Test Bank for Infection Control and Management of Hazardous Materials 7th Edition by Chris Miller

TEST BANK

TEST BANK

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Chapter 01: Scope of Microbiology and Infection Control Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. Who is reported to have first observed microbes? a. Pasteur b. Oliver Wendell Holmes c. Lister d. Leeuwenhoek ANS: D

Pasteur, Oliver Wendell Holmes, and Lister made other important contributions to microbiology. Leeuwenhoek first observed microbes and called them “animalcules.”

PTS: 1 DIF: Recall REF: p. 2 TOP: CDA, Infection Control, Does not apply

OBJ: 2

2. What year were microbes first observed? a. 1667 b. 1880 c. 1956 d. 1975 ANS: A

Leeuwenhoek first observed microbes and called them “animalcules” in 1667, 1880, 1956, and 1975 are all too recent.

PTS: 1 DIF: Recall REF: p. 2 TOP: CDA, Infection Control, Does not apply

OBJ: 2

3. Choose the microbial killing method referred to as pasteurization. a. 121C for 20 minutes b. 212F for 5 minutes c. 63C for 30 minutes d. 37C for 10 minutes ANS: C

121C for 20 minutes achieves sterilization. 212F for 5 minutes is the temperature of boiling water. 63C for 30 minutes achieves pasteurization which kills harmful microbes in liquids such as milk. 37C for 10 minutes is body temperature.

PTS: 1 DIF: Application REF: p. 2 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 4. When was the “Golden Age of Microbiology”? a. Mid to late 1600s b. Mid to late 1700s c. Mid to late 1800s

d. Mid to late 1900s ANS: C

Mid to late 1600s and mid to late 1700s were too early. Mid to late 1800s was the time when many new discoveries in microbiology were made. Mid to late 1900s was too late.

PTS: 1 DIF: Recall REF: p. 2 TOP: CDA, Infection Control, Does not apply

OBJ: 2

5. What microbes are used to make vinegar, vitamins, drain cleaners, enzymes, and other

products? a. Fungi b. Viruses c. Protozoa d. Bacteria ANS: D

Fungi can make antibiotics but not these products. Viruses grow inside living cells and do not make such products. Protozoa are not very efficient in making such products. Bacteria make these and other products when they are grown in large vats.

PTS: 1 DIF: Recall REF: p. 3 TOP: CDA, Infection Control, Does not apply

OBJ: 3

6. Which microbes are used to make pickles out of cucumbers? a. Bacteria or fungi b. Fungi or viruses c. Viruses or yeasts d. Bacteria of viruses ANS: A

Bacteria or fungi make certain extracellular products that change cucumbers into pickles.

Viruses do not produce products that affect cucumbers.

PTS: 1 DIF: Recall REF: p. 3 TOP: CDA, Infection Control, Does not apply

OBJ: 3

7. What microbe is used to make bread dough rise? a. Bacteria b. Yeasts c. Viruses d. Protozoa ANS: B

Bacteria do not produce enough carbon dioxide (CO2) to make the dough rise. Yeasts metabolize carbohydrates to produce the gas bubbles of CO2 which causes the dough to rise. Viruses only grow inside of living cells and do not have a regular metabolism.

Protozoa do not produce enough carbon dioxide (CO2) to make the dough rise.

PTS: 1 DIF: Recall REF: p. 3 TOP: CDA, Infection Control, Does not apply

OBJ: 3

COMPLETION 1. Louie Pasteur and John Tyndall first recognized the use of ___________ to destroy

bacteria and resistant spores.

ANS:

heat Other physical procedures were found not to be as efficient as heat for killing microbes.

PTS: 1 DIF: Recall REF: p. 2 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 2. In 1915 it was discovered that bacteria can be infected with viruses called

________________.

ANS:

bacteriophages Animal viruses had been previously discovered, so they gave bacterial viruses a different name – bacteriophages – phage means “to eat.”

PTS: 1 DIF: Recall REF: p. 3 TOP: CDA, Infection Control, Does not apply

OBJ: 1

3. Microbiology is the study of bacteria, molds, yeasts, protozoa, certain algae, viruses and

_________.

ANS:

archaea Archaea are single cell microbes morphologically similar to bacteria, but their genes and metabolic pathways are more closely related to eukaryotes. While they may be present in the human body, there have been no clear examples of archaeal human pathogens.

PTS: 1 DIF: Recall REF: p. 2 TOP: CDA, Infection Control, Does not apply

OBJ: 2

TRUE/FALSE 1. The disease of smallpox was involved in the discovery of immunizations in the 1790s by

Edward Jenner.

ANS: T

Edward Jenner is credited with recognizing the concept of immunization when he realized in the 1790s that milkmaids who caught cowpox, a mild disease, were protected from the more serious disease of smallpox.

PTS: 1 DIF: Recall REF: p. 2 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission

Chapter 02: Characteristics of Microorganisms Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. Under what conditions do regular bacteria, excluding Rickettsia and Chlamydia, multiply? a. In the absence of nutrients b. Only when they are inside of living cells c. When they are outside of living cells d. Only when the temperature is below 7C ANS: C

Nothing can grow in the absence of nutrients. Rickettsia and Chlamydia are the only bacteria that can grow inside living cells. Regular bacteria do not need to be inside living cells to grow. They can obtain their nutrients from the environment. Only the special bacteria called psychrophiles can grow at these low temperatures.

PTS: 1 DIF: Application REF: p. 12 TOP: CDA, Infection Control, Does not apply

OBJ: 1

2. Select an environment in which viruses can multiply. a. Only in the absence of nutrients b. Only when they are inside of living cells c. Only when they are outside of living cells d. Only when the temperature is below 7C ANS: B

Nothing can grow in the absence of nutrients. Viruses need the nutrients and metabolic machinery of living cells to multiply. Viruses cannot obtain their nutrients from the environment. Only the special bacteria called psychrophiles can grow at these low temperatures.

PTS: 1 DIF: Application REF: p. 14 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 3. Which of the following microbes is a yeast? a. Streptococcus mutans b. Trichomonas vaginalis c. Candida albicans d. Staphylococcus aureus ANS: C

Streptococcus mutans is a bacterium. Trichomonas vaginalis is a protozoan. Candida albicans can exist as a yeast which is a special fungus. Staphylococcus aureus is a bacterium.

PTS: 1 DIF: Recall REF: p. 15 TOP: CDA, Infection Control, Does not apply

OBJ: 3

4. Which of the following microbes is a type of fungus? a. Influenzae b. Candida albicans c. Trichomonas vaginalis d. Streptococcus mutans ANS: B

Influenzae is a virus. Candida albicans can exist as a yeast or filamentous fungus.

Trichomonas vaginalis is a protozoan. Streptococcus mutans is a bacterium.

PTS: 1 DIF: Recall REF: p. 15 TOP: CDA, Infection Control, Does not apply

OBJ: 3

5. A yeast is what type of microorganism? a. Bacterium b. Fungus c. Virus d. Protozoan ANS: B

Bacteria cannot form yeast. A yeast is a special type of fungus. Viruses and protozoa cannot form yeasts.

PTS: 1 DIF: Recall REF: p. 15 TOP: CDA, Infection Control, Does not apply

OBJ: 3

6. Thrush is caused by a. Candida albicans. b. Streptococcus mutans. c. Staphylococcus aureus. d. human herpesvirus 1.

ANS: A

Candida albicans causes thrush (e.g., oral candidiasis or denture stomatitis) and is a fungus that may exist as a yeast cell or as a filamentous fungus (mold). Streptococcus mutans, Staphylococcus aureus, and human herpesvirus 1 do not cause thrush.

PTS: 1 DIF: Recall REF: p. 15 TOP: CDA, Infection Control, Does not apply

OBJ: 3

7. Bacilli are shaped like a. spheres. b. cylinders or rods. c. curved or spiral forms. d. flat disks.

ANS: B

Spheres are not bacilli. Bacilli are bacterial cells shaped like a rod or cylinder. Spirilla are curved or spiral forms. There are no microbes shaped like a flat disk.

PTS: 1

DIF: Recall

REF: p. 7

OBJ: 1

TOP: CDA, Infection Control, Does not apply 8. Cocci are shaped like ____________. a. spheres b. cylinders or rods c. curved or spiral forms d. flat disks ANS: A

Spherical cells are called cocci. Rod-shaped cells are called bacilli. Curved or spiral cells are called spirilla. This is not a shape associated with bacteria.

PTS: 1 DIF: Recall REF: p. 7 TOP: CDA, Infection Control, Does not apply

OBJ: 1

9. Choose the bacterial structure that controls the flow of nutrients and waste into and out of

the cell? a. Cell wall b. Flagellum c. Cytoplasmic membrane d. Capsule ANS: C

The cell wall protects the cell from being crushed. The flagellum provides locomotion.

The cytoplasmic membrane has a function to regulate the entrance and exit of nutrient materials and waste products. The capsule keeps the cell from drying out and is antiphagocytic.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 8

OBJ: 1

10. Which of the following bacterial structures interferes with phagocytosis? a. Cell wall b. Flagellum c. Cytoplasmic membrane d. Capsule ANS: D

The cell wall protects the cell from being crushed. The flagellum provides locomotion.

One of the functions of the cytoplasmic membrane is to regulate the entrance and exit of nutrient materials and waste products. The capsule’s “slimy” nature interferes with phagocytosis.

PTS: 1 DIF: Recall REF: p. 9 TOP: CDA, Infection Control, Does not apply

OBJ: 1

11. Which of the following bacterial structures helps the cell to attach to surfaces? a. Cell wall b. Capsule c. Cytoplasmic membrane d. Fimbriae

ANS: D

The cell wall protects the cell from being crushed. The capsule keeps the cell from drying out and is antiphagocytic. One of the functions of the cytoplasmic membrane is to regulate the entrance and exit of nutrient materials and waste products. Fimbriae serve as mechanisms by which cells can attach to other cells or other environmental surfaces.

PTS: 1 DIF: Recall REF: p. 9 TOP: CDA, Infection Control, Does not apply

OBJ: 1

12. The main function of the bacterial cell wall is to a. protect against drying. b. protect against crushing. c. to control the exit of wastes from the cell. d. provide the cell with locomotion.

ANS: B

Protect against drying is a function of the capsule. The basic components of the cell wall (peptidoglycan) protect the cell from being crushed. Controlling the flow of nutrients and waste is a function of the cytoplasmic membrane. Providing the cell with locomotion is a function of the flagellum.

PTS: 1 DIF: Recall REF: p. 8 TOP: CDA, Infection Control, Does not apply

OBJ: 1

13. The main function of bacterial fimbriae is to a. control the exit of wastes from the cell. b. protect against crushing. c. allow the cell to attach to surfaces. d. protect against drying.

ANS: C

Controlling the exit of wastes from the cell is a function of the cytoplasmic membrane.

Protection against crushing is a function of the cell wall. Fimbriae serve as mechanisms by which cells can attach to other cells or other environmental surfaces. Protection against drying is a function of the capsule.

PTS: 1 DIF: Recall REF: p. 9 TOP: CDA, Infection Control, Does not apply

OBJ: 1

14. Choose an environment in which psychrophilic bacteria grow best. a. In the human body b. In hot water heaters c. Anywhere the temperature is 37C d. In the refrigerator ANS: D

The human body, hot water, and 37C are all too warm for the growth of psychrophiles.

The refrigerator at 7C provides the optimal grow temperature for psychrophiles.

PTS: 1 DIF: Application TOP: CDA, Does not apply

REF: p. 10

OBJ: 1

15. Which of the following groups of bacteria grow best inside your refrigerator? a. Psychrophiles b. Thermophils c. Mesophils d. Acidophils ANS: A

Psychrophiles are “cold-loving” and optimal growth is refrigerator temperature.

Thermophils love high temperatures. Mesophils love medium (e.g., body) temperatures.

Acidophils produce acids and are unrelated to temperature.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 10

OBJ: 1

16. How would prevent the growth of an obligate anaerobe? a. Adjust the pH of the environment to 7.0. b. Remove protein of the environment. c. Maintain the environmental temperature to 37C. d. Add oxygen to the environment.

ANS: D

A pH of 7.0 will support the growth of most bacteria. Removing protein will not always prevent growth. Keeping the temperature at 37C will allow many bacteria to grow.

Adding oxygen to the environment will prevent growth since they require low or no oxygen for growth.

PTS: 1 DIF: Application REF: p. 11 TOP: CDA, Infection Control, Does not apply

OBJ: 1

17. Those bacteria that die in the presence of oxygen are called a. aerobes. b. mesophils. c. acidogens. d. anaerobes.

ANS: D

Aerobes need oxygen for growth. Mesophils grow at medium temperatures and most are aerobes. Acidogens produce acids during growth and some are aerobes and some anaerobes. Anaerobes cannot tolerate oxygen.

PTS: 1 DIF: Recall REF: p. 11 TOP: CDA, Infection Control, Does not apply

OBJ: 1

18. Acidogenic bacteria are noted for producing large amounts of a. acids. b. vitamins. c. proteins. d. carbohydrates.

ANS: A

Acidogenic bacteria produce large amounts of acid. Vitamins may also be produced but do not relate to being acidogenic. Proteins and carbohydrates are also produced but do not relate to being acidogenic.

PTS: 1 DIF: Recall REF: p. 11 TOP: CDA, Infection Control, Does not apply

OBJ: 1

19. What temperatures are the surest way to kill bacteria (or any other type of

microorganisms) in the shortest amount of time? a. Sterilizing temperatures b. Freezing temperatures c. Fluctuating temperatures d. Refrigerator temperatures ANS: A

Sterilizing temperatures such as those achieved in a steam, dry heat, or unsaturated chemical vapor sterilizer is the surest way to kill bacteria (or any other type of microorganisms) in the shortest amount of time. Freezing will not kill all microbes.

Fluctuating temperatures cannot be relied upon to kill all microbes. Refrigeration will not kill all microbes.

PTS: 1 DIF: Application REF: p. 14 OBJ: 1 TOP: CDA, Infection Control, III.A. Instrument/device processing 20. Anaerobes are bacteria that a. require oxygen for growth. b. grow only in the absence of oxygen. c. can multiply in the presence or absence of oxygen. d. are killed in the presence or absence of oxygen.

ANS: B

Aerobes require oxygen for growth. Anaerobes cannot tolerate oxygen and only grow in its absence. Facultative anaerobes grow in the presence or absence of oxygen.

PTS: 1 DIF: Recall REF: p. 11 TOP: CDA, Infection Control, Does not apply

OBJ: 1

21. Agar is a polysaccharide from seaweed that is used to a. kill bacteria. b. grow viruses. c. kill viruses. d. culture bacteria.

ANS: D

Agar is not lethal to bacteria or viruses. Viruses require living cells to grow. Agar can provide a semisolid surface on which bacteria can grow if adequate nutrients are available.

PTS: 1 DIF: Recall REF: p. 11 TOP: CDA, Infection Control, Does not apply

OBJ: 1

22. What environmental condition will promote the growth of an aciduric bacterium? a. Low oxygen level

b. Low nutrient level c. Low pH d. Low temperature ANS: C

Low oxygen will promote growth of anaerobes. Low nutrients restrict rather than promote bacterial growth. Low pH (usually below pH 5.5) promotes growth of aciduric bacteria.

Low temperature promotes the growth of psychrophiles.

PTS: 1 DIF: Application REF: p. 11 TOP: CDA, Infection Control, Does not apply

OBJ: 1

23. Which type of microbe is the most difficult to kill? a. Endospores b. Vegetative bacteria c. Viruses d. Chlamydiae ANS: A

An endospore is one most resistant forms of life against heat, drying and chemicals due to its thickened cell wall, dense cytoplasm and dormant state. Vegetative bacteria can be killed by exposing it to high heat or with chemicals. Viruses can be killed when outside the body by exposure to high heat or chemicals. Chlamydiae are a type of bacterium and can be killed by exposure to high heat or with chemicals.

PTS: 1 DIF: Recall REF: p. 9 OBJ: 1 TOP: CDA, Infection Control, III.A. Instrument/device processing 24. Select the best description of a bacterial endospore a. a fungus resistant to chemicals. b. one of the most resistant forms of life to heat and chemicals. c. a virus that infects the root canal. d. a bacterium that grows at low temperatures.

ANS: B

A fungus is not a bacterium. An endospore is one of the most resistant forms of life against heat, drying and chemicals due to its thickened cell wall, dense cytoplasm and dormant state. A virus is not a bacterium. A bacterium that grows at low temperatures is called a psychrophile not an endospore.

PTS: 1 DIF: Recall REF: p. 9 OBJ: 1 TOP: CDA, Infection Control, III.A. Instrument/device processing 25. Some bacteria can change into special forms that are dormant and are highly resistant to

heat, chemicals, and drying? These are called a. Rickettsia. b. endospores. c. mold. d. vegetative cells.

ANS: B

Rickettsia are not resistant to heat. An endospore is one most resistant forms of life against heat, drying, and chemicals due to its thickened cell wall, dense cytoplasm, and dormant state. Molds are not bacteria they are fungi. Vegetative cells and bacteria that can grow (multiply) and are not dormant.

PTS: 1 DIF: Recall REF: p. 9 OBJ: 1 TOP: CDA, Infection Control, III.A. Instrument/device processing 26. Chlamydia and Rickettsia are examples of a. viruses. b. fungi. c. bacteria. d. protozoa.

ANS: C

Viruses and fungi are not bacteria. Chlamydia and Rickettsia are special bacteria called obligate intracellular parasites which multiply only inside living cells. Protozoa are not bacteria.

PTS: 1 DIF: Recall REF: p. 12 TOP: CDA, Infection Control, Does not apply

OBJ: 1

27. Which of the following microbes cannot be killed with antibiotics? a. Streptococcus mutans b. Staphylococcus aureus c. Human herpes virus type 1 d. Mycobacterium tuberculosis ANS: C

Streptococcus mutans and Streptococcus aureus can be killed with certain antibiotics.

Human herpes virus type 1 and other viruses are not killed by antibiotics. Mycobacterium tuberculosis can be killed with certain antibiotics.

PTS: 1 DIF: Recall REF: p. 15 TOP: CDA, Infection Control, Does not apply

OBJ: 1

28. Before a virus multiplies inside of our body cells, what must it do? a. Uncoat (shed its capsid) b. Assemble the capsid and nucleic acid to make a whole virus c. Adsorb (attach) to the host cell d. Kill the host cell ANS: C

Uncoating is the third step in the virus life cycle. Assembling is the fifth step in the virus life cycle. Adsorbing (attaching) to the host cell is the first step in the virus life cycle. Host cell death happens at the end of the life cycle of most viruses.

PTS: 1 DIF: Recall REF: p. 15 TOP: CDA, Infection Control, Does not apply 29. Which of the following diseases is a bacterial disease? a. Influenza

OBJ: 2

b. Hepatitis B c. Mumps d. Dental caries ANS: D

Influenza, Hepatitis B, and humps are all viral diseases. Dental caries are caused by bacteria.

PTS: 1 DIF: Recall REF: p. 11 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 30. What is the result of a virus invading a host cell? a. There is no effect on the cell. b. The virus always dies. c. The host cell always dies. d. The host cell may die or be changed.

ANS: D

If a virus invades a cell there is always some effect. The virus may survive and kill or damage the cell. Sometimes the host cell survives with minor damage or permanent changes. Depending upon the virus, the cell may be killed or it may survive with minor damage.

PTS: 1 DIF: Recall REF: p. 15 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 31. Viruses cause diseases in humans because they a. produce exotoxins. b. produce endotoxins. c. invade and kill or damage cells in our body. d. “swim” away from phagocytes using their flagella.

ANS: C

Exotoxins are involved in some bacterial or fungal diseases. Endotoxins are involved in some bacterial diseases. Viruses cause disease by entering and multiplying in our body cells and killing or changing them. Viruses do not have flagella.

PTS: 1 DIF: Application REF: p. 15 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 32. During the life cycle of a virus, what is the next step after the virus attaches to the host

cell? a. Uncoating b. Release c. Replication d. Enters the cell ANS: D

Uncoating is the third step in the life cycle of a virus. Release is the sixth and final step in the life cycle of a virus. Replication is the fourth step in the life cycle of a virus. In the second step of the life cycle of a virus (penetration), the virus enters the host cell.

PTS: 1 DIF: Application REF: p. 15 TOP: CDA, Infection Control, Does not apply

OBJ: 2

33. The genes of a virus are in the a. capsid. b. nucleic acid core. c. envelope. d. capsid and envelope.

ANS: B

The capsid is the protein coating of virus that protects the nucleic acid core and determines the shape of the virus. The nucleic acid core contains the DNA or RNA genes of a virus.

The envelope is the outer lipid-rich layer found in some viruses that is derived from the host cell membrane on release of the virus from the host cell. The capsid and envelope is referring to the outer protein coating (capsid) and the outer lipid-rich layer found in some viruses (envelope).

PTS: 1 DIF: Recall REF: p. 14 TOP: CDA, Infection Control, Does not apply

OBJ: 2

34. What is the final product from the bacterial fermentation of sugar (e.g., glucose)? a. Nucleic acid b. Lactic acid c. Hydrochloric acid d. Pyruvic acid ANS: B

Nucleic acid is DNA or RNA neither of which are direct products of fermentation. Lactic acid is the final product. Hydrochloric acid is stomach acid. Pyruvic acid is the second to the last fermentation product.

PTS: 1 DIF: Recall REF: p. 13 TOP: CDA, Infection Control, Does not apply

OBJ: 1

35. Which of the following substances is a component of some bacterial outer membranes and

when released in the human body contributes to the causes of periodontal disease? a. Lysozyme b. Mesosome c. Capsid d. Endotoxin ANS: D

Lysozyme is an enzyme in saliva produced by the human body. Mesosomes are part of the bacterial structure but are not directly involved in periodontal diseases. The capsid is the protein coat of viruses. The action of endotoxin is thought to play a role in many infectious diseases, including periodontal diseases.

PTS: 1

DIF: Application

REF: p. 9

OBJ: 1

TOP: CDA, Infection Control, Does not apply 36. Agents that prevent bacterial growth without killing them are referred to as a. bacteriostatic agents. b. sterilant agents. c. disinfectant agents. d. nucleic acid agents.

ANS: A

Bacteriostatic agents prevent or slow down bacterial growth which resumes when, and if, the agents are removed or degraded. Sterilant and disinfectant agents kill bacteria. Nucleic acid agents do not directly affect the growth of bacteria.

PTS: 1 DIF: Recall REF: p. 13 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 37. Colony-forming-units (CFU) are defined as a. measurements of the diameter of colonies that develop on an agar medium. b. individual bacterial cells or a small group of cells each of which can form a colony

on agar media. c. units used to estimate the distance a bacterial cell can move away from its colony on agar media. d. highly resistant forms of certain bacteria.

ANS: B

Colony diameter is measured in millimeters. One or a small number of bacterial cells deposited on an appropriate agar medium will develop into a single colony (clone) of cells and be referred to as a colony-forming unit. The distance a bacterial cell can move away from its colony on agar media is seldom measured but is expressed in millimeters. Highly resistant forms of bacteria are referred to as endospores.

PTS: 1 DIF: Recall REF: p. 12 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 38. How are bacterial spores important in dental infection control? a. They cause periodontal disease. b. They are used to monitor surface disinfection. c. They are used to test the functioning and use of sterilizers. d. They cause thrush.

ANS: C

Periodontal diseases are caused by nonspore-forming bacteria. There is not an easy test for surface disinfection. Since bacterial spores are highly resistant to heat, they are used to monitor heat sterilization in steam, dry heat and other sterilizers.

PTS: 1 DIF: Recall REF: p. 9 OBJ: 1 TOP: CDA, Infection Control, III.B. Instrument/device processing 39. Which of the following bacteria are important in metabolizing sugar to acids that cause

dental caries? a. Geobacillus stearothermophilus b. Bacillus atrophaeus

c. Clostridium sporogenes d. Streptococcus mutans ANS: D

Geobacillus stearothermophilus is a spore-former use to monitor steam sterilizers. Bacillus atrophaeus is a spore-former use to monitor dry heat sterilizers. Clostridium sporogenes is a spore-former that is used to test the effectiveness of liquid sterilants. Streptococcus mutans forms plaque and metabolizes dietary sugar to acids causing demineralization of tooth enamel.

PTS: 1 DIF: Recall REF: p. 13 TOP: CDA, Infection Control, Does not apply

OBJ: 1

40. Which of the following represents the pH values of acid? a. 0 to 7 b. 7 to 14 c. 8 to 10 d. 10 to 12 ANS: A

Acids have a pH from 0 to 7, 7 to 14, 8 to 10, and 10 to 12 are all alkaline.

PTS: 1 DIF: Recall REF: p. 11 TOP: CDA, Infection Control, Does not apply

OBJ: 1

41. mRNA is formed from DNA through a process called a. transformation. b. transcription. c. transmission. d. transduction.

ANS: B

Transformation is where a bacterial cell takes up extracellular DNA released from other bacteria. Transmission is a general term for spread. Transduction is where viruses transfer genes from one bacterial cell to another.

PTS: 1 DIF: Recall REF: p. 13 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 42. The function of mRNA is to associate with ribosomes and a. link amino acids to from proteins. b. transfer genes through the sex pilus to another bacterial cell. c. exit the cell for uptake up by other cells. d. bind to a virus that exits the cell, infects other cell transmitting the nucleic acid to

the new cell.

ANS: A

DNA is transferred through the sex pilus. DNA can exit the cell for uptake by other cells.

DNA binds to viruses for transfer to other cells.

PTS: 1

DIF: Application

REF: p. 13

OBJ: 1

TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 43. What emerging fungus has caused bloodstream, wound, oral and ear infections? a. Bacillus subtilis b. Staphylococcus aureus c. Mycobacterium tuberculosis d. Candida auris ANS: D

Bacillus subtilis, Staphylococcus aureus, and Mycobacterium tuberculosis are bacteria.

PTS: 1 DIF: Recall REF: p. 15 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission COMPLETION 1. For growth all bacteria need the proper nutrients, temperature, pH, atmosphere and

_________.

ANS:

water Water is essential for all life forms.

PTS: 1 DIF: Application REF: p. 11 TOP: CDA, Infection Control, Does not apply

OBJ: 1

TRUE/FALSE 1. Bacteria are larger than viruses.

ANS: T

Bacteria average about 1.0 m in diameter, and human viruses are smaller than bacteria, ranging from 0.02 to 0.3 m.

PTS: 1 DIF: Recall REF: p. 14 TOP: CDA, Infection Control, Does not apply

OBJ: 2

2. Bacterial growth is defined as an increase in cell numbers.

ANS: T

When bacteria grow they double their numbers with each generation.

PTS: 1 DIF: Recall REF: p. 10 TOP: CDA, Infection Control, Does not apply 3. Human virus are smaller than bacteria.

ANS: T

OBJ: 1

Bacteria average 1.0 m in diameter. Human viruses are smaller than bacteria, ranging from 0.02 to 0.3.

PTS: 1 DIF: Recall REF: p. 14 TOP: CDA, Infection Control, Does not apply

OBJ: 2

4. If bacteria grow in a broth culture, the broth remains clear.

ANS: F

If bacteria grow in broth culture, the broth becomes turbid (cloudy).

PTS: 1 DIF: Recall REF: p. 12 OBJ: 2 TOP: CDA, Infection Control, III.B. Instrument/device processing 5. Unlike bacterial diseases, most viral diseases cannot be successfully treated.

ANS: T

Because viruses use the metabolic machinery of the host cell to replicate, chemicals such as antibiotics used against bacteria may damage the host cells and cannot be used to treat viral diseases.

PTS: 1 DIF: Recall REF: p. 15 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission

Chapter 03: Development of Infectious Diseases Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. Microbes that are usually harmless but can cause disease under certain conditions are

called a. opportunistic pathogens. b. toxigenic pathogens. c. endogenous pathogens. d. exogenous pathogens.

ANS: A

Opportunistic pathogens cause diseases only when given a special opportunity to enter deeper tissues of the body or to accumulate to levels that can harm the body. Toxigenic pathogens are caused by toxins released by a bacterium or fungus. Endogenous pathogens are caused by microbes that already exist within the body. Exogenous pathogens are caused by microbes that enter the body from the outside.

PTS: 1 DIF: Recall REF: p. 17 TOP: CDA, Infection Control, Does not apply

OBJ: 4

2. Microbes that cause disease by producing a toxin are called a. opportunistic pathogens. b. toxigenic pathogens. c. endogenous pathogens. d. exogenous pathogens.

ANS: B

Opportunistic pathogens cause diseases only when given a special opportunity to enter deeper tissues of the body or to accumulate to levels that can harm the body. Toxigenic pathogens are caused by toxins released by a bacterium or fungus. Endogenous pathogens are caused by microbes that already exist within the body. Exogenous pathogens are caused by microbes that enter the body from the outside.

PTS: 1 DIF: Recall REF: p. 17 TOP: CDA, Infection Control, Does not apply

OBJ: 3

3. Members of the normal body microbiota that can cause disease are called a. obligate intracellular parasite. b. toxigenic pathogens. c. endogenous pathogens. d. exogenous pathogens.

ANS: C

Obligate intracellular parasites (e.g., all viruses and some special bacteria) cause diseases by invading body cells. Toxigenic pathogens are caused by toxins released by a bacterium or fungus. Endogenous pathogens are caused by microbes that already exist within the body. Exogenous pathogens are caused by microbes that enter the body from the outside.

PTS: 1 DIF: Recall REF: p. 17 TOP: CDA, Infection Control, Does not apply

OBJ: 3

4. The difference between an infection and an infectious disease is that an a. infection never causes an infectious disease. b. infection comes after the infectious disease has already started. c. infectious disease is an infection that causes damage to the body. d. infectious disease and an infection can never involve the same microbe.

ANS: C

Some infections can lead to disease. Infection comes before the infectious disease starts.

An infection does not always indicate disease, but disease (damage to the body) seldom results without infection (the exception is toxigenic diseases). Infectious disease and an infection can involve the same microbe.

PTS: 1 DIF: Comprehension REF: p. 19 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 5. That period of an infectious disease between the initial infection and the time when the

first symptoms occur is called the a. convalescent stage. b. acute stage. c. prodromal stage. d. incubation stage.

ANS: D

Convalescent stage is the recovery phase. Acute stage is when the symptoms are at or near maximum levels. Prodromal stage is the early symptoms stage. Incubation stage is the time between infection and appearance of signs/symptoms.

PTS: 1 DIF: Recall REF: p. 18 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 6. That period of an infectious disease when the symptoms are at or near the maximum level

is called the a. convalescent stage. b. acute stage. c. prodromal stage. d. incubation stage.

ANS: B

Convalescent stage is the recovery phase. Acute stage is when the symptoms are at or near maximum levels. Prodromal stage is the early symptoms stage. Incubation stage is the time between infection and appearance of signs/symptoms.

PTS: 1 DIF: Recall REF: p. 18 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission

7. That period of an infectious disease when the symptoms are declining is called the a. convalescent stage. b. acute stage. c. prodromal stage. d. incubation stage.

ANS: A

Convalescent stage is the recovery phase in which symptoms are waning. Acute stage is when the symptoms are at or near maximum levels. Prodromal stage is the early symptoms stage. Incubation stage is the time between infection and appearance of signs/symptoms.

PTS: 1 DIF: Recall REF: p. 18 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 8. An asymptomatic carrier can be in which of the following stages of an infectious disease? a. Convalescent stage b. Acute stage c. Prodromal stage d. Incubation stage ANS: D

Convalescent stage is the recovery phase in which symptoms are waning. Acute stage is when the symptoms are at or near maximum levels. Prodromal stage is the early symptoms stage. Incubation stage is the time between infection and appearance of signs/symptoms.

PTS: 1 DIF: Recall REF: p. 18 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 9. The mode of microbe transmission that involves touching the patient’s teeth while not

wearing gloves is called a. direct contact. b. indirect contact. c. droplet infection. d. airborne infection.

ANS: A

Direct contact is person-to-person body contact. Indirect contact is contact with an item (e.g., an instrument) that was contaminated with another patient’s microbes. Droplet infection involves contact with larger droplets in sprays or spatter containing microbes.

Airborne infection involves contact with the smaller droplet nuclei (e.g., dental aerosols) in sprays or spatter.

PTS: 1 DIF: Application REF: p. 19 OBJ: 1 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission | CDA, Infection Control, II.A. Prevent cross-contamination during procedures 10. The mode of microbe transmission that involves a needlestick is called a. direct contact. b. indirect contact.

c. droplet infection. d. airborne infection.

ANS: B

Direct contact is person-to-person body contact. Indirect contact is contact with an item (e.g., an instrument needle) that was contaminated with another patient’s microbes.

Droplet infection involves contact with larger droplets in sprays or spatter containing microbes. Airborne infection involves contact with the smaller droplet nuclei (e.g., dental aerosols) in sprays or spatter.

PTS: 1 DIF: Application REF: p. 19 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 11. The mode of microbe transmission that involves small droplet nuclei such as those

generated from dental aerosols is called a. direct contact. b. indirect contact. c. droplet infection. d. airborne infection.

ANS: D

Direct contact is person-to-person body contact. Indirect contact is contact with an item (e.g., an instrument) that was contaminated with another patient’s microbes. Droplet infection involves contact with larger droplets in sprays or spatter containing microbes.

Airborne infection involves contact with the smaller droplet nuclei (e.g., dental aerosols) in sprays or spatter.

PTS: 1 DIF: Application REF: p. 19 OBJ: 1 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 12. Which of the following best describes antibodies? a. Chemicals produced by bacteria or fungi that can kill other microorganisms. b. Proteins that are released from bacteria to degrade large substances to smaller

chemicals that can be taken into the cell and used for growth. c. Special proteins produced in our body in the presence of antigens that aid in

destroying those antigens or help in their removal from the body. d. A part of the cell wall of gram-negative bacteria that enhances inflammation when

released from the bacterial cell.

ANS: C

Chemicals produced by bacteria or fungi that can kill other microorganisms are referred to as antibiotics. Extracellular enzymes are proteins that are released from bacteria to degrade large substances to smaller chemicals that can be taken into the cell and used for growth.

Antibodies are special proteins produced in our body in response to the presence of antigens, and they aid in destroying those antigens or help in their removal from the body.

An endotoxin is part of the cell wall of gram-negative bacteria that enhances inflammation when released from the bacterial cell.

PTS: 1 DIF: Recall REF: p. 23 OBJ: 5 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission

13. Which of the following best describes extracellular enzymes? a. Chemicals produced by bacteria or fungi that can kill other microorganisms. b. Proteins that are released from bacteria to degrade large substances to smaller

chemicals that can be taken into the cell and used for growth. c. Special proteins produced in our body in the presence of antigens that aid in

destroying those antigens or help in their removal from the body. d. A part of the cell wall of gram-negative bacteria that enhances inflammation when

released from the bacterial cell.

ANS: B

Chemicals produced by bacteria or fungi that can kill other microorganisms are referred to as antibiotics. Extracellular enzymes are proteins that are released from bacteria to degrade large substances to smaller chemicals that can be taken into the cell and used for growth. If these macromolecules are parts of host cell surfaces or are tissue components, this process can kill cells or damage the tissue. Antibodies are special proteins produced in our body in response to the presence of antigens, and they aid in destroying those antigens or help in their removal from the body. An endotoxin is part of the cell wall of gram-negative bacteria that enhances inflammation when released from the bacterial cell.

PTS: 1 DIF: Recall REF: p. 21 TOP: CDA, Infection Control, Does not apply

OBJ: 3

14. The major source of disease agents in the dental office is a. dental unit water. b. the mouth of the patient. c. air. d. dust.

ANS: B

Dental unit water contains microbes but not as many potential pathogens as patients’ mouths. Microbes in patient’s mouths include those that may be present in saliva, respiratory secretions, and blood that may enter the mouth during dental care. Air and dust contain microbes but not as many potential pathogens as patient’s mouths.

PTS: 1 DIF: Recall REF: p. 17 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 15. Special proteins that are made by the body after a microbe invades the body are called a. antigens. b. acids. c. antiseptics. d. antibodies.

ANS: D

Antigens are cells, microbes or substances that invade the body and activate the immune response. Acids are not proteins. Antiseptics are germicides applied to the body.

Antibodies are proteins produced by the body after an antigen (e.g., a microbe) invades the body.

PTS: 1 DIF: Recall REF: p. 23 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease

transmission 16. The next to the last step in the development of an infectious disease is a. damage to the body. b. escape from the source. c. infection. d. spread to a new person. e. entry into a new person.

ANS: C

Damage to the body is the sixth and final step of infectious disease. Escape from the source is the second step. Infection is the next to last step (the sixth step) in the development of an infectious disease. Spread to a new person is the third step, and entry into a new person is the fourth step.

PTS: 1 DIF: Application REF: p. 19 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 17. Host defense mechanisms that we are born with and are always active are referred to as

_________ defenses. a. acquired b. long-term c. artificial d. innate ANS: D

Acquired defenses are acquired after birth. Long-term defenses are long-lasting immunities. Artificial defenses are acquired after being immunized with a vaccine. Innate immunity is a naturally occurring body defense mechanism against infectious disease agents.

PTS: 1 DIF: Recall REF: p. 22 OBJ: 4 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 18. Hay fever and asthma and are examples of a. bacterial diseases. b. allergic reactions. c. contact dermatitis. d. anaphylactic shock.

ANS: B

Bacterial diseases are not allergic reactions. Hay fever and asthma are antibody mediated allergic reactions. Contact dermatitis and anaphylactic shock are other types of allergic reactions.

PTS: 1 DIF: Recall REF: p. 24 OBJ: 5 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 19. Which of the following is an antimicrobial chemical barrier to infectious diseases? a. Ciliary escalator

b. Hair in the nose c. Lysozyme d. Coughing ANS: C

Ciliary escalators, nose hairs, and coughing are mechanical barriers. The enzyme lysozyme can lyse and kill some bacteria and is present in saliva, tears, nasal secretions, intestinal secretions, colostrum, and inside phagocytes.

PTS: 1 DIF: Recall REF: p. 22 TOP: CDA, Infection Control, Does not apply

OBJ: 4

20. Which of the following is a physical barrier to infectious diseases? a. Mucous membranes b. Acid in the stomach c. Complement fragments d. Interferon ANS: A

The mucous membranes of the eyes, mouth, nose, respiratory tract, vagina, and intestinal tract serves as physical barriers and inhibit or retard penetration by microbes. Stomach acid, complement fragments, and interferon are chemical barriers.

PTS: 1 DIF: Recall REF: p. 22 TOP: CDA, Infection Control, Does not apply

OBJ: 4

21. What type of body cells makes antibodies? a. Brain cells b. Red blood cells c. Plasma cells d. Phagocytes ANS: C

Lymphocytes are the body cells that produce antibodies. Brain cells, red blood cells and phagocytes are important cells of the body, but they do not make antibodies.

PTS: 1 DIF: Recall REF: p. 22 OBJ: 4 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 22. What type of cells engulf (“eat”) and destroy bacteria? a. Brain cells b. Red blood cells c. Lymphocytes d. Phagocytes ANS: D

Phagocytes first engulf (swallow up) microorganisms and then kill and digest them using enzymes that degrade the microbial structures. Brain cells, red blood cells and phagocytes are important cells of the body, but they do not engulf and destroy bacteria.

PTS: 1

DIF: Recall

REF: p. 22

OBJ: 4

TOP: CDA, Infection Control, Does not apply 23. Special proteins that are made by the body after a microbe invades the body and that can

destroy that microbe are called a. antibodies. b. antigens. c. barriers. d. enzymes.

ANS: A

Antibodies are special proteins that are made by the body after an antigen (e.g., a microbe) invades the body and that can destroy that microbe. Antigens are substances or cells that the body identifies as foreign and mounts an immune response. Barriers are host defense systems against harmful infections. Enzymes are protein catalysts that control the rate of chemical reactions in cells.

PTS: 1 DIF: Recall REF: p. 23 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 24. An allergic reaction is best defined as a. a disease caused by a microbe. b. damage to the body by the immune system. c. the multiplication of a microbe on or in the body. d. a disease cause by a microbe that invaded the body from the outside.

ANS: B

A disease caused by a microbe is an infectious disease. An allergic reaction is a disorder in which the immune system reacts to an allergen, and this reaction results in damage to the body. The multiplication of a microbe on or in the body is an infection. A disease caused by a microbe that invaded the body from the outside is an exogenous disease.

PTS: 1 DIF: Recall REF: p. 24 OBJ: 5 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 25. Which of the following patients appear the same? a. Normal patients and acute stage patients b. Normal patients and prodromal patients c. Asymptomatic patients and normal patients d. Asymptomatic patients and acute stage patients ANS: C

Acute stage and prodromal stage patients have symptoms that normal patients do not.

Normal and asymptomatic patients appear the same with no recognizable symptoms.

Acute stage patients have symptoms asymptomatic patients do not.

PTS: 1 DIF: Application REF: p. 18 TOP: CDA, Infection Control, Does not apply 26. The prodromal stages of a disease is defined as the a. appearance of early symptoms. b. recovery phase of a disease.

OBJ: 1

c. period between infection and development of symptoms. d. time when the symptoms are maximal.

ANS: A

At the appearance of early symptoms, the invading microbes have multiplied just enough to cause early symptoms. The convalescent phase of a disease is the recovery phase. The incubation stage of a disease is the period between infection and development of symptoms. The acute stage of a disease is the time when the symptoms are maxima.

PTS: 1 DIF: Recall REF: p. 18 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 27. Aerosol particles generated from the use of a prophylaxis angle mainly enter the body

through a. breaks in the skin and ingestion. b. inhalation and mucous membranes. c. only breaks in the skin. d. mucous membranes and breaks in the skin.

ANS: B

Aerosols are very small particles and remain airborne. Aerosol particles can be inhaled and contact the oral mucous membranes.

PTS: 1 DIF: Application REF: p. 19 OBJ: 1 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 28. Some strains of Streptococcus mutans are aciduric which allows them a. to survive within a carious lesion. b. attach to oral mucous membranes. c. resist phagocytosis. d. to be inhaled.

ANS: A

Aciduric means to survive in an acid environment, and carious lesions are highly acidic.

Surface structures on bacteria allow them to attach to other surfaces. Phagocytes can engulf aciduric bacteria. Being aciduric is unrelated to being inhaled.

PTS: 1 DIF: Recall REF: p. 21 TOP: CDA, Infection Control, Does not apply

OBJ: 3

29. A very important disease-producing property of Mycobacterium tuberculosis that

interferes with a host defense mechanism is a. being aciduric. b. producing histolytic enzymes. c. containing endotoxin. d. resisting phagocytic digestion.

ANS: D

Surviving in acids is not important in causing tuberculosis. Producing histolytic enzymes is not important in causing tuberculosis. Mycobacterium tuberculosis does not contain endotoxin. Mycobacterium tuberculosis interferes with host defenses by resisting digestion by phagocytes.

PTS: 1 DIF: Recall REF: p. 21 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 30. Anaphylactic shock is defined as a. a bacterial disease of the lungs and skin also called tuberculosis. b. a viral disease of the brain and spinal cord similar to bacterial meningitis. c. an allergy to a substance distributed throughout the body affecting the blood,

lungs, and heart. d. the production of large amounts of antibodies in response to a particular bacterial

disease.

ANS: C

Tuberculosis, a bacterial disease of the lungs and skin, is not an allergic reaction. A viral disease of the brain and spinal cord similar to bacterial meningitis is not an allergic reaction. Anaphylaxis is an allergy to a substance that is distributed throughout the body (e.g., penicillin inoculation) may result in a widespread reaction affecting the blood system, lungs, and heart. The production of large amounts of antibodies in response to a particular bacterial disease is not an allergic reaction.

PTS: 1 DIF: Recall REF: p. 24 OBJ: 5 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 31. Which of the following best defines an antigen? a. A foreign substance, cell or microbe that invades the body and activates an

immune response. b. Special proteins produced by the body in response to an invading microbe. c. Cells of the body that engulf and destroy invading bacteria. d. Agents used to treat bacterial diseases.

ANS: A

The immune response is activated by antigens (sometimes referred to as immunogens).

Examples of antigens are bacteria, viruses, fungi, protozoa, extracellular macromolecules produced by these microorganisms, and other macromolecules or cells that are normally not present in the body. Antibodies are special proteins produced by the body in response to an invading microbe. Phagocytes are cells of the body that engulf and destroy invading bacteria. Antibiotics are agents used to treat bacterial diseases.

PTS: 1 DIF: Recall REF: p. 23 OBJ: 5 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 32. The immunity that develops from receiving the hepatitis B vaccination series is called a. innate immunity. b. allergic immunity. c. interferon immunity.

d. artificial immunity.

ANS: D

Innate immunity is the immunity we are born with. Allergic immunity refers to allergies.

Interferon is a substance that interferes with virus replication. Artificial immunity is called artificial because the immunity develops from receiving a vaccine rather than actually being infected.

PTS: 1 DIF: Recall REF: p. 23 OBJ: 5 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 33. Spreading a microbe from one patient to another by reusing improperly sterilized

instruments is referred to as cross-contamination through a. direct contact. b. indirect contact. c. droplet infection. d. airborne infection.

ANS: B

Direct contact is direct touching of contaminants. Indirect contact happens when an intermediate object is involved in transferring microbes from one site to another. Droplet infection involves large spatter droplets on contaminated materials. Airborne infection involves very small particles (aerosols) that become airborne and may be inhaled.

PTS: 1 DIF: Application REF: p. 19 OBJ: 1 TOP: CDA, Infection Control, III.A. Instrument/device processing 34. Choose the step in the chain of infection that immediately follows “mode of spread.” a. Reservoir b. Portal of exit c. Portal of entry d. Susceptible host ANS: C

Reservoir follows infectious agent. Portal of exit follows reservoir. Portal of entry follows mode of spread. Susceptible host follows portal of entry.

PTS: 1 DIF: Comprehension REF: p. 19-20 OBJ: 1 | 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 35. Having a patient use an antimicrobial mouthrinse immediately before dental treatment is

an attempt to break the chain of infection at which link? a. Portal of exit b. Portal of entry c. Mode of spread d. Susceptible host ANS: A

Portal of exit is interfered with by reducing the number of microbes that can escape from the patient’s mouth. Portal of entry relates to microbes entering a new host. Mode of spread relates to the spread of microbes after the escape from the mouth. Susceptible host determines if the new host will actually acquire a new infection.

PTS: 1 DIF: Application REF: p. 21 OBJ: 1 | 2 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 36. Immunization against hepatitis B addresses which link in the chain of infection? a. Portal of exit b. Portal of entry c. Mode of spread d. Susceptible host ANS: D

Portal of exit is interfered with by reducing the number of microbes that can escape from the patient’s mouth. Portal of entry relates to microbes entering a new host. Mode of spread relates to the spread of microbes after the escape from the mouth. Immunization breaks the chain by making the new host not susceptible.

PTS: 1 DIF: Comprehension REF: p. 21 OBJ: 1 | 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 37. Sterilization of contaminated dental instruments before they are used on a subsequent

patient interferes with which link in the chain of infection? a. Portal of exit b. Portal of entry c. Mode of spread d. Susceptible host ANS: C

Portal of exit relates to the initial escape of microbes from the patient’s mouth on the used instruments. Portal of entry relates to microbes entering a new host if the instruments are not sterilized before reuse. Mode of spread is interfered with because the microbes on the used instruments have been killed. Susceptible host is related to the host and not infection control procedures.

PTS: 1 OBJ: 1 | 2

DIF: Comprehension REF: p. 19-20 TOP: CDA, Infection Control, III.A. Instrument/device processing

TRUE/FALSE 1. Our bodies are usually free of bacteria except when we get sick from an exogenous

disease.

ANS: F

Our bodies are infected constantly with large numbers of bacteria multiplying and surviving in our mouths, nose, eyes, intestines, and skin on a normal basis.

PTS: 1 DIF: Recall REF: p. 17 TOP: CDA, Infection Control, Does not apply

OBJ: 1

Chapter 04: Emerging Diseases Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. New infectious disease that have not been recognized before are referred to as a. emerging diseases. b. opportunistic diseases. c. endogenous diseases. d. exogenous diseases.

ANS: A

An emerging disease is a new infectious disease that has not been recognized before.

Opportunistic diseases are known diseases caused only under certain conditions, endogenous diseases are known diseases caused by microbes already in the body, and exogenous diseases are known diseases caused by microbes that enter the body from the outside.

PTS: 1 DIF: Recall REF: p. 26 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 2. An example of a disease that emerged through international commerce and travel is a. hantavirus pulmonary syndrome. b. cholera from strain O139. c. Rift Valley fever. d. Lyme disease.

ANS: B

Hantavirus pulmonary syndrome emerged because of ecological changes. Cholera from the strain O139 emerged in southern Asia in 1992 and was detected in South and Central America within a year. Transmission possibly involved the water on and in cargo ships.

Rift Valley fever and Lyme disease both emerged because of ecological changes.

