Card # 287

Quaternary ammonium compounds are cationic detergents.

They can be used for skin antisepsis.

both statements are true

both statements are false

the first statement is true, the second is false

the first statement is false, the second is true

Explanation

• both statements are true

Detergents are “surface-active” agents composed of a long-chain, lipid-soluble, hydrophobic portion and a polar
hydrophilic group, which can be a cation, an anion, or a nonionic group. These surfactants interact with the lipid
in the cell membrane (through their hydrophobic chain) with the surrounding water through their polar group
and thus disrupt the membrane.

Quaternary ammonium compounds (e.g., benzalkonium chloride) are cationic detergents. They are used
as disinfectants and antiseptics. Gram-positive bacteria are the most susceptible to destruction. These
compounds are not sporicidal, tuberculocidal, or viricidal and are inactivated by anionic detergents (soaps and
the iron in hard water).
Anionic surface-acting substances include synthetic anionic detergents and soaps. These substances alter the
nature of interfaces to lower surface tension and increase cleaning. Their primary value appears to be their
ability to remove microorganisms mechanically from the skin surface.
1. Nonionic chemicals do not possess any antimicrobial properties.
2. Disinfection destroys all the microorganisms in a certain environment except for spores.
Therefore, objects that have been disinfected may still transmit a pathogenic
microorganism. Sterilization, however, is the complete elimination of all organisms
including spores.
3. Antiseptics are germicidal substances used on skin or other living tissue in an attempt to
inhibit or destroy microorganisms. Antiseptics include alcohols, chlorhexidine, iodine,
quaternary ammonium compounds, and triclosan.
 Card # 288

Which of the following is a powerful oxidizing agent that inactivates bacteria and most viruses by
oxidizing free sulfhydryl groups?

alcohol

chlorine

formaldehyde

phenol

Explanation

• chlorine

Chlorine is the active component of hypochlorite (bleach), which is used as a disinfectant.

Disinfectants are antimicrobial agents that kill (germicide) or prevent the growth (microbiostatic) of
pathogenic microorganisms. Disinfectants are not considered safe for use on living tissue (as
opposed to antiseptics which are) and are applied only to inanimate objects (counter tops, light handles,
headrests, etc.). Disinfectants do not destroy bacterial endospores. Disinfection is not as potent as
sterilization.

1. Phenol was the original disinfectant used in hospitals, but is rarely used as a disinfectant
today because it is too caustic.
2. Formaldehyde (37% solution in water = Formalin ) denatures protein and nucleic acids.
3. Concentration and contact time are critical factors that determine the effectiveness of an
antimicrobial agent against a particular microorganism. Any or all of the three major
portions of microbial cells can be affected: the cell membrane, cytoplasmic
contents (particularly enzymes), and nuclear material.
 Card # 289

How long does it take to kill bacterial endospores when a dental instrument is immersed in a chemical sterilant
such as 2% glutaraldehyde, hydrogen peroxide or peracetic acid?

10-30 minutes

1-2 hours

10-12 hours

24 hours

Explanation

• 10-12 hours

2% glutaraldehyde is an alkalizing agent highly lethal to essentially all microorganisms if sufficient contact time
(10 hours) is provided with an absence of extraneous organic material. Hydrogen peroxide and peracetic acid can
require up to 12 hours to sterilize equipment. Note: Alcohols, chlorhexidine, and quaternary ammonium
compounds are disinfectants.

Advantages of glutaraldehyde:

• Most potent category of chemical germicide

• Capable of killing spores (after 10 hours)
• EPA registered as an immersion sterilant
• Can be used on heat sensitive materials

Disadvantages of glutaraldehyde:
 • Long period required for sterilization
• Allergenic
• Not an environmental disinfectant
• Extremely toxic to tissues

Remember: In hospitals, glutaraldehydes are used to sterilize respiratory therapy equipment.

 Card # 290

The effectiveness of autoclaving is best determined by culturing bacterial spores.

Spore testing of autoclave units is recommended monthly.

both statements are true

both statements are false

the first statement is true, the second is false

the first statement is false, the second is true

Explanation

• the first statement is true, the second is false

Moist heat destroys bacteria by denaturation of the high protein-containing bacteria. The autoclave provides
sterilization when used at 250°F (121°C) for 15-20 minutes because it applies the heat under pressure, which
greatly speeds up the denaturation process when compared with boiling water. Bacterial spores require a
temperature of 121°C for eradication. Usually only 10 minutes is required to destroy all of the bacteria and
spores, but the increased time is allowed for penetration when the instruments are wrapped in thick towels.
These conditions will yield 15 lbs. pressure of steam per square inch.
1. The effectiveness of autoclaving is best determined by culturing bacterial spores.
2. Spore testing of autoclave units is recommended weekly.
3. Precleaning is the most important step in instrument sterilization. Debris acts as a
barrier to the sterilant and sterilization process.
4. Ultrasonic instrument cleaning is the safest and most efficacious method of precleaning.
 Card # 291

The proper time and temperature for dry heat sterilization is:

320°F (160°C) for 2 hours

250°F (121°C) for 20-30 minutes

450°F (232°C) for 5 minutes

89°F (31°C) for 30 minutes

Explanation

• 320°F (160°C) for 2 hours

Note: 340°F (170°C) for 1 hour is also effective.

Items which are usually sterilized by dry heat can be autoclaved. They should be removed immediately after cycle
to diminish the possibility of corrosion of the instruments and dulling of sharp points or edges (carbon steel
instruments). Dry heat destroys microorganisms by causing coagulation of proteins.

Advantages of dry heat:

• Effective and safe for sterilization of metal instruments

• Does not dull or corrode instruments

Disadvantages of dry heat:

• Long cycle
• Poor penetration
 • Will ruin heat-sensitive materials

Important: Instruments must be dry before both dry heat sterilization and ethylene oxide sterilization. Water
will interfere with the sterilization process.
 Card # 292

Which one of the following is NOT considered as the parameter for the effectiveness of moist heat sterilization?

temperature

pure saturated steam

exposure time

relative humidity

Explanation

• relative humidity

Moist heat sterilization works by creating an increased temperature of saturated steam under pressure. Moist
heat sterilization is best accomplished in an autoclave (a sophisticated pressure cooker). Moist heat destroys
microorganisms by irreversible denaturation of bacterial protein and disrupting hydrogen bonds between
peptide groups.

