steam sterilization (autoclaving) is the most widely used method for wrapped and unwrapped critical
and semi-critical items that are not heat and moisture sensitive.

B. To kill microorganisms, steam sterilization requires exposure of each item to direct steam contact at
a specified temperature and pressure for a defined period of time.

C. The majority of tabletop sterilizers used in oral healthcare settings are gravity displacement
sterilizers.

D. Gravity displacement steam sterilizers should be tested daily for adequate air removal.

6. All of the following statements with respect to unsaturated chemical-vapor sterilizers are
correct except which one?

A. Unsaturated chemical-vapor sterilization involves heating a chemical solution, primarily alcohol with
0.23% formaldehyde, in a closed pressurized chamber.

B. The advantage of using unsaturated chemical-vapor sterilization is that the instruments do not have
to be dry before sterilization.

C. When using an unsaturated chemical-vapor sterilizer federal, state and local authorities must be
consulted for hazardous waste disposal requirements.

D. Unsaturated chemical-vapor sterilization causes less corrosion of carbon steel instruments than
steam sterilization because less water is present during the cycle.

7. Which of the following statements is correct with respect to dry heat sterilization?

A. Dry heat may be used to sterilize patient-care items that might be damaged by moist heat (e.g., burs
and certain orthodontic instruments).

B. Dry heat has the advantages of low operating cost and being noncorrosive.

C. Dry heat is a prolonged process and the high temperatures required are not suitable for the
sterilization of many instruments and devices.

D. All of the above are correct.

8. Which of the following statements is correct with respect to the use of chemical sterilants and
disinfectants?

A. Heat-sensitive critical items must be cleaned and sterilized by immersing them for 3-12 hours in
liquid germicides registered by the FDA as chemical sterilants.

B. Heat-sensitive semi-critical items must minimally undergo high-level disinfection, i.e., they must be
immersed in an FDA-registered chemical sterilant, but for a shorter contact time (≥12 min.).

C. Non-critical patient-care items, when visibly soiled, must be cleaned and disinfected (10-minute
contact time for most products) using an EPA-registered intermediate-level disinfectant with
tuberculocidal claim.

D. All of the above are correct.

9. Which of the following statements is correct with respect to processing contaminated

reusable patient-care items?

A. There should be a central processing area (CPA) of adequate size with four successive stations for (1)
receiving and cleaning; (2) preparation and packaging; (3) sterilization or disinfection; and (4) storage of
sterilized units.

B. Within CPA, each station should be physically separated to control traffic flow and to contain
contaminants during the process.

C. Reusable contaminated patient-care items must be transported from the point of use to the CPA in
sealed, leak proof containers displaying a biohazard symbol.

D. All of the above are correct.

10. All of the following statements are correct with respect to cleaning reusable instruments and
other devices except which one?

A. If visible debris (both organic and inorganic contaminants) is not removed, it will interfere with
microbial inactivation and compromise the sterilization and disinfection processes.

B. Factors to consider in selecting a cleaning method include (1) efficacy of the method, process, and
equipment used; (2) compatibility with items to be cleaned; and (3) occupational health and exposure
risks.

C. The use of automated equipment (e.g., ultrasonic cleaner or washer/disinfector) is discouraged

because manual cleaning of instruments is more efficient.
 D. If the manual method is used, the instruments must be placed in a leak proof, puncture-resistant
container and soaked with a detergent, a disinfectant/detergent, or an enzymatic cleaner to prevent
drying of contaminants.

11. All of the following statements are correct with respect to detergents and enzymatic cleaners
except which one?

A. Detergents with an acidic pH generally provide the best material compatibility profile and good soil
removal.

B. Enzymes, usually proteases, sometimes are added to neutral pH solutions to assist in removing
organic material.

C. Some cleaning solutions also contain lipases (enzymes that inactivate fat) and amylases (enzymes
that inactivate starches).

D. After cleaning, the instruments must be washed to remove detergent and enzyme residues.

12. All of the following statements are correct with respect to preparing and packaging
instruments except which one?

A. The individual instruments should be placed in individual self-sealed or heat-sealed plastic and paper
pouches or arranged in rigid or perforated trays/cassettes and wrapped.

B. Hinged instruments placed in various packs must be in a closed, locked position.

C. Each instrument unit must have an internal indicator placed on the inside and, if the internal
indicator cannot be seen, an external indicator must be applied to the outside.