PTS: 1 DIF: Recall REF: p. 29 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 3. HIV disease is an example of a disease that has mainly been spread through a. ecological changes. b. microbial changes. c. human behavioral changes. d. breakdowns in public health.

ANS: C

Ecological changes involve bringing human beings into close contact with animals or insect vectors. Microbial changes involve mutations in the microbial world.

HIV disease is spread mainly through human behavior such as injection drug abuse and sexual activities. Breakdowns in public health involve a problem or gap with public health measures put into place to protect against the spread of disease.

PTS: 1 DIF: Recall REF: p. 28 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 4. What disease was caused by a highly virulent strain of bacterium that developed in India

and was spread to South America? a. Tuberculosis b. Cholera c. HIV-disease d. Lyme disease ANS: B

Tuberculosis is caused by Mycobacterium tuberculosis and the number of cases in the US have increased due to increased population densities (e.g., the homeless, prisoners).

Cholera (caused by Vibrio cholerae strain O139) emerged in southern Asia in 1992 and was detected in South and Central America within a year. Transmission possibly involved the water on and in cargo ships. HIV-disease is caused by a virus that is passed from person to person via the sharing of body fluids. Lyme disease is caused by Borrelia burgdorferi, and is transmitted through tick bites. It was first recognized in the US in 1975 in Lyme Connecticut.

PTS: 1 DIF: Recall REF: p. 29 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 5. Which of the following diseases emerged as a result of a breakdown in a public health

measure? a. HIV disease b. Diphtheria in the USSR c. Lyme disease d. Rift valley fever ANS: B

HIV disease emerged primarily due to the human behaviors of injection drug abuse and sexual activities. When the formation of the New Independent States occurred in Russia some vaccination programs were relaxed which resulted in the emergence of 45,000 new cases of diphtheria in 1994. Lyme disease is caused by Borrelia burgdorferi, and is transmitted through tick bites. It was first recognized in the US in 1975 in Lyme Connecticut. Rift Valley fever emerged due to ecological changes in the forests near populated sites and along the Senegal River in Africa.

PTS: 1 DIF: Recall REF: p. 31 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 6. Which form of hepatitis was discovered most recently? a. Type E

b. Type C c. Type G d. Type D ANS: C

Type D was discovered in 1977. Type E was discovered in 1987. Type C was discovered in 1989. Type G was discovered in 1995.

PTS: 1 DIF: Recall REF: p. 27 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 7. In 2003 a coronavirus was discovered as the cause of ____________________. a. monkeypox in humans b. hepatitis F c. gastric ulcers d. severe acute respiratory syndrome (SARS) ANS: D

Monkeypox in humans is caused by the monkey pox virus. Hepatitis F was discovered in 1991. Gastric ulcers are caused by Helicobacter pylori, and its association with gastric ulcers was discovered in 1983. International travel was responsible for the spread of SARS from China.

PTS: 1 DIF: Recall REF: p. 29 |p. 27 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 8. Mass food processing technology led to the emergence of hemorrhagic colitis (and the

complication of hemolytic uremic syndrome) caused by a special strain of _______________________. a. Escherichia coli b. Bartonella henselae c. Legionella pneumophila d. Cryptosporidium parvum ANS: A

A pathogenic strain of Escherichia coli (O157:H7) contaminated meat used to make hamburger for a fast-food chain infecting about 700 persons and causing two deaths.

Bartonella henselae causes cat-scratch fever. Legionella pneumophila causes legionnaire’s disease. Cryptosporidium parvum causes an acute enterocolitis.

PTS: 1 DIF: Recall REF: p. 30 TOP: CDA, Infection Control, Does not apply

OBJ: 2 | 3

9. In 1995 human herpesvirus 8 was associated with human ____________________. a. hand-foot-mouth disease b. roseola c. Kaposi sarcoma d. hantavirus pulmonary syndrome ANS: C

Hand-foot-mouth disease is caused by a coxsackievirus. Roseola is caused by human herpesvirus 6. Kaposi sarcoma is commonly associated with acquired immunodeficiency syndrome as an opportunistic infection with human herpesvirus 8. Hantavirus pulmonary syndrome is caused by Sin Nombre virus.

PTS: 1 DIF: Recall REF: p. 27 TOP: CDA, Infection Control, Does not apply

OBJ: 3

10. New outbreaks of influenza emerge frequently (almost every year) because of a. a breakdown in public health measures. b. ecological changes that bring humans and animals together in new ways. c. changes in human behaviors. d. microbial changes.

ANS: D

Neither breakdowns in public health measures, ecological changes that bring humans and animals together in new ways, nor changes in human behaviors is the cause of regular influenza emergence. New strains of the influenza virus appear every year requiring a new vaccine to protect against the changed virus.

PTS: 1 DIF: Recall REF: p. 30 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 11. Which of the following microbes can cause a respiratory disease (mainly in

immunocompromised persons) and has emerged as an opportunistic pathogen found in technologically advanced water handling devices including in dental unit waterlines? a. Staphylococcus aureus b. Bartonella henselae c. Legionella pneumophila d. Cryptosporidium parvum ANS: C

Staphylococcus aureus is not commonly found in water handling devices. Bartonella henselae causes cat-scratch fever. Legionella pneumophila bacterium emerged in 1976 among attendees at a Legionnaire convention in a hotel with contaminated water.

Cryptosporidium parvum can cause an intestinal disease.

PTS: 1 DIF: Comprehension REF: p. 30 OBJ: 2 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 12. Pathogenic antibiotic-resistant bacteria are referred to as a. endogenous pathogens. b. superbugs. c. gram-positive bacteria. d. psychrophiles.

ANS: B

Endogenous pathogens may or may not be antibiotic resistant. Superbugs are antibiotic-resistant and often are resistant to several antibiotics. Gram-positive bacteria may or may not be antibiotic resistant. Psychrophiles may or may not be antibiotic resistant.

PTS: 1 DIF: Recall REF: p. 30 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 13. What do the following pathogens have in common? (Streptococcus pneumoniae,

enterococci, Staphylococcus aureus, Enterobacteriaceae, Mycobacterium tuberculosis, and Clostridium difficile). a. They all have strains that are antibiotic-resistant. b. They can all cause the same type of infection. c. They all are endogenous pathogens. d. They are all viruses.

ANS: A

They all have strains that are antibiotic-resistant. They cause different types of infections.

Not all are endogenous pathogens. None are viruses.

PTS: 1 OBJ: 3

DIF: Comprehension REF: p. 30 TOP: CDA, Infection Control, Does not apply

14. A care giver received a sharps injury while caring for a patient with unexplained bleeding,

vomiting, diarrhea, severe headache, and muscle pain. After 21 days the care giver began to develop the same symptoms. What disease is involved? a. Legionnaire’s disease b. Lyme disease c. Ebola disease d. SARS ANS: C

Legionnaire’s disease is a respiratory disease spread by through contaminated water. Lyme disease is spread through tick bites. Ebola is spread through direct contact through broken skin or mucous membranes, has an incubation period of 21 days, and causes severe bleeding and other symptoms. SARS (severe acute respiratory syndrome) is a respiratory disease.

PTS: 1 DIF: Application REF: p. 31 TOP: CDA, Infection Control, Does not apply

OBJ: 3

15. In 2014 over 11,000 people died from Ebola disease in what part of the world? a. New Mexico b. Western Africa c. Canada d. India ANS: B

There were over 28,000 suspected, probable, and confirmed cases in Western Africa.

There has not been a major outbreak of Ebola in the US, Canada, or India.

PTS: 1 DIF: Recall REF: p. 32 TOP: CDA, Infection Control, Does not apply

OBJ: 3

16. What viruses cause the respiratory diseases SARS, MERS and COVID-19? a. Herpes viruses b. Influenzae viruses c. Staphylococci d. Coronaviruses ANS: D

Herpes viruses primarily cause skin diseases. Influenza causes a respiratory disease but is not associated with SARS, MERS or COVID-19. Staphylococci are bacteria not viruses.

PTS: 1 DIF: Recall REF: p. 29 OBJ: 1 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 17. The ERBEVO is a vaccine indicated for the prevention of hemorrhagic fever caused by a. SARS-CoV-1. b. SARS-CoV-2. c. Human immunodeficiency virus. d. Zaire ebolavirus.

ANS: D

SARS-CoV-1 and 2 and human immunodeficiency virus do not cause hemorrhagic fevers.

PTS: 1 DIF: Recall REF: p. 32 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission COMPLETION 1. Ecological changes that result in disease emergence in humans usually involve diseases

from ______________ or insect-borne diseases.

ANS:

animals Ecological changes can bring humans and animals closer together which increases the chances for sharing their microbes leading to new infections.

PTS: 1 DIF: Recall REF: p. 26 TOP: CDA, Infection Control, Does not apply

OBJ: 3

Chapter 05: Oral Microbiology and Plaque-Associated Diseases Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. What causes the critical pH to be reached during formation of dental caries? a. The saliva stagnates and putrefies producing a large amount of acid. b. The bacteria in saliva cause an immune response to occur lowering the pH in the

mouth. c. Lysozyme in saliva lyses bacteria causing the release of internal chemicals from

the dead bacterial cells which lower the pH in the mouth. d. Plaque bacteria convert dietary sugar into acids.

ANS: D

Not enough acid is produced in saliva to reach a critical pH. Immune responses do not produce a large amount of acids. The release of internal chemicals from the dead bacterial cells does not produce enough acid to reach the critical pH. The acids produced by plaque bacteria lower the pH at the tooth surface to a level (critical pH) that causes minerals in the tooth enamel and dentin to dissolve.

PTS: 1 DIF: Application TOP: CDA, Does not apply

REF: p. 33

OBJ: 2

2. A bacterial mechanism involved in plaque formation based upon cell population density is

called a. anaphylactic shock. b. quorum sensing. c. catabolism. d. cellulitis.

ANS: B

Catabolism is the breakdown of large molecules. Quorum sensing facilitates plaque formation when cell population densities reach certain levels. Anaphylactic shock and cellulitis are not bacterial mechanisms.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 35

OBJ: 2

3. The most important bacteria in causing dental caries are a. Mutans streptococci and Staphylococcus aureus. b. Lactobacillus acidophilus and Porphyromonas gingivalis. c. Mutans streptococci and Lactobacillus acidophilus. d. Aggregatibacter actinomycetemcomitans and mutans streptococci.

ANS: C

Staphylococcus aureus is important in skin diseases rather than dental caries.

Porphyromonas gingivalis is strongly associated with chronic periodontitis. Mutans streptococci consists of the most caries-conductive bacteria in the mouth. Lactobacillus acidophilus is important in the progression of carious lesions after other bacteria have initiated tooth destruction. Aggregatibacter actinomycetemcomitans is strongly associated with juvenile periodontitis.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 35

OBJ: 2

4. What is the most caries conductive component of our diet? a. Protein b. Sucrose c. Fatty acid d. Cellulose ANS: B

Sucrose allows Mutans streptococci to attach to the tooth surface and accumulate rapidly in plaque. Also sucrose is metabolized to acids by plaque bacteria. Protein, fatty acids, and cellulose are dietary components but have low cariogenicity.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 36

OBJ: 2

5. Mutans streptococci convert ____________ to glucans that are used by these bacteria to

from plaque. a. starch b. omega-3 fatty acids c. sucrose d. fructose ANS: C

The enzyme glucosyltransferase cannot use starch. The enzyme glucosyltransferase cannot use omega-3 fatty acids. Mutans streptococci has an enzyme (glucosyltransferase) that converts sucrose to glucans plus fructose. The enzyme glucosyltransferase cannot use fructose.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 35

OBJ: 2

6. Which of the following periodontal diseases occurs in persons with normal body defense

mechanisms? a. Chronic b. Rapidly progressive c. Prepubertal d. Juvenile ANS: A

The continuous presence of plaque in people with normal body defense mechanisms leads to chronic periodontitis. Rapidly progressive, prepubertal, and juvenile periodontal disease occur in people with weakened body defenses.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 36

OBJ: 3

7. Oral biofilm (dental plaque) is a. accumulated food debris that occurs in the absence of oral hygiene. b. an accumulation of glycoproteins from saliva. c. a microbial mass that accumulates in the absence of oral hygiene. d. an aggregation of white blood cells that come from the gingival sulcus.

ANS: C

Foods, glycoproteins, and white blood cells are not bacteria, so cannot form biofilm. All kinds of biofilm, including dental plaque, are composed of bacteria.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 34

OBJ: 2

8. How many different genera of bacteria may be isolated from human mouths? a. At least 50 b. 100 c. 100 million d. 200 billion ANS: A

There are at least 50 genera of bacteria represented in the mouth; although, one person may not have all of them. 100 and 100 million are both too high. 200 billion is the average number of bacterial cells in one gram of plaque.

PTS: 1 DIF: Recall REF: p. 33 OBJ: 1 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 9. Calculus is a. accumulated food debris that occurs in the absence of oral hygiene. b. mineralized plaque. c. a microbial mass that accumulates in the absence of oral hygiene. d. an aggregation of white blood cells that come from the gingival sulcus.

ANS: B

Calculus forms when calcium and other minerals build up within plaque causing the plaque to become hard (mineralize). Oral biofilm is a microbial mass that accumulates in the absence of oral hygiene. Food debris and white blood cells do not mineralize.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 34-35

10. What actually destroys the tooth enamel in dental caries? a. Amino acids in the diet b. Acids made by bacteria c. Fats in saliva d. Nucleic acids ANS: B

OBJ: 2 | 3

The acids made by bacteria accumulate in plaque to a critical pH which is the level of acids needed to dissolve minerals from enamel and dentin. The presence of amino acids, fats, and nucleic acids do not cause a sufficient lowering of the pH to a critical level.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 33-34

OBJ: 2

11. Which of the following bacteria is the most important in causing the progression of a

carious lesion after the lesion has been initiated? a. Streptococcus sanguinis b. Lactobacillus acidophilus c. Porphyromonas gingivalis d. Prevotella intermedia ANS: B

Streptococcus sanguinis is not strongly cariogenic. Lactobacillus acidophilus is aciduric and thrives as a lesion becomes acidic. Porphyromonas gingivalis is involved in periodontal diseases not dental caries. Prevotella intermedia is involved in periodontal diseases not dental caries.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 35

OBJ: 2

12. Dental plaque is best defined as a. a microbial mass. b. composed of pieces of food that have stuck to the teeth. c. mineralized proteins. d. dried saliva.

ANS: A

Dental plaque is a microbial mass that accumulates on the teeth in the absence of oral hygiene. Food, proteins and dried saliva are not composed of microorganisms and therefore cannot form plaque on their own.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 34

OBJ: 2 | 3

13. How soon do bacteria begin to reattach to the tooth surface and start forming plaque again

after a prophylaxis? a. Within seconds b. 12 hours c. 1 day d. 1 week ANS: A

The pellicle followed by bacteria reattach as soon as the teeth become recontaminated with saliva (within seconds). Plaque has started to reform long before 12 hours, one day, or one week.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 34-35

OBJ: 2 | 4

14. Removing dental plaque and instituting good oral hygiene will reverse which of the

following diseases? a. Gingivitis b. Periodontitis c. Dental caries in dentin d. “Strep throat” ANS: A

Gingivitis is a reversible disease. When plaque is removed gingival tissue returns to normal. Progression of periodontitis and dental caries in the dentin can be stopped but the damage already done will not be reversed. Strep throat is unrelated to plaque.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 36

OBJ: 4

15. The three mechanisms of action of topical fluoride are (1) inhibiting bacterial metabolism

after diffusing into the bacteria as hydrogen fluoride; (2) inhibiting demineralization when present at the crystal surfaces of teeth during an acid challenge; and (3) a. enhancing remineralization. b. stopping plaque formation. c. killing all oral bacteria. d. enhancing saliva flow.

ANS: A

When fluoride adsorbs to a demineralized tooth site it attracts minerals from saliva such as calcium which contributes to remineralization. Fluoride will not stop plaque formation.

Fluoride may retard acid production by some bacteria but will not kill all oral bacteria.

Fluoride will not greatly enhance saliva flow.

PTS: 1 OBJ: 2 | 4

DIF: Comprehension TOP: CDA, Does not apply

REF: p. 37-38

16. Untreated dental caries can lead to a. “strep throat.” b. necrotizing ulcerative gingivitis. c. pulpitis. d. fever blisters.

ANS: C

“Strep throat” is caused by -hemolytic group A Streptococcus that is not related to dental caries. Necrotizing ulcerative gingivitis is caused by different bacteria than those that cause dental caries. As the bacteria progress deeper through the dentin they can reach the tooth pulp and cause inflammation. Fever blisters are caused by a herpes virus.

PTS: 1 DIF: Application REF: p. 38 OBJ: 5 TOP: CDA, Infection Control, I.A. Demonstrate an understanding of infectious diseases and their relationship to patient safety and occupational risk 17. The pellicle is best defined as a. part of the outer membrane of gram-negative bacterial cells. b. a proteinaceous layer that coats the teeth exposed to saliva. c. that part of the bacterial gene that codes for acid production.

d. the protein coat of viruses.

ANS: B

A lipid bilayer and endotoxin are parts of the outer membrane of gram-negative bacterial cells. Glycoproteins from saliva are first absorbed onto the tooth surface to form a thin proteinaceous layer called the pellicle that coats all tooth surfaces exposed to saliva. The part of the bacterial gene that codes for acid production is unrelated to the pellicle. The protein coat of a virus is called the capsid.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 34

OBJ: 2

18. Most of the bacteria important in causing periodontal diseases are a. in the group called mutans streptococci. b. gram-positive. c. gram-negative. d. also important causes of “strep throat.”

ANS: C

Mutans streptococci are the bacteria most important in causing dental caries.

Gram-positive bacteria are more important in causing dental caries than periodontal diseases. Although caries-conducive bacteria are gram-positive, most of the periodontopathogens are gram-negative. Periodontopathogens do not cause “strep throat.”

This is caused by -hemolytic group A Streptococcus.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 37

OBJ: 3

19. Where do periapical infections occur? a. Around the tooth pulp b. In the outer portion of the tooth enamel c. In the deep part of the tooth dentin d. In the tissue around the tooth apex ANS: D

The tooth pulp is in the dentin. Many caries begin in the outer portion of the tooth enamel.

Enamel caries can progress through the dentin. Progression of caries into the pulp may extend the infection through the canal and the tooth apex causing a periapical infection.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 38

20. Further progression of a periapical infection may cause a. “strep throat.” b. cellulitis. c. pulpitis. d. enamel caries.

ANS: B

OBJ: 5

The bacteria that cause periapical infections are not the same as the causative agent of “strep throat.” The periapical infection can spread to connective tissue causing a cellulitis.

Pulpitis usually occurs before a periapical infection. Enamel caries occurs long before periapical infections.

PTS: 1 DIF: Recall REF: p. 38 OBJ: 5 TOP: CDA, Infection Control, I.A. Demonstrate an understanding of infectious diseases and their relationship to patient safety and occupational risk 21. For microorganisms to colonize the mouth (become established members of the oral

microbiota) they must a. not be infected with bacteriophages. b. be gram-positive bacteria that are aciduric. c. attach to oral surfaces and be able to multiply in the oral environment. d. come from the nonhuman environment (e.g., water, dust, soil).

ANS: C

Bacteriophage infection is not related to oral colonization. Bacteria that are aciduric do colonize the mouth, but being gram-positive is not a requirement for colonization. For microorganisms to become established members of the oral microbiota, they must attach to oral surfaces and be able to multiply in the oral environment. If they do not attach to an oral surface, they will be washed away in salivary flow. Members of the oral microbiota come from other humans.

PTS: 1 DIF: Recall REF: p. 33 OBJ: 1 TOP: CDA, Infection Control, I.A. Demonstrate an understanding of infectious diseases and their relationship to patient safety and occupational risk COMPLETION 1. After a prophylaxis plaque begins to reform within _____________.

ANS:

seconds Salivary microbes have special surfaces properties that allow them to rapidly attach/reattach to oral surfaces. This attachment allows them to survive at the attachment site.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 34-35

OBJ: 2 | 3 | 4

2. The best approach to preventing periodontal disease is to ________ and _________.

ANS:

brush; floss floss; brush Since periodontal disease is caused by subgingival plaque, removal of that plaque by regularly brushing and flossing is a way to prevent the disease.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 37

OBJ: 4

TRUE/FALSE 1. Simple or acute gingivitis involves the bone in which the teeth are set.

ANS: F

Simple or acute gingivitis involves only the soft tissue around the tooth.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 36

OBJ: 3

2. The same bacteria that cause dental caries also cause periodontal diseases.

ANS: F

Caries-conducive bacteria are gram-positive, most of the periodontopathogens are gram-negative.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 37

OBJ: 2 | 3

3. Plaque causes periodontal diseases.

ANS: T

Plaque accumulated in the gingival sulcus and the bacteria present in the plaque cause damage to the hard and soft tissues surrounding the tooth.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 34 | p. 37

OBJ: 3

4. Periodontitis occurs only in older adults.

ANS: F

Juvenile periodontitis can occur in the early teen years and prepubertal periodontitis occurs around primary teeth.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 37

OBJ: 3

Chapter 06: Bloodborne Pathogens Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. Which of the following forms of hepatitis is transmitted through contaminated food or

water? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis D ANS: A

Hepatitis A is food/water borne. Hepatitis B, Hepatitis C, and Hepatitis D are bloodborne diseases usually transmitted by direct or indirect contact with infected body fluid.

PTS: 1 DIF: Recall REF: p. 41 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 2. The greatest occupational risks for exposure to hepatitis B virus are: (1) blood and saliva

contamination of cuts and cracks in the skin or ungloved hands or hands with torn gloves; (2) spraying of blood and saliva onto open lesions on the skin or onto mucous membranes; and (3) a. by ingesting contaminated water. b. through injuries with contaminated sharps. c. through inhalation. d. by shaking hands with patients.

ANS: B

Hepatitis B is most commonly spread to health care workers by contact with infected body fluids, for example, a sharps injury. Occupational spread through ingesting water, inhalation, or shaking hands with a patient has not been documented.

PTS: 1 DIF: Recall REF: p. 42 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 3. What bloodborne disease has the greatest potential for occupational transmission risk to

dental professionals? a. Hepatitis B b. HIV c. Hepatitis C d. Hepatitis A ANS: A

Hepatitis B is the greatest risk to health care workers mainly because of the high concentration of hepatitis B viruses in the blood of infected persons. HIV reaches lower concentration in blood during disease states. Hepatitis C is of low occupational risk for health care workers. Hepatitis A is not an occupational threat to dental professionals because it is spread by ingesting contaminated water or food.

PTS: 1 DIF: Recall REF: p. 43 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 4. The best way for you to avoid contracting a bloodborne disease in the office is to a. not shake hands with patients. b. wear a mask all day long even between patients. c. handle sharps carefully. d. disinfect operatory surfaces with undiluted bleach.

ANS: C

Not shaking hands with patients, wearing a mask all day long, even between patients, and disinfecting operatory surfaces with undiluted bleach all relate to very low risk routes of spread for bloodborne diseases. Sharps injuries are the main route of occupational spread of bloodborne diseases.

PTS: 1 DIF: Recall REF: p. 44 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 5. How does HIV cause AIDS? a. It destroys the liver. b. It destroys the body defenses against diseases. c. It destroys the ability to control muscle action. d. It paralyzes the body.

ANS: B

The virus multiplies in lymphocytes and kills them. This weakens the immune system, making the patient more susceptible to other infections. When a patient experiences one or more opportunistic infections/cancer the patient is considered to have AIDS. Liver damage, the inability to control muscle action, and paralysis of the body are not usually involved in the direct pathogenesis of HIV disease.

PTS: 1 DIF: Recall REF: p. 47 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 6. Which of the following hepatitis diseases seldom, if ever, establishes a chronic infection? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis D ANS: A

Types B, C, and D establish chronic infections. Type A does not establish a chronic infection.

PTS: 1 DIF: Recall REF: p. 42 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols

7. Which of the following hepatitis diseases does not have a chronic carrier state? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis D ANS: A

Since type A does not establish a chronic infection, it does not have a chronic carrier state.

About 5% to 10% of those with type B develop a chronic carrier state. About 75% to 85% of those with type C develop a chronic carrier state. Some with type D can develop a chronic carrier state.

PTS: 1 DIF: Recall REF: p. 42 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 8. HIV makes people sick by a. damaging the liver. b. causing a respiratory infection. c. causing food poisoning. d. by destroying their immune system.

ANS: D

HIV multiplies best in lymphocytes that provide our immune responses. This replication kills the lymphocytes which weakens and eventually destroys the immune system. Now the person is susceptible to many infectious and cancerous diseases. Damage to the liver, respiratory infection, and food poisoning are not usually involved in the direct pathogenesis of HIV disease.

PTS: 1 DIF: Recall REF: p. 46 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 9. HIV-disease is not spread a. to a developing fetus from the infected mother. b. by inhalation. c. through percutaneous exposure. d. from sexual activities.

ANS: B

A developing fetus can become infected from the infected mother. HIV is a blood-borne disease, not an airborne infection. Percutaneous exposure and sexual activities are common modes of HIV infection.

PTS: 1 DIF: Recall REF: p. 47 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 10. A vaccine is available for which of the following types of hepatitis? a. Hepatitis A and hepatitis C b. Hepatitis B and hepatitis A c. Hepatitis C and hepatitis B d. Hepatitis C and hepatitis D

ANS: B

There is a vaccine for types A and B but not for types C and D. PTS: 1 DIF: Recall REF: p. 42 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 11. A hepatitis B carrier is a. HIV-positive. b. HBsAg-positive. c. Anti HBsAg-positive. d. HBs-Ag-negative.

ANS: B

HBsAg-positive denotes the presence of the hepatitis B virus as would occur in an acute infection and in a carrier state. Anti HBsAg is the antibody to hepatitis B virus and occurs after infection in non-carriers and after being vaccinated. HBs-Ag-negative indicates that the virus is likely not present in the body. HIV-positive is related to HIV disease, not hepatitis B. PTS: 1 DIF: Recall REF: p. 42 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 12. What is the main ingredient in the hepatitis B vaccine? a. Antibodies to the HBsAg b. HBsAg c. HIV-Ag d. HBeAg ANS: B

Antibodies to the HBsAg are made after one receives the vaccine. The hepatitis B vaccine consists of HBsAg synthesized using yeast cells. HIV-Ag is related to HIV-disease not to hepatitis. HBeAg is another antigen of the hepatitis B virus but is not present in the vaccine.

PTS: 1 DIF: Recall REF: p. 44 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 13. A person who is positive for HBsAg and ______________ is highly infectious for

hepatitis B (can more easily spread the disease). a. HBcAg b. anti-HBc c. HBeAg d. anti-HBe ANS: C

HBcAg is the core antigen but does not indicate high infectivity. Anti-HBc is the antibody to the core antigen that indicated prior infection with hepatitis B virus. HBeAg indicates the presence of high numbers of hepatitis B virus in the blood; therefore, only small amounts of blood are necessary to transmit the virus. This translates into high infectivity.

Anti-HBe indicates a lower titer of hepatitis B virus.

PTS: 1 DIF: Recall REF: p. 42 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 14. Which antibody is formed after a person responds to the hepatitis B vaccine? a. Anti-HBc b. Anti-HBe c. Anti-HAV d. Anti-HBs ANS: D

Anti-HBc, anti-HBe, and anti-HBs are made after a natural infection with the hepatitis B virus but not after receiving the vaccine. These are the antibodies made after one receives the hepatitis B vaccine.

PTS: 1 DIF: Recall REF: p. 44 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 15. Which of the following forms of hepatitis is not bloodborne? a. A b. B c. C d. D ANS: A

Hepatitis A is food/water borne. Hepatitis B, hepatitis C, and hepatitis D are bloodborne diseases usually transmitted by direct or indirect contact with infected body fluid.

PTS: 1 DIF: Recall REF: p. 41 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 16. Which of the hepatitis viruses causes disease only in persons who are simultaneously or

previously infected with the hepatitis B virus? a. Type A b. Type C c. Type E d. Type D ANS: D

The type A virus can cause disease on its own. The type C virus can cause disease on its own. The type E virus can cause disease on its own. The type D virus is defective and need to use part of the type B virus to replicate.

PTS: 1

DIF: Recall

REF: p. 45

OBJ: 1

TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 17. The vaccine for hepatitis B also protects against a. hepatitis A. b. hepatitis C. c. hepatitis E. d. hepatitis D. ANS: D

The type B vaccine does not protect against hepatitis A. There is a separate vaccine for hepatitis A. The type B vaccine does not protect against hepatitis C. There is no vaccine for hepatitis C. The type B vaccine does not protect against hepatitis E. There is no vaccine for hepatitis E. Since the hepatitis D virus causes disease only in those infected with hepatitis B, prevention of hepatitis B through vaccination also prevents hepatitis D. PTS: 1 DIF: Recall REF: p. 46 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 18. Which of the following AIDS exposure categories has had the highest number of AIDS

cases in the US? a. Men who have sex with men b. Injection drug abusers c. Men who have sex with men and who also are injection drug abusers d. Heterosexual contact ANS: A

As of 2009 men who have sex with men represented 48% of AIDS cases in the US. As of 2009 injection drug abusers represented 25% of AIDS cases in the US. As of 2009 men who have sex with men and who are also injection drug abusers represented 7% of AIDS cases in the US. As of 2009 heterosexual contact represented 18% of AIDS cases in the US. PTS: 1 DIF: Recall REF: p. 47 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 19. A percutaneous route of exposure to an infectious agent means that exposure occurred a. through the nose. b. through the skin. c. through the mouth. d. through the eye.

ANS: B

Cutaneous refers to the skin. Exposure through the nose, mouth, or eye involves infection through a mucous membrane.

PTS: 1 DIF: Recall REF: p. 42 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 20. Most of the healthcare workers who have occupationally acquired HIV infection from

infected patients had what type of exposure?

a. b. c. d.

Through the mouth Through the eye Through the skin Through the nose

ANS: C

84% had puncture or cut injuries with contaminated sharps. Exposure through the mouth, eye, or nose is not a significant route of exposure but could occur.

PTS: 1 DIF: Recall REF: p. 48 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 21. As of 2015 how many documented cases of occupationally related HIV transmissions have

been reported in dental personnel? a. 0 b. 6 c. 57 d. 143 ANS: A

Although no documented cases have been reported, there have been reports of six possible transmissions involving dental personnel (three dentists, one oral surgeon, and three dental assistants). 6 is the number of possible transmissions that have been reported. 57 is the total number of documented transmissions that have been reported among all healthcare workers. 143 is the total number of possible transmissions that have been reported among all healthcare workers.

PTS: 1 DIF: Recall REF: p. 48 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 22. What percentage of those infected with hepatitis C virus develop chronic liver disease? a. 5% to 10% b. 20% to 30% c. 60% to 70% d. 90% to 100% ANS: C

60% to 70% of those infected with hepatitis C develop chronic liver disease. 5% to 10% and 20% to 30% is too low. 90% to 100% is too high.

PTS: 1 DIF: Recall REF: p. 45 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 23. What is the most likely route of hepatitis B transmission from an infected patient to an

unvaccinated dental assistant wearing, exam gloves, protective eyewear and a long-sleeved gown but no face mask? a. Inhalation of salivary aerosols b. Needlestick c. Swallowing salivary droplets d. Touching a blood-contaminated instrument ANS: B

Hepatitis B is not transmitted through inhaled aerosols. Hepatitis B is a bloodborne disease and sharps injuries provide a means of entry into the blood stream. Hepatitis B is not transmitted by ingestion. The gloves protected against direct contact.

PTS: 1 DIF: Application REF: p. 44 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 24. How long can the hepatitis C virus in blood dried on an inanimate surface remain

infectious? a. Up to 2 days b. Up to 1 week c. Up to 3 weeks d. Up to 6 weeks ANS: D

A study has shown that the hepatitis C virus in blood dried in an inanimate surface remains infectious for up to 6 weeks. 2 days, 1 week, and 3 weeks are too short.

PTS: 1 DIF: Recall REF: p. 45 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 25. What is the least important way a dental assistant can prevent the chairside spread of HIV

from a dental patient? a. Prevent sharps injuries b. Wear examination gloves c. Wear protective eyewear d. Have the patient use a preprocedure mouthrinse ANS: D

Sharps injuries are a major route of spread. Examination gloves prevent direct contact with the patient’s potentially contaminated oral fluids. Eyewear protects the mucous membranes of the eyes which can serve as an entry point for the virus. Preprocedure mouthrinsing will temporarily reduce the number of microbes in the patient’s mouth, but subsequent treatment may cause bleeding with potential increased contamination of the oral fluids.

PTS: 1 DIF: Application REF: p. 48 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols COMPLETION 1. Hepatitis B is a bloodborne pathogen that causes a harmful infection of the _________.

ANS:

liver Hepatitis is an inflammation of the liver and all of the hepatitis viruses multiply best in liver cells.

PTS: 1 DIF: Recall REF: p. 41 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols

2. Acquired immunodeficiency syndrome is caused by the __________________________.

ANS:

human immunodeficiency virus (HIV) HIV infects the body and destroys the immune system which makes the person susceptible to a variety of diseases.

PTS: 1 DIF: Recall REF: p. 47 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 3. AIDS is the acronym for _____________.

ANS:

acquired immunodeficiency syndrome AIDS is the acronym for acquired immunodeficiency syndrome disease caused by the human immunodeficiency virus.

PTS: 1 DIF: Recall REF: p. 46 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols TRUE/FALSE 1. A person infected with HIV can have the virus present in saliva.

ANS: T

Although HIV has been isolated from saliva, so far this route in casual or household contacts has not resulted in any documented cases of transmission.

PTS: 1 DIF: Recall REF: p. 48 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols

Chapter 07: Oral and Respiratory Diseases Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. Which of the following is a viral disease of the mouth? a. Syphilis b. Gonorrhea c. Tuberculosis d. Herpangina ANS: D

Herpangina is caused by a coxsackievirus and produces small vesicles on the soft palate or elsewhere in the posterior of the mouth. Syphilis, gonorrhea, and tuberculosis are all bacterial diseases.

PTS: 1 DIF: Recall REF: p. 54 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 2. Which of the following is a fungal disease? a. Denture stomatitis b. Common cold c. Measles d. Chickenpox ANS: A

Denture stomatitis is mainly caused by the fungus Candida albicans. Common cold, measles, and chickenpox are viral diseases.

PTS: 1 DIF: Recall REF: p. 51 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 3. What microbe causes denture stomatitis? a. Streptococcus mutans b. Herpes simplex virus c. Candida albicans d. Streptococcus pyogenes ANS: C

Streptococcus mutans causes dental caries. Herpes simplex virus causes herpes labialis and other infections. Candida albicans is the fungal yeast that causes thrush and denture stomatitis. Streptococcus pyogenes causes streptococcal pharyngitis and scarlet fever.

PTS: 1 DIF: Recall REF: p. 51 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 4. What microbe causes “strep throat”?

a. b. c. d.

Streptococcus mutans Herpes simplex virus Candida albicans Streptococcus pyogenes

ANS: D

Streptococcus mutans causes dental caries. Herpes simplex virus causes herpes labialis and other infections. Candida albicans is the fungal yeast that causes candidiasis and denture stomatitis. Streptococcus pyogenes (also known as -hemolytic, group A streptococcus) causes streptococcal pharyngitis (“strep throat”).

PTS: 1 DIF: Recall REF: p. 55 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 5. Which herpes virus causes most of the oral and ocular herpes infections and some of the

genital herpes infections? a. Human herpes virus type 1 b. Human herpes virus type 3 c. Human herpes virus type 5 d. Human herpes virus type 8 ANS: A

Human herpes virus type 1 (also known as herpes simplex 1) causes intraoral herpes, recurrent herpes labialis, infections of the eye and some of the herpes infections of the genitalia. Human herpes virus type 3 causes chickenpox and shingles. Human herpes virus type 5 causes cytomegalovirus disease. Human herpes virus type 8 causes Kaposi sarcoma.

PTS: 1 DIF: Recall REF: p. 51 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 6. Which of the following is a respiratory disease that can be screened for using the Mantoux

test or purified protein derivative test? a. Strep throat b. Tuberculosis c. HIV-disease d. Syphilis ANS: B

The Mantoux test does not detect strep throat. The Mantoux test or purified protein derivative test is used to screen for tuberculosis infection. HIV-disease and syphilis are not considered respiratory diseases.

PTS: 1 DIF: Recall REF: p. 55 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 7. Some strains of which of the following bacteria are known as “flesh-eating” bacteria? a. Mycobacterium tuberculosis b. Staphylococcus aureus c. Corynebacterium diphtheriae

d. Streptococcus pyogenes ANS: D

Mycobacterium tuberculosis causes tuberculosis. Staphylococcus aureus causes skin infections and secondary pneumonia. Corynebacterium diphtheriae causes diphtheria.

Certain strains of Streptococcus pyogenes (known as “flesh-eating bacteria”) cause necrotizing fasciitis, which produces rapidly spreading damage to the muscle tissue.

PTS: 1 DIF: Recall REF: p. 55 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 8. Rheumatic heart disease occurs in a small percent of those previously infected with a. Mycobacterium tuberculosis. b. Staphylococcus aureus. c. Corynebacterium diphtheriae. d. Streptococcus pyogenes.

ANS: D

Mycobacterium tuberculosis causes tuberculosis. Staphylococcus aureus causes skin infections and secondary pneumonia. Corynebacterium diphtheriae causes diphtheria.

Some people who become infected with Streptococcus pyogenes (the cause of “strep throat” and scarlet fever) may experience complications such as rheumatic heart disease or kidney failure.

PTS: 1 DIF: Recall REF: p. 55 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 9. All of the following microbes may be found in the throat, but which one causes most

middle ear infections? a. Streptococcus pneumoniae b. Neisseria meningitidis c. Streptococcus pyogenes d. Candida albicans ANS: A

Streptococcus pneumoniae is a bacterium that causes the most middle ear infections.

Neisseria meningitides causes meningitis. Streptococcus pyogenes causes “strep throat,” scarlet fever and skins infections. Candida albicans causes thrush and denture stomatitis.

PTS: 1 DIF: Recall REF: p. 57 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 10. Which of the following types of respiratory infections is usually caused by inhaling or

aspirating contaminated water? a. Chickenpox b. Infectious mononucleosis c. Legionnaire’s disease d. Influenza

ANS: C

Chickenpox, infectious mononucleosis, and influenza are infections acquired by contact with another person’s respiratory droplets. Legionnaire’s disease is a pneumonia that can result from the inhalation of contaminated water from water-handling systems.

PTS: 1 DIF: Recall REF: p. 59 OBJ: 4 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 11. Which of the following is a systemic disease that commonly produces lesions in the

mouth? a. Chickenpox b. Tuberculosis c. Legionnaire disease d. Influenza ANS: A

About 2 weeks after infection with the Varicella-zoster virus vesicles frequently develop in the mouth. Tuberculosis usually does not produce oral lesions. Legionnaire disease and influenza do not produce oral lesions.

PTS: 1 DIF: Recall REF: p. 54 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 12. Which of the following diseases may produce palatal petechiae, widespread erythema

(reddening) of the oral mucosa, and swelling of the uvula? a. Infectious mononucleosis b. Influenza c. Herpes labialis d. Legionnaire’s disease ANS: A

Infectious mononucleosis caused by human herpesvirus 4 (also called the Epstein–Barr virus) produces these oral lesions. Influenza and Legionnaire’s disease do not produce oral lesions. Herpes labialis produces lesions on and around the lips.

PTS: 1 DIF: Recall REF: p. 55 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 13. About 5% to 10% of the cases of _______________ occur in or around the mouth in the

form of an open ulcer commonly on the tongue or lips. a. Tuberculosis b. Chickenpox c. Syphilis d. Infectious mononucleosis ANS: C

Tuberculosis usually does not produce oral lesions. Chickenpox produces oral lesions more frequently that 5% to 10%. Syphilis is caused by the bacterium Treponema pallidum and can cause a primary oral infection if the mouth is directly exposed. Infectious mononucleosis causes oral lesions but not of the ulcer type.

PTS: 1 DIF: Recall REF: p. 53 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 14. In untreated ________________ a secondary oral phase (infectious mucous patches) of the

disease may appear 2 to 10 weeks after the initial nonoral lesion occurs and has subsided. a. tuberculosis b. chickenpox c. syphilis d. infectious mononucleosis ANS: C

Tuberculosis usually does not produce oral lesions. Chickenpox produces oral lesions but they are vesicular rather than mucous patches. The causative bacterium in syphilis (Treponema pallidum) can spread within the body from the primary nonoral lesion (e.g., a genital lesion) to the mouth causing mucous patches that contain the T. pallidum.

Infectious mononucleosis causes oral lesions but not of the mucous patches type.

PTS: 1 DIF: Application REF: p. 54 TOP: CDA, Infection Control, Does not apply

OBJ: 2

15. Primary herpetic gingivostomatitis mainly occurs in children and is usually caused by a. human herpesvirus 8. b. human herpesvirus 6. c. human herpesvirus 3. d. human herpesvirus 1.

ANS: D

Human herpesvirus 8 causes a skin disease called Kaposi sarcoma. Human herpesvirus 6 causes roseola, a skin disease usually in children. Human herpesvirus 3 causes chickenpox.

About 10% of those infected with human herpesvirus 1 (also known as herpes simplex virus 1) have intraoral lesions (vesicles) referred to as primary herpetic gingivostomatitis.

The other 90% may never have any symptoms or may have recurrent herpes lesions (e.g., herpes labialis) periodically throughout their lives.

PTS: 1 DIF: Recall REF: p. 51 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 16. Herpes labialis is caused by a. human herpesvirus 8. b. human herpesvirus 6. c. human herpesvirus 3. d. human herpesvirus 1.

ANS: D

Human herpesvirus 8 causes a skin disease called Kaposi sarcoma. Human herpesvirus 6 causes roseola, a skin disease usually in children. Human herpesvirus 3 causes chickenpox.

About 10% of those infected with human herpesvirus 1 (also known as herpes simplex virus 1) have intraoral lesions (vesicles) referred to as primary herpetic gingivostomatitis.

The other 90% may never have any symptoms or may have recurrent herpes lesions (e.g., herpes labialis) periodically throughout their lives.

PTS: 1 DIF: Recall REF: p. 51 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 17. Entrance of the herpes virus through breaks in the skin on unprotected hands and fingers

can lead to vesicle development at these sites called ____________. a. herpes labialis b. herpetic whitlow c. secondary herpes d. recurrent herpes ANS: B

Herpes labialis is a recurrent (secondary) form of herpes that occurs on or around the lips.

This can occur on the hands of dental personnel who are not wearing gloves and treating a patient with human herpesvirus 1 in the mouth. Secondary herpes is a general term for any form of recurrent herpes. Recurrent herpes is a general term for any form of secondary herpes.

PTS: 1 DIF: Recall REF: p. 51 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 18. Who has published guidelines for the prevention of tuberculosis in dental health care

facilities? a. The Food and Drug Administration b. The Centers for Disease Control and Prevention c. The Environmental Protection Agency d. The American Dental Association ANS: B

The Food and Drug Administration clears foods, drugs, and medical devices for sale. The Centers for Disease Control and Prevention issued these tuberculosis prevention guidelines in 1994. The Environmental Protection Agency does not regulate prevention of infectious diseases. The American Dental Association supports the CDC’s guidelines for prevention of tuberculosis but has not prepared its own guidelines.

PTS: 1 DIF: Recall REF: p. 55 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 19. What disease is not a particular problem for dental professionals but is a worldwide

problem affecting about one third of the world population with about 10 million new cases in 2019? a. Hepatitis C b. Tuberculosis

c. Hand-foot-mouth disease d. Gonococcal pharyngitis ANS: B

Hepatitis C is a bloodborne disease and, thus, is important to dental personnel.

Tuberculosis is a worldwide problem causing about 1.5 million deaths per year, but it is not a particular problem for dental personnel because of the relatively short exposure times that occur with dental patients. Hand-foot-mouth disease is of concern for dental workers since it is an infectious disease that occurs in the mouth. Gonococcal pharyngitis is of concern for dental workers since it is an infectious disease that occurs in the throat.

PTS: 1 DIF: Application REF: p. 55 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 20. Which of the following human herpesviruses causes hairy leukoplakia, an infection of the

tongue? a. Type 1 b. Type 2 c. Type 3 d. Type 4 ANS: D

Type 1 mainly causes primary herpetic gingivostomatitis and herpes labialis. Type 2 mainly causes genital herpes. Type 3 causes chickenpox and shingles. Type 4 causes infectious mononucleosis and hairy leukoplakia of the tongue.

PTS: 1 DIF: Recall REF: p. 51 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 21. What microbe that is spread through respiratory/oral droplets causes a vaccine-preventable

lung disease, is the leading cause of middle ear infections, and also can cause meningitis and invasive disease? a. Mycobacterium tuberculosis b. Human herpes virus type 1 c. Streptococcus pneumoniae d. Candida albicans ANS: C

Mycobacterium tuberculosis is not a leading cause of middle ear infections. There are two vaccines available against the respiratory pathogen Streptococcus pneumoniae. Human herpes virus 1 and Candida albicans do not cause a lung disease and have no related vaccines.

PTS: 1 DIF: Application REF: p. 57 OBJ: 3 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 22. What virus was first associated with human disease in 2012 and causes a severe acute

respiratory illness, including fever, cough, and shortness of breath? a. MERS-CoV

b. Mycobacterium tuberculosis c. Streptococcus pneumoniae d. MRSA ANS: A

Middle Eastern Respiratory Syndrome-Coronavirus (MERS-CoV) was originally recognized in Saudi Arabia, and early victims in the US had recently traveled to Saudi Arabia. Mycobacterium tuberculosis, Streptococcus pneumonia and Methicillin-resistant Staphylococcus aureus (MRSA) are bacteria not viruses.

PTS: 1 DIF: Application REF: p. 58 OBJ: 3 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 23. What infection prevention procedure would be least effective in preventing the spread of

Methicillin-resistant Staphylococcus aureus (MERSA) in the dental office? a. Hand hygiene b. Antimicrobial treatment of dental unit water c. Wearing appropriate personal protective equipment d. Cleaning and disinfecting or using surface barriers on clinical contact surfaces ANS: B

Hand hygiene, wearing of appropriate personal protective equipment, and cleaning and disinfecting or using surface barriers on clinical contact surfaces are important in preventing spread from direct contact of contaminated surfaces. MERSA is not spread through dental unit water. It usually causes a skin infection and is spread by contact with those lesions or items the person has used or contacted.

PTS: 1 DIF: Application REF: p. 60 OBJ: 5 TOP: CDA, Infection Control, I.C. and I.D. Standard precautions and the prevention of disease transmission | CDA, Infection Control, II.A. Prevent cross-contamination during procedures 24. What virus has caused the COVID-19 pandemic? a. SARS-CoV-1 b. SARS-CoV-2 c. MERS-CoV d. MRSA ANS: B

SARS-CoV-1 caused the severe acute respiratory syndrome that occurred in 2003.

MERS-CoV caused the middle Eastern respiratory syndrome that was first reported in Saudi Arabia in 2012. MRSA is the name of a disease caused by methicillin-resistant Staphylococcus aureus.

PTS: 1 DIF: Application REF: p. 58 OBJ: 5 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 25. The primary mode of spread of COVID-19 is a. through needlesticks and other sharps injuries. b. through beaks in the skin when not wearing gloves. c. from contaminated respiratory droplets and aerosols.

d. from mosquito bites.

ANS: C

COVID-19 is a respiratory disease, so the virus multiplies in the lungs and bronchi so when an infected person sneezes, talks, sings, or coughs, contaminated droplets and aerosol particles are released into the air. Mosquito bites, needlesticks and other sharps injuries are modes of spread for bloodborne diseases.

PTS: 1 DIF: Application REF: p. 58 OBJ: 5 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission

Chapter 08: Infection Control Rationale and Regulations Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. The goal of infection control is a. to reduce the number of microbes that are shared between individuals. b. to sterilize all surfaces in the dental operatory. c. to increase the body’s resistance to all microbes. d. decrease the virulence of all microbes.

ANS: A

Reduction in the number of microbes that are shared between individuals will reduce the dose of microbes that can be spread between persons or surfaces to decrease the chance of infection or contamination. Sterilization of all surfaces in the dental operatory is not possible. The body’s resistance to microbes can only be done for some microbes for which vaccines are available. It is impossible to decrease the virulence of microbes except by gene manipulation.

PTS: 1 DIF: Recall REF: p. 67 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 2. Which governmental agency regulates disinfectants? a. The Department of Labor b. Occupational Health and Safety Administration c. The Centers for Disease Control and Prevention d. The Environmental Protection Agency ANS: D

The Department of Labor contains OSHA which is charged with protecting the workers of America. The Occupational Health and Safety Administration agency is charged with protecting the workers of America. The Centers for Disease Control and Prevention makes recommendations for disease prevention and investigates disease outbreaks. The Environmental Protection Agency requires manufacturers of disinfectants to submit information that shows the safety and effectiveness of antimicrobial agents used on environmental surfaces.

PTS: 1 DIF: Recall REF: p. 68 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 3. Wearing gloves when treating a patient prevents which of the following modes of entry of

the patient’s microbes into your body? a. Inhalation b. Ingestion c. Mucous membranes d. Percutaneous through breaks in the skin ANS: D

Inhalation means breathing in aerosol particles. Ingestion means swallowing droplets of saliva/blood spattered into the mouth. Mucous membranes are not present on the hands.

Gloves protect hands against contact with blood, saliva, mucous membranes, nonintact skin, or contaminated items, but give little protection against needlesticks or cuts.

PTS: 1 DIF: Application REF: p. 74 OBJ: 1 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 4. Which of the following pathways of cross-contamination is the main pathway prevented

when instruments are cleaned and sterilized? a. Patient to dental team b. Dental team to patient c. Patient to patient d. Office to community ANS: C

Patient to patient is the main cross-contamination pathway prevented as the instruments will be reused on other patients. The dental team handles instruments only with gloved hands and practices sharps safety. Occasionally sharps injuries will contaminate a member of the dental team but this is not the main pathway prevented. The dental team handles the instruments with gloved hands which prevents the team members microbes from contaminating the instruments. Contaminated instruments are not commonly sent out into the community—only when rare repairs are needed, but this is not the main pathway prevented.

PTS: 1 DIF: Application REF: p. 66 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 5. Which of the following pathways for cross-contamination is the most difficult to control? a. Patient to dental team b. Dental team to patient c. Patient to patient d. Office to community ANS: A

The patient to dental team pathway includes more opportunities for microbe spread than the other pathways and includes direct contact, indirect contact, and droplet infection. The dental team to patient, patient to patient, and office to community pathways involve indirect contact.

PTS: 1 DIF: Application REF: p. 66 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 6. What pathway of cross-contamination is the main pathway prevented when protective

eyeglasses are worn by a member of the dental team? a. Patient to dental team b. Dental team to patient c. Patient to patient

d. Office to community ANS: A

Patient to dental team is the main cross-contamination pathway prevented since the glasses will reduce/prevent droplets from the patient’s mouth from contacting the employee’s eyes. The dental team to patient, patient to patient and office to community pathways are unrelated to the eyeglasses worn by the dental team members.

PTS: 1 DIF: Application REF: p. 66 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 7. The manufacturing of medical devices like sterilizers is regulated by what U.S. agency? a. EPA b. OSHA c. CDC d. FDA ANS: D

The EPA regulates disinfectants and drinking water. OSHA regulates the safety of workers. The CDC makes recommendations for disease prevention and investigates disease outbreaks. The FDA regulates the manufacturing and labeling of medical devices and a sterilizer is a medical device.

PTS: 1 DIF: Recall REF: p. 68 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 8. The rule that requires employers to do certain things to prevent employees from being

exposed to human body fluids at work is called the a. Universal Precautions Standard. b. Hazard Communications Standard. c. The Bloodborne Pathogens Standard. d. Medical Device Standard.

ANS: C

The Universal Precautions Standard an approach to disease prevention originally describes

by OSHA. The Hazard Communications Standard is a standard from OSHA designed to protect employees from exposure to hazardous chemicals. The Bloodborne Pathogens Standard (developed by OSHA) directs employers to protect employees from occupational exposure to blood and other potentially infectious materials. The Medical Device Standard is not a specific set of rules or a standard.

PTS: 1 DIF: Recall REF: p. 68 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 9. Which of the following infection control procedures is not mentioned in the bloodborne

pathogens standard? a. Wearing gloves and protective clothing to prevent contact with blood or saliva. b. Wearing masks to prevent contact with oral spatter. c. Sterilizing instruments before they are reused on another patient. d. Cleaning and disinfecting contaminated surfaces.

ANS: C

Sterilizing instruments is a patient protection procedure, and OSHA is charged to protect workers not patients. Wearing gloves and protective clothing, wearing masks, and cleaning and disinfecting contaminated surfaces are important parts of the bloodborne pathogens standard.

PTS: 1 DIF: Recall REF: p. 75 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 10. The bloodborne pathogens standard requires action by whom? a. Dental patients b. Dentist employers c. Dental office employees d. Dental sales representatives ANS: B

The bloodborne pathogens standard requires employers to take steps to protect employees from occupational exposure to blood and other infectious material. It does not address or require any action by the patient, employees, or sales representatives.

PTS: 1 DIF: Recall REF: p. 69 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 11. What is required by the postexposure evaluation part of the bloodborne pathogens

standard? a. That all patients exposed to an HIV-positive or hepatitis B-positive dental office employee be evaluated for their bloodborne disease status. b. That employees exposed to a patient’s blood or saliva be evaluated for their bloodborne disease status. c. That an OSHA inspector evaluate employers and employees exposed to a patient’s blood or saliva for their bloodborne disease status. d. The employees get hepatitis A and tetanus vaccinations.

ANS: B

Evaluation for bloodborne disease status is not a part of the bloodborne pathogen standard.

The standard requires employers to provide medical evaluation and follow-up for exposed employees. OSHA inspectors are not required to evaluate employers and employees exposed to a patient’s blood or saliva for their bloodborne disease status. The postexposure evaluation does not require these hepatitis A and tetanus vaccinations.

PTS: 1 DIF: Recall REF: p. 67 OBJ: 4 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 12. According to the bloodborne pathogens standard who must provide gloves, masks,

eyeglasses and protective clothing to the dental assistant in the office? a. The dental assistant must supply her/his own protective equipment. b. The employing dentist must supply this protective equipment. c. OSHA must supply this protective equipment. d. A dental sales representative of a protective equipment manufacturer must provide the protective equipment to the office free of charge.

ANS: B

The bloodborne pathogens standard is directed to the employer; therefore, the employer must provide gloves, masks, eyeglasses, and protective clothing to employees. Dental assistants, OSHA, and sales representatives are not required to provide the protective equipment.

PTS: 1 DIF: Recall REF: p. 74 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 13. Which U.S. government agency helps assure the safety and effectiveness of surface

disinfectants? a. CDC b. FDA c. EPA d. OSHA ANS: C

The CDA makes recommendations for disease prevention and investigates disease outbreaks. The FDA regulates the manufacturing and labeling of medical devices and a sterilizer is a medical device. The EPA ensures the safety and effectiveness of disinfectants and regulates drinking water. OSHA makes laws to protect the safety of workers.

PTS: 1 DIF: Recall REF: p. 68 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 14. Which governmental agency sets the standard for drinking water? a. Occupational Safety and Health Administration b. Food and Drug Administration c. Environmental Protection Agency d. Centers for Disease Control and Prevention ANS: C

OSHA makes laws to protect the workers of America. FDA regulates medical devices, food, drugs, and cosmetics. The EPA sets the standard for drinking water, and this is the quality of water that should be used for routine dental care. CDC makes recommendations on disease prevention and investigates outbreaks of diseases.

PTS: 1 DIF: Recall REF: p. 77 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 15. The bloodborne pathogens standard was designed to a. protect patients from getting diseases in health care facilities like the dental office. b. make all patients divulge their HIV status to their health care workers. c. assure the safety and effectiveness of medical devices. d. require employers to do certain things to prevent employees from being exposed to

human body fluids.

ANS: D

The standard does not relate to patients, just to employers and employees. Patient safety is covered by the infection control recommendations from CDC. It is not required for patients to divulge their HIV status Ensuring the safety and effectiveness of medical devices is an activity of the FDA and is not related to the bloodborne pathogens standard.

The bloodborne pathogen standard directs employers to do certain things to prevent employees from being exposed to human body fluids.

PTS: 1 DIF: Recall REF: p. 69 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 16. What is a part of the CDC infection control recommendations for dental facilities rather

than OSHA’s bloodborne pathogens standard? a. Written exposure control plan b. Sterilizing all instruments before they are reused c. Hepatitis B vaccination d. Postexposure medical evaluation ANS: B

A written exposure control plan, hepatitis B vaccinations, and postexposure medical evaluation relate to both CDC and OSHA. Sterilizing instruments relates to protecting patients which is not part of the bloodborne pathogens standard.

PTS: 1 DIF: Recall REF: p. 75 OBJ: 5 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 17. Use of high-volume evacuation, preprocedure mouthrinsing, and _______________ are

designed to reduce the spread of patient’s microbes in dental aerosols and spatter. a. dry heat sterilizer b. disinfectant c. wearing latex gloves d. the rubber dam ANS: D

A sterilizer is designed to kill or remove all microorganisms on an object. A disinfectant is for environmental surfaces and is not to be used on the body. Latex gloves are intended to protect from directly contacting patient microbes not from exposure to aerosol and spatter.

The rubber dam serves as a barrier between the patient’s saliva and the extraoral environment by reducing the aerosolization of the patient’s saliva.

PTS: 1 DIF: Application REF: p. 73 OBJ: 4 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 18. What involves patient to dental team cross-contamination? a. Not wearing protective eyewear by the dental team member b. Not using biological indicators c. Not sterilizing instruments before reuse d. Not cleaning and disinfecting operatory surfaces before the next appointment ANS: A

Not wearing protective eyewear allows spatter from the patient’s mouth to contact the eyes and this would be patient to dental team spread. Not using biological indicators, not sterilizing instruments, and not cleaning and disinfecting operatory surfaces before the next appointment relate to dental team to patient or patient to patient spread.

PTS: 1 DIF: Application REF: p. 66 OBJ: 1 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 19. How can we best prevent disease considering the dose of the microbe and body resistance? a. Increase the dose and decrease body resistance. b. Decrease the dose and increase body resistance. c. Increase the dose and increase body resistance. d. Decrease the dose and decrease body resistance.

ANS: B

Increasing the dose and decreasing body resistance gives higher contamination.

Decreasing the dose and increasing body resistance yields less contamination and higher body resistance. Increasing the dose and increasing body resistance gives high contamination. Decreasing the dose and decreasing body resistance lowers body resistance.

PTS: 1 DIF: Recall REF: p. 67 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 20. If you are working in a private dental office and your employer says that you must buy

your own gloves, where is the best place to go to complain? a. CDC b. OSHA c. The local school of dentistry d. Another dental office ANS: B

The CDC is the government agency that makes infection control recommendations, but does not have authority to accept such complaints. Being made to purchase your own gloves is a violation of OSHA’s bloodborne pathogens standard that requires the employer to provide these items. A school of dentistry has no authority over a private dental practice. A dental office has no authority over another dental practice.

PTS: 1 DIF: Application REF: p. 74 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 21. The seven sections of the bloodborne pathogens standard are: written exposure control

plan; exposure prevention methods; hepatitis B vaccinations; postexposure medical evaluation; hazard communication; training; and a. new office construction. b. instrument sterilization. c. patient protection. d. recordkeeping.

ANS: D

Construction codes are usually regulated by the state. Instrument sterilization relates to the CDC recommendations. Patient protection relates to the State Department of Health and the CDC recommendations. Recordkeeping is an important part of the bloodborne pathogens standard and includes training records, employee medical records, vaccination records and postexposure evaluation records.

PTS: 1 DIF: Recall REF: p. 69 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 22. Which of the following is a not-for-profit nongovernmental organization involved with

infection control in dentistry? a. CDC b. OSAP c. EPA d. OSHA ANS: B

The Organization for Safety, Asepsis and Prevention is a not-for-profit professional organization which is the premier infection control education organization in dentistry.

The CDC, EPA, and OSHA are governmental agencies.

PTS: 1 DIF: Recall REF: p. 68 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 23. The CDC recommends that dental unit water should have no more than _____________

colony-forming-units (CFU) of heterotrophic bacteria per milliliter. a. 5 b. 50 c. 500 d. 5000 ANS: C

500 CFU is the recommendation and is the same as the EPA’s standard for good quality drinking water.

PTS: 1 DIF: Recall REF: p. 77 OBJ: 5 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures | CDA, Infection Control, IV.A. Occupational safety/administrative protocols 24. According to the CDC extracted teeth that do not contain amalgam and will be used by

schools for educational purposes need to be a. disinfected with bleach. b. ultrasonically cleaned. c. soaked in alcohol. d. heat sterilized.

ANS: D

Disinfection is not sufficient to kill all microbes inside the teeth. Ultrasonic cleaning will not kill all the microbes. Alcohol is not sufficient to kill all microbes inside the teeth. Heat sterilization will kill all the microbes on the outside and inside of teeth.

PTS: 1

DIF: Recall

REF: p. 78

OBJ: 5

TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 25. When does the required OSHA training on bloodborne pathogens have to be given to

employees who have a potential for exposure to human body fluids? a. When an employee is initially hired and at least annually thereafter. b. Only when an employee is initially hired. c. Within 1 month of hiring the employee and every 6 months thereafter. d. After the employee has received the hepatitis B vaccination series.

ANS: A

Training initially and at least annually is the OSHA requirement. Training only on initial hiring does not take into account any infection control changes that may occur after the employee is hired. Problems could happen in that first month that proper training could alleviate. The training is to be given before the employer offers the hepatitis B vaccination so the employee can make an informed consent.

PTS: 1 DIF: Recall REF: p. 63 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 26. According to OSHA, employers of healthcare workers must offer their employees the

hepatitis B vaccination series; (1) free of charge, (2) within 10 days of their employment, and (3) after they have a. prescreened for immunity to hepatitis B. b. received the required training on bloodborne pathogens. c. agreed to practice universal precautions. d. been fitted or protective clothing and gloves.

ANS: B

Prescreening for immunity to hepatitis B is specifically prohibited by the bloodborne pathogens standard. The training will allow the employee to make an informed decision about receiving the vaccine. Agreement to practice universal precautions is not a prerequisite. Being fitted for protective clothing and gloves is not a prerequisite.

PTS: 1 DIF: Recall REF: p. 66 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 27. What will reduce the chances for cross-contamination from patient to dental team? a. Using good quality treatment water b. Using a preprocedure mouthrinse c. Using disposable items d. Heat sterilizing high- and low-speed handpieces ANS: B

Using good quality treatment water relates to preventing cross-contamination from dental team to patient and from patient to patient. Using a preprocedure mouthrinse will reduce the number of microbes in the patient’s mouth so there will be fewer to exit the mouth and contaminate the dental team and environment. Using disposable items relates to preventing cross-contamination from patient to patient. Heat sterilizing high- and low-speed handpieces relates to preventing cross-contamination from patient to patient.

PTS: 1 DIF: Application REF: p. 64 OBJ: 1 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease

transmission 28. The difference between universal precautions and standard precautions is that universal

precautions relate only to a. blood and body fluids containing blood. b. respiratory diseases. c. contaminated saliva. d. skin diseases.

ANS: A

Universal precautions was expanded by CDC’s standard precautions which apply not just to blood but to nonintact skin, mucous membranes, all body fluids, excretions (except sweat) and secretions regardless of the presence of blood. The other options are too limited.

PTS: 1 DIF: Recall REF: p. 73 OBJ: 5 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 29. The employer must give to the evaluating physician who is evaluating an employee

exposed to a patient’s saliva five pieces of information: (1) past written physician’s opinions on the employee’s hepatitis B vaccination status and any past exposure incidents; (2) an incident report describing circumstances surrounding the exposure; (3) the employees job description related to the exposure incident; (4) results of the source individuals blood testing, if available; and (5) a. the names and addresses of all patients seen in the office that day. b. the office’s spore testing records for the past 6 months. c. a copy of OSHA’s bloodborne pathogens standard. d. the names and hepatitis B vaccination status of all the employees in the office.

ANS: C

The names and addresses of all patients seen in the office that day, or the names and hepatitis B vaccination status of all employees would not help the evaluation of the exposed employee. The office’s spore testing record is usually not related to an exposure incident. A copy of OSHA’s bloodborne pathogens standard is required.

PTS: 1 DIF: Recall REF: p. 72 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 30. The correct name for the dental infection control guidelines issued by the CDC is a. regulations. b. suggestions. c. recommendations. d. laws.

ANS: C

The term suggestions is not strong enough. They make recommendations because they do not have the authority to make regulations or laws like OSHA. PTS: 1 DIF: Recall REF: p. 67 OBJ: 5 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols

31. When during a patient visit to the dental office should respiratory hygiene and cough

etiquette begin? a. Immediately when they enter the office b. When they first see the receptionist c. When they leave the waiting area and approach the clinical area d. When they are seated in the dental chair ANS: A

Respiratory microbes can start to be spread as soon as they enter the office. It is too late to begin cough etiquette after this.

PTS: 1 DIF: Application REF: p. 70 OBJ: 1 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 32. What part of an infection control program is occurring when a patient enters a dental office

and sees a sign stating: “Please cover your mouth/nose when coughing or sneezing”? a. Use of disposables b. Respiratory hygiene c. Postexposure medical evaluation d. Disinfection ANS: B

Respiratory hygiene and cough etiquette involves reducing the spreading of respiratory microbes, coughs or sneezes. The use of disposables, postexposure medical evaluation, and disinfection do not relate to cough etiquette.

PTS: 1 DIF: Recall REF: p. 70 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 33. Establishing procedures for post-exposure management relates to what principle of

infection control? a. Take action to stay healthy. b. Avoid contact with infectious materials. c. Limit the spread of contaminants. d. Make objects safe for use.

ANS: A

Avoid contact with infectious materials, Limit the spread of contaminants, and Make objects safe for use are principles related to pre-exposure activities and post-exposure activities.

PTS: 1 DIF: Application REF: p. 63 OBJ: 1 | 6 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 34. Use a preprocedure mouthrinse, rubber dam, and HVE best relates to what two infection

control principles? a. Take action to stay healthy and limit the spread of contaminants. b. Avoid contact with infectious materials and take action to stay healthy. c. Limit the spread of contaminants and avoid contact with infectious materials. d. Make objects safe for use and limit the spread of contaminants.

ANS: A

Preprocedure mouthrinses, rubber dams, and HVEs reduce the number of microbes exiting the patient’s mouth, so this would exposure of the dental team to fewer microbes promoting health. With fewer microbes exiting the patient’s mouth fewer contaminants would be spread into the environment.

PTS: 1 DIF: Application REF: p. 63 OBJ: 1 | 6 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 35. What procedures related best to the infection control principle of making objects safe for

use? a. Using gloves during patient treatment b. Disposing of contaminated needles in a sharps container c. Spore-testing sterilizer loads d. Performing hand hygiene ANS: C

Biological monitoring help determine if the processed instruments are safe for use.

Disposing of contaminated needles in a sharps container and using gloves during patient treatment relates to the principle of avoiding contact with infectious materials. Performing hand hygiene relates to the principle of taking action to stay healthy.

PTS: 1 DIF: Application REF: p. 64 OBJ: 1 | 6 TOP: CDA, Infection Control, III.B. Instrument/device processing

Chapter 09: Preparing for Patient Safety and Occupational Health Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. A disease prevention strategy based on the shared commitment of everyone in the office is

referred to as a. an OSHA Standard on occupational safety. b. a FDA recommendation on patient safety. c. a culture of safety. d. an EPA regulation.

ANS: C

OSHA does not have such a standard. FDA does not have such a recommendation. The EPA does not have such a regulation. This describes a culture of safety to ensure the safety of the work environment, the dental personnel, and the patients.

PTS: 1 DIF: Recall REF: p. 81 OBJ: 1 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 2. After the successful development of a safety culture in a dental office what comes next? a. Commitment of management to improve patient and worker safety. b. Identify and remove hazards in the work environment. c. Determine the cause of identified problems. d. Give rewards.

ANS: D

Commitment of management to improve patient and worker safety, identification and removal of hazards in the work environment, and determination of the cause of identified problems are all parts of the development process. Rewarding success helps to maintain the safety culture.

PTS: 1 DIF: Recall REF: p. 81 OBJ: 1 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 3. What is the least helpful action that can be taken by employers to help ensure a safety

culture in the workplace? a. Requiring staff to wear heavy utility gloves when recapping contaminated needles by hand. b. Openly supporting the safety culture through supply of resources. c. Engaging worker participation in safety planning. d. Having written safety guidelines and policies.

ANS: A

Recapping needles by hand would never be a part of a safety culture. There must be adequate supplies to support a safety culture. Worker involvement in planning is important. The safety guidelines form the basis of a safety culture.

PTS: 1

DIF: Application

REF: p. 81

OBJ: 1

TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 4. When should dental healthcare personnel first be introduced to the office’s culture of

safety? a. During their first participation in the overall infection prevention program evaluation b. Just before caring for their first infectious patient c. After their first exposure incident d. When they are first hired ANS: D

Dental healthcare personnel have a potential for exposure to infectious agents before their first participation in the overall infection prevention program evaluation, before caring for their first infectious patient. After their first exposure incident is too late as they may have been exposed to infectious agents. Introduction to the office’s culture of safety when personnel are first hired ensures they receive the proper information before there is a chance for exposure to infectious agents.

PTS: 1 DIF: Recall REF: p. 81 OBJ: 1 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 5. What is the least important aspect of a safety culture? a. Adherence to safety guidelines b. Having patients review the safety plan c. Worker participation in safety planning d. Having appropriate protective equipment available ANS: B

Adherence to safety guidelines, worker participation in safety planning, and having appropriate protective equipment available are very important in a safety culture. Patients need not review the safety plan.

PTS: 1 DIF: Recall REF: p. 81 OBJ: 1 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 6. Who should be involved in creating a safety culture in a dental facility? a. The dentist employer, dental assistants, and hygienists b. The dental assistants, hygienists, and front office staff c. The dental assistants and hygienists d. Everyone in the facility ANS: D

It is very important that everyone in the facility be involved in creating a safety culture in a dental facility.

PTS: 1 DIF: Recall REF: p. 81 OBJ: 1 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 7. What agency has developed a survey to determine the safety climate in a dental office? a. National Institute for Occupational Safety and Health b. American Dental Assistants Association c. Food and Drug Administration

d. American Dental Association ANS: A

The National Institute for Occupational Safety and Health has developed a survey to determine the safety climate in a dental office. The American Dental Assistants Association, Food and Drug Administration, and American Dental Association have not developed such a survey.

PTS: 1 DIF: Recall REF: p. 81 OBJ: 2 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 8. What is least important in setting the stage for safety in the office? a. Making sure there is a system to help ensure all appointment times are filled every

day. b. Making sure postexposure management procedures are in place. c. Making sure the sterilizer maintenance is up-to-date. d. Making sure the dental unit water is of good quality.

ANS: A

Full appoint times are the least relevant for office safety. Making sure postexposure management procedures are in place provides a rapid response to exposures. Making sure the sterilizer maintenance is up-to-date helps ensure instruments are safe for use on patients. Making sure the dental unit water is of good quality helps protect patients from potentially harmful microbes.

PTS: 1 DIF: Application REF: p. 84 OBJ: 2 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 9. What is the least safe procedure? a. Changing into heavy utility gloves for operative clean-up b. Hand-scrubbing contaminated instruments c. Having the face mask covering the nose d. Using good quality dental unit water ANS: B

Changing into heavy utility gloves for operative clean-up promotes safety by giving added protection to the hands. Hand-scrubbing contaminated instruments is an unsafe practice that increases the risk for sharps injuries. Having the face mask covering the nose provides protection to the mucous membranes of the nose. Using good quality dental unit water promotes safety against contact with potential pathogens.

PTS: 1 DIF: Application REF: p. 82 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 10. What is a safe procedure? a. Not monitoring the sterilization process b. Not wearing protective eyewear c. Not wearing gloves at chairside d. Not reusing disposables ANS: D

Not monitoring the sterilization process allows for possibly use of unsafe instruments on patients. Not wearing protective eyewear allows possible exposure of the eyes to patient’s oral fluids. Not wearing gloves at chairside allows possible exposure of the hands to patient’s oral fluids. Not reusing disposables promotes safety against patient-to-patient spread of potential pathogens.

PTS: 1 DIF: Application REF: p. 82 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 11. What is the best way to evaluate performance of hand hygiene by the office staff? a. Periodically measuring the level of handwashing soap used. b. Keep track of the approximate number of paper towels used. c. Observe the staff performing hand hygiene. d. Measure the amount of alcohol hand-rub used every week.

ANS: C

Periodically measuring the level of handwashing soap used, keeping track of the approximate number of paper towels used, and measuring the amount of alcohol hand-rub used every week do not address that actual performance of hand hygiene. Observing the staff performing hand hygiene will show if hand hygiene is being performed properly.

PTS: 1 DIF: Application REF: p. 83 OBJ: 3 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 12. What is the best way to evaluate performance of surface asepsis procedures? a. Measure the amount of disinfectant used every week. b. Interview the staff asking how they perform surface asepsis. c. Observe the staff performing surface cleaning and disinfection. d. Estimate weekly the number of towels used to wipe down the surfaces.

ANS: C

Measuring the amount of disinfectant used every week, interviewing the staff to ask how they perform surface asepsis, and estimating weekly the number of towels used to wipe down the surfaces do not address the actual performance of surface asepsis. Observing the staff performing surface cleaning and disinfection will show if surface asepsis is being performed properly.

PTS: 1 DIF: Application REF: p. 81 OBJ: 2 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 13. What infection prevention element provides the least protection to patients? a. Wearing of protective eyewear by the dental team b. Immunization of the dental team against influenza c. When dental team wears exam gloves at chairside d. Dividing instrument processing area into defined sites for decontamination,

packaging, sterilization, and storage ANS: A

Wearing of protective eyewear by the dental team protects the wearer’s eyes but not the patients. Immunizations protect the dental team from getting a disease thus they cannot pass on the disease to patients. Exam gloves protect the patients from contacting microbes on the hands of the dental team. Dividing instrument processing area into defined sites for decontamination, packaging, sterilization, and storage helps prevent the intermingling of sterile with nonsterile instruments to help provide safe instruments for patient care.

PTS: 1 DIF: Application REF: p. 84 OBJ: 2 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 14. What infection prevention element provides protection to both patients and the dental

team? a. The dental team wearing protective eyewear b. Having sharps containers close to chairside c. The dental team being immunized against hepatitis B d. Disinfecting a denture before sending to the dental laboratory ANS: C

The dental team wearing protective eyewear protects the wearer’s eyes but not the patients. Having sharps containers close to chairside does not involve patient protection.

Immunizations protect the dental team from getting a disease thus they cannot pass on the disease to patients. Disinfecting a denture before sending to the dental laboratory protects laboratory personnel not patients.

PTS: 1 DIF: Application REF: p. 84 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 15. What infection prevention element provides protection to patients but not the dental team? a. Hand hygiene by the dental team b. Packaging instruments prior to sterilization c. When the dental team wears gloves at chairside d. The dental team wearing face masks at chairside ANS: B

Hand hygiene by the dental team removes microbes from the hands of the dental team to reduce the chance of entry through breaks in the skin, and it protects patients from contacting microbes on the hands of the dental team. Packaging instruments prior to sterilization protects patients from contacting microbes that may recontaminate unpackaged instruments after sterilization and before use at chairside but provides no protection to the dental team. Wearing gloves at chairside protects the dental team from contacting patients’ oral microbes and protects patients from contacting microbes on the hands of the dental team. The dental team wearing face masks at chairside protects the dental team against mucous membrane contact with droplets of patients’ oral fluids and protects patients from droplets from the dental teams’ mouths.

PTS: 1 DIF: Application REF: p. 84 OBJ: 3 TOP: CDA, Infection Control, III.A. Instrument/device processing 16. What office safety element provides protection to the dental team but not patients?

a. b. c. d.

The dental team’s understanding of the Hazard Communication Standard Use of the rubber dam Use of disposables at chairside The dental team wearing protective clothing

ANS: A

The dental team’s understanding of the Hazard Communication Standard helps protect the dental team from exposure to hazardous chemicals but does not relate to patient safety.

Use of the rubber dam reduces exposure of patients to microbes in dental unit water, and it reduces the chance of microbes entering root canals during endodontic therapy. Use of disposables at chairside helps prevent patient-to-patient cross-contamination. The dental team wearing protective clothing prevents microbes on the clothing or skin of dental personnel from contaminating patients.

PTS: 1 DIF: Application REF: p. 84 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 17. What infection prevention element provides protection to patients but not the dental team? a. Aseptic retrieval of supplies b. Dental team gloving at chairside c. Dental team wearing protective eyewear d. High-volume evacuation ANS: A

Aseptic retrieval of supplies helps protect patients from patient-to-patient cross-contamination but does not protect the dental team. Dental team gloving at chairside protects the dental team from contacting patients’ oral microbes and protects patients from contacting microbes on the hands of the dental team. Dental team wearing protective eyewear protects the wearer’s eyes but not the patients. High-volume evacuation protects both the dental team and patients by reducing the number of microbes in the patient’s mouth and by reducing the number of microbes that can exit the patient’s mouth and contaminate the dental team.

PTS: 1 DIF: Application REF: p. 84 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 18. OSHA’s Bloodborne Pathogens Standard recommends the development of a written

program to maintain occupational health for dental workers that include medical conditions and work restriction, immunizations, postexposure medical evaluations and a. results of patient surveys for treatment satisfaction. b. record of patient appointment cancellations. c. emergency escape routes. d. immunizations.

ANS: D

Neither results of patient surveys for treatment satisfaction nor records of patient appointment cancellations relate to dental occupational health. Emergency escape routes are not a part of the Bloodborne Pathogens Standard. Immunizations are an important part of dental worker health.

PTS: 1

DIF: Recall

REF: p. 83

OBJ: 3

TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols

Chapter 10: Immunizations Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. The most common hepatitis B vaccine requires how many shots? a. One b. Two c. Three d. Four ANS: C

One shot is two shots short of the necessary three. Two shots are one shot short of the necessary three. Four shots are too many. The hepatitis B vaccine requires three injections, two intramuscularly 4 weeks apart and a third 5 months after the second.

PTS: 1 DIF: Recall REF: p. 92 OBJ: 4 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 2. Which of the following best describes the recommended inoculation schedule for the most

common hepatitis B vaccine? a. First dose followed 1 month later by a second dose and a third dose 6 months after the first. b. First dose followed 2 months later by a second dose and a third dose 6 months after the first. c. First dose followed 6 months later by a second dose and a third dose 8 months after the first. d. First dose followed by one additional dose every year.

ANS: A

The schedule recommended by the vaccine manufacturer and has been approved by the CDC and Advisory Committee on Immunization Practices is a first dose followed 1 month later by a second dose and a third dose 6 months after the first. Following the first dose 2 month later by a second dose and a third dose 6 months after the first, the second dose is too late and is not acceptable by the CDC and Advisory Committee on Immunization Practices. A first dose followed 6 month later by a second dose and a third dose 8 months after the first, the second dose is too late is not acceptable by the CDC and Advisory Committee on Immunization Practices. It is not acceptable by the CDC and Advisory Committee on Immunization Practices to have the first dose followed by one additional dose every year.

PTS: 1 DIF: Recall REF: p. 92 OBJ: 4 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 3. How often should one receive a “flu” shot? a. Once every 20 years b. Once every 10 years

c. Once every 5 years d. Once every year ANS: D

The influenza viruses that cause most of the flu cases change every year. Therefore, it is necessary prepare new vaccines every year which are designed to protect against the newly emerged strains of the influenza virus. Vaccinations older than a year may have little or no preventive ability against the prevailing influenzas of the current year.

PTS: 1 DIF: Recall REF: p. 90 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 4. What is the general nature of the hepatitis B vaccine? a. It contains a live virus. b. It contains a whole inactivated virus. c. It contains a single antigen recombinant vaccine. d. It contains an immune globulin.

ANS: C

It is not a live virus which is a weakened virus that causes immunity but not disease. It is not an inactivated virus which is a dead whole virus that causes immunity but not disease.

The hepatitis B recombinant vaccine contains only the surface antigen from the virus made by genetic manipulations. An immune globulin is an antibody.

PTS: 1 DIF: Recall REF: p. 91 OBJ: 4 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 5. There is no vaccine for which of the following diseases? a. Hepatitis C b. Measles c. Mumps d. Influenza ANS: A

Hepatitis C is a bloodborne disease for which there is no vaccine. There is a vaccine for measles, mumps, and influenza.

PTS: 1 DIF: Recall REF: p. 88 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 6. A vaccine is not available in the US for a. human immunodeficiency virus disease. b. measles. c. chickenpox. d. tetanus.

ANS: A

As of 2015 there is no vaccine against human immunodeficiency virus disease. There are vaccines for measles, chickenpox, and for tetanus.

PTS: 1 DIF: Recall REF: p. 88 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 7. According to OSHA’s bloodborne pathogens standard, if a dental office staff person who

is susceptible to hepatitis B refuses the offer to be vaccinated against hepatitis B, what must happen? a. The staff person must see a physician. b. The staff person must not be hired or must be fired. c. The staff person must sign a vaccine declination form. d. The staff person can work in the office but can only work with children under age 12.

ANS: C

OSHA does not require that the staff person see a physician, or that the staff person cannot be hired or must be fired. It is not required that the staff person work only with children under the age of 12. If employees refuse the hepatitis B vaccine, they must read and sign a declination statement.

PTS: 1 DIF: Recall REF: p. 92 OBJ: 4 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 8. Which of the following symptoms are prominent with influenza but rare or slight with the

common cold? a. Headache and body aches b. Sore throat and sneezing c. Stuffy nose and sore throat d. Slow onset and low fever ANS: A

Headache and body aches are common symptoms of influenza. Sore throat, sneezing, stuffy nose, and slow onset and low fever are not common symptoms with the flu but are common with the common cold.

PTS: 1 DIF: Recall REF: p. 90 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 9. What types of viral strains are in the influenza vaccine? a. Three type Bs b. Three type As c. One type A and one type B d. Two type As and one or two type B ANS: D

Only one type B is used to prepare flu vaccines. Two not three type As are used to prepare flu vaccines. Two of the type As are used to prepare flu vaccines. The standard content or flu is two type As and one type B vaccine because it protects the most people.

PTS: 1 DIF: Recall REF: p. 90 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease

transmission 10. The Tdap vaccine is designed to prevent diphtheria, pertussis, and a. tuberculosis. b. typhoid. c. tetanus. d. typhus.

ANS: C

There is no licensed vaccine for tuberculosis in the US. The vaccines for typhoid and typhus are not part of the Tdap vaccine. Tetanus toxoid is part of the Tdap vaccine which is given to prevent tetanus.

PTS: 1 DIF: Recall REF: p. 89 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 11. A vaccine is not available for a. rubella. b. chickenpox. c. some human herpesviruses. d. hepatitis B. ANS: C

There are vaccines for chickenpox, rubella, and hepatitis B. There are no vaccines for some herpesviruses.

PTS: 1 DIF: Recall REF: p. 88 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 12. Why should healthcare workers get tested for hepatitis B antibodies after receiving the

three shots of hepatitis B vaccine? a. To see if they are also HIV-positive. b. To see if they have become immune to hepatitis B. c. To see if they are allergic to the vaccine. d. To see if they need the hepatitis A vaccine.

ANS: B

A person who is HIV-positive does not produce hepatitis B antibodies. As no vaccine is 100% effective, the CDC recommends testing for immunity 1 to 2 months after receiving the third inoculation of the hepatitis B vaccination series. The presence of hepatitis B antibodies does not determine the presence of an allergic response. The presence or absence of hepatitis B antibodies does not determine if a person should be vaccinated against hepatitis A. PTS: 1 DIF: Application REF: p. 92 OBJ: 4 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 13. The vaccine against _____________ consists of an inactivated toxin. a. hepatitis B

b. tetanus c. measles d. mumps ANS: B

The hepatitis B vaccine contains the HBsAg which is a surface component of the virus.

The tetanus vaccine consists of the inactivated tetanus toxin called a toxoid. A toxoid is not damaging but does stimulate an immune response. The measles vaccine and mumps vaccine consist of a weakened live virus.

PTS: 1 DIF: Recall REF: p. 89 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 14. Which of the following diseases is not on the list of vaccine preventable diseases in the

United States? a. Hepatitis B b. Measles c. Influenza d. Tuberculosis ANS: D

The vaccines against measles, influenza and hepatitis B are on CDC’s list. Tuberculosis is not on the list because the BCG vaccine is not licensed for general use in the U.S. PTS: 1 DIF: Recall REF: p. 88 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 15. What is the CDC’s recommendation for hepatitis B vaccinations of infants? a. Vaccination of only the females b. No vaccination until age 3 years c. Vaccination of only premature infants d. Vaccination of all infants at birth ANS: D

It is too restrictive to vaccinate only females or premature infants, or to not vaccinate until age 3 years. Vaccination of all infants at birth provides the best protection.

PTS: 1 DIF: Recall REF: p. 92 OBJ: 4 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 16. A dental assistant was an asymptomatic carrier of hepatitis B. What happens when she

receives the hepatitis B vaccination series? a. She’ll develop symptoms of hepatitis B. b. The carrier state will be eliminated. c. She’ll become immune to hepatitis B. d. The vaccine will not work and she’ll remain a carrier.

ANS: D

She will likely remain asymptomatic. The vaccine will not affect her carrier state. It will not work, as she is already infected with the hepatitis B virus.

PTS: 1 DIF: Application REF: p. 92 OBJ: 4 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 17. The CDC estimates that what will prevent more than 21 million hospitalizations and

732,000 deaths among children born in the last 20 years? a. Increased use of prophylactic antibiotics b. Vaccinations c. High protein diets d. Infection control ANS: B

Increased use of prophylactic antibiotics will increase the occurrence of antibiotic-resistant infections. Vaccinations will prevent many diseases from occurring. High protein diets do not relate to the CDC estimate. Infection control will prevent the spread of some diseases, but an estimate of the total affect has not been made.

PTS: 1 DIF: Recall REF: p. 93 OBJ: 5 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 18. When is a person fully vaccinated after receiving the Johnson & Johnson-Janssen

COVID-19 vaccine? a. Immediately after the shot b. Two days after the shot c. One week after the shot d. Two weeks after the shot ANS: D

Immediately after, two days after and one week after do not give enough time for the immune system to fully respond to the shot.

PTS: 1 DIF: Recall REF: p. 93 OBJ: 5 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 19. When is a person fully vaccinated after receiving the Pfizer-BioNtech COVID-19 vaccine? a. Immediately after the second shot b. Two days after the second shot c. One week after the second shot d. Two weeks after the second shot ANS: D

Immediately after, two days after, and one week after the second shot do not give enough time for the immune system to fully respond.

PTS: 1 DIF: Recall REF: p. 93 OBJ: 5 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission

TRUE/FALSE 1. A vaccine is available in the US against pneumococcal pneumonia.

ANS: T

This is a vaccine that healthcare personnel should consider receiving after discussion with their healthcare provider.

PTS: 1 DIF: Recall REF: p. 93 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 2. A vaccine is available in the US against human immunodeficiency virus disease.

ANS: F

As of 2012 there is no vaccine available in the US against human immunodeficiency virus disease.

PTS: 1 DIF: Recall REF: p. 88 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 3. After persons have received the hepatitis B vaccination series, they must be given a

booster shot every 5 years to maintain their immunity.

ANS: F

The CDC currently does not recommend booster after hepatitis B vaccination.

PTS: 1 DIF: Recall REF: p. 92 OBJ: 4 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission

Chapter 11: Hand Hygiene Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. The category of bacteria on the hands that refers to the normal skin bacteria rather than the

pathogens is called a. transient. b. resident. c. resistant. d. a colony.

ANS: B

Transient skin flora consists of microorganisms that contaminate the hands during touching of or exposure to contaminated surfaces. They serve as a source of disease spread. Resident skin flora consists of microorganisms that colonize the skin and become permanent residents. They are less important than the transient flora in disease spread.

“Resistant” is not a category of skin bacteria. “A colony” is not a category of skin bacteria.

PTS: 1 DIF: Recall REF: p. 95 OBJ: 1 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 2. Which of the following best describes the transient skin flora on the hands? a. Microbes that live on the skin all the time b. Microbes that are never completely killed or removed by handwashing c. Microbes that are usually involved in the spread of disease from the hands d. Microbes that are nonpathogenic ANS: C

Microbes that live on the skin all the time and are never completely killed or removed by handwashing describes the resident flora. Transient skin flora consists of microorganisms that contaminate hands during touching of or exposure to contaminated surfaces. Transient flora can contain pathogens.

PTS: 1 DIF: Recall REF: p. 95 OBJ: 1 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 3. Which of the following best describes the resident skin flora on the hands? a. Microbes that live on the skin all the time b. Microbes that are usually killed or removed by handwashing c. Microbes that are usually involved in the spread of disease from the hands d. Microbes that are highly pathogenic ANS: A

Microbes that live on the skin all the time describes the resident flora which consists of microorganisms that colonize the skin and become permanent residents. Microbes that are usually killed or removed by handwashing describes the transient flora. Microbes that are usually involved in the spread of disease from the hands describes the transient flora.

Microbes that are highly pathogenic describes the transient flora.

PTS: 1 DIF: Recall REF: p. 95 OBJ: 1 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 4. Before surgery when rinsing your hands after washing, your hands should be a. kept down, with the water dripping off the fingers. b. kept level so the water will not drip. c. kept up with the water dripping off the elbow. d. placed in water as hot as you can stand.

ANS: C

Keeping your hands down, with the water dripping off the fingers may recontaminate the hand with any microbes from the forearms. Hands kept level will be eventually lowered, and may be recontaminated with microbes from the forearms. Hands should be kept up with water dripping off the elbows so that water from the unwashed forearms will not recontaminate the hands. Placing your hands in water as hot as you can stand should not be done for it may help bacteria penetrate into the layers of the skin.

PTS: 1 DIF: Recall REF: p. 98 OBJ: 3 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 5. What is the antimicrobial agent in hand-rubs used without rinsing? a. Sodium hypochlorite b. Hydrogen peroxide c. Alcohol d. Glutaraldehyde ANS: C

Sodium hypochlorite is an active ingredient in bleach and some intermediate-level disinfectants. Hydrogen peroxide is never placed in hand rubs for it is too toxic. Alcohol is a common antimicrobial agent found in hand-rub products. Glutaraldehyde is never placed in hand-rubs for it is too toxic and is an example of a liquid chemical sterilant/high-level disinfectant.

PTS: 1 DIF: Recall REF: p. 96 OBJ: 2 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 6. When should hand-rubs be used? a. To kill microbes when no visible soil is present b. To kill microbes when visible soil is present c. In the presence or absence of visible soil d. Anytime ANS: A

When the hands contain no visible soil hand-rubs can be used without water and without rinsing. The presence of heavy soil can inactivate the alcohol in hand-rubs; therefore, they should only be used when there is no visible soil present.

PTS: 1 DIF: Recall REF: p. 96 OBJ: 3 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 7. Why is it important to wash the hands before gloving? a. The residual moisture from handwashing makes the gloves easier to put on. b. The small amount of soap left on the hands after handwashing prevents any

allergic reaction to the gloves. c. Dirty hands will increase the chances that the gloves will tear during use. d. This reduces the number of microbes on the skin so there will be fewer to multiply

beneath the gloves and irritate the skin.

ANS: D

The residual moisture from handwashing can actually make the gloves more difficult to put on. Small amounts of soap will not prevent allergic reactions. The allergens are in the gloves and glove powder not on the skin. Dirty hands will not make the gloves more susceptible to tearing. Microbes can multiply 4000-fold per hour beneath gloves.

PTS: 1 DIF: Recall REF: p. 97 OBJ: 3 TOP: CDA, Infection Control, I.C. and I.D. Standard precautions and the prevention of disease transmission 8. When alcohol-based hand rubs are used throughout the day, which of the following should

be done? a. Periodically wash the gloves to remove the residual alcohol. b. Perform a surgical scrub using antimicrobial soap at the end of the day because alcohol hand rubs are not very effective. c. Wash and rinse the hands after every four to five hand rubs to remove the build-up of glove powder, sweat, and glove chemicals from the hands. d. For every other hand rub put the gloves on first and then use the alcohol hand rub.

ANS: C

Patient care gloves are never to be washed. Alcohol hand rubs are just as effective or more effective than handwashing in killing microbes on the hands. Materials left on the hands can cause irritations or enhance allergic reactions. Using alcohol hand rub after gloving may adversely affect the integrity of the gloves or make them more susceptible to tearing.

PTS: 1 DIF: Application REF: p. 97 OBJ: 3 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 9. Which hand hygiene agent has the greatest antimicrobial activity? a. Alcohol b. Triclosan c. Quaternary ammonium compounds d. Iodophors ANS: A

Alcohol has the highest activity against gram-negative bacteria, gram-positive bacteria, mycobacteria, fungi, and viruses. Triclosan has lower activity against gram-negative bacteria and no activity against fungi and viruses. Quaternary ammonium compounds have lower activity against gram-positive bacteria, gram-negative bacteria and viruses and no activity against fungi and mycobacteria. Iodophors have lower activity against mycobacteria, fungi, and viruses.

PTS: 1 DIF: Recall REF: p. 96 OBJ: 2 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 10. Which of the following is the correct hand hygiene procedure for using an alcohol hand

rub before surgery? a. Use alcohol hand rub; rinse; dry. b. Wash with a nonantibacterial soap; rinse; dry; use alcohol hand rub. c. Use alcohol hand rub; wash with nonantibacterial soap, rinse, dry. d. Wash with nonantibacterial soap; use alcohol hand rub; dry.

ANS: B

You must remove soil from hands before using an alcohol hand rub because the soil can interfere with the alcohol activity. This is the correct procedure. You need to wash hands before using an alcohol hand rub because the soil can interfere with the alcohol activity.

You need to rinse after the hand wash and before using an alcohol hand rub for the residual dirty water on the hands interfered with the alcohol activity.

PTS: 1 DIF: Recall REF: p. 98 OBJ: 3 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 11. Which of the following is appropriate for hand hygiene and gloving? a. One should keep nails short to allow for thorough cleaning and to prevent glove

tears. b. Wearing artificial nails are fine as long as they are kept short. c. Arm jewelry is fine during surgical procedures as long as it is simple in design and

the arms are thoroughly washed. d. Finger rings are fine during surgical procedures as long as the ring do not tear

gloves.

ANS: A

Keeping nails short allows for thorough cleaning and prevents glove tears. One should not wear artificial nails because they can harbor microbes. One should not wear hand or arm jewelry during surgical procedures.

PTS: 1 DIF: Recall REF: p. 100 OBJ: 1 TOP: CDA, Infection Control, I.C. and I.D. Standard precautions and the prevention of disease transmission 12. Which of the following procedures provides the least cross-contamination during

handwashing? a. Using electric eye soap dispensers b. Using bar soaps

c. Using squeeze bottle soap dispensers d. Using pump soap dispensers ANS: A

Using an electric eye soap dispenser is a hands-free procedure and prevents cross-contamination. Using bar soaps, squeeze bottle soap dispensers, and pump soap dispensers promote cross-contamination because more than one person touches the bar, bottle, or pump.

PTS: 1 DIF: Recall REF: p. 97 OBJ: 4 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 13. What microbe is resistant to alcohols? a. Hepatitis B virus b. Adenovirus c. Salmonella choleraesuis d. Staphylococcus aureus ANS: B

Salmonella choleraesuis, Staphylococcus aureus, and hepatitis B are killed by alcohol.

Adenovirus as well as Clostridium difficile, and rhinoviruses are resistant to alcohol.

PTS: 1 DIF: Recall REF: p. 97 OBJ: 2 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 14. Choose the proper nonsurgical hand hygiene procedure when the hands are contaminated

with blood or saliva. a. Alcohol hand-rub b. Alcohol hand-rub, rinsing, and drying c. Hand washing with soap, and drying d. Hand washing with soap, rinsing, and drying ANS: D

Alcohol hand-rub is not to be used on soiled hands. Also, one never rinses after an alcohol hand-rub. Hand washing with soap, rinsing, and drying removes the soil and microbes.

PTS: 1 DIF: Application REF: p. 98 OBJ: 3 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 15. What antimicrobial agent acts the fastest? a. Alcohol b. Iodophor c. Phenolics d. Quaternary ammonium compounds ANS: A

Iodophors and phenolics are intermediate in their speed of action, quaternary ammonium compounds are even slower.

PTS: 1 DIF: Recall REF: p. 96 OBJ: 2 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 16. What would be least important to provide in a dental office waiting room to comply with

CDC recommendations for respiratory hygiene/cough etiquette? a. Tissues and no-touch receptacles for disposal of tissues. b. Provide resources for performing hand hygiene in or near the waiting area. c. Surface disinfectant and towels for drying surfaces d. Provide space and encourage persons with symptoms of respiratory infections to sit as far away from others as possible.

ANS: C

Tissues are important to provide to help cover coughs. It is important to provide resources for hand hygiene to remove cough microbes from the hands. Surface disinfection would offer the least protection against the spread of respiratory droplets. Separating the ill from others is a standard approach to interfering with disease spread.

PTS: 1 DIF: Application REF: p. 98 OBJ: 3 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission | CDA, Infection Control, IV.A. Occupational safety/administrative protocols TRUE/FALSE 1. A surgical hand scrub will sterilize the hands.

ANS: F

Surgical scrubbing will remove/kill the transient flora but not all of the resident flora.

That’s why surgeons still have to wear gloves after a surgical scrubbing.

PTS: 1 DIF: Recall REF: p. 95 OBJ: 1 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 2. Hands should be washed before gloving and after removing gloves.

ANS: T

Wash before gloving to reduce the number of skin microbes so there will be fewer to multiply beneath the gloves and irritate the skin. Wash after removing gloves to remove microbes, sweat and glove material and any patient materials that might have leaked through unnoticed defects in the gloves.

PTS: 1 DIF: Recall REF: p. 97 OBJ: 3 TOP: CDA, Infection Control, I.C. and I.D. Standard precautions and the prevention of disease transmission 3. Handwashing for routine (nonsurgical) procedures can be performed with antimicrobial or

nonantimicrobial soap.

ANS: T

In handwashing for routine dental procedures the physical removal of microbes through vigorous lathering is more important than the nature of the soap being used.

PTS: 1 DIF: Recall REF: p. 98 OBJ: 4 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission

Chapter 12: Personal Protective Barriers Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. Heavy latex utility gloves are used a. during an oral examination. b. to clean the unit after dental treatment. c. to set up the clean unit. d. as an overglove.

ANS: B

Regular exam gloves are used during an oral examination. Heavy latex utility gloves are used when preparing and using chemicals, precleaning and disinfecting contaminated surfaces/equipment, and handling contaminated items during instrument processing.

Gloves are not required when setting up a clean unit. Heavy gloves are too cumbersome to be used as overgloves.

PTS: 1 DIF: Recall REF: p. 104 OBJ: 1 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 2. When leaving a patient to retrieve supplies, which barrier(s) should be removed and

replaced when you return to the patient? a. Mask b. Protective clothing c. Gloves d. Protective eyewear ANS: C

Masks, protective clothing, and protective eyewear do not need to be removed since they usually do not come into contact other surfaces. Gloves should be removed when the dental professional leaves chairside during patient care to prevent contamination of environmental surfaces touched. This also protects the patient from being contaminated with environmental microbes on the gloves. A fresh pair should be used upon returning to the chairside.

PTS: 1 DIF: Application REF: p. 103 OBJ: 1 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 3. Which reaction to gloves is like the reaction to poison ivy? a. Irritant contact dermatitis b. Allergic contact dermatitis c. Latex allergy d. Anaphylaxis ANS: B

Irritant contact dermatitis is a chemical irritation rather than an allergic reaction like the reaction to poison ivy. Allergic contact dermatitis is a type IV hypersensitivity (as is poison ivy) which is characterized by itching, redness, and vesicles with 24 to 48 hours, followed by dry skin, fissures, and sores. Latex allergy and anaphylaxis are antibody-mediated allergies, and the poison ivy reaction is a cell-mediated allergic response.

PTS: 1 DIF: Recall REF: p. 105 OBJ: 1 TOP: CDA, Infection Control, I.B. Standard precautions and the prevention of disease transmission 4. Which of the following glove types can be washed and reused? a. Latex exam gloves b. Sterile surgeon’s gloves c. Vinyl exam gloves d. Heavy utility gloves ANS: D

Latex exam gloves, sterile surgeon’s gloves, and vinyl exam gloves are never used on patients so it’s OK to wash them for reuse. Heavy utility gloves should never be shared with other office personnel.

PTS: 1 DIF: Recall REF: p. 104 OBJ: 1 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 5. According to the Bloodborne Pathogens Standard, protective eyewear must have a. tinted lenses. b. an elastic head band to hold them on tightly. c. solid side shields. d. nonscratch lenses.

ANS: C

Tinted lenses, elastic head bands, and nonscratch lenses are not required by the standard.

The standard requires solid side shields to give the eyes better protection from spatter droplets.

PTS: 1 DIF: Recall REF: p. 110 OBJ: 2 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission | CDA, Infection Control, V.A. Occupational safety/administrative protocols 6. When putting on your protective equipment, which barrier should be put on last just before

patient care begins? a. Mask b. Protective eyewear c. Protective clothing d. Gloves ANS: D

When putting on protective barriers, protective clothing is put on first, protective eyewear is put on second, and masks are put on third. Gloves should be on last as hands will have direct contact with the patient, and you want to transfer as few microbes to the patient as possible.

PTS: 1 DIF: Recall REF: p. 112 OBJ: 3 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 7. What is the most common form of skin reaction to gloves? a. Irritant contact dermatitis b. Allergic contact dermatitis c. Latex allergy d. Anaphylaxis ANS: A

Irritant contact dermatitis is the most common reaction to wearing gloves. Allergic contact dermatitis is the second most common form of skin reaction to gloves, after irritant contact dermatitis. Latex allergy is a rarer reaction to wearing latex gloves than either irritant contact dermatitis or allergic contact dermatitis. Anaphylaxis is the least common type of reaction to gloves.

PTS: 1 DIF: Recall REF: p. 105 OBJ: 1 TOP: CDA, Infection Control, I.B. Standard precautions and the prevention of disease transmission 8. Protective clothing should be changed over the lunch hour because it is not to be worn

outside the building or into a lunchroom. What other time is it to be changed? a. After every patient b. After every three patients c. When it is visibly soiled d. Only after a high-speed handpiece is used on a patient ANS: C

According to OSHA’s Bloodborne Pathogens Standard, protective clothing should be changed whenever it becomes visibly soiled. It is not necessary to change protective clothing after every patient or every three patients unless it is visibly soiled. High-speed handpiece use is not the only procedure that may cause visible soiling.

PTS: 1 DIF: Recall REF: p. 111 OBJ: 2 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 9. Which of the following protective barriers are to be worn when processing contaminated

instruments? a. Gloves b. Gloves and mask c. Gloves, mask, and protective clothing d. Gloves, mask, protective clothing, and protective eyewear ANS: D

Gloves, mask, protective clothing, and protective eyewear will protect the hands, respiratory tract, clothes/skin, and the eyes.

PTS: 1 DIF: Recall REF: p. 104 | p. 108 | p. 110-111 OBJ: 1 | 2 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 10. Wearing gloves when working at chairside protects a. the dental team members. b. the patient. c. the dental team members and the patient. d. neither the dental team members nor the patient.

ANS: C

The gloves protect the patient from microbes that may be present on team members’ hands and protects the dental team members from the patient’s microbes.

PTS: 1 DIF: Recall REF: p. 102 OBJ: 1 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 11. What role did glove powder play in glove latex allergies? a. It prevented latex allergens from coming out of the gloves. b. It served as a barrier between the latex allergens in the gloves and the skin. c. It inactivated latex allergens. d. It spread latex allergens around the office.

ANS: D

Glove powder served as a route of escape of the allergens from the gloves. It was not a barrier. It did not inactivate the allergens. The powder can adsorb protein allergens from the gloves and then become airborne spreading the allergens throughout the office.

Powdered gloves were banned by the FDA in 2017.

PTS: 1 DIF: Recall REF: p. 106 OBJ: 1 TOP: CDA, Infection Control, I.B. Standard precautions and the prevention of disease transmission 12. Which of the following can be done with a patient who is allergic to latex? a. The staff can handle items that will contact the patient with latex gloves, but

cannot directly contact the patients while wearing latex gloves. b. It’s OK to enter the treatment room while wearing latex gloves, but do not directly contact the patients while wearing latex gloves. c. Schedule the patient as the last appointment of the day. d. No one who has worn latex gloves the day of the allergic patient’s appointment should enter the treatment room.

ANS: D

All items to be used on the patients should be handled with nonlatex gloves. No one wearing latex gloves should enter the treatment room. The patients should be scheduled at the beginning of the day. No one who has worn latex gloves the day of the allergic patient’s appointment should enter the treatment room because entering the room with latex gloves may contaminate the room air or its contents with latex allergens.

PTS: 1 DIF: Application REF: p. 106 OBJ: 1 TOP: CDA, Infection Control, I.B. Standard precautions and the prevention of disease transmission 13. Which of the following is proper handling of reusable protective clothing? a. It can be taken home and laundered by the employee. b. It needs to be removed before leaving the office for lunch. c. It can be worn in the office’s lunchroom as long as it does not come into direct

contact with food or utensils. d. It can be worn in the office’s restrooms as long as it does not come into direct

contact with the handwashing sink, faucets, or towel dispenser.

ANS: B

Reusable protective clothing is not to be worn in the lunchroom or the restroom, and cannot be taken home for laundering by the employee for then it is out of the control of the employer who OSHA states is responsible for laundering. It is to be removed before leaving the office for lunch because it could spread contamination to others or to the environment.

PTS: 1 DIF: Recall REF: p. 112 OBJ: 3 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 14. What’s the most important reason to have a mask that fits well? a. Because a loose-fitting mask can irritate the skin around the mouth and nose. b. Because this minimizes the passage of unfiltered air around the edges of the mask. c. Because it will make talking easier. d. Because it will be less frightening to young children.

ANS: B

It is rare for loose-fitting masks to irritate the skin around the mouth and nose. Because surgical masks do not provide a perfect seal around the edges, unfiltered exhaled and inhaled air can pass through these sites. Thus, selection of a mask that fits the face well is important to minimize passage of unfiltered air. A well-fitting mask may help make talking easier but this is not the most important reason. Some children will be frightened no matter what.

PTS: 1 DIF: Recall REF: p. 107-108 OBJ: 2 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 15. What was the common breach of infection control procedures reported among the 10

dentists who were shown to have spread hepatitis B to one or more of their patients? a. None of them wore masks routinely at chairside. b. None of them sterilized their instruments.

c. None of them spore-tested their sterilizers. d. None of them wore gloves routinely for patient care.

ANS: D

It was reported that none of them wore gloves routinely for patient care. No other common breach of infection control was noted.

PTS: 1 DIF: Recall REF: p. 103 OBJ: 1 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 16. According to OSHA’s Bloodborne Pathogens Standard, the employer is responsible for

providing, maintaining, cleaning/laundering, disposing of and ensuring the use of a. gloves. b. masks. c. protective eyewear. d. personal protective equipment.

ANS: D

Employers are responsible for personal protective equipment, which includes gloves, masks, protective eyewear, and protective clothing.

PTS: 1 DIF: Recall REF: p. 102 OBJ: 1 | 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols | CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 17. The 2017 FDA banning of powder-free latex gloves helped a. to limit the spread of airborne latex protein allergens. b. to prevent all three types of skin reactions to gloves. c. to eliminate the need for hand hygiene after removing the gloves. d. to allow the use of alcohol hand rubs while wearing gloves.

ANS: A

Glove powder can adsorb allergens from latex gloves, and when the powder becomes airborne so does the allergens. Chemicals other than latex allergens can cause gloves reactions. Hand hygiene is still a must after glove removal. One never used alcohol hand rubs on gloved hands.

PTS: 1 DIF: Comprehension REF: p. 106 OBJ: 1 TOP: CDA, Infection Control, I.B. Standard precautions and the prevention of disease transmission 18. Why did the FDA recommend that glove manufacturers do not use the phrase “latex free”

on their packaging or advertising? a. It saves the manufacturer some expense. b. It’s not possible to ensure that a product is completely free of latex. c. The FDA does not want to have to test for the presence of latex in gloves. d. The FDA wants to make it easier for manufacturers to achieve clearance to sell their gloves in the US. ANS: B

The cost savings would be very small if not zero. The phrase “latex free” can be misleading for it’s not possible to ensure that a product is completely free of latex. The FDA does not routinely test for the presence of latex. The FDA would not relax its rules and jeopardize clearing a defective product.

PTS: 1 DIF: Recall REF: p. 103 OBJ: 1 TOP: CDA, Infection Control, I.B. Standard precautions and the prevention of disease transmission 19. What is the least important property when selecting a facemask for use in the dental

office? a. Overall weight of the mask b. Bacterial filtration efficiency c. Fluid resistance d. Flammability ANS: A

The overall weight of the mask is not a standard ASTM specification for facemask material. Bacterial filtration efficiency, fluid resistance, and flammability are standard ASTM specifications for facemask material.

PTS: 1 DIF: Recall REF: p. 107 OBJ: 3 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 20. ASTM levels 1, 2, and 3 classifications of facemasks refer to what property of the masks? a. Cost of the masks b. Fluid resistance c. Color stability d. Fit ANS: B

ASTM does not classify masks according to cost, fit, or color stability. Masks are classified according to fluid resistance in addition to filtration efficiencies and relate to the amount (level) of fluid and debris to which he mask may be exposed.

PTS: 1 DIF: Comprehension REF: p. 108 OBJ: 2 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 21. When is an ASTM level 3 facemask to be used? a. For no fluid exposure b. For low amounts of fluid exposure c. For moderate amounts of fluid exposure d. For moderate to heavy amounts of fluid exposure ANS: D

The ASTM classification system does not include no fluid exposure. Level 1 facemasks are for low amounts of fluid exposure. Level 2 facemasks are for moderate amounts of fluid exposure. Level 3 facemasks are for moderate to heavy amounts of fluid exposure.

PTS: 1 DIF: Recall REF: p. 107 OBJ: 3 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 22. When is an ASTM level 2 facemask to be used? a. For no fluid exposure b. For low amounts of fluid exposure c. For moderate amounts of fluid exposure d. For moderate to heavy amounts of fluid exposure ANS: C

The ASTM classification system does not include no fluid exposure. Level 1 facemasks are for low amounts of fluid exposure. Level 2 facemasks are for moderate amounts of fluid exposure. Level 3 facemasks are for moderate to heavy amounts of fluid exposure.

PTS: 1 DIF: Recall REF: p. 107 OBJ: 3 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 23. When is an ASTM level 1 facemask to be used? a. For no fluid exposure b. For low amounts of fluid exposure c. For moderate amounts of fluid exposure d. For moderate to heavy amounts of fluid exposure ANS: B

The ASTM classification system does not include no fluid exposure. Level 1 facemasks are for low amounts of fluid exposure. Level 2 facemasks are for moderate amounts of fluid exposure. Level 3 facemasks are for moderate to heavy amounts of fluid exposure.

PTS: 1 DIF: Recall REF: p. 107 OBJ: 3 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 24. The CDC interim guidance of 2020 recommends that in communities with moderate to

substantial transmission of SARS-CoV-2 dental personnel wear __________________ during aerosol-generating procedures. a. at least a N95 filtering facepiece respirator b. a face shield over goggles and one surgical mask c. two surgical masks d. a face shield over two surgical masks ANS: A

Surgical masks when worn by themselves or under a face shield do not protect against small aerosol particles that may enter around the edges of the mask. The respirator forms a better seal around the face.

PTS: 1 DIF: Recall REF: p. 108 OBJ: 2 TOP: CDA, Infection Control, I.D. Describe how to protect the patient and operator by using PPE 25. Why don’t surgical masks provide good protection against inhalation of dental aerosols? a. They are not thick enough.

b. Their particle filtration efficiency is only 50%. c. Because they have no resistance to fluids. d. Air can leak in around the edges.

ANS: D

Surgical masks are sufficiently thick, they have at least a 95% filtration efficiency and they have varying degrees of fluid resistance. However, they do not fit well and air can leak around the edges. The respirator forms a better seal around the face.

PTS: 1 DIF: Comprehension REF: p. 108 OBJ: 2 TOP: CDA, Infection Control, I.D. Describe how to protect the patient and operator by using PPE 26. What PPE was banned for sale in the U.S. by the FDA in 2017? a. Surgical masks with elastic ties b. Powdered exam and surgeon’s gloves c. Face shields with attached masks d. Protective eyewear with side shields ANS: D

Surgical masks with elastic ties, face shields with attached masks, and protective eyewear with side shields were not banned by the FDA and are still available.

PTS: 1 DIF: Comprehension REF: p. 107 OBJ: 1 TOP: CDA, Infection Control, I.D. Describe how to protect the patient and operator by using PPE TRUE/FALSE 1. Exam gloves offer little protection against injuries with sharp objects such as instruments,

needles, and scalpel blades.

ANS: T

Gloves offer only a small resistance to sharps injuries.

PTS: 1 DIF: Recall REF: p. 104 OBJ: 1 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 2. Since protective clothing is to protect the skin and underlying clothing, items worn at

chairside should be long sleeved.

ANS: T

Since droplets of a patient’s oral fluids may exit the mouth during treatment, the skin of the forearms needs to be covered with protected clothing.

PTS: 1 DIF: Recall REF: p. 112 OBJ: 2 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 3. One should wear a mask beneath a face shield to reduce contact with fluid aerosols and

dust particles.

ANS: T

The face shield will protect against contact with the larger spatter droplets but not with the smaller airborne aerosol particles.

PTS: 1 DIF: Recall REF: p. 111 OBJ: 2 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 4. It’s acceptable to share with other staff members the heavy utility gloves used for cleaning

and disinfecting the operatory and for instrument processing, as long as the outside is washed.

ANS: F

These gloves should not be shared because the inside can become contaminated.

PTS: 1 DIF: Recall REF: p. 104 OBJ: 1 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 5. In dentistry face masks mainly protect the mucous membranes of the nose and mouth from

contamination with spatter droplets from patients’ mouths.

ANS: T

The important protection offered by masks is against droplet infection. A much lesser degree of protection to the dental team occurs against inhalation of aerosolized particles of oral fluids that may contain infectious disease agents.

PTS: 1 DIF: Recall REF: p. 107 OBJ: 2 TOP: CDA, Infection Control, I.D. and I.E. Standard precautions and the prevention of disease transmission

Chapter 13: Instrument Processing Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. Why should handpieces be heat sterilized rather than just wiped off with a disinfectant

between patients? a. Because wiping off the outside will cause the handpiece to rust. b. Because wiping off the outside will not kill the microbes that were retracted up inside the handpiece. c. Because wiping off the outside could allow some of the damaging disinfectant to get inside the handpiece and destroy it. d. Because heat sterilization will help the internal lubricant spread to all surfaces in the turbine chamber.

ANS: B

Wiping off the handpiece will not rust the handpiece. Since patient material may enter the internal portions of handpieces during use, decontamination procedures must address both the outside and the inside of handpieces pieces and other intraoral devices. While wiping off the outside could allow some of the damaging disinfectant to get inside the handpiece and destroy it, this is not the main reason to heat sterilize. Heat sterilization may help spread the lubricant, but this is not the main reason to heat sterilize.

PTS: 1 OBJ: 8

DIF: Comprehension REF: p. 140 TOP: CDA, Infection Control, III.A. Instrument/device processing

2. When designing a sterilization facility and purchasing a new sterilizer, one should look for

clearance of the desired sterilizer by what Federal agency? a. EPA b. OSHA c. CDC d. FDA ANS: D

In the area of infection control the EPA regulates disinfectants and drinking water. OSHA that regulates worker safety. The CDC makes infection control recommendations and investigates disease outbreaks. The FDA regulates the manufacturing and labeling of medical devices including the safety and effectiveness of sterilizers.

PTS: 1 DIF: Recall REF: p. 125 OBJ: 3 TOP: CDA, Infection Control, III.A. Instrument/device processing 3. How should instrument packages/cassettes be placed into the sterilizer chamber? a. On their edges or in a single layer b. Layered flat and stacked upon one another c. Packed tight to reduce any air space between the packages or cassettes d. One cassette or package at a time regardless of its size ANS: A

Placing instrument packages/cassettes on their edges allow space around each package for the sterilizing agent to contact the package. Cassettes or packages should not be layered flat and stacked as this impedes circulation of the sterilizing agent and impedes air removal in a steam sterilizer. Tight packaging will impede circulation of the sterilizing agent. Sterilizers should be loaded with the appropriate number of cassettes or packages as indicated by the manufacturer.

PTS: 1 DIF: Recall REF: p. 127 OBJ: 3 TOP: CDA, Infection Control, III.A. Instrument/device processing 4. What should be done to the instruments at the end of a steam sterilization cycle? a. Immediately place the packages/cassettes on a countertop for cooling and drying in

the room air. b. Unwrap the instruments and cool them down by dipping in cold sterile water. c. Remove the instruments from the packaging material and ultrasonically clean

them. d. Let the instrument packages dry inside the sterilizer before handling them.

ANS: D

Placing the packages/cassettes on a countertop can result in wicking, the process that allows microbes to penetrate wet sterilization paper. Unwrapping the instruments will compromise the sterility of the instruments. Removing the instruments from the packaging will compromise sterility, plus ultrasonic cleaning should be done before sterilization.

Drying of the packages in the sterilizer is important to maintain the sterility of the instruments.

PTS: 1 DIF: Recall REF: p. 130 OBJ: 3 TOP: CDA, Infection Control, III.A. Instrument/device processing 5. How would you sterilize a plastic, reusable, rubber dam frame that melts at 100C

(212F)? a. Steam sterilizer b. Liquid chemical sterilant c. Dry heat sterilizer d. Unsaturated chemical vapor sterilizer ANS: B

Steam sterilizers, dry heat sterilizers, and unsaturated chemical vapor sterilizers operate above 100C and would melt the rubber dam frame. Liquid chemical sterilants at room temperature are used on items that are damaged by high heat sterilization.

PTS: 1 DIF: Application REF: p. 141 OBJ: 1 TOP: CDA, Infection Control, III.A. Instrument/device processing 6. What is the first step to be taken after a sterilization failure is detected through spore

testing? a. Review procedure to identify problems. b. Repeat the cycle and observe. c. Determine the fate of the sterilizer. d. Take the sterilizer out of service.

ANS: D

In the event of sterilization failure, the sterilizer should immediately be taken out of service to prevent the further risk of using nonsterile instruments. Afterwards, review the procedure, repeat the cycle, and determine the fate of the sterilizer.

PTS: 1 DIF: Recall REF: p. 134 OBJ: 4 TOP: CDA, Infection Control, III.B. Instrument/device processing 7. What is the main reason for packaging instruments before they are placed in a sterilizer? a. To prevent dirt/dust in the sterilizer from depositing on the instruments b. To protect the instrument from recontamination after sterilization c. To keep the killed microbes inside the packages so they won’t contaminate the

sterilizer chamber d. To prevent rusting of the instruments ANS: B

Dirt/dust is not a major concern. Packaging instruments will keep killed microbes from contaminating the sterilizer, but this is not the main reason for packaging. Packaging will not prevent rusting. Packaging instruments before processing through the sterilizer prevents them from becoming contaminated after sterilization during storage or when distributed chairside.

PTS: 1 DIF: Recall REF: p. 123 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 8. “Autoclave” tape is used for which type of sterilization monitoring? a. Chemical b. Biological c. Mechanical d. Mechanical and biological ANS: A

“Autoclave” tape is a type of chemical indicator that changes color or physical form when exposed to certain temperatures. Biological monitoring involves the use of bacterial spores. Mechanical monitoring involves observing the time, temperature, and pressure.

PTS: 1 DIF: Recall REF: p. 134 OBJ: 4 TOP: CDA, Infection Control, III.B. Instrument/device processing 9. Bacillus atrophaeus spores are used to monitor which of the following sterilizers? a. Dry heat sterilizer b. Unsaturated chemical vapor sterilizer c. Steam sterilizer d. Dry heat sterilizer and steam sterilizer ANS: A

Bacillus atrophaeus is used to test dry heat sterilizers but Geobacillus stearothermophilus is used to test steam sterilizers and unsaturated chemical vapor sterilizers.

PTS: 1 DIF: Recall REF: p. 131 OBJ: 4 TOP: CDA, Infection Control, III.B. Instrument/device processing

10. Which of the following sterilization methods lead to corrosion (e.g., rusting) of carbon

steel instruments? a. Steam b. Dry heat c. Unsaturated chemical vapor d. Dry heat and steam ANS: A

The steam sterilizer provides the water and oxygen required for rusting of the carbon steel.

In the dry heat sterilizer there is no water, which is required for rusting of carbon steel. In the unsaturated chemical vapor sterilizer there is not enough water present to cause rusting the carbon steel.

PTS: 1 DIF: Recall REF: p. 126 OBJ: 3 TOP: CDA, Infection Control, III.A. Instrument/device processing 11. What is the main concern/precaution with using a dry heat oven-type sterilizer? a. There is no biological indicator that can be used to monitor the sterilization

process. b. It has a long sterilization time. c. It causes corrosion of carbon steel instruments. d. It requires the purchase and use of a special chemical sterilizing solution.

ANS: B

There is a biological indicator (Bacillus atrophaeus) for dry heat sterilizers. The precaution for dry heat oven-type sterilizers is the long sterilization time of 60 to 120 minutes, plus sufficient time must be included for the sterilizer to heat to the correct temperature. There is no corrosion because there is no water present. A special chemical solution is needed for the unsaturated chemical vapor sterilizer not the dry heat sterilizer.

PTS: 1 DIF: Recall REF: p. 126 OBJ: 3 TOP: CDA, Infection Control, III.A. Instrument/device processing 12. What is the main concern/precaution with using an unsaturated chemical vapor sterilizer? a. There is no biological indicator that can be used to monitor this sterilization

process. b. It has a long sterilization time. c. It causes corrosion of carbon steel instruments. d. It requires the purchase and use of a special chemical sterilizing solution.

ANS: D

There is a biological indicator (Bacillus stearothermophilus) for this sterilizer. The sterilization time is about the same as that for a steam sterilizer. There is no corrosion because very little water is present in the special sterilizing solution used. The main concern when using an unsaturated chemical vapor sterilizer involves the purchase of a special chemical solution which when heated the vapors kill microorganisms.

PTS: 1 DIF: Recall REF: p. 126 OBJ: 3 TOP: CDA, Infection Control, III.A. Instrument/device processing 13. Spores of Geobacillus stearothermophilus are used in biological indicators to monitor a. dry heat and steam sterilizers.

b. dry heat and unsaturated chemical vapor sterilizers. c. steam and unsaturated chemical vapor sterilizers. d. dry heat, steam, and unsaturated chemical vapor sterilizers.

ANS: C

Bacillus atrophaeus is used with the dry heat sterilizer. Geobacillus stearothermophilus is used for testing steam or chemical vapor sterilizers.

PTS: 1 DIF: Recall REF: p. 131 OBJ: 4 TOP: CDA, Infection Control, III.B. Instrument/device processing 14. Why should ultrasonic cleaners or automatic instrument washers be used instead of routine

hand-scrubbing to clean contaminated dental instruments? a. Ultrasonic cleaning and instrument washers sterilize the instruments. b. Ultrasonic cleaning and instrument washers are less expensive to perform. c. Hand-scrubbing does not get the instruments clean. d. Hand-scrubbing increases the chances of sharps injuries.

ANS: D

It cannot be confirmed that an instrument is sterile after ultrasonic cleaning and instrument washers. Ultrasonic cleaning and use of washers are more expensive than hand-scrubbing.

Hand scrubbing can get instruments clean if performed properly, but it’s too risky.

Ultrasonic cleaning and washers compared with scrubbing instruments by hand, reduce direct handling of contaminated instruments and the chances of sharps injuries.

PTS: 1 DIF: Recall REF: p. 120 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 15. Why is it important to let instruments packaged in paper/plastic pouches, paper bags or

sterilization wrap dry inside the steam sterilizer? a. To complete the killing of microbes that may have survived the sterilization process. b. To minimize tearing of packaging materials when handling the sterilized items and to avoid wicking. c. To prevent water spots from appearing on the instruments. d. To let the chemical indicators fully turn the appropriate color.

ANS: B

The microbes are killed in the sterilization cycle not the dry cycle. Handling of the wet packages can easily tear the paper, causing contamination of the instruments, and exposing the wet packages to the environment can result in wicking, the process that allows bacteria and fungi to penetrate wet sterilization paper. Packaging does not prevent water spots for they can still occur if hard water is used. Chemical indicators turn color long before the dry cycle.

PTS: 1 OBJ: 3

DIF: Comprehension REF: p. 128 TOP: CDA, Infection Control, III.A. Instrument/device processing

16. During instrument processing, what is the reason for sterilizing instruments? a. To remove all visible debris from the instruments. b. To protect the instruments after they are removed from the sterilizer. c. To kill all remaining microbes on the instruments after they have been cleaned.

d. To make the instruments easier to clean.

ANS: C

Removing all visible debris applies to the precleaning which reduces the bioburden that may insulate a microorganism from the sterilizing agent. Protection of instruments after they are removed from the sterilizer applies to packaging which protects instruments from becoming recontaminated after sterilization. Sterilization is the process intended to kill all microorganisms and is the highest level of microbial kill that can be achieved. It occurs after instruments have been cleaned. Precleaning is completed before sterilization occurs.

PTS: 1 DIF: Recall REF: p. 117 OBJ: 1 TOP: CDA, Infection Control, III.A. Instrument/device processing 17. How would you sterilize burs made of carbon steel? a. In a steam autoclave at 121C b. In a steam autoclave at 134C c. In a dry heat sterilizer d. In a bead sterilizer ANS: C

A steam autoclave will cause the burs to rust. Bead sterilizers cannot be confirmed as a sterilization method. Dry heat sterilization is best as carbon steel items do not corrode in dry heat as they would in a steam sterilizer.

PTS: 1 DIF: Application REF: p. 139 OBJ: 8 TOP: CDA, Infection Control, III.A. Instrument/device processing 18. The goal of instrument processing is to a. provide sterile instruments at chairside for use on a subsequent patient. b. sterilize contaminated instruments. c. clean instruments free of visible debris. d. eliminate water spots.

ANS: A

The goal of instrument processing is to prepare contaminated instruments for reuse.

Instrument processing will result in sterilization of contaminated instruments, cleaning of visible debris, and elimination of water spots, though these are not the overall goal of instrument processing.

PTS: 1 DIF: Recall REF: p. 116 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 19. Which of the following statements is true about ultrasonic cleaning of dental instruments? a. Never use a basket when cleaning loose instruments. b. Using dishwashing detergent is best for cleaning dental instruments. c. Used cleaning solution contains live microbes. d. Instrument cassettes cannot be cleaned in an ultrasonic cleaner.

ANS: C

A basket should always be used when cleaning loose instruments to reduce the handling of contaminated instruments and keep instruments together. Dishwashing detergents are too harsh to use on dental instruments. Cleaning solutions that have antimicrobial activity reduce the buildup of microorganisms in the solution as it is used repeatedly. Instrument cassettes can be cleaned using an ultrasonic cleaner.

PTS: 1 DIF: Recall REF: p. 121 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 20. Paper-plastic peel pouches cannot be used in a ________________ sterilizer. a. dry heat b. steam c. steam or unsaturated chemical vapor d. dry heat sterilizer or steam ANS: A

Due to the high temperature used in a dry heat sterilizer, paper-plastic-peel pouches come apart and cannot be used. Paper/plastic peel pouches will not separate when processed through a steam or unsaturated chemical vapor sterilizer.

PTS: 1 DIF: Recall REF: p. 123 OBJ: 3 TOP: CDA, Infection Control, III.A. Instrument/device processing 21. There are two reasons why packages of instruments should be allowed to dry inside the

steam sterilizer before they are handled. One reason is because wet paper can easily tear when handled. The other is because a. of wicking. b. the color of chemical indicators can only be seen on a dry package. c. wet instruments will have more water spots on them. d. the killing of the microbes is not yet complete until after the dry cycle.

ANS: A

Wicking is the process that allows microbes to penetrate wet sterilization paper thus contaminating the instruments inside the pouches. The color of chemical indicators does not affect the unloading of instruments from the steam sterilizer. Additional water spots is not a factor that affects the unloading of instruments from the steam sterilizer. Incomplete killing of microbes is not a factor that affects the unloading of instruments from the steam sterilizer.

PTS: 1 DIF: Recall REF: p. 130 OBJ: 3 TOP: CDA, Infection Control, III.A. Instrument/device processing 22. Which bacterial spore is used to spore test a steam sterilizer and the unsaturated chemical

vapor sterilizer? a. Geobacillus stearothermophilus b. Clostridium tetani c. Bacillus atrophaeus d. Bacillus cereus ANS: A

Geobacillus stearothermophilus is best for spore testing steam or chemical vapor sterilization. Clostridium tetani, Bacillus atrophaeus, and bacillus cereus are spore-formers but do not have the best resistance to these forms of sterilization.

PTS: 1 DIF: Recall REF: p. 131 OBJ: 4 TOP: CDA, Infection Control, III.B. Instrument/device processing 23. The reason for holding (presoaking) instruments prior to cleaning is to a. prevent rusting. b. kill microbes. c. reduce water spotting. d. facilitate cleaning.

ANS: D

This does not prevent rusting. In fact it may promote rusting of non stainless steel instruments if left in the holding solution too long. This does not occur unless a disinfectant is used, but this is not the reason for using a holding solution. This does not prevent water spotting. Holding (presoaking) instruments prior to cleaning facilitates the cleaning process by preventing debris from drying.

PTS: 1 DIF: Recall REF: p. 133 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 24. According to CDC how often is one to perform mechanical monitoring of a sterilizer? a. Once a day b. Once a week c. Once a month d. Every load ANS: D

Mechanical monitoring of a sterilizer should be done with each load. Any less often is not often enough.

PTS: 1 DIF: Recall REF: p. 136 OBJ: 4 TOP: CDA, Infection Control, III.B. Instrument/device processing 25. Which of the following is a problem when using a liquid chemical sterilant on

heat-sensitive instruments? a. These sterilants all require at least 24 of contact time. b. These sterilants destroy all plastic items. c. These sterilants cannot be spore-tested. d. These sterilants are all glutaraldehydes.

ANS: C

Some will act in as little as 3.5 hours. They do not destroy plastic items. There aren’t any biological indicators available to test liquid chemical sterilants like there are for heat sterilizers. Some sterilants are hydrogen peroxide.

PTS: 1 DIF: Application REF: p. 141 OBJ: 3 TOP: CDA, Infection Control, III.A. Instrument/device processing

26. According to CDC how often is one to perform chemical monitoring of the sterilization

process? a. With one package a day b. With one package a week c. With one package a month d. With every package in every load ANS: D

A chemical indicator should be placed inside of every package in every load so that when each package is opened at chairside it is obvious that the package has indeed been processed through a sterilizer.

PTS: 1 DIF: Recall REF: p. 136 OBJ: 4 TOP: CDA, Infection Control, III.B. Instrument/device processing 27. According to CDC how often is one to perform biological monitoring of a sterilizer? a. Once a day b. Once a week c. Once a month d. Every load ANS: B

Biological monitoring of routine sterilizer loads should be done once a week. Once a day is too often to perform biological monitoring of a sterilizer. Once a month is not often enough to perform biological monitoring of a sterilizer. Every load is too often to perform biological monitoring of a sterilizer.

PTS: 1 DIF: Recall REF: p. 136 OBJ: 4 TOP: CDA, Infection Control, III.B. Instrument/device processing 28. Why is it important to dry instruments before dry heat or unsaturated chemical vapor

sterilization? a. To prevent the instruments from getting too hot. b. To keep the instruments from sticking to each other during the sterilization process. c. To maintain the antirusting nature of these two methods of sterilization. d. To make sure the chemical indicators do not get wet.

ANS: C

Residual water remaining on wet instruments could override the rust-free processes. In the dry heat sterilizer there is no water available for rusting, and in the unsaturated chemical vapor sterilizer the water content of the special solution used is too low to promote rusting.

It is not to keep the instruments from getting too hot or from sticking to each other. It is not to make sure the chemical indicators do not get wet.

PTS: 1 DIF: Recall REF: p. 122 OBJ: 3 TOP: CDA, Infection Control, III.A. Instrument/device processing 29. Sterilization is best defined as a. a process designed to kill microbes normally present in the mouth. b. a process intended to kill all microbes. c. a process designed to kill all diseases-producing microns but not necessarily high

level of bacterial spores. d. a process designed to kill microbes normally present on the skin.

ANS: B

Antisepsis is a process designed to kill microbes normally present in the mouth and on the skin. Disinfection is a process intended to kill all microbes which is less lethal then sterilization. Sterilization is a process designed to kill all diseases-producing microns but not necessarily high level of bacterial spores which is the highest level of microbial kill that can be achieved.

PTS: 1 DIF: Recall REF: p. 116 OBJ: 1 TOP: CDA, Infection Control, III.A. Instrument/device processing 30. Disinfection is best defined as a. a process designed to kill microbes normally present in the mouth. b. a process intended to kill all microbes. c. a process designed to kill all diseases-producing microns but not necessarily high

level of bacterial spores. d. a process designed to kill microbes normally present on the skin.

ANS: C

Antisepsis is a process designed to kill microbes normally present in the mouth and on the skin. Disinfection is a process intended to kill all microbes which is less lethal then sterilization. Sterilization is a process designed to kill all diseases-producing microns but not necessarily high level of bacterial spores which is the highest level of microbial kill that can be achieved.

PTS: 1 DIF: Recall REF: p. 117 OBJ: 1 TOP: CDA, Infection Control, III.A. Instrument/device processing 31. What is sterility assurance? a. Using liquid sterilants on critical instruments with a submersion time of 20 hours. b. The correct performance of the proper instrument processing steps and monitoring

of the sterilization step. c. Using two complete sterilizing cycles on instruments used on infectious patients. d. Managing the office infection control program so that no sharps injuries occur.

ANS: B

Critical instruments are not to be processed in liquid chemical sterilants because the effectiveness of these chemicals cannot be confirmed as they are being used. The correct performance of the proper instrument processing steps and monitoring of the sterilization step helps assure that instruments are indeed sterile when used on patients. Using two complete sterilizing cycles on instruments used on infectious patients, as well as maintaining the office infection control program so that no sharps injuries occur, is important, but is not sterility assurance.

PTS: 1 DIF: Recall REF: p. 118 OBJ: 1 TOP: CDA, Infection Control, III.A. Instrument/device processing 32. Choose an advantage of using instrument cassettes? a. It permits the instruments inside to be just rinsed with hot water rather than being

ultrasonically cleaned or processed through an instrument washer.

b. It reduces the sterilization time in half. c. They do not have to be wrapped before sterilization. d. It reduces the risks of sharps injuries by reducing the direct handling of the

instruments.

ANS: D

All contaminated instruments must be thoroughly cleaned before sterilization. Using cassettes will not reduce sterilization time. All instruments including instrument cassettes need to be wrapped (packaged) before sterilization. Cassettes have perforations which must be covered to maintain sterility after processing through the sterilizer. Instrument cassettes contain functional sets of instruments during use at chairside and during the precleaning, rinsing, and sterilizing processes.

PTS: 1 DIF: Application REF: p. 124 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 33. What is the main reason why cloth (e.g., terry cloth towels, denim) is not be used as a

sterilization wrap? a. It is too expensive. b. It is not a good microbe barrier. c. It is too difficult to store. d. It is too difficult to launder.

ANS: B

It is likely less expensive than sterilization wraps, but it still should not be use as sterilization wrap. The weave in cloth leaves openings for microbes to penetrate and contaminate the instruments inside. Sterilization wraps need to maintain sterility of the instruments inside during storage. It is not too difficult to store, but it still should not be use as sterilization wrap. It is fairly easy to launder, but it still should not be use as sterilization wrap.

PTS: 1 DIF: Application REF: p. 123 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 34. A system of storage of sterilized instrument packages that recognizes a package’s contents

should remain sterile until some event causes items inside to become contaminated is correctly referred to as a. event-horizon storage. b. event-occurrence storage. c. event-related storage. d. event-entitled storage.

ANS: C

If FDA-cleared sterilization packaging material is used, sterility should be maintained until some event causes a breach in the integrity of the packaging material such as becoming wet, drying out and cracking, tearing from compression, or excess handling. Event-horizon storage, event-occurrence storage, and event-related storage are incorrect terms.

PTS: 1 DIF: Application REF: p. 137 OBJ: 5 TOP: CDA, Infection Control, III.A. Instrument/device processing 35. According to the CDC critical instruments are those that

a. penetrate soft tissue, contacts, bone, enters into or contacts the bloodstream or

other normally sterile tissue. b. contact mucous membranes but will not penetrate soft tissue, contact bone, enter

into or contact the bloodstream or other normally sterile tissue. c. contact the skin. d. are very expensive and in short supply.

ANS: A

Instruments that penetrate soft tissue, contact bone, enters into or contacts the bloodstream or other normally sterile tissue are critical instruments that have the greatest chance of spreading disease because of the sites they contact during use. Critical instruments should be cleaned and sterilized by heat. Instruments that contact mucous membranes but will not penetrate soft tissue, contact bone, enter into or contact the bloodstream or other normally sterile tissue are semicritical instruments that don’t have as great a chance of spreading disease when they are used as do critical instruments. Instruments that contact the skin are called noncritical instruments. The CDC does not define instruments that are very expensive and in short supply.

PTS: 1 DIF: Recall REF: p. 118 OBJ: 1 TOP: CDA, Infection Control, III.A. Instrument/device processing 36. According to the CDC semicritical instruments are those that a. penetrate soft tissue, contact bone, enters into or contacts the bloodstream or other

normally sterile tissue. b. contact mucous membranes but will not penetrate soft tissue, contact bone, enter

into or contact the bloodstream or other normally sterile tissue. c. contact the skin. d. are very expensive and in short supply.

ANS: B

Instruments that penetrate soft tissue, contact bone, enters into or contacts the bloodstream or other normally sterile tissue are critical instruments that have the greatest chance of spreading disease because of the sites they contact during use. Instruments that contact mucous membranes but will not penetrate soft tissue, contact bone, enter into or contact the bloodstream or other normally sterile tissue are semicritical instruments that don’t have as great a chance of spreading disease when they are used as do critical instruments.

Instruments that contact the skin are called noncritical instruments. The CDC does not define instruments that are very expensive and in short supply.

PTS: 1 DIF: Recall REF: p. 118 OBJ: 1 TOP: CDA, Infection Control, III.A. Instrument/device processing 37. According to the CDC how should critical instruments be prepared for use? a. Thoroughly wiped down with alcohol. b. Processed with high-level disinfection. c. Sterilized in an ultrasonic cleaner. d. Heat sterilized.

ANS: D

Alcohol wipe-down should not be used as a final preparation for any instrument.

Processing with high-level disinfection is insufficient for critical instruments. Ultrasonic cleaners are to be used for cleaning instruments not for killing microbes. Critical instruments need to be prepared using the system that gives the highest level of microbial kill which is heat sterilization.

PTS: 1 DIF: Recall REF: p. 118 OBJ: 1 TOP: CDA, Infection Control, III.A. Instrument/device processing 38. According to the CDC how should non-heat sensitive semicritical instruments be prepared

for use? a. Thoroughly wiped down with alcohol. b. Processed with high-level disinfection. c. Sterilized in an ultrasonic cleaner. d. Heat sterilized.

ANS: D

Alcohol wipe-down should not be used as a final preparation for any instrument.

Processing with high-level disinfection is insufficient for non-heat sensitive semicritical instruments. Ultrasonic cleaners are to be used for cleaning instruments not for killing microbes. Non heat sensitive semicritical instruments need to be prepared using the system that gives the highest level of microbial kill which is heat sterilization.

PTS: 1 DIF: Recall REF: p. 118 OBJ: 3 TOP: CDA, Infection Control, III.A. Instrument/device processing 39. According to the CDC how heat sensitive semicritical instruments be prepared for use? a. Thoroughly wiped down with alcohol. b. Processed with high-level disinfection. c. Sterilized in an ultrasonic cleaner. d. Heat sterilized.

ANS: B

Alcohol wipe-down should not be used as a final preparation for any instrument.

Processing with high-level disinfection is appropriate for heat sensitive semicritical instruments. Ultrasonic cleaners are to be used for cleaning instruments not for killing microbes. Heat sterilization will destroy heat sensitive instruments.

PTS: 1 DIF: Recall REF: p. 117 OBJ: 3 TOP: CDA, Infection Control, III.A. Instrument/device processing 40. According to the CDC how should noncritical instruments be prepared for use? a. Thoroughly cleaned. b. Processed with high-level disinfection. c. Processed with intermediate-level or low-level disinfection. d. Heat sterilized.

ANS: B

Thorough cleaning is not sufficient. Processing with high-level disinfection will work, but is not the CDC recommendation. Heat sterilization will destroy many noncritical items. If there is no blood present, then low-level disinfection is sufficient. If there is blood present, then intermediate-level disinfection is necessary.

PTS: 1 DIF: Recall REF: p. 117 OBJ: 3 TOP: CDA, Infection Control, III.A. Instrument/device processing 41. What is the correct sequence of the instrument processing steps? a. Precleaning, holding, sterilization, corrosion control, packaging, monitoring,

handling b. Holding, precleaning, corrosion control, packaging, sterilization, monitoring,

handling c. Corrosion control, precleaning, packaging, holding, sterilization, monitoring,

handling d. Precleaning, corrosion control, holding, sterilization, packaging, handling,

monitoring ANS: B

The correct sequence is holding, precleaning, corrosion control, packaging, sterilization, monitoring, handling.

PTS: 1 DIF: Recall REF: p. 117 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 42. What are the three main areas in a sterilizing facility? a. Holding, rust control, sterilization and storage b. Decontamination, monitoring, storage c. Waste disposal, sterilization and storage, monitoring d. Decontamination, packaging, sterilization and storage ANS: D

Holding, rust control, sterilization and storage provide inadequate packaging.

Decontamination, monitoring, and storage provide no packaging or sterilization. Waste disposal, sterilization and storage, and monitoring provide incomplete decontamination.

Decontamination consists of holding, waste disposal, cleaning, rust control; packaging consists of adding sterilization indicators and packaging the clean instruments; sterilization and storage consists of sterilization, storage, recordkeeping.

PTS: 1 DIF: Recall REF: p. 120 OBJ: 6 TOP: CDA, Infection Control, III.A. Instrument/device processing 43. What’s the rationale for the precleaning step as part of instrument processing? a. To remove as much of the bioburden as possible to give the sterilization step the

best chance to work. b. To help ensure the proper functioning of the instruments after instrument processing. c. To help maintain sterility of the instruments after instrument processing. d. To facilitate the cleaning process by keeping the debris on the instruments from drying.

ANS: A

Bioburden can interfere with the sterilization process, so precleaning is necessary to help assure sterilization. Packaging before sterilization keeps the instruments protected from recontamination after sterilization during storage and before they are opened at chairside.

Holding facilitates the cleaning step, and is most important if the contaminated instruments will stand for over 30 minutes before be cleaned. Ensuring proper functioning of the instruments after processing is the rationale for corrosion control, drying, and lubrication.

PTS: 1 DIF: Recall REF: p. 119 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 44. What’s the rationale for the packaging step as part of instrument processing? a. To remove as much of the bioburden as possible to give the sterilization step the

best chance to work. b. To help ensure the proper functioning of the instruments after instrument

processing. c. To help maintain sterility of the instruments after instrument processing. d. To facilitate the cleaning process by keeping the debris on the instruments from drying.

ANS: C

Packaging before sterilization keeps the instruments protected from recontamination after sterilization during storage and before they are opened at chairside. Holding facilitates the cleaning step, and is most important if the contaminated instruments will stand for over 30 minutes before be cleaned. Removing bioburden is the rationale for precleaning. Ensuring proper functioning of the instruments after processing is the rationale for corrosion control, drying, and lubrication.

PTS: 1 DIF: Recall REF: p. 119 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 45. What’s the rationale for the holding step as part of instrument processing? a. To remove as much of the bioburden as possible to give the sterilization step the

best chance to work. b. To help ensure the proper functioning of the instruments after instrument

processing. c. To help maintain sterility of the instruments after instrument processing. d. To facilitate the cleaning process by keeping the debris on the instruments from

drying.

ANS: C

Holding facilitates the cleaning step, and is most important if the contaminated instruments will stand for over 30 minutes before be cleaned. Removing bioburden is the rationale for precleaning. Ensuring proper functioning of the instruments after processing is the rationale for corrosion control, drying, and lubrication. Maintaining sterility after processing is the rationale for packaging.

PTS: 1 DIF: Recall REF: p. 117 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 46. Why should heavy and/or sharp instruments not be packaged in paper bags for steam

sterilization?

a. These bags are too difficult to open after sterilization. b. The bags will get wet during sterilization and the instruments may puncture the

bag or the bag may easily tear. c. These bags are not good microbial barriers so they give little protection to the

instruments inside after sterilization. d. These bags cannot be adequately sealed before sterilization.

ANS: B

Paper bags are easily opened. Wet paper bags, as occurs during steam sterilization, are easily torn or punctured. Sharp instruments can puncture the bags and present a risk for injury when the bag is handled. They are good microbial barriers as long as they are not wet. So they must be dried inside the sterilizer at the end of the sterilization cycle. These bags can be easily sealed with sterilization tape (e.g., “autoclave tape”).

PTS: 1 DIF: Recall REF: p. 123 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 47. Paper bags for steam sterilization are best used to package a. metal impression trays. b. hand mirrors and napkin chains. c. explorers and periodontal probes. d. light weight nonsharp items.