The major parameters of steam sterilization are:

1. Steam: The recommended steam for sterilization is dry pure saturated steam (dryness fraction ≥97%). The
effectiveness of an autoclave depends on the penetration of steam into the materials to be sterilized
(determined by size and density of the material placed and flow rate of steam), absence of air, and
duration of exposure.
2. Pressure: Moist heat in the form of pressurized steam elevates the temperature that will kill all the
microorganisms and their spores. On removal of air from the autoclave, the chamber temperature
becomes directly proportional to the steam pressure. Under these conditions, spores are killed in less than
5 minutes.
 3. Temperature: A specific temperature should be maintained to kill the microorganisms in minimal time. The
recommended common steam sterilizing temperatures are 121°C and 132°C.
4. Exposure time: Minimum exposure period for sterilization of wrapped objects are 30 minutes at 121°C in a
gravity displacement autoclave or 4 minutes at 132°C in a high speed prevacuum sterilizer.

To monitor the effectiveness of sterilization, Bacillus stearothermophilus spores are placed in the center of the
autoclave as a biological indicator. At the end of sterilization, these spores are killed, therefore unable to grow
when incubated at 37°C, determining the success of sterilization.
 Card # 293

Ethylene oxide sterilization is faster than a moist heat autoclave.

Ethylene oxide sterilization can be used to sterilize heat sensitive instruments.

both statements are true

both statements are false

the first statement is true, the second is false

the first statement is false, the second is true

Explanation

• the first statement is false, the second is true

Sterilization with ethylene oxide is a slow process (10-16 hours) depending on the material to be
sterilized. Ethylene oxide gas has been widely used as a sterilization agent, particularly for prepackaged,
disposable plastic ware in hospitals. This gas is very toxic to humans and is also flammable, making its
general use limited. Exposure of materials to ethylene gas must be performed in special sealed
chambers. Items must be cleaned and dried thoroughly before the sterilization process.

Advantages of ethylene oxide sterilization:

• Highly penetrative
• Does not damage heat-labile materials (rubber, cotton, plastic, etc.)
• Evaporates without leaving a residue
• Works well for materials that cannot be exposed to moisture
Important: Ethylene oxide functions as an alkylating agent by irreversibly inactivating cellular nucleic
acids (DNA) and proteins.
 Card # 294

The killing or removal of all microorganisms, including bacterial spores, is called:

disinfection

cleaning

sterilization

wiping

Explanation

• sterilization - refers to the absence of all living forms

Disinfection is the killing of many, but not all, microorganisms. It does not include the destruction of spores. The
term “disinfectant” is reserved for chemicals applied to inanimate surfaces (lab tops, counter tops, headrests,
light handles, etc.). They are not considered safe for use on living tissue.

Antiseptics are chemical agents similar to disinfectants, but they may be applied safely to living
tissue. Note: Soap only removes microorganisms.

Important: Remember the doctrine of sterilization – Do not disinfect what you can sterilize!
1. The immersion of dental instruments in cold disinfectants will not destroy spores or the
hepatitis viruses – they are resistant to physical and chemical agents.
2. Liquids are generally sterilized by filtration. The most commonly used filter is composed
of nitrocellulose and has a pore size of 0.22 µm. This size will retain all bacteria and spores.
3. Filters work by physically trapping particles larger than the pore size.
 Card # 295

All of the following are advantages of using alcohols (70% isopropyl and 70% ethyl alcohol) as surface
disinfectants EXCEPT one. Which one is the EXCEPTION?

they are bactericidal

they are sporicidal

they are tuberculocidal

they are economical

Explanation

• they are sporicidal

***This is false; they are not sporicidal.

Alcohol is probably the most widely used antiseptic and is used to reduce the number of microorganisms on the
skin surface in the area of a wound. Alcohol denatures proteins, extracts membrane lipids and acts as a
dehydrating agent, all of which contribute to its effectiveness as an antiseptic. Even some viruses (lipophilic
viruses only) are inactivated by alcohol. The drawbacks of alcohol are that it evaporates too quickly and has
diminished activity against viruses in dried blood, saliva, and other secretions on surfaces (this is due to the
presence of tissue proteins and glycoproteins which render alcohol ineffective).

For the above reason, alcohols are not regarded as effective surface cleansing agents (i.e., cleaning a dental
operatory following patient treatment).
1. Isopropyl alcohol (90%–95%) is the major form in use in hospitals.
2. Ethanol (70%) is widely used to clean the skin prior to immunization or venipuncture.
3. Iodine is the most effective skin antiseptic used in medical practice. It acts as an oxidizing
agent and combines irreversibly with proteins.
 Card # 296

The greatest occupational health care worker risk for blood borne infection is:

hepatitis C virus

human immunodeficiency virus

hepatitis B virus

tuberculosis

Explanation

• hepatitis C virus

The basis of the current standard (formerly “universal”) infection control precautions was first recommended by
the CDC in 1987. The purpose was to protect health care workers (HCW) from occupational transmission of all
blood borne infectious diseases during provision of patient care. While many health professionals focused on the
Human Immunodeficiency Virus (HIV) as the major risk, accumulated evidence clearly demonstrated that the
hepatitis B virus (HBV) was responsible for infection in 10%–30% of exposed, susceptible HCW at that time.
Concentrations of HBV in the blood of a chronic carrier can range between 1,000,000 to 100,000,000 virions per
mL, in contrast to significantly lower viral loads demonstrated for both HIV-infected persons and persons with
AIDS.

Viral concentrations detected in hepatitis C virus (HCV) infected individuals range between those noted for HBV
and HIV. Thus, we target the most infectious blood borne pathogen with our infection control standards.
Precautions that minimize potential HBV spread, also by inference, prevent cross-infection of less infectious
microorganisms. Since the implementation of HBV vaccination, the risk of bloodborne infection with HBV has
lessened significantly, and HCV is now considered the greatest occupational risk. There is currently no vaccine to
prevent HCV transmission.
1. Remember: Semen, serum, amniotic fluid and breast milk are fluids that can transmit HIV.

Accumulating evidence suggests that HIV is not transmitted by casual household or social

contact.

2. Important: Contact with saliva, tears, or sweat has never been shown to result in transmission

of HIV.
 Card # 297

For each numbered definition below, select the most closely linked term from the list provided.

• 1. An ability to induce a disease.

• 2. Any microorganism capable of causing infection.
• 3. A site where the microorganisms reside and multiply.
• 4. The number of microorganisms available to induce disease.
• 5. The site from where the infection is transmitted to a susceptible host.
• A. Reservoir
• B. Infection source
• C. Pathogenicity
• D. Infectious vector
• E. Infecting dose

Explanation

• 1. C, 2. D, 3. A, 4. E, 5. B

An infection is transmitted depending on three elements that are interconnected, i.e., causative agent, source,
and mode of transmission.

A microorganism that is capable of causing infection is known as an infectious vector.

An important property of a causative agent is pathogenicity, which determines the extent to which an agent is
capable of producing disease in an infected population.

The pathogenicity of an organism is characterized by its virulent nature, i.e., infection severity, which is
determined by morbidity and mortality rates of germs and by the level of invasiveness, i.e., the capability of an
organism to invade tissues. Typhoid bacilli, rabies, measles, varicella, and rhinoviruses show high pathogenicity.
Intermediate pathogenicity is shown by rubella, mumps, and adenoviruses, while the poliovirus and tubercle
bacillus show low pathogenicity.

Factors that increase the risk of infection are as follows:

1. Infecting dose is the number of organisms or pathogens required to cause an infection.

2. Reservoir is the site that harbors the microorganisms, allowing them to multiply. Thus, controlling an agent
in its reservoir reduces the occurrence of a disease. For example, chlorination of water and pasteurization
of milk causes the death of an agent in its reservoir.
3. Infection source is the site from where infection is transmitted to a host through an intermediary object
either directly or indirectly. Infection arising from a pathogen that is transported from an external source
to the host is called as exogenous infection. If the source of a pathogen is within the body, the infection is
called an endogenous infection.
 Card # 298

Which of the following antiseptics does NOT exhibit persistent activity?

isopropyl alcohol

chlorhexidine gluconate

triclosan

quaternary ammonium compounds

Explanation:
Incorrect Answer! Flip to read detailed explanation.

Explanation

• isopropyl alcohol

Persistent activity (previously known as residual activity or substantivity) is the ability of a substance to prevent
or inhibit the proliferation or survival of microorganisms after the substance has been applied. Persistent activity
can last for minutes to hours. Chlorhexidine, quaternary ammonium compounds, octenidine and
triclosan all exhibit persistent activity. Isopropyl alcohol does not inherently exhibit persistent activity, but some
alcohol-based antiseptics can include another additive that possesses the characteristic.

Note: Isopropyl alcohol, when used for hand antisepsis does not require the use of water, and thus is a form
of waterless hand hygiene.
 Card # 299

Bactericidal agents work best during which of the following phases of bacterial growth?

lag phase

log phase

stationary phase

death phase

Explanation

• log phase

The use of bactericidal chemicals is preferable to those which are “static.” The latter do not directly kill or
inactivate microbes, but instead inhibit their metabolism and replication. These affected organisms can remain
viable but inactive for extended intervals. Application of “cidal” agents or processes are designed to ensure
microbial inactivation.
 Card # 300

The marker microorganism for intermediate surface disinfection is:

•
Bacillus stearothermophilus

•
Pseudomonas aeruginosa

hepatitis B virus

•
Mycobacterium tuberculosis

Explanation

• Mycobacterium tuberculosis

Antimicrobial activity against Mycobacterium tuberculosis is recognized as a significant benchmark criterion for
disinfectant effectiveness. While tuberculosis is not transmitted via inanimate environmental surfaces, the
morphology and structure of the tubercle bacilli (heavy waxy outer membrane with mycolic acid) make them
relatively resistant to penetration by a number of low-level disinfectant chemicals.

Intermediate-level agents, such as phenols, iodophors, hypochlorite, and certain preparations containing
alcohols plus other cleaner disinfectant chemicals are able to penetrate the wax and lipid outer layers
surrounding mycobacteria.
 Card # 301

The antigens most responsible for an immediate Type I reaction to natural rubber latex are:

proteins

accelerators

corn starch powders

anti-oxidants

Explanation

• proteins

Only a few of the more than 250 proteins found in the sap from the rubber tree Hevea brasiliensis are
responsible for causing the Type I, immediate, IgE-mediated reactions to natural rubber latex. These are water-
soluble macromolecules that can leach out of latex gloves when a person perspires, or be detected on the
surfaces of other products containing natural rubber latex (NRL).
 Card # 302

Cleaning surfaces prior to disinfection in clinical settings is required to:

destroy all pathogens

inhibit pathogen growth

reduce the concentration of pathogens

weaken the virulence of pathogens

Explanation

• reduce the concentration of pathogens

The simplest way to approach environmental surface disinfection is to adhere to a basic premise of aseptic
technique – clean it first. All disinfectant products include specific label instructions for cleaning prior to
disinfection.

Cleaning is defined as the physical removal of debris.

Two effects result from efficient cleaning:

1. A reduction in the number of microorganisms present.

2. The removal of blood, tissue bioburden, and other debris which can interfere with disinfection.
 Card # 303

The most efficient way to kill microbes is:

cold sterilization

proper handwashing with sterilizing antiseptics

heat sterilization

immersion of contaminated items in chemical sterilants

Explanation

• heat sterilization

The use of heat has long been recognized as the most efficient, reliable, biologically monitorable method of
sterilization. During a routine cycle using an autoclave, unsaturated chemical vapor sterilizer, or dry heat unit,
cell death is accomplished via heat inactivation of critical enzymes and other proteins within microbial cells.

The recommendation stating that all reusable items that come in contact with a patient's blood, saliva, or
mucous membranes must be sterilized using heat is now routinely accepted and used in dental facilities.
 Card # 304

The most common form of an adverse epithelial reaction noted for healthcare professionals is:

irritation dermatitis

type I immediate latex allergy

type IV, delayed latex allergy

superficial fungal infections on the fingers

Explanation

• irritation dermatitis

A number of published reports have cited data suggesting that between 20% and 30% of health care
workers suffer from occasional or chronic dermatitis on their hands. The most common manifestation of
the condition is irritation dermatitis, a non-specific immune reaction often caused by contact with a
substance that physically or chemically damages the skin.

The condition can be aggravated by frequent handwashing, residual glove powder left on hands, and
the harshness of repeated use of some antiseptic handwash agents. Health care workers located in
colder climates may also experience chapping during the winter months.
 Card # 305

A patient develops a Type I, immediate allergic reaction to latex. When treating him and wearing gloves from
now on, you can:

wear vinyl or nitrile gloves

wear hypoallergenic latex gloves

get an exemption and not wear gloves

refuse to treat him

Explanation

• wear vinyl or nitrile gloves

A wide variety of latex-alternative infection control items have appeared in the marketplace within the last 10
years. The most widely recognized are newer generations of vinyl or nitrile gloves which do not cross-react with
latex allergens. Products with the designation "hypoallergenic" are no longer to be labeled latex alternatives, as
they contain latex with a chemical coating over the latex.

Note: Studies over recent years have shown that not all latex-allergic persons are able to use hypoallergenic
gloves, since many Type I allergic individuals still develop allergic manifestations when using these gloves.
Card # 305

A patient develops a Type I, immediate allergic reaction to latex. When treating him and wearing gloves from
now on, you can:
•

wear vinyl or nitrile gloves

wear hypoallergenic latex gloves

get an exemption and not wear gloves

refuse to treat him

Explanation

• wear vinyl or nitrile gloves

A wide variety of latex-alternative infection control items have appeared in the marketplace within the last 10
years. The most widely recognized are newer generations of vinyl or nitrile gloves which do not cross-react with
latex allergens. Products with the designation "hypoallergenic" are no longer to be labeled latex alternatives, as
they contain latex with a chemical coating over the latex.

Note: Studies over recent years have shown that not all latex-allergic persons are able to use hypoallergenic
gloves, since many Type I allergic individuals still develop allergic manifestations when using these gloves.
 Card # 306

Which of the following is the process of killing all microorganisms on an object or in a material?

standardization

sanitization

disinfection

sterilization

Explanation:
Correct Answer!

Explanation

• sterilization

Sanitization is a particular kind of antimicrobial treatment that lowers the total microbial load to safe public
health levels.

Disinfection is the process of reducing the numbers of or inhibiting the growth of microorganisms, especially
pathogens, to the point where they no longer pose a threat of disease.

1. An antiseptic is a chemical that can be administered safely to external body surfaces or

mucous membranes to decrease microbial numbers. Antiseptics cannot be taken internally.
2. A disinfectant is a chemical agent used to destroy microorganisms on inanimate objects
such as dishes, tables, and floors. Disinfectants are not safe for living tissues.
 Card # 307

The most likely route for a dentist to be infected with Hepatitis C from a patient is from the inhalation of
aerosols.
There is no vaccination for Hepatitis C.

both statements are true

both statements are false

the first statement is true, the second is false

the first statement is false, the second is true

Explanation

• the first statement is false, the second is true

Hepatitis C virus (HCV) is transmitted primarily in infected blood (blood transfusions). Historically, parenteral
drug abusers, persons receiving transfusions, organ recipients, and hemophiliacs receiving factor VIII or IX were
shown to be at high risk of HCV infection. More recently, persons receiving tattoos or undergoing body piercings
have been infected via contaminated, unsterilized needles.
1. The most likely route for a dentist to be infected with Hepatitis C from a patient is from
a contaminated needlestick (as opposed to saliva or the inhalation of aerosols).
2. Important: Hepatitis C is a significant risk factor for the development of hepatocellular
carcinoma.
3. There is no vaccination for Hepatitis C.
 Card # 308

A 62-year-old male was placed on a ventilator in the ICU, post elective surgery (CABG) due to myocardial
infarction. After 48 hours the patient developed fever, purulent sputum, and respiratory distress and was
diagnosed with ventilator-associated pneumonia. Pneumonia acquired in the hospital is an example of?

community acquired infection

nosocomial infection

opportunistic infection

secondary infection

Explanation

• nosocomial infection

Nosocomial infections or hospital acquired infections (HAI) originate in a hospital, or hospital-like setting,
generally occurring more than 48 hours after hospital admission. They are also known as complications arising
during hospitalization. Patients in burn units and surgical ICUs have the highest risk of developing nosocomial
infections.

Sources and modes of transmission of nosocomial infections are as follows:

1. Patient’s own microbiota (resistant organisms associated with hospitalization), immunocompromised

disease or therapy (due to vulnerability of hospitalized patients).
2. Hospital personnel including healthcare providers, therapists, students who come in contact with the
patient and may transmit infection.
 3. Medical equipment, i.e., indwelling urinary catheters, intravenous lines, endotracheal tubes that cross the
normal defense barriers giving microbes access to normally sterile fluids and tissues.
4. Complex drug-altered environment of the hospital such as hospital air, walls, floors, linen, which can be
sources of nosocomial infection.
5. Unsafe injection practices during which medications from a single syringe are administered to multiple
patients.

Community-acquired infections can occur during hospitalization but differ from nosocomial infections in that
community-acquired infections are present or are incubating before hospitalization.

Opportunistic infections are caused by bacteria, viruses, fungi, or protozoa that infect patients with a
compromised immune system. Patients with cystic fibrosis, uncontrolled diabetes mellitus, organ transplants,
and acquired or congenital immune deficiencies are at high risk of developing opportunistic infections. Normal
resident flora proliferates and causes disease due to defective defense systems.
 Card # 309

It is recommended that face masks be changed:

between patients

daily

twice per day

twice in the morning and twice in the afternoon

Explanation

• between patients

Face masks should be changed at least with every patient and more often if heavy spatter is generated during
treatment. The CDC recommends that masks be changed between patients or during patient treatment if the
mask becomes wet or moist from within or outside.

BFE (Bacterial Filtration Efficiency) measures the percent efficiency at which the face mask filters bacteria passing
through the mask.

PFE (Particulate Filtration Efficiency) measures the percent efficiency at which the face mask filters particulate
matter passing through the mask.

Fluid resistance is defined as the ability of a face mask's material construction to minimize fluids from traveling
through the material and potentially coming into contact with the user of the face mask. Fluid resistance helps
reduce potential exposure to blood and body fluids caused from splashes, spray, or spatter.
 Card # 310

Latex allergy risk factors include all of the following EXCEPT one. Which one is the EXCEPTION?

persons with multiple surgeries

atopy

rubber industry workers

persons with an allergy to pollen

persons with an allergy to bananas

Explanation

• persons with an allergy to pollen

Published studies have demonstrated an increased risk of developing an allergic reaction to either latex protein
(type I) or certain chemicals used in the latex manufacturing process (type IV) in certain groups of people. Current
information has not shown a cross-reaction between pollen allergies and water-soluble latex allergens. Individuals
who appear to be predisposed to readily developing type I hypersensitivity reactions (i.e., who are atopic),
however, can become sensitized to latex allergens more readily than people with few or no allergies.
Note: Atopy is the genetic tendency to develop the classic allergic diseases – atopic dermatitis, allergic rhinitis
(hay fever), and asthma. Atopy involves the capacity to produce IgE in response to common environmental
proteins such as house dustmites, grass pollen, and food allergens.

Remember: Naive T cells fall into two large groups, one of which carries the co-receptor CD8 on its surface and
the other bears the co-receptor CD4. CD8 T cells all differentiate into CD8 cytotoxic T cells (aka, cytotoxic
lymphocytes or CTLs), which kill their target cells. They are important in the defense against intracellular
pathogens, especially viruses. Virus-infected cells display fragments of viral proteins as peptide – MHC class I
complexes on their surface and these are recognized by CD8 cytotoxic T cells.

CD4 T cells, in contrast, differentiate into a number of different effector T cells with a variety of functions. The
main functional subsets of CD4 effector T cells now recognized are TH1, TH2, TH17 and the regulatory T cells.
These subsets, particularly TH1, TH2, and TH17 are defined on the basis of the different cytokines that they
secrete. TH1 cells produce cytokines that activate macrophages, enabling them to destroy intracellular
microorganisms more efficiently. They can also activate B cells to produce strongly opsonizing antibodies
belonging to certain IgG subclasses. TH2 cells, in contrast, produce cytokines that drive B cells to differentiate and
produce immunoglobulins of other types, especially IgE. TH17 cells induce local epithelial and stromal cells to
produce chemokines that recruit neutrophils to sites of infection early in the adaptive immune
response. Regulatory T cells suppress T cell activity and help prevent the development of autoimmunity during
the immune response.
 Card # 311

Which of the following precautions that are practiced in contagious patients for controlling the spread of
infection is NOT a component of isolation measures?

use of transmission-based precautions in addition to standard precautions

placement of the patient in a negative airflow room

use of vaccinations

use of N95 respirator masks by hospital personnel

Explanation

• use of vaccination

Isolation involves the physical separation of those known or suspected to have a contagious disease in order to
prevent or limit the spread of disease.

Isolation precautions include the following:

1. Standard precautions
2. Transmission-based precautions

Standard precautions are a combination of universal precautions and body substance isolation. Standard
precautions are used to prevent hospital-based infection where there are high chances of exposure to infected
blood, other body fluids (secretion and excretion, except sweat), nonintact skin, and mucous membranes.

Transmission-based precautions are second-tier precautions that are used in addition to standard precautions
Transmission-based precautions include the following three categories:

1. Contact precautions are intended to check the transmission of infectious agents (like methicillin-
resistant Staphylococcus aureus, Clostridium difficile, etc.) that are spread by direct or indirect contact with
the patient or patient care items. Patients placed in contact isolation should preferably have a private
room. Contact precautions also include hand hygiene, use of gown, gloves, masks, and eye shield for
personnel who come in contact with the patient or immediate surroundings.
2. Droplet precautions are used when mode of transmission of infection is spread by droplets that are
generated when an infected patient coughs, sneezes, or spots, such as with tuberculosis infection.
3. Airborne precautions are intended to check the transmission of infectious agents with a size less than 5
µm or those attached to dust particles, e.g., Varicella virus. Patients are preferably kept in a negative air
pressure private room and hospital personnel should wear N95 respirator masks (special high-density
masks) in the isolation room. The patient should wear an approved respirator outside the isolation room.
 Card # 312

Each of the following are advantages of rapid heat sterilization EXCEPT one. Which one is the EXCEPTION?

very fast cycle time

no dulling of cutting edges

dry instruments after cycle

does not require precleaning

Explanation

• does not require precleaning

FDA-approved, forced air, dry heat convection ovens are appropriate for sterilization of heat-stable instruments
and other reusable items employed in patient care. They use a higher temperature than other dry heat units, and
there is controlled internal airflow within the chamber. In contrast to the traditional type of dry heat sterilizers, a
rapid heat transfer unit can achieve sterilization of items in substantially shorter times, while still offering the
advantages of dry heat.

Advances in the design of the dry heat oven have resulted in the development of the dry heat convection unit,
which uses forced air at higher temperatures. This method of rapid heat transfer achieves sterilization in 12
minutes at 375°F (190°C) for wrapped items and in 6 minutes for unwrapped items.
 Card # 313

For each numbered definition below, select the most closely linked term from the list provided.

• 1. Group of individuals affected by common disease

• 2. Protects medical staff against infection by patients
• 3. Part of standard precautions that isolates all blood and body fluids of infected patients
• 4. Patients suffering from communicable disease are kept in this hospital unit
• 5. Isolation in immunodeficient patients
• A. Body substance isolation
• C. Reverse isolation
• D. Isolation unit
• E. Patient cohort
• F. Barrier nursing

Explanation

• 1. E, 2. F, 3. A, 4. D, 5. C

Isolation unit is a hospital unit that separates patients with communicable diseases from other patients.

Reverse isolation, also known as protective isolation, involves the separation and care of immunodeficient
patients (such as those who have undergone chemotherapy or organ transplants), so that they can be guarded
from the risk of contact with pathogenic microorganisms in the environment.

Body substance isolation is an infection control method that considers all body fluids, i.e., blood, secretions, and
excretions, as potentially infectious, and that stipulates an effective task-specific barrier between the patient and
medical personnel should be maintained. Body substance isolation is an important component of standard
precautions, i.e., combination of universal precautions and body substance isolation.

Patient cohort is a group of patients with the same disease or condition who are grouped together in a
designated area of a unit or ward. Their progress can be assessed in a research study. For example, patient
cohort is practiced in contact isolation where the individuals infected with the same microorganism may share
the same private room.

Barrier nursing is also known as bedside isolation. It is a form of infection control that checks the transmission of
infection to medical staff from patients, particularly those with highly infectious diseases, such as tuberculosis.
Barrier nursing involves the use of gloves, gowns, and masks to prevent the spread of infection.
 Card # 314

What is the most important preventive measure for the spread of nosocomial infections in hospitals?

vaccines

spray-wipe-spray

handwashing

isolation measures

Explanation

• handwashing

In a healthcare setting, handwashing is the primary disease prevention measure against the
transmission of nosocomial (hospital-acquired) pathogens.

Microorganisms that dwell on the hands can be subdivided into following types:

1. Resident flora are organisms of low virulence that are not easily removed by hand-washing. They
are rarely transmitted except through invasive procedures.
2. Transient flora are the most important cause of hospital-associated infections that are acquired
by contact or are loosely attached to the skin. They are easily removed by hand-washing.

Thus, the role of hand hygiene in the hospital is to get rid of transient flora acquired by contact
with the patients or their surrounding environment.

Hand hygiene should be done before:

 • Performing invasive procedures
• Handling open wounds
• Having direct contact with patients in ICUs or with newborns

Hand hygiene should also be performed immediately after touching the source that is likely to be
contaminated, contact with patients or with objects in the patient’s immediate environment, and also
after removing gloves.

Routine hand hygiene can be carried out by the following ways:

• Using regular or antimicrobial soap and water when hands are visibly soiled or contaminated
• Using alcohol-based hand rubs when hands are not visibly soiled or contaminated.

Wall-mounted dispensers containing alcohol-based hand rubs should be placed in all healthcare
facilities. Health care workers should carry a small container of hand rub to use when dispensers are not
available.

Isolation is a special precautionary measure to check the spread of contagious microorganisms and
prevent epidemics. Isolation should be carried out where there is a high risk of cross-infection, such as in
ICUs. Isolation measures require that all individuals entering the room of an infected patient should
wear gloves, gown, and possibly a mask.
 Card # 315

Which one of the following bacteria is capable of forming endospores and is thus difficult to decontaminate with
standard disinfectants or autoclaving conditions?

•
Lactobacillus

•
Listeria

•
Bacillus anthracis

•
Corynebacterium

Explanation

• Bacillus anthracis

An endospore is a thick-walled structure formed by some bacteria.The three most common examples of bacteria
that form endospores are Bacillus anthracis, Clostridium tetani, and Clostridium botulinum.

A bacterium forms an endospore when there is an unfavorable change in environmental conditions or when
nutrients are exhausted (such as depletion of carbon, nitrogen, or phosphorus). Endospores are essentially the
dormant form of the bacterium, enabling it to survive harsh environmental conditions (intense heat, radiation,
and disinfectants). In the endospore form, bacteria are difficult to decontaminate.

An endospore differs in composition from the bacterium’s non-dormant state. The endospore contains
dipicolinic acid and a high calcium content, which allows it to be highly resistant to heat and chemicals. When
growing conditions improve, the endospore is activated and the bacterium resumes its vegetative life by actively
growing and reproducing. For example, tetanus caused by Clostridium and anthrax caused by Bacillus are
associated with endospore infection of wounds, where under appropriate conditions, the endospores are
activated.

Gram-positive rods of medical interest include:

 Gram-positive rods
Endospore forming Bacillus, Clostridium
Regular, non-endospore forming Lactobacillus, Listeria, Erysipelothrix
Irregular, non-endospore forming CorynebacteriumCorynebacterium
 Card # 316

A thermometer is an example of which of the following Spaulding classifications?

critical

semicritical

subcritical

noncritical

Explanation

• semicritical

Spaulding’s Classification of Devices/Medical Instrum

Object and Classification Use of item Example

Enters vascular system or Scalpels and other surgical instruments such as

Critical
sterile body tissues biopsy forceps

Comes in contact with

Semi-Critical Thermometer, vaginal speculum, sigmoid scope
intact mucous membranes
 Comes in contact with Examining table top, blood pressure cuff, baby
Non-Critical
intact skin weight scale

Remember: All instruments to be disinfected or sterilized must be thoroughly cleaned to remove all organic
matter (blood tissue) and other residue. This must precede disinfection and sterilization procedures as organic
matter shields organisms from destruction and may inactivate some disinfectants.
 Card # 317

Each of the following is characteristic of alcohol-based hand hygiene antiseptics, EXCEPT one. Which one is the
EXCEPTION?

broad antimicrobial spectrum

removal of organic debris from contaminated hands

rapid antibacterial action

greater antibacterial effect than anionic detergents

Explanation

• removal of organic debris from contaminated hands

Hand hygiene agents which contain high concentrations of alcohol, denature and dehydrate proteins instead of
accomplishing the removal of proteinaceous bioburden.