D. The packing material e.g., paper or plastic pouches and unwoven and woven wraps must maintain
the sterility of instruments during transport and storage.

13. All of the following statements are correct with respect to sterilizing wrapped instruments
loading instruments except which one?

A. Perforated trays/cassettes should be placed so that they are parallel to the shelf.

B. Non-perforated containers should be placed on their edge.

C. Peel-packs should be placed on edge and small items should be loosely placed in wire baskets

D. Once the sterilization cycle is complete, remove the packs to cool and dry onside the chamber.
14. All of the following statements are correct with respect to sterilizing unwrapped instruments
and their use except which one?

A. Unwrapped the instruments must be thoroughly cleaned and dried prior to sterilization.

B. When sterilizing unwrapped instruments mechanical indicators must be checked, but there is no
requirement to place a chemical indicator with the items.

C. Critical items sterilized unwrapped must be transferred from the sterilizer to the point of use by an
aseptic method for immediate use.

D. Unwrapped sterile instruments can become contaminated with dust, airborne organisms, and other
contaminants and should never be stored.

15. All of the following statements are correct with respect to sterilizing and high-level
disinfecting with germicides except which one?

A. Patient-care items must be rinsed with sterile water after immersion to remove toxic or irritating
residues.

B. Patient-care items must be handled using sterile gloves, dried with sterile towels, and delivered to
the point of use in an aseptic manner for immediate use.

C. The efficacy of the sterilization or high-level disinfection process using germicides is readily verifiable.

D. Federal law requires that label instructions on FDA and EPA-registered products be followed (e.g.,
use-dilution, shelf life, storage, material compatibility, safe use, and disposal).

16. All of the following statements are correct with respect to storing sterilized items except
which one?

A. After the sterilization cycle is completed and the instrument units are dry and cool, inspect all
packages for proper color change by visible chemical indicators.

B. Instruments units should be stored in a clean, dry, closed cabinet.

C. Storage practices for wrapped sterilized instruments are time-related, i.e., recognize that wrapped
instruments maintain their sterility for a specified time.

D. When the packaging is compromised (i.e., torn, wet, or open), the instruments should be re-cleaned,
re-packaged in a new wrap, and re-sterilized.
17. Which of the following statements is correct with respect to the various quality assurance
indicators of the sterilization process?

A. Monitoring physical indicators involves observing the gauges or displays on the sterilizer and
recording the time, temperature, and pressure associated with each sterilization cycle for each load.

B. Chemical indicators use sensitive chemicals to assess critical variables (i.e., time, temperature, steam
saturation) during a sterilization cycle and are applied either to the outside or placed on the inside of
each instrument unit to be sterilized.

C. Biological indicators (BIs), or spore tests, assess directly the killing of known highly resistant,
nonpathogenic bacterial spores.

D. All of the above are correct.

18. Which of the following statements is correct with respect to biological monitoring of the
sterilization process?

A. In oral healthcare facilities, BIs should be processed with a load in all sterilizers at least weekly.

B. A BI must be processed in every load containing an implant and the implant should be quarantined
until the result of the spore test is known.

C. When biological testing is done in-office, the test BI must be incubated (along with a positive control
from the same lot but not processed through the sterilizer) within two hours (or refrigerated).

D. All of the above are correct.

19. All of the following statements relative to the sterilization monitoring record (SMR) are
correct except which one?

A. Documentation, in the form of a log, is an absolute requirement of quality assurance.

B. Mail-in biological monitoring reports are maintained by the testing agency and there is no
requirement for separate recordkeeping in the dental office.

C. The SMR provides a mechanism for determining if a recall is indicated and, in combination with the
date and sterilizer number on each pack, the extent of the recall.

D. The sterilization monitoring record and the sterilizer maintenance record shall be maintained for a
specified period of time (state dental board requirements may vary).
20. Which of the following statements is correct with respect to procedures to follow in the event
of a positive spore test?

A. In case of a positive spore test, the sterilizer should be removed from service and all records of
physical and chemical monitoring since the last negative BI test should be reviewed.

B. If the physical and chemical indicators demonstrate that the sterilizer is functioning correctly
consider the possibility of operator error, using the same cycle that produced the failure, repeat the
spore test immediately after correctly loading the sterilizer.

C. If packaging, loading, and operating procedures have been confirmed as performing correctly and the
repeat BI test is positive, the sterilizer should remain out of service until it has been inspected, repaired,
and re-challenged with BI tests in three consecutive empty-chamber sterilization cycles.

D. All of the above are correct.

1 C

2 D

3 C

4 D

5 D

6 B

7 D

8 D
 9 D

10 c

11 A

12 B

13 D

14 B

15 C

16 C

17 D

18 D

19 B

20 D

Environmental Infection Control

1. In healthcare settings pathogenic organisms can be detected __________.

A. in air

B. in water

C. on fomites

D. primarily under dry conditions

2. Which of the following statements related to the risk of acquiring environmentally related HAIs is
incorrect?

A. There must be a source of infectious agents, i.e., contaminated air, water or fomites.
B. There must be a susceptible host exposed to an adequate number of sufficiently virulent
microorganisms.

C. There must be a mechanism to transfer or mode of transmission of pathogens from the source to the
host.

D. A subset of immunocompromised patients, those with an absolute lymphocyte count of ≤ 500

cells/mL has the greatest risk of HAIs.

3. All the following statements are correct with respect to droplets EXCEPT which one? Droplets
__________.

A. are particles of moisture greater than 5µ

B. can contain infectious pathogens

C. can be transported over a long distance, i.e., beyond 3 feet of the source

D. are instrumental in spreading the influenza virus

4.All the following statements related to laser plumes or surgical smoke, and aerosolized allergens are
correct EXCEPT which one?

A. Lasers and electrosurgical units release laser plumes or surgical smoke containing gases, tissue debris,
and aerosolized infectious agents.

B. The presence of pathogens in laser plumes or surgical smoke will predictably cause disease.

C. Exposure to aerosolized allergens can cause urticaria, asthma, allergic rhinitis, conjunctivitis,
angioedema, and rarely anaphylaxis.

D. The FDA banned all powdered surgeon’s gloves because of unreasonable and substantial risk of
allergic reactions.

5.Typically, which of the following areas in healthcare settings is not equipped with special
ventilation?

A. Operating rooms.

B. Protective environment rooms.

C. Airborne infection isolation rooms.

D. Community-based oral healthcare facilities.

6. Which of the following modes are likely to serve as a vehicle for the transmission for Legionella spp.
from a contaminated water source?

A. Ingestion of water.

B. Aspiration of water or inhalation of aerosols.

C. Direct contact with water.

D. Indirect-contact transmission (e.g., from an improperly reprocessed device).

7.Measures to prevent the spread of waterborne pathogens include all of the following EXCEPT which
one?

A. Pipe runs from the water main as long as practical.

B. Hand hygiene and glove use.

C. Barrier precautions.

D. Eliminating or minimizing contamination at point-of-use fixtures.

8.The presence of biofilms of waterborne bacteria (e.g., Legionella spp. and Pseudomonas aeruginosa)
in dental unit waterlines has been confirmed.

A. True

B. False

9. All the following statements relative to boil-water advisory are correct EXCEPT which one? While
the boil-water advisory is in effect __________.

A. use bottled water for patient rinsing

B. if hands are visibly soiled, use an alcohol-based handrub

C. do not deliver water to the patient through point-of-use fixtures from the public water system

D. do not use water from the public water system for handwashing

10. All the following are specifically designed point-of-use devices to ensure water quality when
performing oral surgical procedures for the delivery of sterile irrigating fluid EXCEPT which one?

A. Bulb syringe.

B. Single-use disposable products.

C. Air-water syringe.

D. Sterilizable tubing.

11. An essential first step to ensure the success of the disinfection process on fomites is the physical
action of scrubbing with a detergent and rising with water, which removes large amounts of
microorganisms from surfaces.

A. True
B. False

12. All the following statements are correct in relation to intermediate-level disinfectants EXCEPT
which one? Intermediate-level disinfectants __________.

A. are regulated exclusively by the FDA

B. inactivate Mycobacterium tuberculosis, which is substantially more resistant to chemical germicides

than ordinary vegetative bacteria, fungi, and viruses (with or without lipid envelops)

C. except for sodium hypochlorite, have no demonstrable sporicidal activity

D. are labeled as “tuberculocidal hospital disinfectants”

13. If barriers are not used, regardless of the surface condition, i.e., visibly soiled or not, first clean the
surface then disinfect with an EPA-Listed product that qualifies under EPA’s emerging viral pathogens
program for use against SARS-CoV-2.

A. True

B. False

14. All the following statements are correct with respect to housekeeping surfaces EXCEPT which one?

A. Extraordinary cleaning and decontamination of floors in healthcare settings is warranted.

B. Cleaning the walls, blinds, and window curtains is recommended when they are visibly soiled.

C. Housekeeping surfaces need to be cleaned only with soap and water, alternatively, a
detergent/disinfectant may be used.

D. The methods, thoroughness, and frequency of cleaning housekeeping surfaces and the products used
are determined by healthcare facility policy.

15. All the following strategies for spills of blood and OPIM are acceptable according to OSHA
regulations EXCEPT which one? Removing visible organic matter with absorbent material such as
disposable paper towels; discard it into a leak-proof properly labeled container; and then, disinfect
the area with __________.

A. household bleach, 1:10 v/v dilution

B. an EPA-List D low-level disinfectant (i.e., hospital disinfectant with HIV and HBV claims)

C. an EPA-List E intermediate-level disinfectant (i.e., hospital disinfectant with tuberculocidal, HIV, and
HBV claims)

D. EPA-List B intermediate-level disinfectant (i.e., hospital disinfectant with tuberculocidal claim)

16. All the following statements are correct with reference to carpeting and cloth furnishings in clinical
setting EXCEPT which one?

A. Carpeting and cloth furnishings harbor a diverse microbial population and allergens and should be
vacuumed regularly; although, the bacterial and allergen burden is reduced only temporarily.
B. Despite evidence of microbial growth and persistence, there is little evidence that carpets and cloth
furnishings influence the rate of HAIs.

C. There are specific recommendations against the use of carpeting and cloth furnishings in general
patient-care areas.

D. Avoiding carpeting and cloth furnishings in areas where spills are likely to occur is prudent because
fully contaminating carpets and cloth furnishings is difficult.

17. All the following statements are correct with reference to contaminated laundry EXCEPT which
one?

A. OSHA defines contaminated laundry as "laundry which has been soiled with blood or OPIM."

B. Healthcare-associated infections linked to contaminated fabrics are so few that the overall risk of
disease transmission during the laundry process is negligible.

C. OSHA regulations prohibit home laundering of PPE, and experts agree that this regulation extends to
uniforms and scrubs not contaminated with blood and OPIM.

D. In response to the recent SARS-CoV-2 virus pandemic, the ADA recommends office attire, such as
scrubs, be changed between street clothes upon entry and exit and not be taken home.

18.All the following statements are correct with reference to disposable (i.e., single use) surgical
gowns, drapes, and fabrics EXCEPT which one?

A. Disposable (i.e., single use) surgical gowns, drapes, and fabrics must be resistant to liquids and
microbial penetration.

B. Disposable (i.e., single use) surgical gowns, drapes, and fabrics must be registered with the FDA to
demonstrate their safety and effectiveness.

C. The CDC offers specific recommendations regarding the use of disposable fabrics and textiles versus
durable goods.

D. Repellency and pore size of the fabric contribute to gown performance, but performance capability
can also be influenced by the item's design and construction.

19. Which of the following statements related to solid waste generated in oral healthcare settings is
incorrect?

A. Solid waste generated in oral healthcare settings is a subset of municipal solid waste.

B. Standard methods of collecting, storing, transporting, and disposing of municipal solid wastes are
regulated by state or local jurisdictions.

C. Municipal solid waste regulations often include mandatory requirements for recycling certain
materials (e.g., newspapers, cardboards, plastics, glass containers, etc.).

D. Most solid waste generated in oral healthcare settings is hazardous solid waste.
 20. All the following items related to waste management and hazard communication compliance are
correct EXCEPT which one?

A. Regulated medical waste is a subset of hazardous solid waste.

B. The federal OSHA and its counterpart state agencies are responsible for developing and enforcing
rules related to regulated medical waste.

C. Universal waste includes chemical agents used or generated in the workplace, which pose a hazard to
human health or to the environment when handled improperly.

D. The federal OSHA and its counterpart state agencies are responsible for developing and enforcing
rules for hazardous chemicals as they relate to workers’ health and safety.

1 D
2 D
3 C
4 B
5 D
6 B
7 A
8 A
Regulated Medical 9Waste Management
B
10 C
11 A
12 A
13 A
14 A . 1.
15 A Under
16 C the

17 C
18 C
19 D
20 C
“Medical Waste Tracking Act of 1988,” the EPA conducted a model waste

management program and concluded that

a. due to the biological instability of most microorganisms commonly regarded as human

pathogens, the actual adverse environmental or public health consequences or risks were
negligible
b. the disease-causing potential of medical waste is greatest at the point of generation
c. medical waste primarily represents an occupational health hazard
d. All of the above are correct.

2. Which of the following federal agencies is responsible for safe and healthy working conditions?

a. EPA
b. OSHA
c. FDA
d. NIOSH

3. All of the following statements with respect to the responsibilities of an Office medical Waste
manager are correct except which one? The Office Medical Waste Manager

a. should be familiar with pertinent federal, state and local requirements for RMW management
b. is solely responsible for the creation and maintenance of a safe and healthy work environment
c. should develop, implement, and maintain a written RMW management protocol that meets
federal, state, and local requirements
d. act as advisor on RMW management matters to all office personnel

4. Waste generated in healthcare facilities may be categorized as

a. office waste
b. hazardous and universal waste
c. medical waste
d. All of the above are correct.

5. Based on the OSHA definition, RMW generated in oral healthcare settings may include

a. contaminated sharps
Regulated Medical Waste Management
b. contaminated items that would release blood or OPIM in a liquid or semiliquid state if
compressed and items caked with dried blood or OPIM and are capable of releasing these
materials during handling
c. liquid or semi-liquid blood and OPIM; and pathological, and microbiological waste
d. All of the above are correct.

6. All of the following are considered preventive measures to minimize occupational

exposure to RMW except which one?
a. Engineering controls
b. Work practice controls
c. Maintaining a Sharps injury Log
d. The use of personal protective equipment

7. All of the following statements with respect to waste segregation and office waste are
correct except which one?
a. The various waste categories generated in oral healthcare facilities (office waste, hazardous
waste, universal waste, and medical waste) must be separated at their points of origin.
b. There are very specific requirements for the containment of office waste.
c. Most waste generated in oral healthcare settings is office waste.
d. The waste receptacle, lined with a plastic liner bag, should be of sufficient size and strength to
accommodate the type and quantity of office waste generated.

8. All of the following statements related to medical waste are correct except which one?
a. Needles, scalpel blades, suture needles, endodontic files, orthodontic wires, local anesthetic
cartridges, and glass slides, even if unused, must be considered RMW.
b. Unfixed oral tissues removed during surgery, biopsies, and extracted teeth are not considered
RMW.
c. Generally, gauze, cotton balls or rolls, swabs, and used dressings containing small amounts of
blood or OPIM are not considered RMW.
d. Generally, disposable non-absorbent materials such as gowns, gloves, drapes, bracket table
covers, rubber dams, patient bibs, and face masks are not considered RMW.

9. As many as one-third of all sharps injuries occur during the disposal process as a result of
a. inadequate sharps disposal container design
b. inappropriate sharps disposal container placement
c. inappropriate sharps disposal handling practices, including overfilling of sharps disposal
containers by HCP
d. All of the above are correct.

10. OSHA mandates that

a. sharps disposal containers be puncture resistant, the sides and the bottom be leak-proof, and
they be closable (i.e., they have a lip, flap, door, or other means of closing the container)
b. sharps disposal containers be labeled with the universal biohazard symbol and the word
“BIOHAZARD,” and/or color-coded red
c. the labels on sharps disposal containers must be fluorescent orange or orange-red, with the
symbol and lettering in a contrasting color
d. All of the above are correct.

11. NIOSH recommends

a. the placement of a sharps container of sufficient size, i.e., one that accommodates both the
volume generated and the largest sharp used, at each workstation
b. that the sharps container be readily accessible, i.e., without obstacles between the user and the
container
c. that horizontally, sharps containers must be located within easy arm’s reach and the vertical
height must be below eye level, i.e., the user must have a clear, unobstructed view of the
container’s opening
d. All of the above are correct.

12. Which of the following statements about the sharps disposal container is correct?
a. Sharps containers must be kept upright throughout use to keep the sharps and any liquid from
spilling out.
b. The fill status of the container must be obvious under prevailing lighting conditions at the
workstation.
c. The container’s opening must be identifiable and easily accessible by the user and must facilitate
one-handed disposal of sharps.
d. All of the above are correct.

13. Which of the following statements related to the safe handling of contaminated needles is
correct?
a. Contaminated disposable needles must never be sheared or broken.
b. If bending or removing of a needle from the syringe is necessary, it must be accomplished with
the use of a mechanical device or a one-handed technique.
c. Recapping must be accomplished by the one-handed “scoop technique,” i.e., using the needle
itself to pick up the cap and then pushing the cap against a hard surface to ensure a tight fit over
the needle.
d. All of the above are correct.
14. All of the following statements related to solid RMW are correct except which one?
a. OSHA requires that solid RMW be placed in containers that are closable, constructed to
contain all contents, and prevent leakage of fluids during handling, storage, transport, or
shipping.
b. Biohazard bags used to collect RMW within a facility must be certified by the manufacturer to
meet the American Society for Testing Materials (ASTM) ASTM D1709 Impact Resistance Of
Polyethylene Film By The Free-Falling Dart Method.
c. Autoclavable biohazard bags are available and some feature an indicator that changes to read
“AUTOCLAVED” during steam sterilization; but RMW that has been decontaminated still needs
to be labeled or color-coding.
d. It is recommended to place a larger general office waste container beside the regulated waste
container.

15. All of the following statements related to liquid RMW generated by suctioning during
surgical procedures are correct except which one?
a. Liquid RMW generated by suctioning during surgical procedures may be decanted directly
into clinical sinks unless prohibited by state or local regulations.
b. In the absence of a surgical sink, liquid RMW generated by suctioning during surgical
procedures may be decanted into the hand washing sink.
c. If discharge into a sanitary sewer is prohibited, liquid RMW must be placed into a rigid
container, labeled or color coded red and double bagged using biohazard bags.
d. The State-by-State Regulated Medical Waste Resource Locator is good resource for the
OMWM to determine available options for the disposal of liquid RMW.

16. All of the following statements about storing RMW prior to disposal are correct except which one?
a. The storage of RMW must be in accordance with applicable regulations of the United
States, States and Territories, and political subdivisions of States and Territories.
b. RMW must be stored in a designated, conveniently located storage area such as under the sink
in the treatment room.
c. In preparation for storage, sharps containers must be closed, if there is a chance of leakage,
the container must be placed in a secondary container.
d. Red biohazard bags must be “twist tied,” if a bag seems especially heavy, it must be place
inside another red biohazard bag prior to moving it to storage.

17. All of the following statements relative to the disposal of RMW are correct except which one?
a. The disposal of RMW is regulated by specific OSHA mandates.
b. Most states require that RMW be treated before disposal and most states allow on-site
treatment.
c. The most common on-site treatment methods include (1) steam sterilization (autoclaving), (2)
microwave sterilization, (3) chemical disinfection, and (4) sewer discharge for liquid RMW.
d. Some states require permits for any type of on-site treatment; other states leave it up to the
generator to select a treatment method based on current best practices.
18. All of the following statements relative to off-site shipping of RMW for treatment and
disposal are correct except which one?
a. In nearly all states, transporters of RMW must have a transport permit to pick up and transport
the waste to a treatment and disposal facility.
b. The United States Department of Transportation (USDOT) mandates that the biohazard bags
used to line approved shipping containers for transport of RMW from the generator’s facility to a
treatment and disposal facility be certified by the manufacturer to meet USDOT standards.
c. If the biohazard bags used to collect and transport RMW within a facility meet impact
resistance of 165 grams by the ASTM D1709 method, it meets USDOT requirements for
shipping RMW from the generator’s facility to a treatment and disposal facility.
d. OSHA requires that RMW containers be closed prior to removal from the workstation to prevent
spillage or protrusion of contents during handling, storage, transport, or shipping.

19. Which of the following statements related to recordkeeping, reporting, and tracking of
RMW is correct?
a. Some states require that generators maintain records of the quantity of RMW generated and its
disposition; some require the submission of an annual report.
b. The OMWM should maintain an Infectious Waste Log that includes: date, type of waste, amount
(weight, volume, or number of containers), and disposition.
c. If infectious waste is transported off-site, the receiving facility must provide the generator
written documentation of proper treatment and disposal.
d. All of the above are correct.
20. Which of the following statements related to spills of infectious material is correct?
a. Infectious waste spills must be cleaned up immediately using appropriate PPE such as gloves,
coveralls, mask, and goggles.
b. Small spills are managed by removing visible organic matter with absorbent material (e.g.,
disposable paper towels) discarded into a leak-proof, properly labeled containers biohazard
container.
c. OSHA regulations require the use of an EPA-registered disinfectant to disinfect housekeeping
surfaces after a spill.
d. All of the above are correct.

1 D
2 B
3 B
4 D
5 D
6 C
7 B
8 B
9 D
10 B
11 D
12 D
13 A
14 C
15 B
16 B
17 A
18 C
19 D
20 A