ANS: D

Metal impression trays, hand mirrors, and napkin chains are heavy and may cause the wet paper bags to tear open. Wet paper bags, as occurs during steam sterilization, are easily torn or punctured. Sharp instruments can puncture the bags and present a risk for injury when the bag is handled. These bags are fine for gauze pads, cotton balls and other light-weight non sharp items, and they can be easily sealed with sterilization tape (e.g., “autoclave tape”).

PTS: 1 DIF: Recall REF: p. 123 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 48. Why did the CDC and the FDA issue a Health Advisory in 2015 urging all healthcare

facilities to immediately review current reprocessing practices at their facility to ensure they (1) are complying with all steps as directed by the device manufacturers, and (2) have in place appropriate policies and procedures that are consistent with current standards and guidelines? a. Recent infection control lapses due to noncompliance with recommended medical device reprocessing procedures highlighted a critical gap in patient safety. b. It was part of a 10-year plan to boost patient safety practices. c. Both agencies just developed new guidelines or regulations on instrument processing in healthcare facilities. d. A new director of the CDC and a new Commissioner of the FDA were just appointed.

ANS: A

Recent breaches in infection prevention had occurred in some healthcare facilities that prompted the issuing of the Health Advisory. It was not related to part of a 10-year plan, new guidelines, or new leadership.

PTS: 1 DIF: Recall REF: p. 116 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 49. What type of containers should be used to transport contaminated instruments from the

operatory to the sterilizing room? a. An open metal pan so that everyone can see the contents. b. A covered, leak-proof, puncture-proof, container marked with a biohazard symbol. c. A closed glass containers marked with a biohazard symbol. d. An open, leak-proof, puncture-proof, plastic tub marked with a biohazard symbol.

ANS: B

A covered, leak-proof, puncture-proof container marked with a biohazard symbol gives the personnel by most protection and provides excellent containment of the contaminants.

Glass containers will break if dropped and allow the contaminants to spread.

PTS: 1 DIF: Recall REF: p. 119 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 50. What does the test solution contain that is used to evaluate the efficiency of medical/dental

instrument cleaning equipment in the TOSI test? a. Motor oil and sand b. Human blood and pumice c. Mustard, ketchup, and salt d. Albumin, fibrin, and hemoglobin ANS: D

Motor oil, sand, mustard, ketchup and salt do not simulate a healthcare related soil. Use of human blood would be risky due to its possible infectious nature. Albumin, fibrin, and hemoglobin are a good simulation of blood.

PTS: 1 DIF: Recall REF: p. 121 OBJ: 4 TOP: CDA, Infection Control, III.B. Instrument/device processing 51. What is a Bowie-Dick test? a. A test for the efficiency of instrument cleaning equipment. b. A test using biological indicators for sterilization monitoring. c. A test for air removal in vacuum and prevacuum steam sterilizers. d. A test for the level of microbes in used ultrasonic cleaning solution.

ANS: C

A Bowie-Dick test ensures that there are no air pockets chamber of a steam sterilizer which may not reach sterilizing temperatures. A TOSI test involves the efficiency of instrument cleaning equipment. There is no name for tests using biological indicators for sterilization monitoring or for the level of microbes in used ultrasonic cleaning solution.

PTS: 1 DIF: Recall REF: p. 135 OBJ: 4 TOP: CDA, Infection Control, III.B. Instrument/device processing 52. Choose the meaning of a failed Bowie-Dick test. a. The instruments cleaned in an automatic instrument washer/disinfector are totally

clean. b. There may be places in the sterilizer chamber that did not reach sterilizing temperature. c. The ultrasonically cleaned instruments are not totally clean. d. It’s time to change the ultrasonic cleaning solution.

ANS: B

The Bowie-Dick test determines the presence of air in a steam sterilizing chamber, and air pockets are insulated from the high temperatures needed for sterilization. There is no standard test for when to change the ultrasonic cleaning solution. A TOSI test would determine whether the instruments cleaned in an automatic instrument washer/disinfector are totally clean, or whether ultrasonically cleaned instruments are totally clean.

PTS: 1 DIF: Application REF: p. 135 OBJ: 4 TOP: CDA, Infection Control, III.B. Instrument/device processing 53. What equipment should not be used as an instrument sterilizer? a. A bead sterilizer b. An autoclave c. A dry heat sterilizer d. An unsaturated chemical vapor sterilizer ANS: A

The temperature varies at different levels of the beads in a bead sterilizer, and biological indicators are not available for these units. So sterilization may not occur and it can’t be monitored. An autoclave (steam sterilizer), dry heat sterilizer, or unsaturated chemical vapor sterilizer is a viable means to sterilize objects.

PTS: 1 DIF: Recall REF: p. 142 OBJ: 9 TOP: CDA, Infection Control, III.A. Instrument/device processing 54. What would be a proper process challenge device (PCD) for a table-top steam sterilizer? a. One-half of the packages in the sterilizer load would contain a biological indicator. b. One package on the top of the load would contain a chemical indicator. c. One package in the center of the load would contain a biological and a chemical

indicator. d. One package in the center of the load would contain a biological indicator.

ANS: C

Having 1/2 of the packages containing a biological indicator (BI) would be excessing.

Having just a chemical indicator inside a package would not be adequate. Having both a biological and a chemical indicator inside a package would give the most meaning results.

PTS: 1 DIF: Application REF: p. 132 OBJ: 4 TOP: CDA, Infection Control, III.B. Instrument/device processing 55. Autoclave tape belongs to what class of chemical indicators? a. Class 1 b. Class 2 c. Class 4 d. Class 5

ANS: A

The Class 1 indicator (e.g., autoclave tape) is used on the outside of packages to determine exposure to high temperatures. A Class 2 indicators is a Bowie-Dick test for air removal.

A Class 4 indicator is used inside of packages and reacts to two or more conditions such as temperature and time. A Class 5 indicator is used inside packages and reacts to all critical variables (such as temperature, time and/or the presence of steam).

PTS: 1 DIF: Application REF: p. 134 OBJ: 4 TOP: CDA, Infection Control, III.B. Instrument/device processing TRUE/FALSE 1. Proper steam sterilization involves placing the instruments in a completely closed

container before processing them through the sterilizer.

ANS: F

Completely closed containers prevent the sterilizing agent from reaching the surfaces of the instruments which is needed for sterilization.

PTS: 1 DIF: Recall REF: p. 123 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing

Chapter 14: Surface and Equipment Asepsis Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. What type of disinfectants is not tuberculocidal? a. Chlorines b. Iodophors c. Complex phenols d. Quaternary ammonium compounds ANS: D

Chlorines, iodophors, and complex phenols are all intermediate-level disinfectants and are tuberculocidal. Quaternary ammonium compounds are low-level disinfectants and are not tuberculocidal.

PTS: 1 DIF: Recall REF: p. 156 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 2. Which of the following is the strongest (kills the most microbes)? a. A tuberculocidal disinfectant b. A hospital-level disinfectant c. A low-level disinfectant d. An antiseptic ANS: A

Disinfectants that can kill Mycobacterium tuberculosis are more potent than others because this bacterium is more difficult to kill than many other bacteria. Intermediate-level disinfectants are tuberculocidal. A hospital-level disinfectant is a low-level disinfectant which is not tuberculocidal. Thus it’s less potent than tuberculocidal agents. A low-level disinfectant is not tuberculocidal. Thus it’s less potent than tuberculocidal agents. An antiseptic is not a disinfectant.

PTS: 1 DIF: Recall REF: p. 152 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 3. Which of the following is a high-level disinfectant/sterilant? a. Glutaraldehyde b. Alcohol c. Bleach d. Iodophor ANS: A

Glutaraldehyde is a high-level disinfectant/sterilant. Alcohol, bleach and iodophor are intermediate-level disinfectants.

PTS: 1 DIF: Recall REF: p. 154 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 4. What is the most important property of a surface cover?

a. b. c. d.

It must be made of latex.

It must be made of aluminum foil.

It must be disinfected before being placed on a surface.

It must be impervious to water.

ANS: D

Latex can work as a surface barrier, but being latex is not the most important property of a surface cover. Aluminum foil can work as a surface barrier, but being aluminum foil is not the most important property a surface cover. It is not true that a surface cover must be disinfected before being placed on a surface. Surface covers are used to prevent moisture from contacting the underlying surface. Thus they must be impervious to moisture (e.g., saliva and blood).

PTS: 1 DIF: Recall REF: p. 148 OBJ: 2 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 5. Which of the following best describes an intermediate-level disinfectant? a. A virucidal agent b. A sporicidal agent c. A tuberculocidal agent d. A bactericidal agent ANS: C

A virucidal agent could be a low-level, intermediate-level or high-level disinfectant depending upon the virus involved. A sporicidal agent is a high-level disinfectant/sterilant.

Intermediate-level disinfectants are tuberculocidal. A bactericidal agent could be a low-level, intermediate-level or high-level disinfectant depending upon the bacterium involved.

PTS: 1 DIF: Recall REF: p. 154 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 6. Which of the following terms indicate the strongest microbial killing power? a. A virucidal agent b. A sporicidal agent c. A tuberculocidal agent d. A bactericidal agent ANS: B

There are virucidal, tuberculocidal, and bactericidal agents that cannot kill spores.

Sporicidal agents (agents that can kill spores) are sterilants because bacterial spores are the most difficult to kill of all microorganisms. Thus sporicidal agents are the strongest.

PTS: 1 DIF: Application REF: p. 149 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 7. What should be done before disinfecting a contaminated operatory surface? a. Preclean the surface. b. Cover the surface with a plastic surface cover for 10 minutes. c. Wipe the surface with a sterilant/high-level disinfectant. d. Make sure it has been uncovered and open to the air for at least 10 minutes.

ANS: A

Surfaces to be disinfected must first be precleaned. This reduces the number of contaminating microorganisms and the blood or saliva present and facilitates action of the disinfecting chemical. Covering the surface does nothing to facilitate the disinfection step.

Sterilant/high-level disinfectants are not to be used on environmental surfaces.

Making sure it has been uncovered does nothing to facilitate the disinfection step.

PTS: 1 DIF: Recall REF: p. 151 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 8. What is a housekeeping rather than clinical contact surface? a. Dental light handle b. Sink c. Switches on the handpiece unit d. Dental light switch ANS: B

The dental light handle and the dental light switch are clinical contact surfaces which means they will come in contact with hands involved in patient treatment. The sink is considered a housekeeping surface which means it will not come in contact with the hands or devices used in patient treatment. Switches on the handpiece unit are clinical contact surfaces which means they will come in contact with hands involved in patient treatment.

PTS: 1 DIF: Recall REF: p. 147 OBJ: 2 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 9. What should be done to a clinical contact surface after its protective surface cover has

been carefully removed at the end of a patient appointment? a. Clean and disinfect the surface with an intermediate-level disinfectant and then add a fresh cover for the next patient. b. Clean and disinfect the surface with a low-level disinfectant and then add a fresh cover for the next patient. c. Clean and disinfect the surface with a high-level disinfectant and then add a fresh cover for the next patient. d. Nothing—just carefully add a fresh cover for the next patient.

ANS: D

Cleaning and disinfecting are not necessary and is a waste of time since the cover protected the surface from becoming contaminated. The cover protected the surface from becoming contaminated, and since it was carefully removed and the underlying surface was not contaminated with the hands, no cleaning and disinfecting is necessary. Just add the new cover.

PTS: 1 DIF: Application REF: p. 149 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 10. If you properly use surface covers on clinical contact surfaces at chairside for each patient,

which of the following is not necessary? a. Use gloves for patient care. b. Clean and disinfect those surfaces between patients. c. Package the instruments before sterilization.

d. Wear protective clothing at chairside.

ANS: B

Gloves must always be worn. If you properly use surface covers on touch surfaces, the surfaces will not become contaminated and cleaning and disinfecting those surfaces do not need to be done. Instruments are always to be packaged prior to sterilization. Protective clothing must always be worn at chairside.

PTS: 1 DIF: Application REF: p. 149 OBJ: 2 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 11. If surface covers are properly used during patient treatment, which of the following

procedures is not needed? a. Wearing gloves for operatory clean-up. b. Performing hand hygiene before putting on gloves at the beginning of the appointment. c. Cleaning and disinfecting covered surfaces after the appointment. d. Changing masks between patients.

ANS: C

It is always necessary to wear gloves for operatory clean-up, perform hand hygiene before putting on gloves at the beginning of the appointment, and change masks between patients.

If surface covers are used properly during patient treatment, cleaning, and disinfecting the covered surfaces after the appointment is not needed.

PTS: 1 DIF: Application REF: p. 149 OBJ: 2 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 12. If you are using a disinfectant wipe (a paper towelette saturated with a disinfectant) rather

than a spray disinfectant, how many wipes should be used to achieve proper cleaning and disinfection of a surface? a. One b. Two c. Three d. Four ANS: B

One wipe involves only the first step which is cleaning. You use one to clean and another one to disinfect. The process is referred to as “wipe-discard-wipe.” Three or four are too many.

PTS: 1 DIF: Application REF: p. 151 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 13. Which of the following is used to kill microbes on the skin just before an injection? a. Sterilant b. Antiseptic c. Antibiotic d. Disinfectant ANS: B

Sterilants and disinfectants are used for killing microbes on inanimate surfaces.

Antiseptics are antimicrobial agents used on the skin or other parts of the body. Antibiotics are used to treat harmful infections by killing or inactivating microbes on or in the body.

PTS: 1 DIF: Recall REF: p. 151 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 14. Which of the following surfaces is usually not involved in patient-to-patient spread of

microbes? a. Air/water syringe handle b. Curing light handle c. Sink d. Handpiece control switch ANS: C

The air/water syringe handle and the handpiece control switch are directly involved during patient treatment. The curing light handle is commonly touched with contaminated hands during patient treatment. The sink is not directly involved in patient treatment.

PTS: 1 DIF: Recall REF: p. 147 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 15. Why are two disinfecting towelettes used during the wipe-discard-wipe procedure? a. The first one wets the surface and the second one cleans the surface. b. The first one cleans the surface and the second one disinfects the surface. c. The first one disinfects the surface and the second one cleans the surface. d. The first one disinfects the surface and the second one re-disinfects the surface for

double assurance.

ANS: B

The first one cleans and the second one disinfects.

PTS: 1 DIF: Application REF: p. 151 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 16. Which of the following protective barriers are to be worn when disinfecting a surface? a. Utility gloves b. Utility gloves and mask c. Utility gloves, mask, and protective clothing d. Utility gloves, mask, protective clothing, protective eyewear ANS: D

Utility gloves, mask, protective clothing and protective eyewear protect the hands, mouth, nose, skin/clothing, and eyes.

PTS: 1 DIF: Application REF: p. 151 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 17. Gloves need not be worn during which of the following activities? a. Cleaning and disinfecting an operatory surface. b. Removing surface covers after the patients leaves. c. Placing new surface covers between patients.

d. Assisting at chairside with a patient below the age of 6 years.

ANS: C

Utility gloves are needed when cleaning the operatory surface (along with protective eyewear and clothing and masks) to protect against contacting the contaminated surfaces and the chemicals being used. Gloves are needed when replacing surface covers because the surface covers have become contaminated. Gloves are not needed when placing new surface covers because the fresh surface covers are not contaminated with patient materials. Gloves are needed when removing the old surface covers because they are contaminated. Gloves (and other barriers) are always needed with all patients.

PTS: 1 DIF: Application REF: p. 149 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 18. Which of the following is a housekeeping surface rather that a clinical contact surface and

does not have to be covered or routinely cleaned and disinfected between each patient? a. Light handles on the dental unit b. Wall next to the dental chair c. Switch that controls the handpieces d. Radiographic equipment ANS: B

Light handles on the dental unit, the switch that controls the handpieces, and radiographic equipment are clinical contact surfaces. They get contaminated and might be used with the following patient. The wall next to the dental chair need not be covered or routinely cleaned and disinfected because it does not come into direct contact with patients.

PTS: 1 DIF: Application REF: p. 147 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 19. Hospital disinfectants are low-level disinfectants that have been shown to kill a. Streptococcus mutans, bacterial spores and Mycobacterium tuberculosis var. bovis

are not tuberculocidal or sporicidal. b. Mycobacterium tuberculosis var. bovis. c. Bacterial spores. d. Staphylococcus aureus, Salmonella choleraesuis, and Pseudomonas aeruginosa.

ANS: C

They are not tuberculocidal or sporicidal. Staphylococcus aureus, Salmonella choleraesuis, and Pseudomonas aeruginosa have been shown to be killed by low-level disinfectants.

PTS: 1 DIF: Recall REF: p. 152 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 20. What microbe is not killed by low-level disinfectants nor intermediate-level disinfectants? a. Mycobacterium tuberculosis b. Pseudomonas aeruginosa c. Staphylococcus aureus d. Bacterial spore ANS: D

Mycobacterium tuberculosis is killed by intermediate-level disinfectants but not by low-level disinfectants. Pseudomonas aeruginosa and Staphylococcus aureus are killed by intermediate-level disinfectants and by low-level disinfectants. Bacterial spores are the most resistant to killing because of their high density and impermeability. They are killed by high-level disinfectants/sterilants.

PTS: 1 DIF: Recall REF: p. 154 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 21. Which of the following should never be used as a surface disinfectant? a. A high-level disinfectant b. An intermediate-level disinfectant c. A low-level disinfectant d. A hospital disinfectant ANS: A

High-level disinfectants are to be used for immersion only (e.g., on submerged plastic items that cannot be heat sterilized). They vaporize when spread on surfaces, and this enhances contact with the toxic vapors. An intermediate-level disinfectant can be used as a surface disinfectant. A low-level disinfectant or hospital disinfectant can be used as a surface disinfectant in certain instances.

PTS: 1 DIF: Recall REF: p. 154 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 22. How can you tell if a disinfectant has been registered with the EPA? a. Its label displays a blue “R.” b. Its label displays a registration number. c. Its label states that it is tuberculocidal. d. Its label states that it is a hospital disinfectant.

ANS: B

A label displaying a blue “R” is not indicative EPA registration. A label stating that a disinfectant is tuberculocidal or that it is a hospital disinfectant is not indicative of EPA registration. If a disinfectant has been registered with EPA, there will be a registration number on the label.

PTS: 1 DIF: Recall REF: p. 153 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 23. What kinds of dental operatory surfaces best lend themselves to being covered with a

surface barrier rather than being cleaned and disinfected between each patient? a. Those that are difficult to clean and disinfect b. Flat surfaces such as countertops c. Sink basins d. Walls ANS: A

Surfaces that are difficult to disinfect are best covered with a surface cover. Flat surfaces such as countertops can be covered but also are easily cleaned and disinfected. Sink basins and walls are never covered, for they are not clinical contact surfaces.

PTS: 1 DIF: Recall REF: p. 149 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 24. How often should a surface cover on a dental light handle or light switch be replaced? a. After every patient b. After every three patients c. When the cover is visibly soiled d. Only after a high-speed handpiece is used on a patient ANS: A

Surface covers are touched with contaminated hands during patient treatment, so they need to be replaced after every patient. Replacing after every three patients will result in patient-to-patient cross-contamination. It does not need to be replaced when visibly soiled, nor after the use of a high-speed handpiece, as long as it involves just one patient.

PTS: 1 DIF: Recall REF: p. 149 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 25. According to the CDC low-level disinfectants can be use on clinical contact surfaces if

they are EPA-registered as a hospital disinfectant and have been shown to kill a. Staphylococcus aureus, Salmonella choleraesuis, and Pseudomonas aeruginosa. b. Mycobacterium tuberculosis var. bovis. c. human immunodeficiency virus. d. human immunodeficiency virus and hepatitis B virus.

ANS: D

Killing Staphylococcus aureus, Salmonella choleraesuis, and Pseudomonas aeruginosa is standard for a hospital disinfectant. Killing Mycobacterium tuberculosis var. bovis is not required for this use. The disinfectant must have a label claim of killing both human immunodeficiency virus and hepatitis B virus.

PTS: 1 DIF: Recall REF: p. 156 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 26. What is the purpose of the second spray in the spray-wipe-spray procedure? a. To sterilize the surface b. To disinfect the surface c. To clean the surface d. To wash off the previous spray material ANS: B

The spray-wipe-spray procedure is used to clean and disinfect not sterilize a surface. The first spray, followed by wiping, cleans the surface and the second spray disinfects the surface. The first spray is involved in cleaning. Washing off the previous spray material is not the reason for the second spray.

PTS: 1 DIF: Recall REF: p. 150 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 27. Your office just received a new disinfectant. What’s the easiest way to find out how it

should be used? a. Look up the product on the internet.

b. Call the manufacturer. c. Contact the sales who recommended the product representative. d. Read its label.

ANS: D

Looking up the product on the internet takes too much time, and it may not be easily found. Getting to the correct person at a company that can answer your questions is not always easy. The sales representative may not be readily available. The label contains this information as well as other important data and precautions, and it is right at your fingertips.

PTS: 1 DIF: Application REF: p. 151 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 28. Which of the following types of disinfectants can contain the same active ingredient as

bleach? a. Iodophors b. Phenolics c. Chlorines d. Quaternary ammonium compounds ANS: C

The active ingredient in iodophors is organic iodine. The active ingredient in phenolics is one or more synthetic phenolics. Some chlorines contain sodium hypochlorite the same ingredient as is in bleach. The active ingredient in these is one or more quaternary ammonium compounds.

PTS: 1 DIF: Recall REF: p. 154 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 29. Manufacturers have added alcohol to which of the following types of disinfectants to make

it tuberculocidal? a. Iodophors b. Phenolics c. Chlorines d. Quaternary ammonium compounds ANS: D

Iodophors, phenolics, and chlorines are tuberculocidal without adding alcohol. Quaternary ammonium compounds by themselves are not tuberculocidal but adding alcohol makes the combination tuberculocidal.

PTS: 1 DIF: Recall REF: p. 156 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 30. The labels of properly approved surface disinfectants contain a registration number from

which Federal agency? a. EPA b. FDA c. CDC d. OSHA

ANS: A

Manufacturers of disinfectants submit to the Environmental Protection Agency (EPA) testing data and other information that show the effectiveness and safety of the product. If the data are consistent with the label claims and other requirements are met, the EPA registers the disinfectant allowing its legal sale in the US. The FDA approves medical devices, food, drugs, and sterilants/high-level disinfectants. The CDC makes infection control recommendations and investigates disease outbreaks. OSHA makes laws to protect the workers of America.

PTS: 1 DIF: Recall REF: p. 153 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 31. Supplying sterile forceps or cotton pliers with each instrument set-up to reach into

containers of bulk supplies (e.g., cotton rolls, or cotton pledgets) is best referred to as a. antisepsis. b. unit dosing. c. aseptic retrieval. d. high-tech management.

ANS: C

Antisepsis is using antiseptics on the skin or other body surfaces. Unit dosing refers to supplies being distributed or packaged in small numbers sufficient for care of just one patient and placed at chairside before care begins. Aseptic retrieval prevents items in a bulk container from becoming contaminated and involved in cross-contamination the next time the supply is needed for another patient. High-tech management is unrelated to aseptic retrieval.

PTS: 1 DIF: Recall REF: p. 158 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 32. Which of the following germicidal agents is least desirable as a surface disinfectant? a. Alcohols b. Chlorines c. Iodophors d. Phenolics ANS: A

Alcohols evaporate rapidly and are poor cleaning agents. They are better used as antiseptics such as in alcohol hand rubs. Chlorines, iodophors, and phenolics are better surface disinfectants than plain alcohols.

PTS: 1 DIF: Recall REF: p. 154 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 33. How should a cotton roll or other items be retrieved from a bulk container at chairside? a. With your fingers b. With sterile cotton pliers or forceps c. Dump the container contents out on a sterile towel and pick up one with your

gloved fingers d. With gloved hands ANS: B

Using your fingers may contaminate other items in the container. Cotton rolls or other items should be retrieved from a bulk container with sterile cotton pliers or tongs as part of each patient’s instrument set-up. This technique prevents contamination of item in the bulk container. It is not necessary and a waste of time and materials to dump the container contents onto a sterile towel. If the gloves are contaminated, then other items in the container will be touched and contaminated. Putting on fresh gloves just to retrieve a cotton roll is too time consuming.

PTS: 1 DIF: Recall REF: p. 158 OBJ: 6 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 34. The spray-wipe-spray procedure is a technique for a. washing your hands. b. disinfecting surfaces or objects. c. adding a rust inhibitor to instruments prior to ultrasonic cleaning. d. flushing out your eye after a chemical exposure.

ANS: B

Spray-wipe-spray does not relate to washing your hands or to ultrasonic cleaning. Spray the cleaner/disinfectant on the surface and wipe (preclean) the surface vigorously with a paper towel or gauze pad. Then respray the disinfectant/cleaner on the precleaned surface and let it remain moist for the longest contact time indicated on the disinfectant label (usually 10 minutes). Flushing of the eye involves the use of an eyewash station at the sink.

PTS: 1 DIF: Application REF: p. 150 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 35. Which microbe is the most susceptible to the environment and usually dies within one to

three days? a. Hepatitis C virus b. Methicillin-resistant Staphylococcus aureus c. Mycobacterium tuberculosis d. SARS-CoV-2 ANS: D

Hepatitis C virus is hardy, surviving up to 6 weeks outside the body. Methicillin-resistant Staphylococcus aureus can survive for weeks outside the body. Mycobacterium tuberculosis is extremely hardy surviving for several weeks outside the body.

PTS: 1 DIF: Recall REF: p. 147 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 36. What is the best approach for decontaminating high-tech equipment such as computers,

cameras, and digital radiography equipment? a. Sterilize in a dry heat sterilizer for the minimum amount of time to achieve sterilization. b. Sterilize in an autoclave for the minimum amount of time to achieve sterilization. c. Heavily spray the outer surfaces with a liquid sterilant/high-level disinfectant. d. Contact the manufacturer for instructions.

ANS: D

Sterilization in a dry heat sterilizer or autoclave will likely destroy most high-tech equipment. Spraying heavily with a liquid sterilant/high-level disinfectant will likely destroy most high-tech equipment. Different types of equipment are decontaminated by different procedures so the manufacturer needs to provide specific related instructions.

PTS: 1 DIF: Recall REF: p. 157 OBJ: 5 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 37. How would one manage a piece of equipment marketed for use in patients’ mouths but is

not disposable, and cannot be heat sterilized, covered with a protective barrier, or contact a liquid disinfectant? a. Don’t use it. b. Use it on just one patient. c. Blow it off with compressed air between each use. d. Get permission from each patient for its use, then wipe if with a dry cloth before reuse.

ANS: A

It’s too risky to use because it cannot be properly decontaminated. It cannot be used in the mouth of even one patient because it cannot first be properly decontaminated. Blowing if off with air is grossly inadequate for decontamination. Patients would likely not give their permission, plus wiping with a dry cloth is not adequate decontamination.

PTS: 1 DIF: Application REF: p. 156 OBJ: 5 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures TRUE/FALSE 1. Storing supplies in drawers at chairside for retrieval during patient treatment can lend itself

to cross-contamination of the drawer handle or of bulk items inside.

ANS: T

When drawers at chairside are opened to retrieve something, contamination can easily occur through touching with contaminated gloves as well as from spatter droplets.

PTS: 1 DIF: Recall REF: p. 158 OBJ: 6 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 2. When using surface disinfectants in the office one cannot verify whether the microbes on

the surface have been removed or killed.

ANS: T

There is no easy way to determine effectiveness of surface disinfectants as they are being used in the office.

PTS: 1 DIF: Recall REF: p. 148 OBJ: 5 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures

Chapter 15: Dental Unit Water Asepsis and Air Quality Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. What is the maximum number of microbes CDC states should be in dental unit water used

for patient treatment? a. 200,000 CFU/mL b. 10,000 CFU/mL c. 500 CFU/mL d. 1 CFU/mL ANS: C

10,000 CFU/mL and 200,000 CFU/mL exceed the regulatory standards set by the EPA. The recommendations from the CDC state that dental offices use water that meets the regulatory standards set by the EPA for drinking water (fewer than 500 CFU/mL of heterotrophic water bacteria). Since 1 and zero are almost the same, sterilization of the water (which is not practical) would be required to achieve 1 CFU/mL. PTS: 1 DIF: Recall REF: p. 165 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 2. If you attach a separate water bottle containing sterile water to a previously untreated

dental unit with biofilm in its waterlines, what will the water quality be when it enters the patient’s mouth? a. The water will be sterile. b. The water will contain microorganisms. c. The water will contain mercury. d. The water will be fluoride-free.

ANS: B

Sterile water is impossible to achieve with the water passing through the dental unit.

Sterile water can only be provided using a sterile reservoir and waterlines. The biofilm in the waterlines will contaminate the sterile water as it passes through those lines. Mercury and fluoride are unrelated to the microbes in water.

PTS: 1 DIF: Application REF: p. 166 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 3. The level of microbes in water coming out of an unmodified dental unit is almost always a. the same as drinking water. b. higher than drinking water. c. lower than drinking water. d. zero.

ANS: B

As the water coming out of an unmodified dental unit has been contaminated as it passes over the biofilm in the waterlines, the level of the microbes in the water will be higher than level of drinking water. Sterility is not possible to achieve with water coming through the dental unit.

PTS: 1 DIF: Recall REF: p. 160 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 4. When does CDC recommend that dental unit waterlines with the attached handpieces

should be flushed? a. Between every patient b. Once a day c. Once a week d. Every 10 minutes during an appointment ANS: A

The CDC recommends that high-speed handpieces should be flushed to discharge water and air for a minimum of 20 to 30 seconds after use on each patient. Once a day or once a week is too infrequent because retraction of patient materials up into the lines may occur with each patient on which the handpiece is used. Every 10 minutes is too frequent and a waste of time for it will be flushed at the end of the appointment.

PTS: 1 DIF: Recall REF: p. 165 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 5. How does biofilm in dental unit waterlines affect the microbial concentration in the water

coming out of the dental unit? a. It may cause a decrease in the microbes in the water. b. It always causes a decrease in the microbes in the water. c. It does not affect the microbes in the water. d. It causes an increase in the microbes in the water.

ANS: D

The biofilm in dental unit waterlines always causes an increase in the microbial concentration as the flowing water “picks up” microbes from the biofilm.

PTS: 1 DIF: Application REF: p. 163 OBJ: 2 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 6. Why should you flush water through dental unit waterlines between patients? a. To remove all the biofilm in the waterlines. b. To help lubricate the high-speed handpiece. c. To sterilize the inside of the air–water syringe handle. d. To temporarily lower the number microbes in the water.

ANS: D

The biofilm was formed as water was passing through the line, so flushing will not remove it. Flushing water through the dental unit waterline has nothing to do with lubricating handpieces. Flushing water through the dental unit waterlines is not a sterilization procedure. Flushing can reduce the microbial count in the water temporarily and help clean the handpiece waterlines of material that may have entered through the patient’s mouth. If municipal water is being used, flushing also brings in fresh chlorinated water.

PTS: 1 DIF: Comprehension REF: p. 165 OBJ: 2 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 7. Planktonic microbes are microbes that a. are free-floating in water. b. have been killed with a disinfectant. c. never multiply but remain dormant for ever. d. form spores.

ANS: A

“Planktonic” comes from the word “plankton” which are microbes and small plants that float in natural bodies of water. Microbes that have been killed with a disinfectant are simply called dead microbes. Microbes that never multiply are called dormant microbes or spores. Microbes that form spores are called spore-forming bacteria.

PTS: 1 DIF: Recall REF: p. 162 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 8. Which of the following is a waterborne bacterium that can cause a harmful infection in

compromised persons? a. Streptococcus mutans b. Legionella pneumophila c. Candida albicans d. Herpes simplex ANS: B

Streptococcus mutans is not a waterborne bacterium. Legionella pneumophila is a gram-negative bacterium that naturally occurs in the water and is a causative agent of a type of pneumonia call Legionnaires’ disease. Candida albicans is a fungus not a bacterium. Herpes simplex is a virus not a bacterium.

PTS: 1 DIF: Recall REF: p. 161 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 9. What is the main reason why relatively greater amounts of biofilm form in dental unit

waterlines than in other types of waterlines? a. Because there are no microbes in any other type of waterlines. b. Because water in dental units never contains any chlorine normally added at the water treatment plant. c. Because the small diameter of these lines cause a high ratio of waterline surface to water volume. d. Because the microbes in water are capable of attaching only to the material used to make dental unit waterlines.

ANS: C

Other types of waterlines do contain microbes. The water that enters the dental unit is the same water that supplies the entire office and comes from municipal supplies or wells. The small diameter of dental unit waterlines causes large amounts of biofilm to form. The smaller the diameter, the more surface for biofilm to form in relation to the volume of water in the line. The microorganisms that make up biofilm can attach to any almost surface exposed to moisture and can form anywhere a moist, nonsterile environment is found.

PTS: 1 DIF: Comprehension REF: p. 163 OBJ: 2 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 10. Water that meets the EPA standard for drinking is called ___________ water. a. distilled b. deionized c. naturally filtered d. potable ANS: D

Distilled water has been boiled, evaporated, and condensed. Deionized water has had its mineral ions removed. Naturally filtered water has been passed through specific filters to remove most chemical additives and metals. Potable water is defined as water meeting the US drinking water standards. It contains no more than a total of 500 CFU/mL of noncoliform bacteria.

PTS: 1 DIF: Recall REF: p. 160 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 11. What waterborne bacteria are of most concern in dentistry? a. Pseudomonas, Legionella, Mycobacterium b. Streptococcus, Staphylococcus, Bacillus c. Clostridium, Geobacillus, Porphyromonas d. Prevotella, Micrococcus, Serratia ANS: A

The microorganisms of main concern in dentistry are Pseudomonas (which can cause urinary tract and wound infections, pneumonia, and septicemia), Legionella (which causes legionnaires’ disease), and Mycobacterium (which can cause infections in dialysis patients and in others). Streptococcus, Staphylococcus, Bacillus, Clostridium, Geobacillus, Porphyromonas, Prevotella, Micrococcus, and Serratia are not usually considered as waterborne bacteria.

PTS: 1 DIF: Recall REF: p. 160 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 12. The level of microbes in dental unit water is expressed as a. mg/L. b. CFU/mL. c. ppm. d. g/gal.

ANS: B

Mg/L stands for milligrams per liter. CFU/mL stands for colony-forming units per milliliter which expresses the concentration of microbes. Ppm stands for parts per million. g/gal stands for micrograms per gallon.

PTS: 1 DIF: Recall REF: p. 160 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 13. Which of the following components of gram-negative bacteria that has been found in

unmodified dental unit water and that can cause inflammation and shock? a. Fats b. Flagella c. Endotoxin d. Capsules ANS: C

One study showed that the water contained 1000 unit of endotoxin per milliliter. Fats, flagella, and capsules have not been shown to be present in dental unit water.

PTS: 1 DIF: Application REF: p. 162 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 14. Improvement in the microbial quality of dental unit water may involve use of an

independent water reservoir which is a. a lake that supplies treated water to healthcare facilities for patient treatment. b. a city water tower that supplies water to healthcare facilities for patient treatment. c. a bottle attached to the dental unit that supplies the treatment water or other solutions. d. an independent waterline from the city water treatment plant that is directly plumbed into dental units.

ANS: C

Good quality water is placed in these bottles and used for patient treatment. Also various chemicals used to clean the waterlines can be placed in these bottles. Lakes supplying treated water, city water towers, and independent waterlines are not available to dental offices.

PTS: 1 DIF: Comprehension REF: p. 166 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 15. Manufacturers of devices for the control of microbes in dental unit waterlines must be

cleared by the _______________ before such devices can be legally marketed. a. FDA b. EPA c. CDC d. OSHA ANS: A

The dental chair/unit is a medical device, so any other devises that affect the dental unit also must be cleared by the FDA. The EPA registers chemicals that are intended for treatment of dental unit waterlines. Neither the CDC nor OSHA clear, approve or register devices, chemicals or other products.

PTS: 1 DIF: Recall REF: p. 167 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 16. Manufacturers of devices for the control of microbes in dental unit waterlines must be

registered by the _______________ before those chemicals can be legally marketed. a. FDA b. EPA c. CDC d. OSHA ANS: B

The FDA does not regulate chemicals used in dental unit waterlines. They regulate devices designed to be used with the dental unit. The EPA registers chemicals that are intended for treatment of dental unit waterlines. Neither the CDC nor OSHA clear, approve or register devices, chemicals or other products.

PTS: 1 DIF: Recall REF: p. 167 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 17. If using an independent water reservoir on a dental unit to deliver good quality treatment

water, how often should the bottle be removed and cleaned? a. Daily b. Twice a week c. Weekly d. Monthly ANS: A

Microbes in the system can immediately begin to attach to the inside of the bottle and begin to form biofilm. If this biofilm is not removed it contributes microbes to the treatment water that ends up in the patients’ mouths. Weekly, twice a week, and monthly are not soon enough because microbial attachment begins immediately.

PTS: 1 DIF: Application REF: p. 167 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 18. What would be needed for a dental office to continue to perform restorations and give

prophys under a “boil water notice”? a. A dry heat sterilizer and sterile treatment gloves b. An independent water reservoir on the dental units and an alcohol hand rub c. An unsaturated chemical vapor sterilizer and a high-level disinfectant d. Masks with attached face shields and barriers for all of the clinical contact surfaces in the operatory ANS: B

Dry heat sterilizers, sterile treatment gloves, unsaturated chemical vapor sterilizers, high-level disinfectant, masks with attached face shields, and barriers for clinical contact surfaces will not prevent exposure to the contaminated municipal water coming into the dental unit and faucets at the sinks. Purchased distilled water can be used in the independent water reservoir and use of the alcohol hand rub would alleviate using the contaminated tap water.

PTS: 1 DIF: Application REF: p. 161 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 19. What is the meaning of a “boil water notice”? a. Boiling water should be use to sterilize contaminated instruments. b. The water should not be consumed or should be boiled before use. c. The local water treatment plant has a problem and will boil all water before being

sent out to the city. d. You are not to boil the water because toxic materials got through the water

treatment plant and boiling the water will release these potentially harmful substances in the water vapor.

ANS: B

A “boil water notice” indicates that the water should not be consumed or should be boiled before use. Usually the problem is with a broken main water pipe. Boiling water cannot be regularly confirmed to be a sterilization method.

PTS: 1 DIF: Application REF: p. 168 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 20. What is the primary source of microbes in dental unit waterline biofilm? a. Oral fluids retracted through handpieces b. Incoming water c. Air entering the lines d. Contaminants that enter the lines during manufacturing ANS: B

Some microbes come from patients’ oral fluids, but the primary source is the incoming water. The incoming water is not sterile and contains microbes that are prone to attaching to surfaces and forming biofilm. Although some air does enter the lines, this is not the primary source. There are some microbes that enter the lines during manufacturing, but this is not the major source.

PTS: 1 DIF: Comprehension REF: p. 160 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 21. The dental unit water quality recommended by the CDC is based upon what standard? a. OSHA’s Hazard Communication Standard b. OSHA’s Bloodborne Pathogens Standard c. EPA’s drinking water standard d. FDA’s special regulation ANS: C

Dental unit water is to be at least as safe as drinking water. The OSHA Hazard Communication Standard and Bloodborne Pathogens Standard do not relate to water quality. The FDA does not regulate dental water quality.

PTS: 1 DIF: Recall REF: p. 165 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures

22. Explain the CDC recommendation for monitoring the microbial quality of dental unit

water? a. The quality should be monitored weekly. b. The quality should be monitored when the patients begin to complain about the smell of the water. c. The quality should be monitored when the patients begin to complain about the taste of the water. d. The quality should be monitored as recommended by the manufacturer of the dental unit or waterline treatment product.

ANS: D

Weekly monitoring is not the CDC recommendation. Smell and taste may not indicate the microbial quality of the water. The approach to monitoring will vary according to the type of dental unit and the type of water treatment system used.

PTS: 1 DIF: Comprehension REF: p. 165 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 23. How is backflow prevention related to a dental facility? a. Backflow of contaminated water from dental units to patients may contaminate

patients with potential pathogens. b. Backflow of contaminated air from dental units to patients may contaminate

patients with potential pathogens. c. Backflow of contaminated water from dental units may contaminate the public

water supply with potential pathogens. d. Backflow of contaminated air from dental units may contaminate the public water supply with potential pathogens.

ANS: C

Prevention of backflow of contaminated water from dental units to patients does not relate to patient safety. Prevention of backflow of contaminated air from dental units to patients does not relate to patient safety. Potential pathogens entering dental unit water may be siphoned and backflow into the public water supply. There are backflow prevention valves that can prevent this from occurring. Prevention of backflow of contaminated air from dental units to the public water supply does not relate to dental air.

PTS: 1 DIF: Comprehension REF: p. 168 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 24. Compare the potential for microbial contamination of dental unit water with that dental

unit air? a. Air contains fewer microbes than water. b. Air contains more microbes than water. c. Air has about the same level of microbes as water. d. Air is sterile and water is not.

ANS: A

Air does contain some microbes but not nearly as much as the water. Dental unit air comes from an air compressor that does not have the same constant significant source of microbes as does the incoming water. Dental unit air is not sterile and does contain a few microbes.

PTS: 1 DIF: Comprehension REF: p. 168 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures TRUE/FALSE 1. Any water that passes through dental unit waterlines containing biofilm will become

heavily contaminated.

ANS: T

As water passes over the biofilm microbes are released and are carried through the line into that patient’s mouth.

PTS: 1 DIF: Recall REF: p. 162 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 2. Most, if not all, unmodified dental units produce water that is below the standard for

drinking water.

ANS: T

It is normal for unmodified dental units to produce water of poor microbial quality even if the incoming water is of good quality. This occurs because all the waterlines contain biofilm that further contaminates the water as it flows through the lines into the patients’ mouths.

PTS: 1 DIF: Recall REF: p. 160 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 3. Although waterborne microbes have been found in dental unit water, the vast majority of

microbes present are human oral microbes.

ANS: F

Most of the microbes originate from the incoming water. Municipal water may be of good quality but it is not sterile. So the incoming water continually inoculates the dental units, and waterborne bacteria have developed mechanisms to attach to surfaces and for biofilm.

PTS: 1 DIF: Recall REF: p. 160 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 4. Current evidence indicates that there is a widespread public health problem from exposure

to the microbes in dental unit water.

ANS: F

There is no evidence for such a widespread problem. The only scientific report that directly implicates any microorganism from dental unit water as a health risk has involved Pseudomonas. The report from England implicated P. aeruginosa from dental unit water as the cause of oral infections in two medically compromised dental patients.

PTS: 1 DIF: Recall REF: p. 165 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures

Chapter 16: Aseptic Techniques Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. How does a preprocedure mouthrinse contribute to infection control? a. It will permanently kill all microorganisms in the mouth. b. It will temporarily reduce the number of oral microorganisms that come out of the

mouth during dental care. c. It will anesthetize the mouth and eliminate the need for an injection. d. It will eliminate plaque and calculus and begin to reverse dental caries by adding

calcium back to the demineralized portions of the teeth.

ANS: B

A preprocedure mouthrinse with a long-lasting antimicrobial agent reduces the number of oral microorganisms for up to 5 hours. Permanent killing of all microorganisms in the mouth, anesthetization of the mouth, and plaque and calculus elimination are not outcomes of a preprocedure mouthrinse.

PTS: 1 DIF: Application REF: p. 171 OBJ: 4 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 2. You can use a plastic disposable high-volume evacuator tip on how many patients? a. 1 b. 2 c. 3 d. 10 ANS: A

The HVE tip is disposable which means it can be used only on a single patient. Using a plastic disposable HVE tip on more than one patient violates infection control guidelines.

PTS: 1 DIF: Recall REF: p. 171 OBJ: 5 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 3. Research has shown that in one of five cases, fluids from the line may be retracted back

into the patient’s mouth if the patient closes his/her lip around the a. high-speed handpiece. b. saliva ejector. c. high-volume evacuator. d. air/water syringe tip.

ANS: B

Closing the lips around a high-speed handpiece, high-volume evacuator, or air/water syringe tip will not result in fluids being retracted back into the patient’s mouth. Fluids from the line may be sucked back into the patient’s mouth if the patient closes his/her lips around a saliva ejector. The seal can cause a type of “suck back” or reverse flow in the vacuum line that may allow the contents to reach the patient’s mouth.

PTS: 1 DIF: Comprehension REF: p. 172 OBJ: 3 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 4. What is the main infection control advantage of using a rubber dam? a. It eliminates the need for using a water spray from the air/water syringe. b. It prevents microbes on the isolated tooth or teeth from being aerosolized. c. It reduces the microbes escaping from the patient’s mouth in aerosols or spatter. d. It keeps the dental team from having to wear gloves when treating that patient.

ANS: C

Air/water syringes may still be used in procedures that include a rubber dam. Microbes on the isolated tooth/teeth can still escape in aerosols. Using a rubber dam can reduce the microbes escaping from the patient’s mouth in aerosols or spatter up to 100% with proper use. Gloves should be worn with all patient contacts.

PTS: 1 DIF: Comprehension REF: p. 171 OBJ: 3 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 5. Preprocedure mouthrinses need to be _________________ for them to provide an

infection control advantage. a. antimicrobial b. sweet c. blue or green in color d. held in the mouth for 10 minutes ANS: A

In order for preprocedure mouthrinses to be advantageous, they must be antimicrobial.

Flavor, color, and the amount of time held in the mouth have no effect on the infection control advantage of a preprocedure mouthrinse.

PTS: 1 DIF: Recall REF: p. 171 OBJ: 4 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 6. The difference between dental aerosols and spatter is that a. dental aerosols remain airborne for a much longer period of time. b. spatter droplets are much smaller than aerosol particles. c. dental aerosols are created only during use of the air/water syringe. d. spatter droplets remain airborne much longer than aerosols.

ANS: A

Dental aerosols remain airborne for a much longer period of time because aerosol particles are much smaller than spatter droplets. Aerosol particles are smaller than spatter droplets.

Both dental aerosols and spatter are created during the use of high- and low-speed handpieces, ultrasonic scalers, and air/water syringes. Spatter droplets remain airborne for a shorter time than aerosols as they are larger.

PTS: 1 DIF: Comprehension REF: p. 170 OBJ: 1 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 7. The smallest particles generated during the use of high-speed handpieces are called a. droplets. b. spatter particles. c. aerosols. d. sprays.

ANS: C

The smallest particles generated during the use of high-speed handpieces are called aerosols. They are less than 50 m in diameter and can remain airborne for some time.

Sprays may contain both aerosols and droplets. Spatter particles are the droplets generated from the mouth. Droplets are larger than 50 m in diameter and settle quickly.

PTS: 1 DIF: Recall REF: p. 170 OBJ: 1 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 8. Which of the following infection control procedures best minimizes the patient-to-dental

team route of transmission when patient treatment involves using of a high-speed handpiece? a. Use of sterile gloves b. Sterilization of the handpiece c. The high-volume evacuator d. Preprocedure mouthrinse ANS: C

The use of sterile gloves is important but will not minimize the aerosols and spatter from high-speed handpiece use. Sterilization of the handpiece is important but most of the contamination that exits the mouth comes from the patient’s saliva not the inside of the handpiece. The high-volume evacuator is an excellent way to remove most of the aerosols, spatter of the patient’s saliva and tooth or restoration materials before they exit the mouth.

Preprocedure mouthrinse can reduce the total number of microbes in the patient’s mouth but is not the best way to reduce the aerosols and spatter during high-speed handpiece use.

PTS: 1 DIF: Application REF: p. 170 OBJ: 2 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 9. Which of the following infection control procedures best minimizes the patient-to-dental

team route of transmission when patient treatment involves using the air/water syringe? a. Use of sterile gloves b. Using a disposable air/water syringe tip c. The high-volume evacuator d. Preprocedure mouthrinse ANS: C

The use of sterile gloves and a disposable air is important but will not minimize the aerosols and spatter from air/water syringe use. The high-volume evacuator is an excellent way to remove most of aerosols and spatter of the patient’s saliva before they exits the mouth. Preprocedure mouthrinse can reduce the total number of microbes in the patient’s mouth but is not the best way to reduce the aerosols and spatter during air/water syringe use.

PTS: 1 DIF: Application REF: p. 170 OBJ: 2 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 10. What barriers should be worn before changing the vacuum line trap? a. Gloves b. Gloves and mask c. Gloves, mask, and protective eyewear d. Gloves, masks, protective eyewear, and protective clothing ANS: D

Gloves, mask, protective eyewear, and protective clothing give protection to the hands, eyes, nose, forearms, and clothing.

PTS: 1 DIF: Application REF: p. 170 OBJ: 6 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 11. Which of the following procedures would give additional protection (above that from

wearing appropriate personal protective barriers) when changing or cleaning the vacuum line trap? a. Evacuate a disinfectant down the line before cleaning or changing the trap. b. Double sterilize the handpiece used on the patient treated just before changing or cleaning the trap. c. Using a rubber dam on the patient treated just before changing or cleaning the trap. d. Use a disposable high-volume evacuator tip.

ANS: A

Evacuation with disinfectant will disinfect the line and reduce the chances of contamination through direct contact or splashing. Double sterilization of the handpiece will not provide extra protection with manipulating the trap. Use of rubber dams or disposable high-volume evacuator tips will not provide extra protection with manipulating the trap.

PTS: 1 DIF: Application REF: p. 170 OBJ: 6 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 12. What should be done to reduce the spread of contamination when leaving chairside during

patient treatment to retrieve a supply item? a. Remove your protective clothing. b. Remove your gloves. c. Remove your mask. d. Remove your protective eyewear.

ANS: B

Removal of protective clothing, mask, and eyewear can be done but is not the best way to prevent the spread of contamination. The gloves are contaminated and will spread that contamination to any surface touched when away from chairside unless the gloves are removed.

PTS: 1 DIF: Application REF: p. 170 OBJ: 1 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 13. Which of the following will best reduce the spread of patient microbes to environmental

surfaces? a. Switching from disposable to reusable air/water syringe tips. b. Not having carpeting on the operatory floor. c. Touching as few surfaces as possible. d. Using disposable high-volume evacuator tips.

ANS: C

The gloves are contaminated and will spread that contamination to any surface touched.

Switching from disposable to reusable air/water syringe tips, not having carpeting on the operatory floor, and using disposable high-volume evacuator tips can be done but are not the best ways to prevent the spread of contamination.

PTS: 1 DIF: Recall REF: p. 170 OBJ: 1 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 14. What is a major advantage of using a disposable item versus its reusable counterpart? a. Using disposables is always less expensive. b. Disposables can be used on two to three patients saving cleaning and sterilization

time and labor. c. Disposables always have a more efficient operation. d. Disposables are the best way to prevent patient-to-patient spread of contamination.

ANS: D

Using disposables are frequently more expensive. Disposables are to be used on only one patient. Sometimes disposables are less efficient than the reusable counterparts.

Disposables are discarded after use and are not used on another patient.

PTS: 1 DIF: Comprehension REF: p. 171 OBJ: 5 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 15. Which of the following will minimize the spread of patient materials to the dental team? a. Using a disposable rather that a reusable air/water syringe tip. b. Using a vacuum line to receive the spray when cleaning/flushing high-speed

handpieces. c. Using a reusable rather that a disposable high-volume evacuator tip. d. Using an overglove when leaving chairside.

ANS: B

Using a disposable rather that a reusable air/water syringe tip, using a reusable rather that a disposable high-volume evacuator tip, or using an overglove when leaving chairside is fine to do but will not significantly reduce the spread of patient materials to the dental team.

High-speed handpieces can retract small amounts of patient materials. When flushing out or lubricating high-speed handpieces, an aerosol of the internal materials is created that might be inhaled. Flushing into a vacuum line eliminates this possibility.

PTS: 1 DIF: Application REF: p. 173 OBJ: 6 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 16. What is the problem with positioning the saliva ejector line above the patient’s head? a. This could increase the vacuum to dangerous levels possibly harming the patients

during subsequent use. b. This could allow the flow of line contents toward the tip. c. This could cause a deafening noise. d. This could stop the vacuum.

ANS: B

This will not increase the vacuum level. It may contaminate the patient with line contents.

This will not cause a deafening noise or stop the vacuum.

PTS: 1 DIF: Application REF: p. 171 OBJ: 3 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission 17. Safe injection practices recommended by the CDC include a. using sterilizable needles for administering local anesthesia. b. wearing heavy utility gloves when recapping used needles by hand. c. using multiple dose injection medication vials rather than single dose vials

whenever possible. d. disinfecting the rubber septum on a medication vial with alcohol before using.

ANS: D

Disposable not reusable needles are recommended. One should never recap needles by hand regardless of the gloves worn. Multiple dose vials create a greater risk for contamination than single dose vials. The rubber “stopper” needs to be disinfected with alcohol before use to reduce the risk of contaminating the inside medication.

PTS: 1 DIF: Recall REF: p. 172 OBJ: 6 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 18. Why is it important to put gloves on last when donning PPE? a. To prevent contamination of the gloves before contacting the patient b. To keep the hands from sweating during the activity c. To get a better feel of the gown material d. To make it easier to tie the gown straps ANS: A

The hands will not sweat much during this activity. Feeling the gown material is not important. Tying gown straps can be done with or without gloves. Donning PPE involves significant touching of potentially contaminated surfaces that results in contaminated hands.

PTS: 1 DIF: Recall REF: p. 170 OBJ: 1 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission TRUE/FALSE 1. One should not use bleach (use sodium hypochlorite) to flush or clean out the vacuum line.

ANS: T

Sodium hypochlorite can damage the metal part in the vacuum line system.

PTS: 1 DIF: Recall REF: p. 170-171 OBJ: 2 | 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 2. When a rubber dam and high-volume evacuator are used during a restorative procedure on

a child patient, the chairside assistant need not wear a mask or eye protection.

ANS: F

Gloves, mask, protective eyewear and protective clothing need to be worn with all patients regardless of the use of a rubber dam or high-volume evacuator or any other infection control device.

PTS: 1 DIF: Comprehension REF: p. 170 OBJ: 1 TOP: CDA, Infection Control, I.E. Standard precautions and the prevention of disease transmission

Chapter 17: Laboratory and Radiographic Asepsis Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. The main rule of laboratory asepsis is that prostheses and appliances must be a. heat sterilized before being handled in the laboratory. b. cleaned before being handled in the laboratory. c. rinsed with warm water before being handled in the laboratory. d. cleaned and disinfected before being handled in the laboratory.

ANS: D

Many prostheses and appliances cannot withstand heat sterilization. Cleaning is not sufficient. Rinsing is not sufficient. Cleaning and disinfecting the prostheses and appliances before being handled in the laboratory is the most complete procedure.

PTS: 1 DIF: Recall REF: p. 175 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 2. Impressions that are sensitive to immersion should be rinsed, shaken to remove excess

water and then a. steam sterilized. b. sprayed with a disinfectant and wrapped in a paper towel. c. rinsed for 5 minutes with hot tap water. d. boiled in water for 30 minutes.

ANS: B

Impressions that are sensitive to immersion should be rinsed, shaken to remove excess water and then sprayed with a disinfectant and wrapped in a paper towel. Steam sterilization and rinsing in hot tap water or boiling in hot water will damage the impression.

PTS: 1 DIF: Application REF: p. 176 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 3. Disinfection of dental impressions should last _______ minutes. a. 5 b. 15 c. 30 d. 60 ANS: B

Fifteen minutes is the recommended time but be sure to follow the manufacturer’s directions. Five minutes is not long enough for disinfection.30 and 60 minutes are excessive.

PTS: 1 DIF: Recall REF: p. 176 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures

4. Although some x-ray film packets can be disinfected after removal from the patient’s

mouth, it is best to a. steam sterilize them. b. place them in boiling water for 5 minutes. c. just rinse them under running tap water. d. cover them with a plastic pouch before they are placed in the patient’s mouth.

ANS: D

Boiling water and steam sterilization will destroy the film packets. Rinsing under tap water is insufficient to kill microbes. Covering the x-ray film packets with a plastic pouch prevents contamination and eliminates any possibility of leakage of a disinfectant through the film wrapper.

PTS: 1 DIF: Recall REF: p. 178 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 5. Which of the following is the best way to manage contamination of a daylight loader? a. Disinfect the inside of the sleeves after every use. b. Remove the sleeves after every use and sterilize them in a steam autoclave. c. Never contaminate the sleeves. d. Always wear the same gloves used with the patient when you enter the sleeves of

the loader for this prevents wasting gloves.

ANS: C

Removing the sleeves will destroy the unit. These sleeves are impossible to adequately disinfect if contaminated. Since the gloves used with the patient will be contaminated, they will contaminate the daylight loader sleeves.

PTS: 1 DIF: Recall REF: p. 179 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 6. Which of the following cannot be disinfected? a. Inside the sleeves of a daylight loader b. The handle of an x-ray unit head c. An impression d. A denture ANS: A

These sleeves are impossible to adequately disinfect if contaminated. X-ray unit head handles, impressions, and dentures can be disinfected.

PTS: 1 DIF: Recall REF: p. 179 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 7. How should one manage the infection control of most digital radiographic sensors? a. Heat sterilize them between patients. b. Cover them to prevent contamination when placed in the mouth. c. Soak them for 60 minutes in a liquid sterilant then thoroughly rinse between

patients. d. Rinse them with warm eater between patients.

ANS: B

Covering will protect the sensor from contamination. Rinsing with warm water is not adequate to kill microbes and may harm the sensor. Heat sterilization or soaking in liquid sterilant will destroy the sensor.

PTS: 1 DIF: Recall REF: p. 179 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 8. The best way to manage films in a daylight loader is to a. use fresh powdered gloves to hold the contaminated film packets when inserting

the hands through the sleeves, when inside remove the plastic protective pouches and proceed with developing. b. insert only disinfected or uncontaminated film packets into the loader using fresh uncontaminated powder-free gloves, and proceed with developing. c. put on fresh gloves, take the film packets out of the protective plastic pouches, pass them through to the inside of the loader, remove the film from the packets and proceed with developing. d. with bare hands (so as not to contaminate the loader sleeves) remove the contaminated protective pouches, pass the film packets through the sleeves, open the packets and proceed with developing.

ANS: B

One keeps from contaminating the inside of the loader by using disinfected or uncontaminated film packets and using fresh uncontaminated powder-free gloves.

Removing the film packet from the protective plastic pouch will contaminate the gloves.

These gloves will in turn contaminate the inside of the loader. Bare hands would become contaminated from contacting the plastic protective pouch.

PTS: 1 DIF: Application REF: p. 179 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 9. What is the main infection control tenant concerning laboratory receiving areas? a. Always wear fresh heavy utility gloves when entering the laboratory. b. Never wear contaminated clothing into the laboratory. c. All items coming from patients’ mouths must be sterilized or disinfected before

being taken into the laboratory. d. Place prostheses and impressions in sterile containers before taking them into the

laboratory.

ANS: C

It is not necessary to wear heavy utility gloves or to refrain from wearing contaminated clothing. It is not necessary to place prostheses and impressions in sterile containers before taking them into the laboratory. If contaminated items enter the lab, there is a chance that the contamination could be spread to equipment and to prostheses and impressions from other patients.

PTS: 1 DIF: Recall REF: p. 175 OBJ: 2 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 10. Which of the following laboratory items can always be cleaned and heat sterilized? a. Impressions b. Prostheses

c. Bite registrations d. Metal impression trays and face-bow forks ANS: D

Heat sterilization destroys most prostheses, impressions, and bite registrations. Metal impression trays and face-bow forks are metal and can withstand heat sterilization.

PTS: 1 DIF: Recall REF: p. 176 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 11. What should be done with the leftover polishing agents such as rouge after an appliance is

polished? a. Place it in a cup and run a slow stream of water into the cup to rinse the material. b. Spread the material out in a pan and steam sterilize it. c. Let it air dry overnight and return it the central bulk stock. d. Throw it away.

ANS: D

Placing in a cup with water will not adequately decontaminate the material. It is not necessary to steam sterilize the material. Also powder is to be sterilized in a dry heat sterilizer. Letting it air dry overnight and returning it to the central bulk stock risks contaminating the entire central bulk stock. Throwing it away will avoid the spread of contamination.

PTS: 1 DIF: Recall REF: p. 177 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 12. What should be done to decontaminate items that do not normally contact the patient (e.g.,

burs, stones, polishing points, case pans)? a. Rinse with warm water and dry. b. Always sterilize in a dry heat sterilizer. c. Clean and heat sterilize or disinfect according to the manufacturer’s directions. d. Ultrasonically clean, rinse, and dry.

ANS: C

It is inadequate to rinse with warm water and dry, or to ultrasonically clean, rinse, and dry.

The high temperatures of dry heat sterilization may destroy some items. Cleaning and heat sterilizing or disinfecting, according to the manufacturer’s directions, will provide for the safe reuse of these items.

PTS: 1 DIF: Recall REF: p. 177 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 13. How should one disinfect an impression that is sensitive to immersion? a. Steam sterilize it. b. Dry heat sterilize it. c. Spray it with the disinfectant and wrap with a disinfectant-soaked towel. d. Brush it with a liquid sterilant.

ANS: C

Steam sterilization, dry heat sterilization, and brushing with a liquid sterilant will destroy the impression. Spraying the impression with disinfectant and wrapping it with a disinfectant-soaked towel will safely decontaminate the impression.

PTS: 1 DIF: Application REF: p. 176 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 14. What’s the best way to clean a heavily soiled denture? a. Place in a beaker under running tap water for 15 minutes. b. Submerge in boiling water for 15 minutes. c. Place in a zip locked plastic bag or beaker containing an ultrasonic detergent and

ultrasonically clean. d. Use a shell blaster.

ANS: C

Placing in a beaker under running tap water will result in inadequate cleaning. Submerging in boiling water may damage the denture and may yield adequate cleaning. Placing in a zip-locked bag or beaker will clean the denture and protect the ultrasonic detergent in the cleaner tank from contamination. Shell blasters are to be used only on cleaned and disinfected prostheses.

PTS: 1 DIF: Application REF: p. 175 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 15. What is the main risk of handling gypsum? a. Corrosion b. Skin irritation c. Combustion d. Inhaling particles ANS: D

Gypsum does not cause corrosion. It could cause irritation of the skin is broken but is not the main risk. It is not flammable. It can generate airborne particulate particles that may be inhaled or contact the eyes.

PTS: 1 DIF: Recall REF: p. 177 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 16. What is the main risk of handling pumice? a. Corrosion b. Skin irritation c. Combustion d. Inhaling particles ANS: D

Pumice does not cause corrosion. It could cause irritation of the skin is broken but is not the main risk. It is not flammable. It can generate airborne particulate particles that may be inhaled or contact the eyes.

PTS: 1 DIF: Recall REF: p. 175 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures

17. What is the main risk of handling alginate? a. Corrosion b. Skin irritation c. Combustion d. Inhaling particles ANS: D

Alginate does not cause corrosion. It could cause irritation of the skin is broken but is not the main risk. It is not flammable. It can generate airborne particulate particles that may be inhaled or contact the eyes.

PTS: 1 DIF: Recall REF: p. 175 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 18. Protective eyewear and a mask are the most important personal protective equipment

(PPE) when using a a. dry heat sterilizer. b. steam sterilizer. c. dental lathe. d. x-ray unit.

ANS: C

Heavy utility gloves or heat resistant gloves are the main PPE when using sterilizers.

Gloves are the main PPE when adjusting the x-ray unit. The lathe generates airborne particles that may contact the eyes and be inhaled.

PTS: 1 DIF: Application REF: p. 176 OBJ: 3 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission

Chapter 18: Waste Management Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. Which of the following is not considered as regulated waste in dentistry? a. Sharps contaminated with blood or saliva b. Non-sharps solids (e.g., a 2  2 pad) saturated with blood c. Extracted teeth d. Used face masks ANS: D

Contaminated sharps, saturated non-sharps solids, and extracted teeth are regulated waste.

Masks are not considered regulated waste. Solid non-sharp items must be dripping wet or caked with blood or saliva to be considered as regulated waste.

PTS: 1 DIF: Recall REF: p. 182 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 2. Which of the following is regulated waste in a dental office? a. A used patient bib b. A 2  2 gauze pad with a few spots of blood on it c. Used exam gloves d. A double-ended scaler with a broken tip ANS: D

Used patient bibs, gauze pads, or used exam gloves must be dripping wet or caked with blood or saliva to be considered as regulated waste. Broken instruments are considered as sharps which are regulated waste.

PTS: 1 DIF: Recall REF: p. 182 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 3. Which of the following is regulated waste? a. Used plastic surface barriers b. Used scalpel blade c. Used sterilization wrap d. A cotton roll damp with saliva ANS: B

Plastic surface barriers, sterilization wraps, and cotton rolls must be dripping wet or caked with blood or saliva to be considered as regulated waste. A used scalpel blade is a sharp which is regulated waste.

PTS: 1 DIF: Recall REF: p. 182 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 4. OSHA requires sharps containers to be a. made of glass.

b. securely attached to a wall. c. leak proof. d. reusable.

ANS: C

A glass container would break if dropped and create many more contaminated sharps.

Sometimes holders for removable sharps containers are attached to the wall but not the sharps container itself. If not leak proof, contaminated materials would leak out and contaminate surfaces. They are not to be reused for this would require the contents to be emptied which would be a dangerous activity.

PTS: 1 DIF: Recall REF: p. 183 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 5. Sharps containers should have which of the following properties? a. Be made so that it can be closed. b. Be made of glass. c. Be made of clear see-through plastic. d. Be reusable after emptying its contents.

ANS: A

If the containers were not closable and are accidently dropped, the content would spill creating a dangerous situation. If dropped, a glass container would break and create many more contaminated sharps. It should be made of plastic but it need not be clear. They are not to be reused for this would require the contents to be emptied which would be a dangerous activity.

PTS: 1 DIF: Recall REF: p. 183 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 6. The CDC recommends that sharps containers should be located a. just outside the restrooms. b. next to the registration window in the waiting room. c. in the laboratory. d. as close as possible to the work area.

ANS: D

It is not wise to have sharps containers exposed to the public. Sharps containers may be needed in the laboratory, but this is not the specific recommendations of CDC. Having them as close as possible to the work area avoids having to transport sharps to other areas where the containers may be located.

PTS: 1 DIF: Recall REF: p. 183 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 7. Which of the following can be thrown away in the regular trash even if it is contaminated

with a little saliva? a. Injection needles b. Burs c. Cotton rolls d. Broken explorer

ANS: C

Injection needles, burs, and broken explorers must be discarded into sharps containers.

Cotton rolls can be thrown away in the regular trash if just damp with saliva.

PTS: 1 DIF: Recall REF: p. 182 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 8. Extracted teeth without amalgam fillings may be disposed of by a. placing in sharps containers. b. discarding in the regular office trash. c. taking them home and placing them in the regular trash. d. rinsing with water and giving them back to the patient.

ANS: A

Extracted teeth without amalgam fillings may be disposed of by placing in sharps containers. Teeth are regulated waste unless given back to their owner. You cannot transport regulated waste without a license, and nonsterilized teeth are not to be placed in regular trash. If the tooth is to be given back to the patient it must first be cleaned, disinfected and rinsed.

PTS: 1 DIF: Application REF: p. 182 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 9. What is regulated medical waste? a. Infectious medical waste that requires special handling, neutralization, and

disposal b. Waste posing a risk or peril to human beings or the environment c. Waste capable of having a poisonous effect d. Items that have had contact with blood or other body secretions ANS: A

Infectious medical waste that requires special handling, neutralization, and disposal would include liquid or semiliquid blood or saliva; nonliquid items saturated or caked with blood or saliva; contaminated sharps; pathologic or microbiologic materials. Waste posing a risk or peril to human beings or the environment is called hazardous waste. Waste capable of having a poisonous effect is called toxic waste. Items that have had contact with blood or other body secretions are called contaminated waste.

PTS: 1 DIF: Recall REF: p. 181 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 10. Most of the regulated medical waste in dental office consists of a. liquid blood and contaminated sharps. b. nonliquid solids saturated with blood or saliva and liquid saliva. c. nonliquid solids saturated with blood or saliva and extracted teeth. d. contaminated sharps and extracted teeth.

ANS: D

Liquid blood seldom if ever occurs in a dental office. Nonliquid solids saturated with blood or saliva will only occasionally exist. Contaminated sharps and extracted teeth are the most generated types of regulated medical waste in dental offices.

PTS: 1 DIF: Recall REF: p. 182 OBJ: 2 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 11. Which Federal agency regulates the final treatment of regulated medical waste? a. OSHA b. EPA c. FDA d. CDC ANS: B

OSHA regulates how employees are to handle regulated medical waste. EPA regulates the transport and final treatment of regulated medical waste. FDA is not directly involved with regulated medical waste. CDC makes recommendations on how to manage and handle regulated medical waste.

PTS: 1 DIF: Recall REF: p. 181 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 12. Which of the following is to be done when steam sterilizing sharps containers? a. Process for 15 minutes or one normal cycle. b. Dump out the contents so that the container is only 1/2 full. c. Place the container upright not on its side. d. Make sure the container is completely closed.

ANS: C

15 minutes is not long enough. It should be 40 to 60 minutes. Dumping the container must not be done for it increases the chances for sharps injuries. Containers placed on their side are sterilized more quickly, but this allows the contents to spill increasing the chances for sharps injuries. A closed container will not permit the steam to contact the items inside.

Thus sterilization will not occur.

PTS: 1 DIF: Application REF: p. 184 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 13. Which of the following is to be done when steam sterilizing sharps containers? a. Process for 15 minutes or one normal cycle. b. Fill the container to no more than 3/4 full. c. Place the container on its side. d. Make sure the container is completely closed.

ANS: B

15 minutes is not long enough. It should be 40 to 60 minutes. Filling the container no more than 3/4 full prevents items from protruding increasing the risk for sharps injuries.

Containers placed on their side are sterilized more quickly, but this allows the contents to spill increasing the chances for sharps injuries. A closed container will not permit the steam to contact the items inside. Thus sterilization will not occur.

PTS: 1 DIF: Application REF: p. 184 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 14. Which federal agency has standards for the discharge and final treatment of regulated

medical waste?

a. b. c. d.

OSHA EPA FDA CDC

ANS: B

OSHA regulates how employees are to handle regulated medical waste. EPA regulates the transport and final treatment of regulated medical waste. FDA is not directly involved with regulated medical waste. CDC makes recommendations on how to manage and handle regulated medical waste but do not issue standards.

PTS: 1 DIF: Recall REF: p. 181 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 15. What is used as the container for non-sharp regulated medical waste? a. A sharps container b. The regular trash container c. A red bag d. A metal container with a tight-fitting lid ANS: C

Sharps containers are for sharps. Regulated medical waste must not be placed in regular trash containers for this may spread disease agents. A red bag will contain the waste and be recognized as regulated waste from the red color or biohazard symbol. A metal container with a tight-fitting lid is excessive and is not properly marked as regulated waste.

PTS: 1 DIF: Application REF: p. 183 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 16. What should be received (besides the bill) from the medical waste hauler a few weeks after

the medical waste is picked up? a. The emptied sharps containers so they can be reused. b. A manifest stating how the waste was treated and where it was disposed. c. The treated waste for disposal in the office’s regular trash bin. d. A video disc describing how to handle regulated waste.

ANS: B

The containers are disposed of along with their contents by the hauler. A manifest proves that the office followed the regulation on proper disposal of the regulated waste. The waste is disposed of by the waste hauler. A video disc is not provided.

PTS: 1 DIF: Recall REF: p. 184 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 17. A dental assistant removed used surface barriers from the dental light handles and placed

them in a red bag for disposal as regulated waste. Was this an appropriate way to manage this waste? a. No, the barriers should have been placed in the regular trash. b. No, the barriers should have been directly placed into a sharps container. c. No, the barriers should have been autoclaved before disposal. d. Yes, this was the right way to dispose of the barriers.

ANS: A

The barriers are not saturated with blood or saliva, and are not sharps, so are not considered as regulated medical waste, and should be placed in the regular trash.

Regulated waste disposal would just unnecessarily increase the volume of the regulated waste costing more money for final transport and/or treatment.

PTS: 1 DIF: Application REF: p. 182 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 18. How should used, disposable, amalgam capsules be discarded? a. Place in a biohazard container. b. Discard in and sharps container. c. Recycle. d. Deposit in the regular trash.

ANS: C

Since used amalgam needs to be recycles, placing in a biohazard or sharps container prevents recycling. Since amalgam is a hazardous chemical it is not to be placed to regular trash.

PTS: 1 DIF: Recall REF: p. 185 TOP: CDA, Infection Control, Does not apply

OBJ: 4

Chapter 19: Prevention of Sharps Injuries Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. Which of the following is the best way to dispose of a contaminated needle? a. Cut the needle before placing it in a sharps container. b. Place the needle in a sharps container as soon as possible after use. c. Bend the needle before placing it in a sharps container. d. Pass it to someone else for disposal.

ANS: B

Cutting or bending the needle is an unnecessary manipulation of a sharp which increases the risk for an injury. Passing the needle to someone else puts that person at risk for an injury. Placing the needle in a sharps container as soon as possible after use places the needle in a safe place.

PTS: 1 DIF: Recall REF: p. 190 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 2. Which of the following should be done before disposing of a used anesthetic needle? a. Bend the needle. b. Recap the needle by hand. c. Recap the needle by the scoop technique. d. Pass it to someone else for recapping.

ANS: C

The scoop technique is the safest way to recap a needle. Passing the needle to someone else puts someone else at risk for an injury. Recapping the needle by hand is too dangerous because one can miss the cap and stick the finger or thumb holding the cap. Bending the needle is an unnecessary manipulation of a sharp which increases the risk for an injury.

PTS: 1 DIF: Application REF: p. 190 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 3. Which of the following techniques is a safe way to handle sharps? a. Hurry up and move quickly when disposing of a sharp so the time in handling the

sharp will be as short as possible. b. Use cotton pliers or tongs rather than your gloved fingers to pick up dropped

sharps. c. Have the bur facing out when placing the handpiece back into its holder. d. Use exam gloves when handling contaminated instruments during cleaning to get a

better feel of the items.

ANS: B

Hurrying increases the risk for an injury. Using cotton pliers or tongs prevents direct contact with the contaminated sharp. The bur should be facing in away from the operator.

Heavy utility gloves give better protection.

PTS: 1 DIF: Recall REF: p. 190 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 4. What should be done if you drop a contaminated anesthetic needle on the floor during

patient treatment at chairside? a. Pick it up immediately and place it on the instrument tray. b. Put on heavy utility gloves, pick it up and place it in the sharps container. c. Use tongs or cotton pliers to pick it up and place it on the instrument tray. d. Use tongs or cotton pliers to pick it up and place it in the sharps container.

ANS: D

Needles are not to be placed in instruments trays, for this means that someone else will have to handle that needle. Picking the needle up with gloved hands places your fingers at risk for a needlestick. Using tongs or cotton pliers prevents direct contact with the contaminated sharp and disposes of the needle properly.

PTS: 1 DIF: Application REF: p. 190 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 5. Sharps containers should be a. occasionally drained to remove any contaminated liquid. b. filled only 3/4 full before disposing. c. made of glass so contents are visible. d. periodically emptied and reused.

ANS: B

Sharps containers should never be drained for it increases the chance for spread of disease agents. Filling only 3/4 full prevents items from protruding from the top and causing injuries. Glass containers will break if dropped and release contaminants. These containers are disposable and should never be emptied and reused.

PTS: 1 DIF: Recall REF: p. 190 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 6. Sharps containers should be a. closed before moving them from one room to another in the office. b. filled full before disposing to be as efficient as possible. c. kept in the sterilizing room. d. periodically emptied and reused.

ANS: A

Closing the container prevents sharps from spilling if the container is dropped. Filling full increases the chance that sharps will protrude from the top presenting a risk for injury.

Sharps containers need to be placed wherever sharps are used or may be found. These containers are disposable and should never be emptied and reused.

PTS: 1 DIF: Recall REF: p. 190 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 7. Which of the following techniques is a safe way to handle sharps? a. Place instruments on the bottom of the ultrasonic cleaning chamber during

cleaning.

b. Sharpen instruments at chairside whenever possible. c. Recap an anesthetic needle after it’s removed from the syringe and before placing

it in the sharps container. d. Do not sharpen contaminated instruments.

ANS: D

It is not ideal to place instruments on the bottom of the ultrasonic cleaning chamber for cleaning and requires using the hands to retrieve them from the bottom of the chamber.

Sharpening contaminated instruments increases the chances for injury. Provide extra sterile instruments in the set-up rather than sharpening contaminated ones. Needles need to be recapped before being removed from the syringe.

PTS: 1 DIF: Recall REF: p. 190 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 8. Which of the following techniques is a safe way to handle sharps? a. Place instruments on the bottom of the ultrasonic cleaning chamber during

cleaning. b. Sharpen instruments at chairside whenever possible. c. Recap an anesthetic needle before it is removed from the syringe. d. Remove the anesthetic needle from the syringe and carefully bend it before

dropping it in a sharps container.

ANS: C

It is not ideal to place instruments on the bottom of the ultrasonic cleaning chamber for cleaning and requires using the hands to retrieve them from the bottom of the chamber.

Sharpening contaminated instruments increases the chances for injury. Provide extra sterile instruments in the set-up rather than sharpening contaminated ones. Recapping anesthetic needles helps prevent a needlestick when removing the needle from the syringe.

Removing an uncapped needle from the syringe and then bending it increases the chances for injury.

PTS: 1 DIF: Recall REF: p. 190 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 9. When could a sharps injury most likely occur? a. When operating the dry heat sterilizer b. When inserting a bur into the handpiece c. When cleaning and disinfecting a countertop d. When using a biological indicator ANS: B

Operating the dry heat sterilizer, cleaning and disinfecting a countertop, and using a biological indicator normally do not involve handling sharps. Burs are sharps and need to be handled carefully.

PTS: 1 DIF: Recall REF: p. 188 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 10. When could a sharps injury most likely occur? a. When operating the dry heat sterilizer b. When cleaning and disinfecting a countertop

c. When handling sterile packages of hand instruments d. When using a biological indicator ANS: C

Operating the dry heat sterilizer, cleaning and disinfecting a countertop, and using a biological indicator normally do not involve handling sharps. Instruments could be protruding through the packaging, so look before grabbing packages.

PTS: 1 DIF: Recall REF: p. 188 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 11. When could a sharps injury most likely occur? a. When hand instruments are placed back into the instrument tray b. When cleaning and disinfecting the light handle c. When using the high-volume evacuator d. When placing the patient bib ANS: A

Instruments could be protruding up from the tray, so look before placing the instrument.

Cleaning and disinfecting the light handle, using a high-volume evacuator, and placing the patient bib do not normally involve handling sharps.

PTS: 1 DIF: Recall REF: p. 188 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 12. The risk of acquiring which of the following infections is greatest after receiving a

percutaneous exposure to infected blood? a. Tuberculosis b. Hepatitis B c. Hepatitis C d. HIV-disease ANS: B

Tuberculosis is seldom bloodborne. The risk of hepatitis B is 37% to 62% if the blood is positive for both HBsAG and HBeAG. The risk for hepatitis C is 0% to 7%. The risk for HIV-disease is 0.3%.

PTS: 1 DIF: Recall REF: p. 191 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 13. A “Culture of Safety” is best defined as a. bacterial and viral cultures that have been sterilized. b. efforts made by the employer and employees to provide a safe work environment. c. a system to make patients feel as safe as possible during treatment. d. a video program supplied by numerous sales representatives to support purchase of

their products or equipment.

ANS: B

“Culture of Safety” refers to factors that influence overall attitudes and behavior in the office. A system to make patients feel as safe as possible during treatment is great to have but is not called a culture of safety. Neither sterilization of cultures nor video programs provided by sales representatives are a culture of safety.

PTS: 1 DIF: Recall REF: p. 187 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 14. What is an engineering control? a. An action that alters the manner in which a task is performed. b. A device that removes the potential hazard. c. A system that controls patient compliance with oral hygiene. d. A approach to positioning the patient’s head to minimize aerosolization of saliva

during use of the air/water syringe or high-speed handpiece.

ANS: B

A device that removes the potential hazard is an engineering control, for example a sharps container. An action that alters the manner in which a task is performed is a work practice control. An example would be an approach to positioning the patient’s head to minimize aerosolization of saliva during use of the air/water syringe or high-speed handpiece. A system that controls patient compliance with oral hygiene is an education system not an engineering control.

PTS: 1 DIF: Recall REF: p. 189 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 15. What is a work practice control? a. An action that alters the manner in which a task is performed. b. A devise that removes the potential hazard. c. A machine that kills microbes. d. An apparatus that controls to spread of microbes.

ANS: A

An example of a work practice control would be the one-handed scoop technique for recapping a used needle. A device that removes the potential hazard is an engineering control, for example an engineered medical device with sharps injury prevention features such as a protective needle sheath. Machines that kill microbes and apparatus that control the spread of microbes are engineering controls.

PTS: 1 DIF: Recall REF: p. 189 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 16. What is the safest approach to cleaning and managing contaminated hand instruments? a. Hand-scrubbing the instruments with a long-handled brush then placing them on

the bottom of an ultrasonic cleaner tank and ultrasonically cleaning them. b. Ultrasonic cleaning the instruments placed on the bottom of the cleaner tank then hand-scrubbing them with a long-handled brush. c. Ultrasonic cleaning in a cleaning basket. d. Ultrasonic cleaning them in instrument cassettes.

ANS: D

With the instruments in an instrument cassette, the direct handling of the instruments is eliminated or greatly reduced during processing. Hand-scrubbing the instruments or ultrasonic cleaning in a cleaning basket requires direct handling of sharps, which increases the risk for injuries.

PTS: 1 DIF: Recall REF: p. 190 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 17. Describe the OSHA-required exposure determination. a. Keeping a record of all bloodborne exposures that occur in a year. b. Placing a description of each bloodborne exposure in the employees medical file. c. Listing all tasks and procedures used in the facility in which occupational exposure

may occur. d. Documenting the qualifications of the health care professional providing medical

evaluation of exposed employees.

ANS: C

Keeping a record is not required by OSHA for dental offices. Placing a description of the exposure can occur but is not called an exposure determination. It is beneficial to list all tasks and procedures where exposure may occur in order to identify potential hazards in the workplace so they can be addressed. Documentation of qualifications is required but is not called an exposure determination.

PTS: 1 DIF: Recall REF: p. 187 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 18. What is a main beneficial result from a safety culture? a. Fewer x-ray retakes. b. Employees have less time off work. c. Less infection control supplies are used. d. Sterilizers and ultrasonic cleaners last longer.

ANS: B

Fewer x-ray retakes would not be a main benefit. A safety culture should decrease sharps injuries meaning less time off work for medical evaluations and recoveries. A safety culture might increase the use of infection control supplies. Sterilizers and ultrasonic cleaners may be used most in a safety culture and would not last longer.

PTS: 1 DIF: Recall REF: p. 187 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 19. Two patients are being seen on the same morning for multiply extractions. What is the

safest approach to administering their parenteral medications? a. Use a multidose vial for both patients. b. Replace the needle on the syringe before entering the multidose vial a second time. c. Use a single dose vial for each patient and combine any leftover material in case second infection is needed for one or both patients. d. Use single dose vials for each patient.

ANS: D

Single dose vials should be used whenever possible for the safest approach and the lease chance for cross-contamination. If a multidose vial is used both the needle and the syringe need to be replaced before reentering the vial. Leftover material from medication vials should never be combined for this increases the risk of spreading contaminants that may be present.

PTS: 1

DIF: Application

REF: p. 191

OBJ: 1

TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 20. According to the needlestick prevention portion of OSHA’s Bloodborne Pathogens

Standard, how often should a dental practice review the marketplace for safer medical devices designed to eliminate or minimize occupational exposure? a. Every month b. Bimonthly c. Every six months d. Annually ANS: D

The standard indicates this is to be done annually.

PTS: 1 DIF: Recall REF: p. 189 OBJ: 1 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols TRUE/FALSE 1. OSHA’s Needlestick Safety and Prevention Act requires that a dental office conduct an

annual consideration and implementation of appropriate commercially available and effective safer medical devices designed to eliminate or minimize occupational exposure.

ANS: T

This law provides additional safety from sharps injuries, but such commercial devices for dentistry are not readily available.

PTS: 1 DIF: Recall REF: p. 188 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 2. OSHA determined that offices and clinics of dentists are of a low hazard and do not have

to keep an OSHA injury and illness record unless the government ask for it.

ANS: T

But all employers still have to report any workplace incident that results in a fatality or the hospitalization of three or more employees.

PTS: 1 DIF: Recall REF: p. 189 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols

Chapter 20: A Clinical Asepsis Protocol Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. Environmental surface covers on clinical touch surfaces should be replaced a. after every two to three patients. b. just before lunch and at the end of the day. c. at the end of the day. d. after every patient.

ANS: D

Environmental surface covers should be replaced after every patient because they become contaminated with each patient. If covers are not replaced with every patient, then cross-contamination will always occur with the next patient.

PTS: 1 DIF: Recall REF: p. 199 OBJ: 2 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 2. After seating the patient, what personal protective barrier should be put on last? a. Mask b. Eyewear c. Gloves d. Gown ANS: C

The mask and eyewear are put on before gloving. After seating a patient, the gloves should be put on last because they will come in direct contact with the patient’s mouth. The gown should be put on before the patient is seated.

PTS: 1 DIF: Application REF: p. 198 OBJ: 2 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 3. Torn gloves should be replaced a. immediately. b. after the patient leaves. c. at the end of the day. d. before going to lunch or leaving the office.

ANS: A

Torn gloves should be removed immediately followed by hand hygiene because you want to wash off any patient materials that got through the glove as soon as possible. Later removal could result in the spread of microorganisms to the hand from the patients’ mouths.

PTS: 1 DIF: Recall REF: p. 198 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 4. Which of the following needs to be at chairside? a. Sterilizer

b. Sharps container c. X-ray unit d. Daylight loader ANS: B

The sterilizer needs to be in the sterilizing room to keep instrument processing away from the clinical area. A sharps container should be at chairside because used disposable needles and other sharps need to be disposed of as soon after their use by the person using the sharp. The X-ray unit is not required to be present at chairside for the patient can be moved to this unit. The daylight loader is not required to be present at chairside.

PTS: 1 DIF: Recall REF: p. 197 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 5. When leaving chairside to obtain a forgotten supply item, what barrier should be removed

and then replaced upon returning to the patient? a. Gloves b. Mask c. Eyeglasses d. Protective clothing ANS: A

Since contaminated gloves will spread microbes to all surfaces touched while away from the patient, they should be removed and replaced. Masks, eyeglasses, and protective clothing do not need to be removed because it does not have direct contact with the environment.

PTS: 1 DIF: Recall REF: p. 198 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 6. Aseptic retrieval means to a. escort the patient from the waiting room to the dental chair while wearing gloves. b. remove contaminated gloves before picking up dropped items from the floor at

chairside to avoid spreading patient materials to the floor. c. use an alcohol hand-rub on your gloves before touching surfaces away from the dental patient (e.g., telephone, doorknobs). d. obtain a single item from a container without contaminating the other items in the container.

ANS: D

The definition of aseptic removal is to obtain a single item from a container without contaminating the other items in the container. This can be accomplished by using sterile cotton pliers issues with each patient set-up. Wearing gloves while escorting the patient, removing contaminated gloves before picking up dropped items, and using alcohol hand-rub on gloves is not a valid definition for aseptic retrieval.

PTS: 1 DIF: Recall REF: p. 198 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 7. What personal protective equipment should be worn when preparing the operatory for a

patient? a. Gloves and protective clothing

b. Protective eyewear, mask, and protective clothing c. Gloves, protective eyewear, and protective clothing d. Protective clothing, protective eyewear, mask, and gloves ANS: D

Protective clothing, protective eyewear, mask, and gloves will protect the clothing, skin, eyes, nose, mouth, and hands.

PTS: 1 DIF: Recall REF: p. 197 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 8. What personal protective equipment needs to be worn when placing fresh surface covers

on previously cleaned and disinfected surfaces? a. Gloves, mask, protective eyewear b. Mask, protective clothing, protective eyewear c. Gloves, mask, protective eyewear, protective clothing d. None ANS: D

Personal barriers are not needed because the surfaces have already been cleaned and disinfected, but likely one will already have on protective clothing.

PTS: 1 DIF: Recall REF: p. 199 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 9. What should be done if an instrument is dropped on the floor during patient treatment? a. Pick it up, wipe it off with alcohol and continue using it. b. Use tongs to pick it up, wipe it off with alcohol and continue using it. c. Put on heavy utility gloves, pick it up, wipe it off with alcohol and continue using

it. d. Obtain a sterile replacement and continue.

ANS: D

Picking it up with exam gloves will contaminate the fingers from contact with the floor.

Also, alcohol is not a good disinfectant. Only sterile instruments are to be used in patient’s mouths.

PTS: 1 DIF: Recall REF: p. 198 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 10. What should be done if exposed to a patient’s saliva? a. Wait until after the patient leaves and thoroughly wash the exposed area. b. Immediately contact the supervisor to institute the postexposure medical

evaluation. c. At the end of that half-day clinic session immediately report to the nearest hospital

for evaluation. d. Stop, wash the exposed area and continue with patient treatment.

ANS: B

It’s important to request that the patient also be evaluated for hepatitis and HIV status. If you wait until after they leave, then this can’t be done. It’s important to receive evaluation as soon as possible, for if HIV prophylaxis is needed, it is the most effective if it can be administered as soon as possible.

PTS: 1 DIF: Recall REF: p. 198 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 11. What should be done to equipment that is brought to chairside (e.g., a curing light) during

patient treatment? a. Remove the exam gloves, put on fresh gloves, use the equipment and continue with patient treatment. b. Make sure the equipment has been cleaned and disinfected or protected with a fresh surface cover before use. c. Keep the exam gloves on, use the equipment then wipe it down with alcohol. d. Remove the exam gloves, used the equipment, put on fresh gloves, wipe the equipment with alcohol, resume patient treatment.

ANS: B

Fresh gloves can be contaminated when touching the equipment and this contamination transferred to the patient because the gloves were not changed. Making sure the equipment has been cleaned and disinfected or protected with a fresh surface cover assures that the equipment will not serve as a source of contamination. The exam gloves may become contaminated by touching the equipment, and will subsequently contaminate the patient if they are not changed. The equipment may contaminate the bare hands.

PTS: 1 DIF: Recall REF: p. 198 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 12. What type of gloves should be worn for instrument processing? a. Heavy utility gloves b. Nitrile exam gloves c. Powder-free latex gloves d. Vinyl exam gloves ANS: A

Heavy utility gloves give the hands good protection. Nitrile and vinyl exam gloves and powder-free latex gloves are fine for patient treatment but too thin for instrument cleaning.

PTS: 1 DIF: Recall REF: p. 199 OBJ: 4 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 13. Where should used needles be placed for disposal? a. In the regular trash in the clinic area b. In the instrument tray to be taken to the sterilizing room for disposal c. In a sharps container at chairside d. In a red bag marked with a biohazard symbol ANS: C

Needles in the regular trash will place the housecleaning staff at risk for a sharps injury.

Needles in the instrument tray will put the sterilizing room staff at risk for a sharps injury for they will have to handle the needle for disposal. Putting used needles in the sharps container at chairside is the safest way to dispose of the needle and any other disposable sharps. Needles can protrude through a red bag and put anyone who handles the bag at risk for a sharps injury.

PTS: 1 DIF: Recall REF: p. 198 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 14. How should the covered operatory surfaces be managed after a patient appointment? a. Remove your gloves, remove the surface covers and place them in the regular

trash. b. Keep your gloves on, remove the surface covers and place them in the regular

trash. c. Put on fresh gloves, remove the surface covers and place them in a biohazard bag. d. Put on fresh gloves, remove the surface covers, clean and disinfect those surfaces and discard the covers in the regular trash.

ANS: B

If the gloves are removed, the bare hands will be touching the contaminated covers. The gloves are already contaminated from patient treatment, so they can be used to remove the contaminated covers taking care not to touch the underlying surface. Since surface covers are never saturated with blood or saliva, they can be discarded into the regular trash. It’s not necessary to don fresh gloves because you will be touching contaminated covers. Also covers are not regulated medical waste and can be placed in the regular trash rather than a biohazard bag. It’s not necessary to clean and disinfect the covered surfaces because the covers prevented their contamination. Just replace the old covers with fresh ones.

PTS: 1 DIF: Recall REF: p. 199 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 15. What should be done to the contaminated high-speed handpiece after a patient

appointment? a. Flush water through it for 30 seconds, remove from the hose and proceed with proper cleaning and heat sterilization. b. Remove it from the hose, wipe it off with alcohol, put it in a sterilization bag and place it with the items that are ready for use on the next patient. c. Wipe it off with alcohol, cover it and the first 6 inches of the hose with a plastic cover and place it back in the holder. d. Remove it from the hose, wipe it off with alcohol, and proceed with heat sterilization.

ANS: A

The handpiece should be flushed and heat sterilized. The flushing helps remove any patient material that may have been retracted back into the handpiece.

PTS: 1 DIF: Application REF: p. 201 OBJ: 4 TOP: CDA, Infection Control, III.A. Instrument/device processing

16. The fit of a lower denture is being adjusted at chairside. After adjustment what should be

done to the denture before taking it into the laboratory for final polishing? a. Rinse it off with warm water. b. Heat sterilize it. c. Soak it in soapy water for 10 minutes. d. Disinfect it.

ANS: D

Rinsing is not adequate to kill microbes, so the laboratory equipment used will become contaminated. Heat sterilization will likely damage the denture. Soaking in soapy water is not adequate to kill microbes, so the laboratory equipment used will become contaminated.

Disinfection will make the denture safe to handle and will not contaminate the laboratory equipment used.

PTS: 1 DIF: Application REF: p. 202 OBJ: 7 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 17. After exposing x-ray films covered with plastic protective barriers how should one handle

the films before darkroom processing? a. Put on fresh gloves, remove the plastic barriers dropping the film packets into a paper cup and proceed to the darkroom. b. Remove the plastic barriers dropping the film packets into a paper cup and proceed to the darkroom. c. Remove the plastic barriers dropping the film packets into a paper cup, reglove and proceed to the darkroom. d. Remove the gloves, remove the plastic barriers dropping the film packets into a paper cup and proceed to the darkroom.

ANS: C

There is no reason to put on fresh gloves before the contaminated barriers are removed.

Fresh gloves need to be donned before entering the darkroom. After removing the gloves, the bare hands should not be touching the contaminated plastic barriers.

PTS: 1 DIF: Application REF: p. 201 OBJ: 5 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 18. What’s the correct procedure for placing fresh surface covers on previously covered

operatory surfaces between patients? a. Remove the old covers without touching the underlying surface and place the fresh covers. b. While wearing gloves remove the old covers without touching the underlying surface, remove the gloves, perform hand hygiene and place the fresh covers. c. Remove the gloves, perform hand hygiene, remove the old covers without touching the underlying surface and place the fresh covers. d. Remove the gloves, perform hand hygiene, remove the old covers without touching the underlying surface, perform hand hygiene, don fresh gloves and place the fresh covers.

ANS: B

Contaminated gloves should not be used to place the fresh covers. If the surface is not contaminated, bare hands are used to place the fresh covers. Bare hands should not be used to remove the contaminated covers. Bare hands should not be used to remove the contaminated covers. Also, gloves are not needed to place fresh covers on uncontaminated surfaces.

PTS: 1 DIF: Application REF: p. 199 OBJ: 7 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 19. When should a newly hired dental assistant receive training on the infection control

procedures used? a. During their first participation in the overall infection prevention program evaluation b. Just before caring for their first infectious patient c. After their first exposure incident d. At the time of initial appointment ANS: D

Training at the time of initial appointment gives the training before they have a chance to have an occupational exposure. After this is too late.

PTS: 1 DIF: Application REF: p. 195 OBJ: 6 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 20. What document is required by OSHA to be readily available for each hazardous material

present in the facility? a. Exposure control plan b. Exposure determination descriptions c. Safety data sheet d. Exposure incident report ANS: C

The exposure control plan, exposure determination descriptions, and exposure incident relates to exposure to bloodborne pathogens rather that to hazardous materials.

PTS: 1 DIF: Recall REF: p. 195 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 21. Respiratory hygiene and cough etiquette for the patients should be first implemented in

what area of the dental facility? a. Clinical operatories b. Restrooms c. Reception area d. Offices ANS: C

Respiratory hygiene and cough etiquette should be implemented in all areas of the office, nut the patients need to be informed immediately when they enter the facility.

PTS: 1 DIF: Recall REF: p. 196 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission

Chapter 21: General Office Asepsis Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. The Occupational Safety and Health Administration (OSHA) requires employers to

provide specific training to their healthcare employees on a. strep throat. b. chickenpox and shingles. c. bloodborne diseases. d. herpes labialis.

ANS: C

OSHA does not require specific training on strep throat, chickenpox, shingles, or herpes labialis, because they are not considered as important occupational diseases. One of OSHA’s standards is the Bloodborne Pathogens Standard which required employee training on bloodborne diseases such as hepatitis and human immunodeficiency virus disease.

PTS: 1 DIF: Recall REF: p. 205 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 2. Which OSHA standard requires training on how to safely handle chemicals in the office? a. Bloodborne Pathogens Standard b. Hazard Communication Standard c. Ionizing Radiation Standard d. Exit Routes Standard ANS: B

The Bloodborne Pathogens Standard relates to certain infectious diseases, not to chemicals. The Hazard Communication Standard relates to handling hazardous chemicals.

The Ionizing Radiation Standard relates to safely using x-ray equipment. The Exit Routes Standard relates to emergency evacuations of facilities.

PTS: 1 DIF: Recall REF: p. 205 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 3. Which of the following contributes most to disease spread in patient and employee

restrooms? a. Use of bar soap b. Use of paper towels for drying hands c. Use of liquid soap containers d. Hands-free soap dispenser ANS: A

Bar soaps are handled by everyone who wash their hands. Contaminants on the bar can be spread to others. Paper towels are single use items, and although they are not usually sterile, they are manufactured by a heat process and usually are low in microbial counts.

With liquid soap containers, fresh liquid soap is dispensed for each person, so contamination is not spread from person to person. Hands-free soap dispensers are the best way to dispense soap.

PTS: 1 DIF: Recall REF: p. 207 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 4. Of all those who may enter a dental office clinic area, who most would need instruction on

infection prevention? a. Dental assistants b. Dental hygienists c. Dental students d. Patient family members ANS: D

Dental professionals should already have a good understanding of infection prevention.

Patient family members should be instructed on what they can and cannot touch and provided appropriate personal protective equipment.

PTS: 1 DIF: Recall REF: p. 207 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 5. An experienced temporary dental assistant new to the office needs what type of training on

the first day in the office? a. Information on where the safety items are located in the office b. The complete hazard communication standard training c. The specific blood borne pathogens standard training d. No training is needed for an experienced assistant ANS: A

Information on the location of safety items should include where the PPE, MSDS, eyewash stations, exits and fire extinguishers are located; a description of the emergency evacuation route; who to contact in case of an exposure. Dental professionals should already have a good understanding of infection prevention.

PTS: 1 DIF: Application REF: p. 205 OBJ: 1 TOP: CDA, Infection Control, V.A. Occupational safety/administrative protocols 6. What surfaces in the waiting room need to be kept clean? a. All surfaces b. The reception window area c. The magazines d. The chairs ANS: A

All surfaces in the waiting room need to be kept clean. Patients can’t see microbes, but they can see dust, fingerprints, smudges, cobwebs and dirt, and they can feel sticky surfaces.

PTS: 1 DIF: Recall REF: p. 205 OBJ: 2 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 7. The CDC guidelines for environmental infection control that relate to the dental office

reception area include suggestions on a. disinfecting all surfaces twice a day. b. preventing patients with respiratory diseases from entering the office. c. properly managing flowers and potted plants so they will not adversely affect patients. d. installing UV-lights to sanitize the air.

ANS: C

It is not necessary to disinfect all surfaces twice a day, and is not a part of the specific guidelines. It is not appropriate to prevent patients with respiratory diseases from entering the office. Some patients, particularly those who are immunosuppressed can be adversely affected by flowers and plants. It is not a part of the guidelines to install UV-lights to sanitize the air.

PTS: 1 DIF: Recall REF: p. 206 OBJ: 2 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 8. Fans should not be used in clinical areas or sterilizing rooms because they a. draw in air contaminants and dust and widely redistribute them throughout the

area. b. are too noisy. c. use excessive electricity. d. are distracting to the staff.

ANS: A

Microbes are in the air, and fans blow them over all the nearby surfaces and cause their continual circulation. Noise, electricity use, and distraction are not the main reasons why fans should not be used.

PTS: 1 DIF: Recall REF: p. 207 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 9. Why should warm air hand driers not be used in the dental office? a. They draw in air contaminants and blow them right on one’s previously washed

hands. b. They are too noisy and use excessive electricity. c. They are esthetically unpleasing. d. They are too expensive.

ANS: A

The object of handwashing is to remove or kill transient microbes on the skin, and warm air hand driers re-contaminate the clean hands. Noise, electricity uses, esthetics, and expense are not the main reasons why this item should not be used.

PTS: 1 DIF: Recall REF: p. 207 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 10. How does dental unit water become so highly contaminated?

a. The incoming city or well water becomes highly contaminated by the time it

reaches the office, so this contamination just passes through the dental unit. b. Contaminated room air enters through the tip of the air/water syringe and the bur

hole of high-speed hand pieces contaminating the water spray as it exits the waterline. c. Biofilm builds up in the waterlines and contaminates the water as it flows through the line. d. All of the microbes in dental unit water come from patients’ saliva that has been retracted back into the line through the high-speed hand pieces.

ANS: A

The incoming water usually has only low levels of microbes. Any room air that might enter the system would not contain enough microbes to match what can be present in dental unit water. The low level of microbes present in incoming water continually inoculates the dental unit waterlines allowing the waterborne microbes to attach to the inside of the lines and form a biofilm that releases large numbers of microbes into the flowing water. Although some oral microbes are retracted back into the system, the vast majority of microbes in the water are waterborne microbes that enter in the incoming water and accumulate as biofilm.

PTS: 1 DIF: Recall REF: p. 207 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 11. The International Sanitary Supply Association reports that most of the dirt that is present

in a building comes from a. the air handling system. b. air coming in through various vents in the building. c. people’s shoes. d. air coming in through open windows and doors.

ANS: C

Everyone who enters has dirt on the bottoms of their shoes. The air handling system only recirculates whatever dirt is in the air. Air coming through vents, or through open windows and doors would be only minor components.

PTS: 1 DIF: Recall REF: p. 208 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 12. According to the International Sanitary Supply Association about 85% of the dirt that

enters a building can be eliminated by a. thoroughly washing the floors weekly. b. using and maintaining proper floor mats. c. by having all air ducts cleaned annually. d. by cleaning the furnace cleaned monthly.

ANS: B

It is good to wash the floors weekly, clean air ducts annually, and clean the furnace monthly, but would not take care of the main problem. Since most of the building dirt is brought in on people’s shoes, the best approach is to have a scraper mat, followed by an absorption mat and a finishing mat.

PTS: 1 DIF: Recall REF: p. 208 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 13. What needs to be confirmed from an infection control point of view when the office

receives a prosthesis from an outside dental laboratory? a. The cost of any infection control supplies used by the laboratory b. The blood borne infectious disease status of all laboratory employees c. The number of laboratory employees that have received the hepatitis B vaccination series d. The decontamination status of the prosthesis ANS: D

The cost of infection control supplies is private information. The bloodborne infectious disease status and hepatitis B vaccination status are confidential medical information. It is important to determine if the prosthesis needs to be cleaned and disinfected before placing the patient’s mouth.

PTS: 1 DIF: Application REF: p. 208 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 14. What does the CDC have that might help prevent the spread of respiratory diseases in the

waiting room? a. Vaccine against the common cold b. Their own brand of facial tissues c. Posters about covering your cough d. The blood borne pathogens standard ANS: C

There is no vaccine against the common cold. The CDC does not provide any products.

The bloodborne pathogens standard is an OSHA standard. The CDC provides posters titled “Cover Your Cough” and “Germ Stoppers.”

PTS: 1 DIF: Recall REF: p. 206 OBJ: 2 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 15. A “Boil Water Notice” usually occurs when a. there is a break in a nearby water main. b. the sterilizer malfunctions. c. a staff person has to use the eye wash station because of a disinfectant splash in the

eyes. d. the high-volume evacuator vacuum line becomes clogged.

ANS: A

A break in a water main will draw in microbes from the dirt around the break which will contaminate all the water downstream. Sterilizer malfunctions, use of the eye wash station, and clogging of the vacuum line are all unrelated to a “Boil Water Notice.”

PTS: 1 DIF: Recall REF: p. 206 OBJ: 4 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 16. What item should be placed in the dental office reception area to comply with CDC’s

cough etiquette/respiratory hygiene recommendation?

a. b. c. d.

Disinfectant wipes Spray disinfectant and paper towels Alcohol hand-rub Protective clothing

ANS: C

Disinfectant wipes, spray disinfectant, paper towels, and protective clothing are not suggested by the CDC. Hands are an important mode of spread of respiratory pathogens.

PTS: 1 DIF: Recall REF: p. 206 OBJ: 2 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 17. What item should be placed in the dental office reception area to comply with CDC’s

cough etiquette/respiratory hygiene recommendation? a. Surface barriers b. Protective eyewear c. Examination gloves d. Facial tissues ANS: D

Surface barriers, protective eyewear, and examination gloves are not suggested by the CDC. Facial tissues held over the mouth and nose when coughing help reduce the spread of respiratory pathogens.

PTS: 1 DIF: Recall REF: p. 206 OBJ: 2 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 18. What is the best way to evaluate the cleanliness of a dental office? a. Ask the patients their opinion of the office cleanliness. b. Have a dental supply sales representative review the disinfection procedures. c. Perform a walk-through observing all areas of the office. d. Estimate the number of infection control supplies used weekly.

ANS: C

Patients do not necessarily see all areas of the office. There are more than just disinfection procedures related to office cleanliness. A walk through will allow observation of all the office areas. The number of infection control supplies used does not necessarily relate to cleanliness of all office areas.

PTS: 1 DIF: Recall REF: p. 208 OBJ: 5 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 19. What is a reasonable method of reducing the spread of respiratory pathogens in the dental

facility? a. Test all incoming people for respiratory agents. b. Institute source control. c. Give EVERYONE who enters the facility an oral examination. d. Issue a pair of examination gloves to everyone who enters the facility.

ANS: B

There are not quick tests for all respiratory pathogens. An oral examination may not detect a respiratory disease. Gloving will not protect against droplet or airborne spread of respiratory secretions. Source control reduces the spread of respiratory agents by providing a mask to everyone in the facility.

PTS: 1 DIF: Comprehension REF: p. 207 OBJ: 2 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 20. Who is responsible for training housekeeping staff about the general aspects of infection

control and about bloodborne pathogens? a. Their original employer b. OSHA c. They are required to train themselves d. EPA ANS: A

OSHA can provide training but this agency is not responsible for training these persons.

The EPA is not equipped or responsible for infection control, training. Self-training would be extremely variable. The Bloodborne Pathogens Standard requires employers to provide the training to employees who may undergo exposure to bloodborne agents.

PTS: 1 DIF: Recall REF: p. 207 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols

Chapter 22: Greener Infection Control Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. What is a good first step in developing an eco-friendlier infection control program? a. Change procedures for sterilizing instruments b. Inventory all infection control practices c. Establish a timeline for implementation d. Purchase different brands of PPE ANS: B

Changing procedures for sterilizing instruments, establishing a timeline for implementation, or purchasing different brands of PPE may be done but not as a first step.

A list of all infection control procedures will allow assessment and evaluation of your program to determine if changes can made to be more kind to the environment.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 211

OBJ: 5

2. “Going green” is best defined as a. changing office procedures to reduce sharps injuries and blood and saliva

exposures to the eyes, mouth and skin. b. using products and procedures that have lower adverse impacts on health and the environment than the regular products and procedures. c. saving money by looking for less expensive infection control products. d. updating the entire infection control program in the office.

ANS: B

“Going Green” relates to both the environment and human health. Changing office procedures to reduce injuries and exposures, saving money, and updating the infection control program are all good activities but do not relate to “Going Green.”

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 210

OBJ: 1

3. A very important consideration when “Going Green” is that the greener procedure a. does not compromise infection control. b. takes less time to perform. c. meets with the approval the local dental school. d. is approved by OSHA. ANS: A

Green infection control procedures must still accomplish disease prevention. Saving time is not a primary consideration. Dental schools have no authority over private dental offices. OSHA does not give approval of greener procedures, but the procedure must not violate OSHA rules.

PTS: 1

DIF: Recall

REF: p. 210

OBJ: 1

TOP: CDA, Does not apply 4. After development and implementation of an infection prevention program with reduced

environmental impact, what should be done? a. Inform OSHA of the new program. b. Inform the CDC of the new program. c. Review and monitor the program. d. Determine a time to switch back to the non-green program.

ANS: C

OSHA and the CDC do not need to know this information. It would not be reasonable to plan to switch back to the old program. Review and monitoring will ensure that all issues have been addressed and it the desired effects are being accomplished.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 211

OBJ: 5

5. Which of the following greenhouse gases is the most prominent in causing adverse

effects? a. Carbon dioxide b. Methane c. Nitrous oxide d. Hydrofluorocarbons ANS: A

These gases are generated in a variety of ways including humans breathing, the burning of fossil fuels (coal, oil, natural gas), and some manufacturing processes.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 210

OBJ: 2

6. What is the greenhouse effect? a. The cooling off of the lower layers of earth’s atmosphere at night after the Sun sets b. As the sun warms the earth some of this heat escapes back into space, but the rest

is trapped in the atmosphere by greenhouse gases and water vapor c. The formation of dew on grass and other plants when the ground is warmer than the air d. Destruction of the “good” ozone layer in the upper atmosphere by greenhouse gases ANS: B

The cooling of the earth’s atmosphere occurs every night and has nothing to do with greenhouse gases. The CO2 and other greenhouse gases trap the infrared radiation (heat) being reflected from the earth. The formation of dew has nothing to do with greenhouse gases. Ozone depleting substances (ODS) such as chlorine can destroy the ozone layer.

Greenhouse gases are not ODS. The CO2 and other greenhouse gases trap the infrared radiation (heat) being reflected from the earth.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 210

OBJ: 2

7. The more greenhouse gases in the atmosphere the more heat that is retained on earth. This

is referred to by some as a. ozone depletion. b. biodegradation. c. ozone (smog) formation. d. global warming.

ANS: D

Ozone depletion is caused by aerosol propellants, coolants and some solvents containing chlorine and bromine. Biodegradation is the action of bacteria and fungi or chemical materials. Ozone is formed when volatile organic compounds (e.g., gasoline vapors) react with oxides of nitrogen in the presence of sunlight. Some believe that the greenhouse effect is causing global warming.

PTS: 1 DIF: Application TOP: CDA, Does not apply

REF: p. 210

OBJ: 2

8. What is the main component of smog? a. Carbon dioxide b. Nitrogen c. Ozone d. Methane ANS: C

Carbon dioxide is a greenhouse gas that traps heat in the atmosphere. Nitrogen is an important component of air. Ozone is formed when volatile organic compounds (e.g., gasoline vapors) react with oxides of nitrogen in the presence of sunlight. Methane is a greenhouse gas that traps heat in the atmosphere.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 210

OBJ: 2

9. How many molecules of ozone in the upper atmosphere are destroyed by one molecule of

chlorine? a. 100,000 b. 10,000 c. 1000 d. 100 ANS: A

Sunlight generates chlorine from some solvents, aerosol propellants, and coolants. The chlorine destroys the ozone in the upper atmosphere causing more UV-light to reach the earth. 10,000, 1,000, and 100 are all too low.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 211

10. How is ozone in the upper atmosphere beneficial to earth? a. It destroys greenhouse gases. b. It destroys smog. c. It filters out most of the Sun’s UV radiation. d. It causes biodegradation.

OBJ: 2

ANS: C

Ozone does not destroy greenhouse gases. Ozone in the lower atmosphere is the main component of smog. It filters 95% to 99% of the UV-light from the Sun. Bacteria cause biodegradation.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 211

OBJ: 2

11. What are the three “R” of going green? a. Ration, reactive, recycle b. Recover, reuse, refer c. Reduce, reuse, recycle d. Retention, retrain, reduce ANS: C

Reduce the use of products and generated waste; reuse things when appropriate; recycle materials so they can be reused.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 211

OBJ: 1

12. Biodegradation is best defined as a. the breakdown of materials by microbes in the environment. b. the formation of smog. c. the depletion of ozone in the upper atmosphere. d. the degradation of greenhouse gases.

ANS: A

Most, but not all biodegradation is beneficial. Smog (mostly ozone at ground level) comes from the interaction of volatile organic compounds, oxides of nitrogen and sunlight.

Certain chemicals containing chlorine or bromine interact with sunlight releasing the chlorine or bromine which destroys ozone in the upper atmosphere. The degradation of greenhouse gasses is not a good definition of biodegradation.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 211

OBJ: 3

13. The term “recycled” on a product label means that the product a. can be recycled. b. cannot be recycled. c. is made of recycled materials. d. is not made of recycled materials.

ANS: C

“Recycled” can relate to the product or its packaging material. “Recyclable” indicates that the item can be recycled.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 211

OBJ: 3

14. Which of the following logos refers to the Environmental Protection Agency’s and

Department of Energy’s program to rate the energy efficiency of products and equipment? a. LEEDS b. DfE Certified c. EPP d. Energy Star ANS: D

LEEDS stands for Leadership in Energy and Environmental Design. DfE Certified stands for Design for the Environment. EPP stands for the Environmentally Preferable Purchasing Program. Energy Star refers to the energy efficiency (e.g., how much electricity is used) of equipment.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 211

OBJ: 4

15. Which of the following refers to a third-party certification program in the US for products

that meet specific standards? a. LEEDS b. DfE Certified c. Green Seal d. EPP ANS: C

LEEDS stands for Leadership in Energy and Environmental Design. DfE Certified stands for Design for the Environment. Green Seal refers to a program that is accredited by the American National Standards Institute. EPP stands for the Environmentally Preferable Purchasing Program.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 211

OBJ: 4

16. Why should regular cloth towels (that are reusable) not be used as sterilization wrap? a. They are too expensive. b. They are not good microbial barriers. c. They wear out too fast. d. They catch fire in a steam sterilizer.

ANS: B

If used and reused they would be less expensive than cleared sterilization wraps. The weave in cloth lets microbe through which would contaminate the items inside. Also sterilization packaging materials are considered medical devices and their manufacturing and sale in the US must be cleared by the Food and Drug Administration. It is not the case that they wear out too fast or would catch fire in a steam sterilizer.

PTS: 1 DIF: Recall REF: p. 212 OBJ: 5 TOP: CDA, Infection Control, III.A. Instrument/device processing 17. Which of the following would be an appropriate “green” procedure in the dental office? a. Reusing regular cloth as sterilization wrap—would reduce waste and add less

plastic to the environment. b. Use cloth towels in the restrooms that are replaced daily—this would reduce waste.

c. Use digital radiography—this would reduce the waste from using regular film

packets and eliminate the chemicals needed for developing films. d. Reuse disposable air/water syringe tips—this would reduce waste volume and add

less plastics to the environment.

ANS: C

Regular cloth is not a good microbe barrier. When several people use the same cloth towel, microbes are easily spread from person to person. Plastic air/water syringe tips cannot be adequately cleaned and sterilized between patients. Items labeled as disposable must not be reused. Digital radiography would reduce the waste from using regular film packets and eliminate the chemicals needed for developing films.

PTS: 1 DIF: Recall REF: p. 212 OBJ: 5 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 18. Which of the following would be an inappropriate green procedure? a. Carefully open paper plastic sterilization pouches and reuse them by taping them

closed. b. Use refillable soap dispensers and other containers. c. Always run full instrument loads through cleaning units and sterilizers. d. Purchase supplies that are packaged in recycled materials.

ANS: A

Standard sterilization pouches are cleared by the Food and Drug Administration only as single use items. Make sure to clean out soap dispensers before refilling—for just topping them off will perpetuate any contamination present. Running full loads does not apply to emergency needs of a small number of instruments. An office may not have a choice of alternative products.

PTS: 1 DIF: Recall REF: p. 212 OBJ: 5 TOP: CDA, Infection Control, III.A. Instrument/device processing 19. How would using more alcohol hand-rubs be greener than handwashing? a. It would eliminate the use of heavy utility gloves for instrument processing. b. It would eliminate the use of examination gloves at chairside. c. It would reduce the risk of needlestick injuries. d. It would save water.

ANS: D

Alcohol hand-rubs would have no effect on the use of utility gloves, examination gloves, or needlestick injuries. Handwashing requires water for rinsing, use of alcohol hand-rubs does not.

PTS: 1 DIF: Application REF: p. 213 OBJ: 5 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 20. What would be a green procedure without compromising infection control? a. Always run full rather than partial instrument loads through the sterilizer. b. Use reusable plain cloth towels as sterilization wrap. c. Use washable cloth towels for drying the hand after handwashing. d. Reuse the paper/plastic sterilization pouches.

ANS: A

Always running full instrument loads help reduce the number of loads and saves energy.

Plain cloth is not a good microbe barrier, so infection control would be compromised.

Multiuse cloth towels enhance the chances for cross-contamination, so infection control would be compromised. Reusing paper/plastic sterilization pouches may compromise their barrier properties, so infection control would be compromised.

PTS: 1 DIF: Application REF: p. 212 OBJ: 5 TOP: CDA, Infection Control, III.A. Instrument/device processing TRUE/FALSE 1. It’s difficult to identify an infection control procedure that would improve the

environment.

ANS: T

Most have a negative effect—increased waste, spread of harmful chemicals, or deleterious effects on humans.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 210

OBJ: 2

2. Recycling is reported to reduce emission of greenhouse gases and water pollutants by

minimizing the manufacturing process from virgin materials.

ANS: T

Recycling saves energy, supplies and valuable raw materials and reduces the need for disposal facilities such as landfills.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 211

OBJ: 3

Chapter 23: Home Hygiene Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. A reasonable solution to deal with contaminated work shoes is to a. wash the shoes at the end of each day. b. disinfect the shoes at the end of each day. c. leave your work shoes at work. d. sterilize the shoes at the end of each day.

ANS: C

Washing, disinfecting, and sterilizing is not practical and may damage the shoes. Leaving your work shoes at work leaves the contamination at work rather than taking it home.

PTS: 1 DIF: Application REF: p. 215 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 2. The CDC recommends that healthcare workers with which of the following diseases be

restricted from patient contact? a. Hepatitis A or periodontal disease b. Shingles or pediculosis c. Rubella or dental caries d. Chickenpox or periapical infection ANS: B

Hepatitis A is communicable, but not periodontal disease. Pediculosis and the virus that causes shingles could be spread to others. Rubella may be communicable but not dental caries. Chickenpox is communicable but not periapical infections.

PTS: 1 DIF: Recall REF: p. 215 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 3. What disease was spread to 51 people by the household cook Mary Mallon? a. Hepatitis B b. Measles c. Influenza d. Typhoid ANS: C

Hepatitis B is a bloodborne disease. Measles and influenza are spread by respiratory contamination. Typhoid is a foodborne disease. Typhoid, caused by strains of Salmonella, is spread through the fecal-oral route, and Mary Mallon (also called “Typhoid Mary”) was an asymptomatic carrier and a cook with poor hygiene.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 216

OBJ: 2

4. What’s the maximum time perishable food should be allowed to sit out at room

temperatures below 90F? a. 2 hours b. 3 hours c. 4 hours d. 5 hours ANS: A

The number of bacteria that can multiply within 2 hours is usually not harmful. If the room temperature is above 90F, 1 hour is the maximum. Any longer than 2 hours, and too many bacteria may be present in the food allowing a greater chance for illness when the food is eaten.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 217

OBJ: 3

5. Which of the following has the highest minimum cooking temperature time? a. Beef stakes b. Fresh ham c. Poultry d. Ground beef ANS: C

Beef steaks and ground beef require a temperature of 160F, which is lower than that for poultry. Fresh ham requires a temperature of 145F, which is lower than that for poultry.

Poultry requires a temperature is 165F. PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 216

OBJ: 3

6. Things at the office that will be taken home (e.g., purses, containers, packages,

nonprotective outer clothing, boots, and garment bags) should not be handled with contaminated hands and should a. be steam sterilized before taking home. b. be soaked in a disinfectant for 15 minutes before taking home. c. be stored in a nonclinical area while at work. d. be ultrasonically cleaned before taking home.

ANS: C

Steam sterilization, soaking in disinfectant, or ultrasonic cleaning will likely destroy the items. Storage in a nonclinical area will help prevent their contamination.

PTS: 1 DIF: Application REF: p. 216 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 7. What is protective clothing? a. It’s whatever you wear in to work. b. It’s whatever you wear home after work. c. It’s what you put on at work to cover whatever your wear in to work. d. It’s what you put on when you are leaving the office during the daytime (e.g., for

lunch).

ANS: C

What you wear in to work, or what you wear home from work is called street clothes or work clothes. Protective clothing is contaminated should not be worn out of the office.

Protective clothing is what becomes contaminated at work, so it needs to cover street clothes, work clothes, undergarments, and skin.

PTS: 1 DIF: Recall REF: p. 215 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 8. How should protective clothing be managed? a. It should be taken home in a plastic bag and laundered in hot soapy water. b. It can be worn home and laundered separately from other items in hot soapy water. c. It should be places in a red biohazard bag and taken to the local Laundromat for

washing. d. It needs to be laundered in the office or sent out to a laundry service.

ANS: D

OSHA indicates that the employer is responsible for cleaning protective clothing (or having cleaned), so it cannot be taken home for laundering or be worn out of the office.

Protective clothing is not to leave the office unless it is being sent to a medical laundry.

PTS: 1 DIF: Recall REF: p. 215 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 9. If you use an alcohol hand rub throughout the day, what should you do at the end of the

day? a. Use a final alcohol hand rub to be sure microbes on the hands are not taken home. b. Take the alcohol hand rub product home to continue good hand hygiene. c. Wash your hands with soap and water, rinse and dry. d. Spray your hands with the surface disinfectant used in the office and rinse them well.

ANS: C

Using a final alcohol hand rub will kill microbes but will not remove the sweat and glove materials that have built up on your hand during the day. Taking the alcohol hand rub home would be stealing. Washing and rinsing your hands removes the sweat and glove materials that have built up on your hand during the day and reduces the chance of adverse reactions to these materials. Never put a surface disinfectant on your hands. They are not designed for this and may damage your skin.

PTS: 1 DIF: Application REF: p. 215 OBJ: 1 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 10. Things taken to work (e.g., purses, gifts, lunch containers, packages, nonprotective outer

clothing, boots, and garment bags) should be properly managed by a. wiping off or spraying the items with a disinfectant immediately after they enter the office. b. rubbing an alcohol hand rub over the items to kill any microbes. c. informing the patients of these contaminated items not regularly present in the

office. d. keeping them out of the clinical areas.

ANS: D

Spraying items with disinfectant or rubbing with alcohol hand rub will likely damage the items. It is not necessary or appropriate to inform patient. Keeping items out of clinical areas will help prevent microbes from home contaminating patients and clinical equipment and supplies.

PTS: 1 DIF: Application REF: p. 216 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 11. What happens to unopened good quality hamburger stored in the refrigerator? a. Nothing. b. It will eventually spoil. c. It simply ages and tastes better when cooked. d. All the contaminating microbes will die.

ANS: B

The meat will spoil. Hamburger is highly contaminated with microbes that continue to slowly grow at cold temperatures. The meat does age, but contains very high numbers of microbes. The microbes will not die.

PTS: 1 DIF: Application TOP: CDA, Does not apply

REF: p. 216

OBJ: 4

12. Which of the following raw foods can be safely stored in a refrigerator for the longest

time? a. Hot dogs b. Luncheon meats c. Ground meats d. Sausage ANS: A

If opened, hot dogs they can be stored for 1 week and unopened for 2 weeks. Lunch meats are ok for just 3 to 5 days. Ground meats and sausage are ok for just 1 to 2 days.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 217

OBJ: 4

13. How should food taken into the office be handled? a. If using a microwave to reheat lunches, heat to 165F, and carefully follow any

heating instructions on prepackaged items. b. Be sure to add fresh food to a platter that already has food on it. c. Use the same cutting board for produce, meats, poultry and boiled eggs to keep

any microbes from being to other surfaces. d. If the food is frozen, thaw it at room temperature to speed up the process.

ANS: A

Reaching 165F helps assure microbes have been killed. Any contaminated food on the platter will contaminate the fresh food. Use new platters with fresh food. If one food item is contaminated, using the same cutting board will spread the contamination to the other foods. Foods should be thawed in the refrigerator to slow down growth of microbes during the thawing process.

PTS: 1 DIF: Application TOP: CDA, Does not apply

REF: p. 217

OBJ: 3

14. What shouldn’t be done if you have a respiratory infection (e.g., the common cold) to

reduce the spread of disease agents? a. Touch only drawer knobs and door pulls in the kitchen and not the silverware. b. Don’t share hand or bath towels with others in the family. c. Don’t use bar soaps. d. Cover your mouth and nose when sneezing.

ANS: A

Avoid touching all “common touch” surfaces in the kitchen and elsewhere. Any multiuse item can easily spread microbes to others. Covering your mouth and nose when sneezing reduces the spread of disease agents.

PTS: 1 DIF: Application TOP: CDA, Does not apply

REF: p. 217

OBJ: 4

15. Which of the following will help reduce the spread of microbes? a. Be sure to completely fill partially empty liquid soap containers to minimize the

amount of air in the container. b. Don’t set your purse down in clinical areas at work on in the kitchen at home. c. Rinse off bar soaps after each use at work and at home. d. When cleaning sinks and toilet bowls start work with the bottom surfaces and work

your way up to the top surfaces.

ANS: B

Always clean and rinse soap containers before refilling to get rid of any contaminants that may be present. The bottoms of purses are commonly contaminated. Bar soaps should not be used at all, for they are multiuse items that can spread disease. Most of the contamination is at the bottom of these sinks and toilet bowls, so starting at the bottom will spread more microbes to the top.

PTS: 1 DIF: Recall REF: p. 215 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 16. You had several nice comments from patients about the bright flowered top you wore at

chairside. What should you do with that top before going out to lunch? a. Nothing. b. Leave it at the office. c. Cover it with a coat or cape. d. Wipe of off with a disinfectant wipe.

ANS: B

The top is contaminated and should not be worn out of the office. It remains contaminated even if covered. Wiping the top off is not adequate to remove or kill all contaminants.

PTS: 1 DIF: Application REF: p. 215 OBJ: 1 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission TRUE/FALSE 1. Do not prepare your lunch the night before taking it into the office.

ANS: F

This is fine if the lunch is placed in the refrigerator immediately after being prepared.

PTS: 1 DIF: Application TOP: CDA, Does not apply

REF: p. 217

OBJ: 3

2. A dental assistant with conjunctivitis should be restricted from patient contact.

ANS: T

Some eye infections (referred to as pink eye) are contagious.

PTS: 1 DIF: Recall REF: p. 216 TOP: CDA, Infection Control, Does not apply

OBJ: 2

3. Most raw foods are seldom contaminated with microbes.

ANS: F

Foods that haven’t been thoroughly cleaned or through some heat process are still contaminated when they reach our homes and kitchens.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 216

OBJ: 4

4. Keep meat, poultry, seafood and eggs and their juices away from ready-to-eat foods during

preparation, in the grocery bags and in the refrigerator.

ANS: T

Contamination from one item can spread to other items if not kept separate.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 216

OBJ: 4

5. Once foods have been cooked to the proper temperature, they can be left out at room

temperature uncovered or up to 5 hours.

ANS: F

Perishable foods should not be left at room temperature for more than 2 hours.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 216

OBJ: 4

6. When serving food at an office party don’t add fresh food to a platter that already had food

in it.

ANS: T

The platter and remaining food may be contaminated from sitting out and possibly touched by several people. Distribute the food in small platters, and when needed set out fresh platters of food that have been stored hot or cold.

PTS: 1 DIF: Application TOP: CDA, Does not apply

REF: p. 217

OBJ: 4

Chapter 24: Occupational Safety and Health Administration Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. What is OSHA’s mission? a. To test and approve all products used for infection control b. To determine the hazards of all chemicals and issue material safety data sheets for

those chemicals c. Enforce protective workplace safety and health standards and to provide

information, training, and assistance to employers and workers d. To protect patients in healthcare facilities from infectious diseases and hazardous

chemicals ANS: C

Developing and enforcing mandatory job safety and health standards informs the employers and employees what must be done to provide occupational safety. No governmental agency tests and approves all products for infection control. Determination of hazards and issuing material safety data sheets for those chemicals is the responsibility of the manufacturer. OSHA is charged with protecting the workers of America not patients.

PTS: 1 DIF: Recall REF: p. 220 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 2. What is one part of OSHA’s mission? a. To test and approve all products used for infection control b. Establish training programs to increase competence of occupational safety and

health personnel c. To determine the hazards of all chemicals and issue material safety data sheets for

those chemicals d. To protect patients in healthcare facilities from infectious diseases and hazardous

chemicals ANS: B

Establishing training programs to increase competence of occupational safety and health personnel educates people on occupational safety. No governmental agency tests and approves all products for infection control. Determination of hazards and issuing material safety data sheets for those chemicals is the responsibility of the manufacturer. OSHA is charged with protecting the workers of America not patients.

PTS: 1 DIF: Recall REF: p. 220 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 3. OSHA standards do not apply to a. dental assistants or dental hygienists in a private practice. b. employers with 11 or more employees. c. self-employed persons. d. workers in state supported universities.

ANS: C

OSHA is designed to protect employees. This includes dental assistants and hygienists in private practice, as well as workers in state supported universities.

PTS: 1 DIF: Recall REF: p. 220 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 4. OSHA is a part of the United States Department of a. The Treasury. b. Health and Human Services. c. Labor. d. Defense.

ANS: C

The United States Departments of the Treasury, Health and Human Services, and Defense do not relate specifically to protecting employees. OSHA relates to work (labor) performed by employees.

PTS: 1 DIF: Recall REF: p. 220 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 5. About ________________ occupational diseases occur in the US each year? a. 300,000 b. 30,000 c. 3000 d. 300 ANS: A

300,000 diseases occur in our workers of America. The other figures are too low.

PTS: 1 DIF: Recall REF: p. 220 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 6. The main publication for all OSHA information is the a. Journal of the American Dental Association. b. Federal Register. c. Morbidity and Mortality Weekly Report. d. Consumers Report.

ANS: B

Journal of the American Dental Association is the official publication of the ADA. Federal Register is a daily publication from the Federal government. Morbidity and Mortality Weekly Report is the official publication of the CDC. Consumers Report is a private publication.

PTS: 1 DIF: Recall REF: p. 221 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 7. An OSHA standard requires employers to a. pay for all medical care received by their employees who are past age 65. b. maintain conditions or adopt practices reasonably necessary and appropriate to

protect workers on the job. c. find jobs for all those employees who are fired because of incompetence. d. provide at least one sick and one personal day per month and 3 to 4 weeks of vacation each year.

ANS: B

It is not possible for employers to pay for all medical care received by their employees who are past age 65. Some of this is provided by Medicare and Medicaid. OSHA is charged with protecting workers of America and they do this through the development of standards. Finding jobs for fired employees is not a part of the standards. Most employers provide sick, vacation, and personal days, but these are not part of OSHA standards.

PTS: 1 DIF: Recall REF: p. 221 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 8. An OSHA standard requires employers to a. pay for all medical care received by their employees who are past age 65. b. be familiar with and comply with standards applicable to their establishments. c. find jobs for all those employees who are fired because of incompetence. d. provide at least one sick and one personal day per month and 3 to 4 weeks of

vacation each year.

ANS: B

It is not possible for employers to pay for all medical care received by their employees who are past age 65. Some of this is provided by Medicare and Medicaid. OSHA requires employers to protect their employees by issuing standards. Finding jobs for fired employees is not a part of the standards. Most employers provide sick, vacation, and personal days, but these are not part of OSHA standards.

PTS: 1 DIF: Recall REF: p. 221 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 9. An OSHA standard requires employers to: a. pay for all medical care received by their employees who are past age 65. b. ensure that employees have and use personal protective equipment when required

for safety and health. c. find jobs for all those employees who are fired because of incompetence. d. provide at least one sick and one personal day per month and 3 to 4 weeks of vacation each year.

ANS: B

It is not possible for employers to pay for all medical care received by their employees who are past age 65. Some of this is provided by Medicare and Medicaid. OSHA requires employers to protect their employees by issuing appropriate personal protective equipment. Finding jobs for fired employees is not a part of the standards. Most employers provide sick, vacation, and personal days, but these are not part of OSHA standards.

PTS: 1 DIF: Recall REF: p. 220 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 10. Under what situation does OSHA’s General Duty Clause apply to the workplace? a. When a new employee is hired

b. When an employee is exposed to a patient’s blood or saliva c. When a specific standard does not exist for a hazardous situation d. When an employee is exposed to a hazardous chemical ANS: C

Hiring of new employees does not relate to the General Duty Clause. The Bloodborne Pathogens standard covers exposure to blood or saliva. The General Duty Clause is a “catch-all” clause that applies when already existing standard do not. The Hazard Communication Standard covers exposure to hazardous chemicals.

PTS: 1 DIF: Recall REF: p. 221 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 11. The National Institute for Occupational Safety and Health is a division of what

governmental agency? a. OSHA b. FDA c. CDC d. EPA ANS: C

OSHA works with NIOSH but it is a division of the CDC. It is not a part of the FDA or EPA. NIOSH conducts research on safety and health in the workplace and works with OSHA in developing standards.

PTS: 1 DIF: Recall REF: p. 221 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 12. What is a characteristic of state OSHA job safety and health plans? a. Can be less stringent than the Federal OSHA plan. b. Are not allowed. States must use the Federal OSHA plan. c. Can be more stringent than the Federal OSHA plan. d. Must have the exact same requirements as the Federal OSHA plan.

ANS: C

Development of State plans is encouraged by Federal OSHA. State plans must be approved by Federal OSHA and must be at least as stringent as the Federal OSHA plan, but can be more stringent.

PTS: 1 DIF: Recall REF: p. 222 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 13. OSHA-approved State job safety and health plans cover what types of employees? a. All employees in the state b. Only the Federal employees who work in the state c. Just the state and local government employees d. Most private sector employees and state and local government employees ANS: D

Federal employees who work in the state are covered by the Federal OSHA standard, which also covers private sector employees.

PTS: 1 DIF: Recall REF: p. 222 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 14. One of the goals of the US Department of Labor’s Strategic plan for 2018 to 2022 is to a. promote safe jobs and fair workplaces for all Americans. b. pay for medical expenses of everyone over age 65. c. investigate all disease outbreaks reported to local health agencies. d. decrease the number of small businesses in the US. ANS: A

The No.1 goal is to prepare workers for good jobs. Payment for medical expenses of everyone over age 65 is partially taken care of by Medicare and Medicaid. Reduction in the number of small businesses and investigation of disease outbreaks are not goals.

PTS: 1 DIF: Recall REF: p. 222 OBJ: 5 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols

Chapter 25: Occupational Safety and Health Administration Inspections Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. Which of the following best describes the “general duty clause”? a. Is part of the Occupational Safety and Health Act of 1970 b. Allows the FDA to recall miss-branded medical devices c. Permits the EPA to test dental office water samples without prior notice d. Converts CDC recommendations to enforceable laws ANS: A

The general duty clause is a “catch-all” rule from OSHA. It is not related to the FDA, EPA or CDC. PTS: 1 DIF: Recall REF: p. 224 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 2. There are several infection control problems in this dental office, and the dental assistant

wants OSHA to conduct an on-site inspection rather than conduct a phone interview. What should she do? a. Call to OSHA. b. Have a fellow worker fax OSHA. c. Send a written signed complaint to OSHA. d. Send an anonymous e-mail message to OSHA. ANS: C

OSHA standards dictate a written signed complaint. Phone calls, faxes, and emails will not be accepted.

PTS: 1 DIF: Application REF: p. 224 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 3. From whom will OSHA take complaints against a dental office? a. Employers b. Employees c. Patients d. Employees and patients ANS: D

Complaints from both employees and from patients are accepted. Complaints will not be taken from employers.

PTS: 1 DIF: Recall REF: p. 224 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 4. After receiving a formal, written, signed complaint, what will OSHA do? a. All complaints are followed up by an on-site inspection b. Stage an inquiry c. Usually nothing

d. Either do nothing, stage an inquiry or conduct an on-site inspection ANS: D

Depending how serious the alleged hazard may be, OSHA may do nothing, stage an inquiry or conduct an on-site inspection.

PTS: 1 DIF: Application REF: p. 225 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 5. During an OSHA on-site inspection which of the following is likely to occur? a. Only the hazard listed in the complaint will be inspected. b. All areas that could involve hazards for employees will be investigated. c. Other areas that could be hazardous to employees in addition to the hazard listed in

the complaint may be investigated. d. Only one other hazard (in addition to the original hazard listed in the complaint) will be considered for investigation if a violation is suspected.

ANS: C

The investigation of other areas that could be hazardous to employees allows for other hazards noticed during the inspection to be investigated.

PTS: 1 DIF: Application REF: p. 225 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 6. An OSHA inspector is conducting an on-site investigation in a dental office. What would

be detrimental to the outcome of the inspection? a. Ask the inspector for credentials. b. Accompany the inspector during the walk-through. c. Refuse to divulge any past accidents or incidents even if asked by the inspector. d. Photographically record all areas inspected.

ANS: C

The inspector likely has the past records and would know if lying occurs. You should ask the inspector for credentials, accompany him/her during the walk-through, and photographically record all areas inspected.

PTS: 1 DIF: Application REF: p. 225 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 7. Most OSHA inspections of dental offices involve complaints about the bloodborne

pathogens standard and a. fire prevention. b. hazard communication. c. emergency exits. d. personal protective equipment.

ANS: B

Hazard communication information is provided by OSHA. Fire prevention, emergency exits, and PPE standards are less frequently violated.

PTS: 1 DIF: Recall REF: p. 226 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols

8. OSHA’s system of inspection priorities starts with Imminent Danger, and Catastrophes

and Fatal Accidents followed in order by a. Complaints and Referrals; Programmed inspections; Follow-up Inspections. b. Follow-up Inspections; Programmed Inspections; Complaints and Referrals. c. Programmed Inspections; Follow-up Inspections; Complaints and Referrals. d. Complaints and Referrals; Follow-up Inspections; Programmed Inspections.

ANS: A

The worst situations come first. Programmed Inspections and Follow-up Inspections may not involve current hazard violations. Programmed Inspections are more serious than Follow-up Inspections.

PTS: 1 DIF: Recall REF: p. 224 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 9. How do you file a hazard-related complaint with OSHA? a. Describe the complaint in an e-mail and OSHA will perform an on-site inspection. b. Request an official complaint form from OSHA, complete it, send it in and OSHA

will follow up. c. Describe the complaint over the phone and OSHA will perform an on-site

inspection. d. Fax OSHA a letter describing the complaint and OSHA will perform and on-site

inspection.

ANS: B

An OSHA-7 form (official complaint from) must be completed before anything can happen.

PTS: 1 DIF: Recall REF: p. 224 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 10. What type of complaint should be filed with OSHA by a dental assistant who was fired

because she told her employer that he needed to supply the gloves, masks and protective eyewear and clothing she is to use at chairside? a. A catastrophe complaint b. A discrimination complaint c. An imminent danger complaint d. A programmed inspection complaint ANS: B

Catastrophe, imminent danger, or programmed inspection are is not a specific OSHA violations. A discrimination complaint should be filed if an employer has punished an employee for exercising any employee rights established under the OSHA Act or for refusing to work when faced with an imminent danger of death or serious injury and there is insufficient time for OSHA to inspect.

PTS: 1 DIF: Application REF: p. 225 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 11. How does OSHA decide the order in which the complaints received are investigated? a. They are addressed on a “first come first served” basis.

b. The order is based upon the inspector’s availability. c. The alleged violations that are potentially the most serious are investigated first. d. There is no particular order.

ANS: C

OSHA ranks complaints based on the severity of the alleged hazard and the number of employees exposed.

PTS: 1 DIF: Recall REF: p. 225 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 12. What information will OSHA review prior to an on-site inspection? a. The medical records of the patients involved on the day or days of the alleged

violations. b. A police background check on the person who made the complaint. c. The financial assets of the employer involved to make sure he/she can pay any fines that may be assessed. d. Facts about the workplace, such as its OSHA-inspection history, the nature of the business, and the particular standards that might apply.

ANS: D

Medical records are confidential and would not relate to OSHA standards. Police background checks are not indicated by OSHA. Review of the financial assets of the employer is not indicated by OSHA. Facts such as OSHA-inspection history, the nature of the business, and particular standards that might apply provide general background information about the work site.

PTS: 1 DIF: Recall REF: p. 225 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 13. When an OSHA inspector enters the office, what will usually occur first? a. An opening conference for the inspector to explain what the inspection will

involve. b. Interviews with all patients in the office to see if they have ever observed any

OSHA violations. c. Demand that the employer vacant the office. d. Conduct the walk-through.

ANS: A

Before an inspection, the inspector will conduct an opening conference during which the purpose of the visit and what to expect during the inspection are explained. Patients will not be interviewed, and the office will not be vacated. The walk-through is done after the opening conference.

PTS: 1 DIF: Recall REF: p. 225 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 14. What should the employer do if the office receives an accurate citation (notice of

violation) from OSHA? a. Wait for 30 days then contact OSHA and demand the name of the person who made the complaint. b. Pursue abatement.

c. Wait for a second notice. d. Ask the employees who made the complaint and suspend that employee without

pay for the period of time it takes to correct the violations.

ANS: B

A delay will not change the situation, and the complainant may have requested anonymity.

If an employer agrees with the citation, he or she must correct the situation (complete abatement) by the date set and pay the penalty (if any). Waiting for a second notice will not change the situation. Suspension against the employee who made the complaint will be an OSHA-discrimination violation and institute another OSHA investigation.

PTS: 1 DIF: Application REF: p. 226 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 15. An employer who does not agree with an OSHA citation (notice of violation) should a. ignore the citation. b. wait 30 days then send OSHA a completed and signed “Notice of Intent to

Contest” form. c. send a written petition to OSHA within 15 days. d. mark the citation “False” and immediately return it to OSHA. ANS: C

Ignoring the citation will not make it go away. The “Notice of Intent to Consent” must be sent to OSHA within 15 days of the citation. A written petition must be sent within 15 days of the citation to meet the OSHA requirement. Marking the citation “False” will do nothing.

PTS: 1 DIF: Application REF: p. 226 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 16. What is meant when an OSHA citation indicated there has been a willful violation? a. That a workplace hazard exists that could cause injury or illness that would most

likely result in death or serious physical harm, unless the employer did not know or could not have known of the violation. b. That the violation has no direct or immediate relationship to safety or health. c. A situation in which the most serious injury or illness that would most likely occur from the hazardous condition cannot reasonably cause death or serious illness. d. The employer knew that a hazardous condition (which violated a standard) existed but made no reasonable effort to eliminate it.

ANS: D

A workplace hazard exists that could cause injury or illness that would most likely result in death or serious physical harm is referred to as a Serious Violation. Violations that have no direct or immediate relationship to safety or health are referred to as De Minimis Violations. A situation in which the most serious injury or illness that would most likely occur from the hazardous condition cannot reasonably cause death or serious illness is referred to as an Other Than Serious Violation. The employer knowing that a hazardous condition (which violated a standard) existed but made no reasonable effort to eliminate it is referred to as a Willful Violation.

PTS: 1

DIF: Application

REF: p. 227

OBJ: 3

TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 17. What is meant when an OSHA citation indicated there has been a serious violation? a. That a workplace hazard exists that could cause injury or illness that would most

likely result in death or serious physical harm, unless the employer did not know or could not have known of the violation. b. That the violations have no direct or immediate relationship to safety or health. c. A situation in which the most serious injury or illness that would most likely occur from the hazardous condition cannot reasonably cause death or serious illness. d. The employer knew that a hazardous condition (which violated a standard) existed but made no reasonable effort to eliminate it.

ANS: A

A workplace hazard exists that could cause injury or illness that would most likely result in death or serious physical harm is referred to as a Serious Violation. Violations that have no direct or immediate relationship to safety or health are referred to as De Minimis Violations. A situation in which the most serious injury or illness that would most likely occur from the hazardous condition cannot reasonably cause death or serious illness is referred to as an Other Than Serious Violation. The employer knowing that a hazardous condition (which violated a standard) existed but made no reasonable effort to eliminate it is referred to as a Willful Violation.

PTS: 1 DIF: Application REF: p. 227 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 18. What is meant when an OSHA citation indicated there has been a De Minimis citation? a. That a workplace hazard exists that could cause injury or illness that would most

likely result in death or serious physical harm, unless the employer did not know or could not have known of the violation. b. That the violations have no direct or immediate relationship to safety or health. c. A situation in which the most serious injury or illness that would most likely occur from the hazardous condition cannot reasonably cause death or serious illness. d. The employer knew that a hazardous condition (which violated a standard) existed but made no reasonable effort to eliminate it.

ANS: B

A workplace hazard exists that could cause injury or illness that would most likely result in death or serious physical harm is referred to as a Serious Violation. Violations that have no direct or immediate relationship to safety or health are referred to as De Minimis Violations. A situation in which the most serious injury or illness that would most likely occur from the hazardous condition cannot reasonably cause death or serious illness is referred to as an Other Than Serious Violation. The employer knowing that a hazardous condition (which violated a standard) existed but made no reasonable effort to eliminate it is referred to as a Willful Violation.

PTS: 1 DIF: Application REF: p. 227 OBJ: 3 TOP: CDA, Infection Control, III.A. Demonstrate an understanding of the standards and guidelines of occupational safety for dental office personnel 19. Which of the following will be the most helpful in preventing a visit from OSHA? a. Making sure all patient records are complete and properly protected

b. Periodically sending OSHA the office’s spore testing records c. Keeping a list of all medications prescribed d. Designate an office safety coordinator ANS: D

It is a good idea to make sure all patient records are complete and properly protected but is not related to preventing an OSHA visit. OSHA should not be sent spore testing records.

This related to the CDC, local state boards of health or dentistry boards. It is a good idea to keep a list of all medications prescribed but is not related to preventing an OSHA visit. A safety coordinator can oversee office safety; make necessary changes that prevent violations; and maintain the safety of the dental team and patients.

PTS: 1 DIF: Application REF: p. 227 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 20. Which of the following will be the most helpful in preventing a visit from OSHA? a. Post the “Job Safety and Health” poster b. Periodically sending OSHA the office’s spore testing records c. Keeping a list of all medications prescribed d. Making sure all patient records are complete and properly protected ANS: A

It is a good idea to make sure all patient records are complete and properly protected but is not related to preventing an OSHA visit. OSHA should not be sent spore testing records.

This related to the CDC, local state boards of health or dentistry boards. It is a good idea to keep a list of all medications prescribed but is not related to preventing an OSHA visit.

The poster gives information to employees about workplace hazards and how they can file complaints.

PTS: 1 DIF: Application REF: p. 227 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 21. Which of the following will be the most helpful in preventing a visit from OSHA? a. Keeping a list of all medications prescribed b. Periodically sending OSHA the office’s spore testing records c. Monitor safety and health compliance by conducting in-house inspections d. Making sure all patient records are complete and properly protected ANS: C

It is a good idea to make sure all patient records are complete and properly protected but is not related to preventing an OSHA visit. OSHA should not be sent spore testing records.

This related to the CDC, local state boards of health or dentistry boards. It is a good idea to keep a list of all medications prescribed but is not related to preventing an OSHA visit. In house inspections can detect workplace hazards before they cause injury.

PTS: 1 DIF: Application REF: p. 227 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 22. Which of the following will be the most helpful in preventing a visit from OSHA? a. Making sure all patient records are complete and properly protected b. Make employee training is up-to-date c. Keeping a list of all medications prescribed

d. Periodically sending OSHA the office’s spore testing records ANS: B

It is a good idea to make sure all patient records are complete and properly protected but is not related to preventing an OSHA visit. OSHA should not be sent spore testing records.

This related to the CDC, local state boards of health or dentistry boards. It is a good idea to keep a list of all medications prescribed but is not related to preventing an OSHA visit.

OSHA requires training on bloodborne pathogens and hazardous chemicals.

PTS: 1 DIF: Application REF: p. 227 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 23. Who issued the hazard communication standard that dental offices must follow? a. FDA b. CDC c. OSHA d. EPA ANS: C

FDA regulates food, drugs, cosmetics and medical devices. Exit routes relate to preventing physical injuries during emergencies. CDC relate to disease prevention and investigation.

EPA relates to environmental concerns involving waste, chemicals and drinking water.

PTS: 1 DIF: Recall REF: p. 226 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 24. Choose the government agency to contact when the insulation on the electrical cord of the

dry heat sterilizers becomes worn and the employer says: “it’ll be OK”? a. EPA b. CDC c. OSHA d. FDA ANS: C

EPA relates to environmental concerns involving waste, chemicals and drinking water.

CDC relate to disease prevention and investigation of infectious disease outbreaks. OSHA relates to workplace hazards. FDA regulates food, drugs, cosmetics and medical devices.

PTS: 1 DIF: Application REF: p. 224 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols

Chapter 26: Management of the Office Safety Program Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. Which of the following tasks should be performed by a member of the dental team other

than the office safety coordinator? a. Call delinquent accounts. b. Maintain smoke alarms and fire extinguishers. c. Conduct sterilizer spore tests. d. Maintain the certification of radiographic equipment.

ANS: A

Calling delinquent accounts would be a task for a front office person. Safety coordinators would maintain smoke alarms and fire extinguishers, conduct sterilizer spore tests, and maintain the certification of radiographic equipment.

PTS: 1 DIF: Recall REF: p. 230 OBJ: 1 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 2. Which of the following tasks should be performed by a member of the dental team other

than the office safety coordinator? a. Manage disposal of regulated medical waste. b. Decontaminate equipment before shipping for repair. c. Organize and maintain MSDS. d. Make appointment reminder calls to patients.

ANS: D

A safety coordinator would manage disposal of regulated medical waste, decontaminate equipment before shipping for repair, and organize and maintain MSDS. A front office worker would make appointment reminder calls.

PTS: 1 DIF: Recall REF: p. 230 OBJ: 1 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 3. Which of the following tasks should be performed by a member of the dental team other

than the office safety coordinator? a. Keep exit doors and evacuation routes clear. b. Manage the updating of the exposure control plan. c. Call patients for re-scheduling of appointments. d. Monitor the availability of personal protective equipment.

ANS: C

The safety coordinator would keep exit doors and evacuation routes clear, manage the updating of the exposure control plan, and monitor the availability of PPE. A front office person would call patients to reschedule appointments.

PTS: 1 DIF: Recall REF: p. 230 OBJ: 1 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols

4. Which of the following would erode patients’ trust regarding infection control procedures

in the office? a. Let patients see you wash your hands or use an alcohol hand-rub. b. Put on your gloves in front of patients. c. Encourage questions about infection control procedures. d. Don’t wear gloves during treatment.

ANS: D

Patients today expect the dental team to be wearing gloves. Letting patients see you wash your hands or use and alcohol hand-rub, putting gloves on in front of patients, and encouraging questions about infection control procedures should be a part of the step-by-step safety and infection control procedures maintained by the safety coordinator.

PTS: 1 DIF: Application REF: p. 235 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 5. Which of the following is an example of infection control overkill? a. Cleaning surfaces before disinfecting them b. Cleaning and disinfecting surfaces after removing contaminated surface barriers c. Packaging instruments before sterilizing them d. Placing used anesthetic carpules in sharps containers for disposal ANS: B

Cleaning surfaces after before disinfecting, packaging instruments before sterilizing, and placing used anesthetic carpules in sharps containers for disposal should be a part of the step-by-step safety and infection control procedures maintained by the safety coordinator.

The covering of surface barriers eliminates the need to disinfect.

PTS: 1 DIF: Recall REF: p. 236 OBJ: 2 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 6. One approach to measuring quality assurance of a particular infection control procedure is

to use the 4-step process of PLAN, DO, CHECK and a. POMOTE. b. DISMISS. c. ACT. d. ANALYZE. ANS: C

Promote, dismiss, and analyze are not part of this evaluation procedure. After Planning, Doing, and Checking one must Act to make any necessary changes identified to improve the process and then monitor the new procedure to ensure continuous compliance.

PTS: 1 DIF: Recall REF: p. 233 OBJ: 1 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 7. A successful infection control evaluation program includes developing standard operating

procedures, assessing performance of infection control procedures, monitoring health care-associated diseases in patients and documenting a. infection control knowledge of the patients.

b. patient appointment failures. c. numbers of delinquent patient accounts. d. adverse outcomes and work-related illnesses.

ANS: D

Infection control knowledge does not apply to program evaluation. Patient appointment failures and delinquent patient accounts are unrelated to program evaluation. Adverse outcomes and work-related illnesses help determine if certain diseases may be transmitted in the office.

PTS: 1 DIF: Recall REF: p. 232 OBJ: 3 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 8. Which of the following office documents comes from a specific CDC recommendation? a. Tuberculosis infection control plan b. Exposure control plan c. Hazard communication plan d. Infection control training records ANS: A

A tuberculosis infection control plan is recommended by the CDC. An exposure control plan is required by OSHA’s Bloodborne Pathogens Standard. A hazard communication plan is required by OSHA’s Hazard Communication Standard. Infection control training records are required by OSHA’s Bloodborne Pathogens Standard.

PTS: 1 DIF: Recall REF: p. 232 OBJ: 2 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 9. The title of an OSHA poster required to be posted in every dental office is a. “Safety for All.” b. “Germ Stoppers.” c. “Job Safety and Health.” d. “Cover Your Cough.”

ANS: C

“Job Safety and Health” is an OSHA-required poster. “Cover Your Cough” and “Germ Stoppers” are posters available from the CDC. “Safety for All” sounds good, but is not correct.

PTS: 1 DIF: Recall REF: p. 232 OBJ: 2 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 10. Where should the safety signs stating “Remove Your PPE” and “Decontaminate Your

Hands” be posted to be most effective? a. On the staff bulletin board b. In the dental operatory c. In the lunchroom d. Reception area ANS: C

They are too specific for the bulletin board. It would be confusing to have them in the dental operatory. All PPE needs to be removed before entering the lunchroom, and hand hygiene is important there as well. Patients don’t need to see signs stating to remove PPE. PTS: 1 DIF: Recall REF: p. 231 OBJ: 2 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 11. Where should the safety signs stating “Dirty,” “Clean,” “Not Ready” be promoted to be

most effective? a. On the staff bulletin board b. In the sterilizing room c. In the lunch room d. Reception area ANS: C

Such signs can help prevent the intermingling of dirty and sterile instruments in the sterilizing room. They don’t relate well to the lunch room, and would be confusing to patients. They are too specific for the bulletin board.

PTS: 1 DIF: Recall REF: p. 231 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 12. What needs to be measured to achieve the evaluation outcome of “the infection control

procedure is being performed correctly”? a. Is the OSHA-required annual infection control training provided to all staff? b. Does surface asepsis include precleaning prior to disinfection? c. What surface disinfectant is being used to clean up visible blood and saliva? d. Has the Exposure Control Plan been updated?

ANS: B

Training is not a specific infection control procedure. Surface asepsis including precleaning prior to disinfection does relate to a procedure and how it is performed. The choice of surface disinfectant relates to using the proper product not a procedure. Updating the Exposure Control Plans is not related to a specific infection control procedure.

PTS: 1 DIF: Application REF: p. 232 OBJ: 3 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 13. How would you best document that used anesthetic needles are being recapped safely by a

newly hired dental assistant? a. Have the assistant read the SOP. b. Directly observe the assistant recapping needles. c. Ask the assistant how needles are to be recapped. d. Ask others in the office how the assistant recaps needles.

ANS: B

Reading the SOP does not document how the recapping is actually being performed.

Direct observation is the most reliable procedure. Response to asking about the procedure may not be reliable.

PTS: 1

DIF: Application

REF: p. 233

OBJ: 3

TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 14. How might one evaluate the use of personal protective equipment in the office? a. Observe and document circumstances of appropriate and inappropriate hand

hygiene. b. Review the use of barrier precautions and careful handling of sharps. c. Ensure the post-exposure management plan is understood by all office staff and

that the exposure evaluation procedures are available at all times. d. Conduct an annual review of the exposure control plan for documentation of new

developments in safety devices.

ANS: B

Observing and documenting circumstances of appropriate and inappropriate hand hygiene would evaluate hand hygiene. Review of the use of barrier precautions and careful handling of sharps helps evaluate use of PPE. Ensuring that the post-exposure management plan is understood by all office staff and that the exposure evaluation procedures are available at all times evaluates the post-exposure medical evaluation plan.

Conducting an annual review of the exposure control plan for documentation of new developments in safety devices evaluates the availability and review of engineered safety devices such as injection needles with protective sheaths.

PTS: 1 DIF: Application REF: p. 234 OBJ: 3 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 15. A new dental assistant has been hired to help you in the sterilizing room. What document

would you have the new person read to review the proper procedures for instrument sterilization? a. The office’s written Exposure Control Plan required by OSHA b. The OSHA Hazard Communication Standard c. The OSHA Bloodborne Pathogens Standard d. The CDC’s infection control guidelines ANS: D

OSHA does not cover sterilization of dental instruments because this relates to patient safety not worker safety. CDC covers infection control procedures for both dental staff and for patients, and instrument sterilization relates to patient safety.

PTS: 1 DIF: Application REF: p. 234 OBJ: 2 TOP: CDA, Infection Control, III.A. Instrument/device processing 16. How does the CDC recommend that a dental office’s infection control program be

managed? a. By complying with the management approach described in the Hazard Communication Standard b. By following with the Bloodborne Pathogens Standard Exposure Control Plan c. By assigning an infection-control coordinator d. By hiring a third-party consultant knowledgeable in infection control procedures to review the program monthly ANS: C

The Hazard Communication Standard is from OSHA and involves the safe handling of hazardous chemicals. The Bloodborne Pathogens Standard Exposure Control Plan is an OSHA-required document that mainly involves procedures not management. The CDC recommends assigning a person (e.g., dentist or other dental health care personnel) knowledgeable or willing to be trained to coordinate the program. The CDC does not recommend hiring a third-party consultant.

PTS: 1 DIF: Application REF: p. 229 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 17. Which of the following would be a good dental team safety topic for a dental office staff

meeting? a. Review of patient appointment cancellations. b. Comparison of prices charged by various near-by dental laboratories. c. Listing the advantages and disadvantages of manual and mechanical toothbrushes. d. Describing various ways exposures may occur.

ANS: D

Review of patient appointment cancellations doesn’t relate to dental team safety.

Comparison of prices charged by various near-by dental laboratories doesn’t relate to dental team safety. Listing the advantages and disadvantages of manual and mechanical toothbrushes doesn’t relate to dental team safety. Describing various ways exposures may occur clearly relates to dental team safety.

PTS: 1 DIF: Recall REF: p. 232 OBJ: 2 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 18. How would an OSHA inspector evaluate a dental office’s Exposure Control Plan if the

plan’s most recent update was 2 years ago? a. Not acceptable because OSHA states it should be updated monthly. b. Not acceptable, because OSHA states it should be updated at least every 6 months. c. Not acceptable, because OSHA states it should be updated at least annually. d. Acceptable, because OSHA states it should be updated at least every 2 years.

ANS: C

It’s not acceptable because it needs to be updated annually.

PTS: 1 DIF: Application REF: p. 233 OBJ: 2 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 19. You have been assigned to evaluate the office’s infection control program. What strategy

will provide the best approach to this assignment? a. Use the CDC’s infection prevention checklists coupled with direct observation of performance. b. Review the training received by the office staff to ensure all important area of infection prevention have been covered. c. Interview all staff asking how they perform office safety procedures. d. Make sure that the OSHA-required Exposure Control Plan is up to date.

ANS: A

The checklist describes how procedures should be performed and direct observation shows how they are being performed. Training reviews can be done but should not be the only approach. Making sure that the OSHA-required Exposure Control Plan is up to date should be done but is not the only approach. Staff interviews may not be a reliable approach to actual performance.

PTS: 1 DIF: Application REF: p. 233 OBJ: 4 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 20. Who should develop and maintain a culture of safety in the facility? a. The employer b. The entire team c. The clinical staff d. The dental assistants ANS: B

The entire team is to develop and maintain the safety culture for this gives, input, ownership, control and compliance to everyone. If just the employer, clinical staff or dental assistants develop the program, other points of view may not be considered.

PTS: 1 DIF: Application REF: p. 233 OBJ: 2 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 21. What is of paramount importance in maintaining the proper functioning of infection

control equipment like sterilizers and instrument cleaning equipment? a. Practice using the item at least 3 weeks before actually used for clinical care. b. Follow the manufacturer’s instructions for use. c. Buy the most expensive brand of the equipment. d. Make sure back-up equipment is available.

ANS: B

Practicing use or the item is important but not for a set time. Sometime the most expensive item does not guarantee longevity. Making sure back-up equipment is available is important, but that does not affect longevity of the original equipment. Following manufacturer’s instructions allow proper use of the item which promote longevity.

PTS: 1 DIF: Application REF: p. 235 OBJ: 4 TOP: CDA, Infection Control, III.B. Instrument/device processing TRUE/FALSE 1. Developing written step-by-step procedures on safety and infection control promotes

performance of and compliance with the procedures and helps with training of new team members.

ANS: T

Having these in the written format serves as the basis for developing, performing, monitoring and evaluating office safety procedures.

PTS: 1 DIF: Recall REF: p. 232 OBJ: 2 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols

Chapter 27: Managing Chemicals Safely Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. The purpose of the Hazard Communication Standard is to a. make sure that employers are able to reprimand employees without being sued in a

court of law. b. have HIV-positive patients inform health-care workers of their HIV status. c. to ensure that hazards of all chemicals produced or imported be evaluated and that employers transmit the information concerning such hazards directly to employees. d. require employers to protect employees from being contaminated with patients’ body fluids during all work activities.

ANS: C

It is not part of the standard to make sure employers are able to reprimand employees. It is not part of the standard to have HIV-positive patients inform health-care workers of their status. It is not stated in the standard that the hazards of chemicals are evaluated and that information concerning their hazards is transmitted to employers and employees.

Requiring employers to protect employees from being contaminated with patients’ body fluids during all work activities is part of the Bloodborne Pathogens Standard.

PTS: 1 DIF: Recall REF: p. 240 OBJ: 1 | 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 2. The purpose of the Hazard Communication Standard is to a. require employers to protect employees from being contaminated with patients’

body fluids during all work activities. b. require patients to inform health care workers if they are HIV positive. c. to ensure that hazards of all chemicals produced or imported be evaluated and that

employers transmit the information concerning such hazards directly to employees. d. make sure that employers are able to communicate their concerns about catching a

disease in the office.

ANS: C

Requiring employers to protect employees from being contaminated with patients’ body fluids during all work activities is part of the Bloodborne Pathogens Standard. It is not part of the standard to have HIV-positive patients inform health-care workers of their status. It is part of the standard to ensure the hazards of chemicals are evaluated and that information concerning their hazards is transmitted to employers and employees. It is not part of the standard to make sure that employers are able to communicate their concerns about catching a disease in the office.

PTS: 1 DIF: Recall REF: p. 240 OBJ: 1 | 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 3. The purpose of the Hazard Communications Standard is to a. to ensure that hazards of all chemicals produced or imported be evaluated and that

employers transmit the information concerning such hazards directly to employees.

b. prevent exposure of employees to bloodborne pathogens at work. c. keep patients informed of the dangers related to fire, flood, and tornados that may

occur during their appointment. d. have health care employees identify and report all potential work hazards to their

employers.

ANS: A

Require employers to protect employees from being contaminated with patients’ body fluids during all work activities is part of the Bloodborne Pathogens Standard. It is part of the standard to ensure the hazards of chemicals are evaluated and that information concerning their hazards is transmitted to employers and employees. It is not part of the standard to keep patients informed of the dangers related to fire, flood, and tornados that may occur during their appointment. It is not part of the standard to have health care employees identify and report all potential work hazards to their employers.

PTS: 1 DIF: Recall REF: p. 240 OBJ: 1 | 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 4. Which federal agency developed the Hazard Communication Standard? a. FDA b. OSHA c. CDC d. EPA ANS: B

FDA regulates foods, drugs, cosmetics and medical devices. This is one of OSHA’s standards to help protect the workers of Americas. CDC helps prevent diseases and investigates outbreaks. EPA regulates areas that involve the environment such as disinfectants, waste and drinking water.

PTS: 1 DIF: Recall REF: p. 240 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 5. Which of the following documents describes the properties and potential hazards of

chemicals? a. OSHA’s Exposure Control Plan b. Organization for Safety, Asepsis and Prevention Guidelines c. Safety Data Sheet d. Bloodborne Pathogens Standard ANS: C

OSHA’s Exposure Control Plan is part of the Bloodborne Pathogens Standard.

Organization for Safety, Asepsis and Prevention Guidelines do not relate to physical nature of chemicals. Safety Data Sheets are required to be present in the office. The Bloodborne Pathogens Standard is an infectious disease-related standard.

PTS: 1 DIF: Recall REF: p. 239 OBJ: 3 | 5 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 6. Who prepares the original Safety Data Sheets? a. The employer dentist b. The manufacturer of the chemical

c. The dental assisting staff must prepare the original from information provided by

the chemical manufacturer d. The governmental agency that developed the Hazard Communication Standard ANS: B

The dentist would not have the information. The manufacturer developed the chemical, and when it is sold it must be supplied with an accompanying SDS. The dental assisting staff would not have the information. OSHA would not have the information.

PTS: 1 DIF: Recall REF: p. 248 OBJ: 3 | 5 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 7. If a disinfectant that contains hazardous chemicals is purchased in a concentrated form and

is then diluted for use and placed in a spray bottle, what must be done to comply with the Hazard Communication Standard? a. Nothing. b. The manufacturer of the disinfectant must be informed of the action. c. The federal agency that controls the Hazard Communication Standard must be informed in advance of this action and must give approval for such action. d. The spray bottle must be labeled with the name of the hazardous chemicals, name and address of the manufacturer and the appropriate hazard warnings.

ANS: D

Labeling the bottle makes sure that users of the spray bottle will have safety information about the contents. The manufacturer need not know. OSHA need not know and does not give such approvals.

PTS: 1 DIF: Application REF: p. 247 OBJ: 5 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 8. According to the Hazard Communication Standard, a list of all chemicals in the office

should be prepared and cross-referenced to a. the Safety Data Sheets. b. the patient appointment schedule for each workday. c. the sterilizer spore-testing record. d. sections of the written exposure control plan.

ANS: A

The patient appointment schedule and sterilizer spore-testing record do not relate to the SDS list. The written exposure control plan is part of the Bloodborne Pathogens Standard not the HazCom standard. Cross-referencing allows a quick location of the SDS and confirms that an SDS is available for the chemical.

PTS: 1 DIF: Recall REF: p. 247 OBJ: 5 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 9. When was the most recent Federal update of OSHA’s Hazard Communication Standard? a. 1991 b. 1999 c. 2005 d. 2012

ANS: D

The standard was updated in 2012. The 2012 update was the first since its origination in 1987.

PTS: 1 DIF: Recall REF: p. 240 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 10. How does one determine the hazard potential of a new bonding agent just before it’s used

in the office? a. Try to contact the chemical manufacturer b. Ask the employer c. Ask a fellow employee who has already used the chemical d. Read the label and the Safety Data Sheet ANS: D

The manufacturer may not be available. The employer or a fellow employee may not know. The hazard potential is described on the label and the corresponding SDS. PTS: 1 DIF: Application REF: p. 248 OBJ: 6 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 11. Which of the following must be managed according to the Hazard Communication

Standard? a. Alcoholic beverages b. Amalgam c. Penicillin d. Lipstick ANS: B

HazCom Exempt chemicals include tobacco and tobacco products; wood and wood products; and food, drugs, cosmetics, or alcoholic beverages packaged and sold for consumer use. Amalgam is considered a hazardous chemical.

PTS: 1 DIF: Recall REF: p. 244 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 12. The OSHA-required written Hazard Communication Program for each dental office must

contain a. an Exposure Control Plan. b. the name of the person responsible for implementing the program. c. the procedures for post-exposure medical evaluation. d. a list of all job classifications in which employees in those jobs have occupational exposure.

ANS: B

The name of the person responsible for implementing the program is one of many items needed in the written Hazard Communication Program. The rest of the items are part of the Bloodborne Pathogens Standard.

PTS: 1 DIF: Recall REF: p. 246 OBJ: 4 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols

13. Training of employees is an essential component of a successful HazCom Standard

program. Training for all continuing employees is required at the time of hiring, when a new hazard is introduced, and a. every 2 years. b. annually. c. every 6 months. d. monthly.

ANS: B

Training is to be provided at least annually.

PTS: 1 DIF: Recall REF: p. 248 OBJ: 6 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 14. Collecting and maintaining safety data sheets is part of what OSHA-required document? a. Exposure control b. Hazard communication c. Emergency action d. Fire safety ANS: B

Exposure control, emergency action, and fire safety plans are OSHA-required documents but do not involve safety data sheets, a requirement of the Hazard Communication program.

PTS: 1 DIF: Recall REF: p. 244 OBJ: 7 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 15. Development of a chemical hygiene plan is part of which OSHA standard? a. Bloodborne Pathogens Standard b. Occupational Exposure to Hazardous Chemicals in the Laboratory Standard c. Hazard Communication Standard d. Personal Protective Equipment Standard ANS: B

The Bloodborne Pathogens Standard, Hazard Communication Standard, and Personal Protective Equipment Standard do not involve a chemical hygiene plan. The Occupational Exposure to Hazardous Chemicals in the Laboratory Standard required development of a chemical hygiene plan to protect workers in a laboratory who handle hazardous chemicals.

PTS: 1 DIF: Recall REF: p. 249 OBJ: 8 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 16. What is the main element for compliance with the Occupational Exposure to Hazardous

Chemicals in the Laboratory Standard? a. Exposure control plan b. Chemical hygiene plan c. Vaccination declination statement d. Hazard communication program ANS: B

Exposure control and the vaccination declination statement are part of the Bloodborne Pathogens Standard. A chemical hygiene plan is the central component for compliance with the Laboratory Standard. A hazard communication program is required by the Hazard Communication Standard.

PTS: 1 DIF: Recall REF: p. 250 OBJ: 8 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 17. Before the 2012 update of OSHA’s Hazard Communication Plan, Safety Data Sheets

(SDS) were referred to as a. Chemical Safety Data Sheets. b. Hygiene Safety Data Sheets. c. Material Safety Data Sheets. d. Written Safety Data Sheets.

ANS: C

They used to be called Material Safety Data Sheets (MSDS).

PTS: 1 DIF: Recall REF: p. 240 OBJ: 5 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 18. The responsibilities of a laboratory’s chemical hygiene officer include monitoring

procurement, use, and disposal of laboratory chemicals; maintaining lists of chemicals present; being aware of current exposure limits for the chemicals present; and a. providing the necessary training for post-exposure medical evaluation and follow-up. b. working with management continually to improve the chemical hygiene plan. c. preparing the original Safety Data Sheets for all hazardous chemicals used. d. maintaining access to evacuation routes.

ANS: B

Training for post-exposure medical evaluation and follow-up relates to infectious diseases and is part of the Bloodborne Pathogens Standard. Working with management continually to improve the chemical hygiene plan a part of the chemical hygiene plan. Manufacturers of the chemicals prepare the Safety Data Sheets. Maintaining access to emergency routes is part of the Emergency Action Plan.

PTS: 1 DIF: Recall REF: p. 250 OBJ: 10 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 19. A new spray disinfectant has been ordered for the office. What should be done to comply

with the Hazard Communication Standard when it arrives? a. Revise the Exposure Control Plan. b. Update the employee medical records. c. File the Safety Data Sheet and revise the list of chemicals. d. Add to the list of universal precautions.

ANS: C

The Exposure Control Plan should be revised, but is part of the Bloodborne Pathogens Standard not the Hazard Communication Standard. The Hazard Communication Standard does not require updating of employee medical records. The information in Safety Data Sheet (SDS) describes how to safely handle the disinfectant, and adding to the list of chemicals is a way to cross-reference it when one needs to review the SDS. The list of universal precautions relates to the Bloodborne Pathogens Standard not the Hazard Communication Standard.

PTS: 1 DIF: Application REF: p. 246 OBJ: 4 | 5 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols TRUE/FALSE 1. A pictogram of an exclamation mark on the label of a chemical indicates that that chemical

is explosive.

ANS: F

The explanation mark indicates skin/eye irritant, skin sensitizer, respiratory tract irritant.

PTS: 1 DIF: Recall REF: p. 241 OBJ: 7 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 2. A chemical hygiene plan requires workers to use purified chemicals in all preparations.

ANS: F

A chemical hygiene plan requires workers to know and follow safety rules and procedures when working with chemicals.

PTS: 1 DIF: Recall REF: p. 252 OBJ: 9 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols

Chapter 28: Employee Fire Prevention and Emergency Action Plans Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. Which of the following statements is one of the nine required elements of a written fire

safety plan? a. Develop an exposure control plan b. Installation of eyewash stations c. Location of the SDSs for all chemicals in the office d. Names or regular job titles of persons responsible for equipment/systems maintenance ANS: D

Names or regular job titles of persons responsible for equipment/systems maintenance is part of a written fire safety plan. Installation of eyewash stations is part of the laboratory safety standard not a fire safety plan. Location of the SDSs for all chemicals in the office is part of the Hazard Communication Standard not a fire safety plan. Development of an exposure control plan is part of the Blood borne Pathogens Standard not a fire safety plan.

PTS: 1 DIF: Recall REF: p. 254 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 2. Which of the following statements is one of the nine required elements of a written fire

safety plan? a. Installation of eyewash stations b. Develop an exposure control plan c. Employee training d. Location of the SDSs for all chemicals in the office ANS: C

Employee training is one of the elements of a fire safety plan. Installation of eyewash stations is part of the laboratory safety standard not a fire safety plan. Location of the SDSs for all chemicals in the office is part of the Hazard Communication Standard not a fire safety plan. Development of an exposure control plan is part of the Blood borne Pathogens Standard not a fire safety plan.

PTS: 1 DIF: Recall REF: p. 254 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 3. Which of the following statements is one of the nine required elements of a written fire

safety plan? a. Proper use, storage, and disposal of potential ignition sources b. Installation of eyewash stations c. Location of the SDSs for all chemicals in the office d. Develop an exposure control plan ANS: A

Proper use, storage, and disposal of potential ignition sources is one of the elements of a fire safety plan. Installation of eyewash stations is part of the laboratory safety standard not a fire safety plan. Location of the SDSs for all chemicals in the office is part of the Hazard Communication Standard not a fire safety plan. Development of an exposure control plan is part of the Blood borne Pathogens Standard not a fire safety plan.

PTS: 1 DIF: Recall REF: p. 254 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 4. Each workplace must have at least _________ means of escape. a. two b. three c. four d. five ANS: A

OSHA states that each workplace must have at least two means of escape. More are fine, but two is the minimum.

PTS: 1 DIF: Recall REF: p. 254 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 5. Why would alcohol hand-rubs be considered as fire hazards? a. Alcohol is flammable. b. They are also recommended for disinfecting electrical components. c. The moisturizers used in these preparations are explosive when warmed above

37C. d. Their containers are made of a special plastic that have a low ignition point.

ANS: A

Alcohols will burn if ignited. Liquids are not to be placed on electrical switches, especially alcohol which could flame if the switch sparked. The moisturizers are not explosive.

Normal containers are used, not special plastic.

PTS: 1 DIF: Recall REF: p. 255 OBJ: 3 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 6. What is a good way to account for all employees following an evacuation? a. Have someone stand at the exit and count them as they pass. b. Go through the facility and make sure everyone is out. c. Predesignate an assembly area outside the facility and take a headcount after the

evacuation. d. Have each employee call a specific person indicating their safety.

ANS: C

Exits need to be kept clear, and everyone needs to vacate the area. Everyone needs to exit the facility. If someone is missing, pass the information to the official in charge. The confusion of the evacuation can lead to not remembering phone numbers or not having a cell phone.

PTS: 1 DIF: Application REF: p. 256 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols

7. Which of the following is part of an emergency action plan? a. Collection of all SDSs in one place b. Listing the names of persons who can be contacted for further information about

the plan c. Preparing an exposure control plan d. Preparing an exposure incident report ANS: B

The Emergency Action Plan should include the names of persons who can be contacted for further information about the plan. Collection of SDSs is part of the Hazard Communication Standard. Preparation of exposure control plans and incident reports is part of the Bloodborne Pathogens Standard.

PTS: 1 DIF: Recall REF: p. 256 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 8. A written Emergency Action Plan (EAP) needs to be present in the workplace. However,

the EAP may be communicated orally if the worksite has fewer than _____ employees. a. 40 b. 30 c. 20 d. 10 ANS: D

OSHA states that the plan may be communicated orally if the worksite has fewer than 10 employees. Any more requires a written plan.

PTS: 1 DIF: Recall REF: p. 254 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 9. An emergency action plan could be incorporated as part of another standard. The most

appropriate other standard for this is a. Bloodborne Pathogens. b. Eye and Face Protection. c. Hand Protection. d. Hazard Communication.

ANS: D

Since emergencies may be hazardous and require communications, the Hazard Communication Standard would be the best standard for incorporation of an Emergency Action Plan. Bloodborne Pathogens, Eye and Face Protection, and Hand Protection Standards are less related to emergency plans.

PTS: 1 DIF: Recall REF: p. 255 OBJ: 1 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 10. Which of the following would be the least helpful as part of the training on the Emergency

Action Plan for the office? a. Individual roles and responsibilities b. Types, proper use, location, removal, handling, decontamination and disposal of personal protective equipment

c. Location and use of common emergency equipment d. Notification, warning and communications systems ANS: B

Individual roles and responsibilities, location and use of emergency equipment, and notification, warning, and communication systems are all important parts of the training.

Types and handling of personal protective equipment relates to the Bloodborne Pathogens Standard training.

PTS: 1 DIF: Recall REF: p. 256 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 11. A facility has two special needs staff persons who may need assistance during an

evacuation. How should this be addressed? a. Train the special needs persons to help each other evacuate. b. Appoint an evacuation warden to assist these persons during an evacuation. c. Make sure these persons know where everyone is to gather after the evacuation. d. Provide these persons with the names and contact information of those responsible for the developing the evacuation plan.

ANS: B

Training them to help each other may not be successful since they both have special needs.

They should know where everyone is to gather, and the names and contact information of those responsible, but that will not assist them in the actual evaluation. The best way to evacuate these persons is to appoint an evacuation warden to assist them.

PTS: 1 DIF: Application REF: p. 256 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols 12. In facilities with fewer than 10 employees the Emergency Action Plan, may be

communicated orally rather than be written. However, a written plan offers several advantages including the ability to be used in training and training updates, and the ability to be modified easily with changes being communicated more effectively to employees, and a. the establishment of a formal office policy. b. shorter in length. c. more easily understood. d. quicker to access.

ANS: A

Written plans document the policies for future reference whereas verbal plans may be forgotten or restated incorrectly.

PTS: 1 DIF: Application REF: p. 255 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols TRUE/FALSE 1. A fire alarm system may consist of a voice communication.

ANS: T

The system may consist of a voice communication, or the alarm system could consist of a sound system such as bells, whistles, or horns.

PTS: 1 DIF: Application REF: p. 254 OBJ: 2 TOP: CDA, Infection Control, IV.A. Occupational safety/administrative protocols

Chapter 29: Infection Control Concerns during Remodeling and Construction Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. Which of the following would be the least helpful in a construction plan sensitive to

infection control? a. Assessing the impact of disrupting essential services b. Positioning of important physical barriers c. Organization and updating of all SDSs d. Isolating some areas to create a safer environment ANS: C

Assessing the impact of disrupting essential services, positioning of important physical barriers, and isolating some areas to create a safer environment is an important part of the plan. Organization and updating of all SDSs relates to the Hazard Communication Standard rather to a construction plan.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 259

OBJ: 2

2. Which of the following would be the least helpful during times of office remodeling? a. More frequent cleaning of non-construction areas. b. Protection of sensitive equipment with surface covers. c. Use of a fan to keep airborne particles from settling onto surfaces. d. Make sure all areas are safe for patients as well as staff.

ANS: C

More frequent cleaning and protection of sensitive equipment with surface covers would be helpful to reduce dust accumulation. Use of a fan is not recommended because it increases the areas which become dusty and contaminated. Making sure all areas are safe for patients as well as staff is an important part of the plan.

PTS: 1 DIF: Recall TOP: CDA, Does not apply

REF: p. 260

OBJ: 3

3. What fungus has been involved in construction-related outbreaks? a. Legionella b. Pseudomonas c. Aspergillus d. Streptococcus ANS: C

Legionella, Pseudomonas, and Streptococcus are bacteria, not fungus. Aspergillus and other fungi can become airborne during construction.

PTS: 1 DIF: Recall REF: p. 259 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission

4. A wall is being removed to enlarge the sterilization area in a dental office. What would be

an important mode of spread of potential contaminants to office personnel from this activity? a. Direct contact b. Indirect contact c. Airborne d. Droplet ANS: C

Direct contact is unlikely since the office personnel would have to directly touch the wall material. Indirect contact since the office personnel would have to touch something that was in contact with the wall material. Removal of the wall would create dust that could become airborne. Removal of a wall would not normally involve the generation of moisture.

PTS: 1 DIF: Application REF: p. 260 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission TRUE/FALSE 1. The key element central to construction and renovation is preventing transmission of

infectious agents to potentially at-risk construction personnel.

ANS: F

While preventing disease spread to construction personnel is important, the main concern is to prevent spread to at-risk patients, dental team, visitors and families.

PTS: 1 DIF: Recall REF: p. 259 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission

Chapter 30: Infection Control Breaches and Disease Transmissions in Dental Facilities Miller: Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition MULTIPLE CHOICE 1. A report has shown that two cancer-weakened patients acquired oral infection with the

bacterium _________________ that originated from dental unit water. a. Staphylococcus aureus b. Streptococcus mutans c. Pseudomonas aeruginosa d. Candida albicans ANS: C

Pseudomonas aeruginosa was identified as the waterborne causative agent in these two patients treated in a dental clinic in England. An additional 78 patients treated in the same clinic were colonized orally with the same bacterium for 4 to 10 weeks after treatment.

However, these 78 patients were medically compromised and did not develop any oral lesions. Candida albicans is a fungus not a bacterium. Streptococcus mutans is not a common inhabitant of water. Staphylococcus aureus is not the organism recovered from these patients.

PTS: 1 DIF: Recall REF: p. 262 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 2. A dental hygienist who had dermatitis on her hands but never wore gloves gave a dental

prophylaxis to a patient with herpes labialis. Over the next 4 days she spread the herpes simplex virus to 20 of her other patients who developed intraoral herpes even though the hygienist used sterile instruments on each patient. What modes of spread were involved? a. Direct contact with labialis lesions then indirect contact with the 20 patients b. Indirect contact with labialis lesions then droplet infection of the 20 patients c. Droplet infection from the labialis lesion then airborne infection of the 20 patients d. Airborne infection from the labialis lesion then droplet infection of the 20 patients ANS: A

She originally contaminated her hands by direct contact with the labialis lesion. Her painful dermatitis was prevented thorough handwashing. Therefore the virus remained on her hands and was transferred to the 20 other patients by indirect contact. Contaminated hands do not generate airborne contaminants or droplets, so the 20 patients were not contaminated by aerosols or droplets.

PTS: 1 DIF: Application REF: p. 262 OBJ: 1 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 3. What infection control procedure could have prevented the disease transmission described

in the report of herpes virus spread by a hygienist to 20 patients? a. The hygienist wearing protective eyewear with all patients

b. The hygienist wearing protective clothing with all patients c. The hygienist wearing fresh gloves with each patient d. The hygienist wearing a face mask with all patients ANS: C

Protective eyewear, face masks, or protective clothing would not have prevented contamination of the hygienist’s hands. Wearing gloves would have protected the hygienist against the original contamination from the labialis lesion.

PTS: 1 DIF: Application REF: p. 262 OBJ: 1 TOP: CDA, Infection Control, I.D. Standard precautions and the prevention of disease transmission 4. What infection control procedure could have prevented the disease transmission described

in the report of herpes virus spread by a hygienist to 20 patients? a. The hygienist being able to thoroughly perform hand hygiene before and after care for each patient b. The hygienist and the original labialis patient wearing protective eyewear c. The hygienist wearing protective clothing with all patients d. The hygienist wearing a face mask with all patients ANS: A

Protective eyewear, face masks, or protective clothing would not have prevented contamination of the hygienist’s hands. Thorough hand hygiene (with no dermatitis) would have originally removed the transient herpes virus from the hygienists’ hands.

PTS: 1 DIF: Application REF: p. 262 OBJ: 1 TOP: CDA, Infection Control, I.C. Standard precautions and the prevention of disease transmission 5. A dental office that does not treat the dental unit water presents a high risk of

contaminating their patients with what microbe? a. Hepatitis B b. Pseudomonas aeruginosa c. Human herpes virus type 1 d. Human immunodeficiency virus ANS: B

Hepatitis B, human herpes virus 1, and HIV are not waterborne. Pseudomonas aeruginosa is a common contaminant of domestic waters.

PTS: 1 DIF: Application REF: p. 262 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 6. A dental office that does not treat the dental unit water presents a high risk of

contaminating their patients with what microbe? a. Hepatitis B b. Legionella pneumophila c. Human herpes virus type 1 d. Human immunodeficiency virus ANS: B

Hepatitis B, human herpes virus 1, and HIV are not waterborne. Legionella pneumophila is a common contaminant of domestic waters.

PTS: 1 DIF: Application REF: p. 263 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 7. A dental office that does not treat the dental unit water presents a high risk of

contaminating their patients with what microbe? a. Hepatitis B b. Mycobacterium abscessus c. Human herpes virus type 1 d. Human immunodeficiency virus ANS: B

Hepatitis B, human herpes virus 1, and HIV are not waterborne. Mycobacterium abscessus is a common contaminant of domestic waters.

PTS: 1 DIF: Application REF: p. 265 OBJ: 1 TOP: CDA, Infection Control, II.D. Demonstrate an understanding of asepsis procedures 8. What microbe is in untreated dental unit water and would presents the highest infection

risk to a compromised dental patient? a. Hepatitis B b. Human herpes virus type 1 c. Pseudomonas aeruginosa d. Human immunodeficiency virus ANS: C

Hepatitis B, human herpes virus 1, and HIV are not waterborne. Pseudomonas aeruginosa is an opportunistic pathogen and is a common contaminant of domestic waters.

PTS: 1 DIF: Application REF: p. 262 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 9. What microbe is in untreated dental unit water and would present the highest infection risk

to a compromised dental patient? a. Hepatitis B b. Legionella pneumophila c. Human herpes virus type 1 d. Human immunodeficiency virus ANS: B

Hepatitis B, human herpes virus 1, and HIV are not waterborne. Legionella pneumophila is an opportunistic pathogen and is a common contaminant of domestic waters.

PTS: 1 DIF: Application REF: p. 263 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 10. What dental patients would be the most susceptible to contaminated dental unit water? a. Normal b. Male age 30 to 50 c. Female age 30 to 50

d. Immunocompromised ANS: D

Several microbes in untreated dental unit water are opportunistic pathogens placing compromised person at higher risk than normal persons. Normal persons are not usually at high risk for infection with opportunistic pathogens in water. Gender does not present a particular risk.

PTS: 1 DIF: Recall REF: p. 262 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 11. Reports of the spread of hepatitis B virus from 11 dentists to patients between 1974 and

1987 described two common occurrences that likely led to the transmissions. What were those two occurrences? a. The dentists were all HBeAg-positive and did not routinely wear gloves. b. The dentists were all over age 60 and did not routinely wear face masks. c. The dentists reused needles and did not perform adequate hand hygiene. d. The dentists did not routinely sterilize their instruments and did not perform sterilization monitoring.

ANS: A

Age was not indicated in these reports. Neither reuse of needles nor improper sterilization was indicated in these reports. Being HBeAg-positive means they were all highly infectious, and without gloves any lesions on the hands could have contaminated patients with small amounts of infected blood.

PTS: 1 DIF: Recall REF: p. 264 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 12. What is an important characteristic of a person infected with hepatitis B virus and who is

highly infectious (communicable)? a. A male over age 60 b. A child under age 3 c. HBeAg-positive d. HBsAg-positive ANS: C

Age is usually not related to infectiousness. The presence of HBeAg in the blood indicates a high level of virus in the blood; therefore, it would take smaller amounts of blood to spread the disease indicating a high infectiousness. All person with hepatitis B are HBsAg-positive regardless of their infectiousness.

PTS: 1 DIF: Application REF: p. 264 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 13. What is the relationship of HBeAg-positive patients and their ability to spread hepatitis B? a. They are not infectious. b. They are highly infectious. c. They should be vaccinated against hepatitis B. d. They are no more infectious than any other hepatitis B patient.

ANS: B

They are highly infectious. The presence of HBeAg in the blood indicates a high level of virus in the blood; therefore, it would take smaller amounts of blood to spread the disease indicating a high infectiousness. Vaccination will not work since they already have hepatitis B. They are more infectious than other hepatitis B patients.

PTS: 1 DIF: Recall REF: p. 264 OBJ: 2 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 14. The CDC has suggested that the only reported case of patient-to-patient spread of hepatitis

C in a dental practice occurred from what breach in infection control? a. Chairside assistants not having their face masks covering their noses b. Using poor quality untreated dental unit water c. Reuse of a contaminated medication vial d. Dental personnel not wearing gloves ANS: C

Neither neglecting to wear gloves, not having face masks covering noses, nor the use of poor quality untreated dental unit water would lead to the spread of a bloodborne disease.

Contamination of a multiuse medication vial with the blood of the source patient could have spread the virus upon reuse of the vial.

PTS: 1 DIF: Application REF: p. 265 OBJ: 3 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols 15. What disease is acquired through the inhalation or aspiration of contaminated water? a. HIV disease b. Hepatitis C c. Hepatitis B d. Legionnaires disease ANS: D

Legionnaires disease is caused by the opportunistic pathogen Legionella pneumophila a bacterium that lives in domesticated and natural waters. HIV, hepatitis C and hepatitis B are bloodborne, not waterborne, diseases.

PTS: 1 DIF: Recall REF: p. 263 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 16. What microbe causes a bloodborne disease? a. Legionella pneumophila b. Hepatitis C virus c. Mycobacterium abscessus d. Herpes simplex virus ANS: B

Legionella pneumophila causes waterborne diseases. The hepatitis C virus is a bloodborne microbe. Mycobacterium abscessus causes waterborne diseases. The herpes simplex virus is spread by direct contact or droplet infection and is nor bloodborne.

PTS: 1 DIF: Recall REF: p. 265 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 17. What incident of disease transmission in a dental facility could have been prevented by the

use of good quality dental unit water? a. Six patients in Florida infected with HIV from 1987 to 1990. b. Patient-to-patient spread of hepatitis C in an oral surgery practice in Tulsa. c. Three patients and two volunteers infected with hepatitis B in a portable dental clinic in West Virginia. d. Twenty children infected with Mycobacterium abscessus after receiving pulpotomies in a pediatric dental practice in Georgia.

ANS: D

The HIV incident was likely a direct contact not waterborne spread of the bloodborne HIV. This practice’s dental unit water was contaminated with the same strain of M. abscessus that caused disease in the 20 children. Hepatitis B is not a waterborne disease.

The hepatitis C incident likely resulted from reuse of a contaminated medication vial containing the bloodborne hepatitis C virus.

PTS: 1 DIF: Application REF: p. 265 OBJ: 3 TOP: CDA, Infection Control, II.D. Demonstrate an understanding of asepsis procedures 18. What incident of disease transmission in a dental facility could have been prevented by the

use of good quality dental unit water? a. Six patients in Florida infected with HIV from 1987 to 1990 b. Patient-to-patient spread of hepatitis C in an oral surgery practice in Tulsa c. Two cancer-weakened patients who acquired oral Pseudomonas infections in England d. Three patients and two volunteers infected with hepatitis B in a portable dental clinic in West Virginia ANS: C

The HIV incident was likely a direct contact not waterborne spread of the bloodborne HIV. The same P. aeruginosa was detected in these patients and in the dental unit water used for treatment. Hepatitis B is not a waterborne disease. The hepatitis C incident likely resulted from reuse of a contaminated medication vial containing the bloodborne hepatitis C virus.

PTS: 1 DIF: Application REF: p. 262 OBJ: 1 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 19. What did the CDC suggest was the mode of HIV spread from a Florida dentist to six

patients during 1987 to 1990? a. Contaminated equipment b. Direct spread from the dentist c. Improperly disinfected surfaces d. Instruments not properly sterilized ANS: B

Contaminated equipment, improperly disinfected surfaces, and improperly sterilized instruments were not suggested to be the most likely cause. The most reasonable cause suggested by the CDC was direct spread from the dentist.

PTS: 1 DIF: Recall REF: p. 265 OBJ: 3 TOP: CDA, Infection Control, I.A. Standard precautions and the prevention of disease transmission 20. A report has shown that 20 children developed confirmed or probable infections with

________________________ after being exposed to contaminated water during pulpotomies. a. Mycobacterium abscessus b. Hepatitis B c. HIV d. Pseudomonas aeruginosa ANS: A

Mycobacterium abscessus was isolated from the infected children and from all samples of the dental unit water tested. Hepatitis B and HIV are not waterborne. Pseudomonas aeruginosa is in untreated dental unit water but was not the cause on the infections.

PTS: 1 DIF: Application REF: p. 265 OBJ: 3 TOP: CDA, Infection Control, II.A. Prevent cross-contamination during procedures 21. Contamination of a multi-dose medication vial likely led to what incident of disease

transmission in a dental facility? a. Six patients in Florida infected with HIV from 1987 to 1990 b. Patient-to-patient spread of hepatitis C in an oral surgery practice in Tulsa c. Two cancer-weakened patients who acquired oral Pseudomonas infections in England d. Twenty children infected with Mycobacterium abscessus after receiving pulpotomies in a pediatric dental practice in Georgia ANS: B

The HIV infections were likely from a direct contact mode of spread. Patient-to-patient spread of hepatitis C likely resulted from reuse of a contaminated medication vial containing the bloodborne hepatitis C virus. Oral Pseudomonas and infection with Mycobacterium abscessus were from the use of contaminated dental unit water.

PTS: 1 DIF: Recall REF: p. 265 OBJ: 3 TOP: CDA, Infection Control, IV.B. Occupational safety/administrative protocols