The use of alcohol-based hand antiseptics (hand sanitizers) does not replace the need for frequent and proper
hand washing. The efficacy of most alcohol-based hand antiseptics approximates simple hand washing. In
addition, many alcohol-based hand antiseptics have very poor activity against bacterial spores, protozoan cysts
and certain non-enveloped viruses, such as noroviruses. Alcohol-based hand antiseptics appear to have very
good to excellent activity against many bacteria and some enveloped viruses. Some scientific evidence suggest
that ethanol-based hand antiseptics containing 60-90 percent alcohol, appear to be the most effective against
common pathogens (including non-enveloped viruses) that cause acute gastroenteritis. In general, ethanol-based
hand antiseptics appear to have greater antimicrobial activity against viruses than isopropanol-based hand
antiseptics, although both appear to offer some activity against these pathogens.
Note: Alcohol-based hand antiseptics are not effective on hands that are visibly dirty or those contaminated with
organic materials. Hands that are visibly dirty or contaminated with organic material must be washed with soap
and water, even if hand antiseptics are to be used as an adjunct measure. It is also worth noting that the amount
of alcohol-based hand antiseptic is important to its overall effectiveness. Failure to cover all surfaces of the hands
and fingers will also greatly reduce the efficacy of alcohol-based hand antiseptics.
 Card # 318

Which of the following items is considered regulated medical waste and cannot be disposed
of with general dental office trash?

gauze soiled with blood, plaque, and saliva used in a dental prophylaxis procedure

blood-saturated gauze used in oral surgical procedures

visibly contaminated environmental surface barriers

plastic saliva ejectors and high-volume evacuator tips

Explanation

• blood-saturated gauze used in oral surgical procedures

Blood-saturated gauze is considered infectious, not merely contaminated, and meets the
OSHA Bloodborne Pathogens Standard criteria for regulated waste. It requires special
handling and disposal.

Regulated Medical Waste: This includes infectious and biohazardous waste defined as a
solid or liquid that contains pathogens in adequate numbers and with sufficient virulence to
cause infectious disease in susceptible hosts exposed to the waste. This waste could pose
a threat to human health or the environment. This type of waste includes:

• Micro biological waste: cultures and discarded live and attenuated viruses
• Pathological waste: tissue; extracted teeth (without amalgam)
• Blood and blood by-products
 • Absorbent materials containing large volumes (greater than 20 mL of blood and blood
products, saliva, nasopharyngeal secretions, etc.) which are liquid and are relatively
slow to dry
• Sharps: hypodermic needles, syringes and scalpel blades, endodontic files/reamers,
matrix bands, etc.
• Anesthetic carpules will be considered "sharps" and infectious waste due to their
potential to transmit disease if they become broken

General waste: General waste which does not pose a significant risk of causing or
transmitting communicable disease or infection under ordinary circumstances. This type of
waste includes:

• Absorbent materials containing blood, saliva, nasopharyngeal secretions, etc. and

which are non-liquid and dry relatively fast
• Infectious waste which has been sterilized
• All solid or liquid waste generated during patient care not classified as infectious
• Shall include, but not limited to, waste such as empty specimen containers,
bandages, dressings and absorbent materials containing non-liquid blood, surgical
gloves, decontaminated biohazardous waste, and other materials which are not
biohazardous
• All waste must be disposed of according to applicable federal, state and local
recommendations
 Card # 319

Iatrogenic infections in the dental setting may be induced:

by failure to perform hand hygiene between patient procedures

by performing treatment procedures

in patients with debilitated or compromised immune defenses

all of the above

Explanation

• all of the above

Iatrogenic infections can be initiated by any activity related to the provision of healthcare, including medical or
dental treatments and diagnostic procedures, regardless of whether they are performed properly and regardless
of host immunity. These infections are also called opportunistic if they could not normally develop in persons
without compromised host immunity.
 Card # 320

Gloves, gowns, masks, goggles, and aprons are personal protective equipment.
Surgical gloves provide first-line defense against microbial contamination.

both statements are true

both statements are false

the first statement is true, the second is false

the first statement is false, the second is true

Explanation

• the first statement is true, the second is false

In a healthcare setting, personal protective equipment (PPE) are worn by patient care providers as protective
barriers. PPE include items such as gloves, gowns, facemasks, protective eyewear, aprons, and other equipment.
These protective barriers protect against transmissible diseases or harmful chemicals.

Personal protective equipment is detailed as follows:

Gloves

Gloves should be worn before touching any body fluid, blood, secretions, excretions, contaminated items, and before touching

Surgical gloves are considered a second line of defense (hand hygiene being the first line of defense) against
microbial contamination.

Gloves should be changed between tasks and procedures on the same patient or after contact with material that has high

risk of being contaminated with microorganisms.

Gloves should be removed after use, before touching noncontaminated objects and surfaces, and before caring for another

patient.

In order to prevent the breach of glove by perforation, thicker gloves or double-gloving is preferred. Double-gloving

with a dark-colored indicator under the gloves helps in identifying a perforation.

Hands should be washed prior to and immediately after the use of gloves to prevent transmission of microorganisms.

Gown

A gown should be worn as a barrier for protecting the skin and clothing of medical personnel during patient care procedures

and activities.

Gowns should have long sleeves with elastic cuffs made of impermeable or water resistant material.

Soiled gowns should be removed immediately after attending to a patient and hand washing is highly recommended in

order to maintain asepsis.

Mask, eye protection, face shield

A mask, eye protection (goggles), and a face shield help protect the mucous membranes of the eyes, nose, and mouth

during lab procedures or patient care activities.

