DANB ICE Infection Prevention & Sterilization 2 — Questions and Answers
Question 1: According to the Spaulding classification, which categories of dental instruments require sterilization?
- