Infection Control and Sterilization in the Anesthesia Setting Flashcards

During a deep sedation case, the assistant draws midazolam from a multi-dose vial. Later, for the SAME patient, the assistant puts a new sterile needle on the same syringe and goes back into that vial to draw a supplemental dose. What is the correct next step under CDC safe injection practices?

Answer: Throw away the vial, because entering it with a used syringe contaminates it even if the needle is new

The CDC treats needles and syringes as single-use. Once a syringe has been used, it is contaminated even if the needle is changed, because backflow can contaminate the syringe barrel and hub. Entering a vial with a used syringe contaminates the vial, so it must be thrown away. Wiping the septum with alcohol does not fix contamination introduced by the syringe. Changing only the needle has caused documented hepatitis B and C outbreaks.

Propofol is drawn into a syringe for a planned bolus at the start of a dental anesthesia case, but the case is delayed. According to the manufacturer's labeling and CDC guidance, what is the main reason propofol must be given or thrown away within a strict time limit (6 hours for syringes)?

Answer: The lipid emulsion supports rapid bacterial and fungal growth, even though the product contains preservatives

Propofol is a soybean-oil lipid emulsion, and that emulsion is an excellent growth medium for microorganisms. Some formulations contain an additive such as EDTA, but it only slows growth; it is not a full antimicrobial preservative. Outbreaks of postoperative sepsis have been traced to propofol that was drawn up too early or shared. That is why the label requires strict aseptic technique, single-patient use, and discarding syringes within 6 hours of opening (infusions within 12 hours).

The weekly biological indicator (Geobacillus stearothermophilus) from the office steam autoclave comes back positive. The load did not contain any implantable items. What is the most appropriate first action according to CDC dental guidelines?

Answer: Take the sterilizer out of service, review operating procedures and mechanical/chemical indicators, and retest right away with a biological indicator and a control; recall items only if the repeat test is also positive

The CDC says that after a single positive spore test, the sterilizer should be taken out of service and the cause looked for (loading, packaging, cycle settings, chemical and mechanical indicators). It should then be retested promptly using three consecutive empty cycles, or a challenge load, with a control BI. If the repeat test is negative and operation was correct, the sterilizer can go back into service. If it is positive again, the sterilizer stays out of service and items processed since the last negative test are recalled and reprocessed as far as possible. Immediate recall is the step for a repeat failure, not the first step.

Under the Spaulding classification, what category is a reusable laryngoscope blade used for intubation in the dental anesthesia setting, and what is the minimum reprocessing it requires?

Answer: Semicritical; at least high-level disinfection after cleaning, with sterilization preferred when the blade tolerates heat

Laryngoscope blades touch mucous membranes and do not normally enter sterile tissue, so they are semicritical items. Semicritical items need thorough cleaning followed by at least high-level disinfection. In the dental setting, the CDC prefers heat sterilization for heat-tolerant semicritical items. Intermediate-level (tuberculocidal surface) disinfection is not enough for items that contact mucous membranes. Outbreaks have been linked to blades that were only wiped down.

A multi-dose vial of local anesthetic or reversal agent was opened and kept on the anesthesia cart in the operatory (the immediate patient treatment area) during a case. The vial is only 3 days old and well within its 28-day beyond-use date. What should happen to it after the case?

Answer: Label it with the patient's name and either throw it away or keep it for that patient only; it should not be used for other patients

The CDC states that if a multi-dose vial enters the immediate patient treatment area (operatory or anesthesia cart), it should be dedicated to a single patient and thrown away after use. The 28-day limit only applies to vials kept and accessed in a dedicated clean medication area away from patient care. Vials in the treatment area can be contaminated by splatter, contact with contaminated hands or surfaces, and inadvertent reuse of equipment. Disinfecting the outside afterward cannot reverse this.

A dental anesthesia assistant gets a percutaneous needlestick from a hollow-bore needle used on a patient whose hepatitis B status is unknown. The assistant completed the hepatitis B vaccine series years ago, and a post-vaccination test documented anti-HBs ≥10 mIU/mL. What hepatitis B post-exposure management is recommended?

Answer: No hepatitis B treatment is needed, because a documented responder is considered protected for life

The CDC says a healthcare worker with documented post-vaccination anti-HBs ≥10 mIU/mL is a responder and is protected long-term, even if antibody levels later fall below detectable levels. No HBIG, booster, or further HBV testing is needed after an exposure, whatever the source's status. The exposure still has to be reported, the wound washed, and the incident evaluated for HCV and HIV risk. HBIG and revaccination are for non-responders or people who are unvaccinated.