 Card # 321

Using automated cleaning equipment is more time efficient, improves cleaning effectiveness, and is
safer than hand-scrubbing.
Cleaned instruments need not be wrapped nor heat sterilized prior to use on subsequent patients.

both statements are true

both statements are false

the first statement is true, the second is false

the first statement is false, the second is true

Explanation

• the first statement is true, the second is false

When automated cleaning equipment, such as an ultrasonic unit or a washer-disinfector, is routinely

used in instrument reprocessing, cleaning effectiveness improves and the potential risks from accidental
sharps exposures with contaminated instruments decreases. Cleaned instruments must still be wrapped
and heat sterilized prior to use on subsequent patients. Heat sterilization remains the “gold standard” for
destruction of microbial pathogens.

Note: Disposable, or single-use items, are not intended to be cleaned and sterilized for reuse on another
patient, because they are usually not heat-tolerant and cannot be readily cleaned.
 Card # 322

According to the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard,
disposable gloves that have been contaminated shall be replaced:

immediately

as soon as possible

as soon as feasible

as soon as practical

Explanation

• as soon as practical

Contamination of the outside surface of gloves during patient care does not require urgent action. The OSHA
Bloodborne Pathogens Standard states: “Disposable (single use) gloves such as surgical or examination gloves,
shall be replaced as soon as practical when contaminated or as soon as feasible if they are torn, punctured, or
when their ability to function as a barrier is compromised.”
 Card # 323

Standard precautions should be practiced when there is risk of transmission of infectious pathogens. Which of
the following specimens is exempted from standard precautions?

urine

mucous membranes and non-intact skin

perspiration

blood

Explanation

• perspiration

Standard precautions are a set of strategies designed to decrease the risk of spread of infectious pathogens from
both identified and unidentified sources. These precautions are applicable to blood, all body fluids, secretions,
excretions (except sweat regardless of whether or not visible blood is present), non-intact skin (cuts, abrasions,
dermatitis, etc.), and mucous membranes (mouth, nose, eye), which are recognized as the primary sources of
transmission of infection.

Standard precautions came into existence in 1996 by encompassing both universal precautions and body
substance isolation precautions. Universal precautions, devised by Centers for Disease Control and Prevention
(CDC) in 1987, were 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. Body substance
isolation precautions were developed in 1984 with the aim of protecting healthcare workers from microbial
transmission from moist body surfaces. Thus, standard precautions superseded and combined the previous
guidelines of both universal precautions and body substance isolation. It is difficult to determine beforehand
whether a particular patient is infectious or not, therefore, standard precautions should be routinely practiced
for all patients.

The various components of standard precautions include hand hygiene and appropriate barriers by wearing
personal protective equipment such as gloves, face mask, protective eye wear (goggles), and gown. Appropriate
measures should be taken to manage soiled patient care equipment, control the hospital environment through
cleaning and disinfection, and properly handle patient’s linen to prevent transmission of infection. Safe injection
practices should be followed such as use of sterile single-use disposable needles and management of used
sharps.

Resuscitation bag, mouthpiece and other devices should be used to avoid contact with the patient’s mouth and
oral secretions. A single-occupancy room is recommended if the patient is at an increased risk of transmission of
infection. Cough etiquette should be taught and followed.
 Card # 324

Using cassettes to process and re-circulate instruments in clinical settings can:

make instrument processing more efficient

increase organization of dental instruments

decrease handling of contaminated instruments during cleaning procedures

reduce the potential for accidental sharps injuries

all of the above

Explanation

• all of the above

Cassettes provide an alternative approach for reprocessing instruments that addresses a number of occupational
issues encountered by health professionals when handling sharp, contaminated instruments.

Using cassettes for reprocessing instruments:

• Requires less handling of contaminated instruments

• Decreases the risk of sharps injuries during reprocessing
• Gives the capacity to hold a complete set of instruments for a single procedure
• Can save time by keeping all instruments for a specific procedure together through the reprocessing cycle
 Card # 325

Which of the following hospital waste is designated by Centers for Disease Control and Prevention (CDC)
as regulated medical waste?

microbiology laboratory waste

blood

sharps

pathology and anatomy waste

contaminated animal carcasses

all of the above

Explanation

• all of the above

 Regulated medical waste (previously called infectious waste) is defined as a medical waste that is
capable of producing an infectious disease. It contains virulent pathogens in enough quantity, and when
a susceptible human host is exposed to such waste, it results in an infectious disease. Hospital waste,
such as microbiology laboratory waste, pathology and anatomy waste, contaminated animal
carcasses, blood, and sharps, is designated as regulated medical waste by the Centers for Disease
Control and Prevention (CDC).

The US Environmental Protection Agency (EPA) also considers the five CDC-designated wastes as
regulated medical waste. Moreover, the EPA also included communicable disease isolation waste as
regulated medical waste.

Note: In the Medical Waste Tracking Act (MWTA), the EPA included only “highly” communicable
disease waste such as those caused by Class 4 infectious agents (e.g., Marburg, Ebola, and Lassa viruses)
as regulated medical waste.

Type of regulated medical waste Description

• Stocks and cultures of infectious agents
• Wastes from the production of biologicals, thrown-away live and

attenuated vaccines
1. Microbiologic laboratory waste
• Culture dishes and apparatus used to transfer, inoculate, and mix

cultures

Tissues, organs, and body parts that are removed during surgical procedures
2. Pathologic waste
or autopsies

3. Blood and blood products Waste human blood and blood products such as serum and plasma

4. Sharps Hypodermic needles, syringes, Pasteur pipettes, broken glass, and scalpel blades

Animal carcasses, body parts, and bedding of animals contaminated during

5. Contaminated animal carcasses research, production of biologicals, or pharmaceuticals
testing

In the past, regulated medical waste was disposed of primarily by incineration. Emission regulations
have limited the use of incineration by hospitals. Thus, autoclaves and steam sterilizers have become the
primary technology for regulated medical waste disposal. Other nonincineration disposal methods such
as mechanical/chemical disinfection, microwave decontamination, steam disinfection, and compacting
have also been proposed. Nonregulated medical waste is disposed in properly regulated sanitary
landfills (a safe and inexpensive disposal method).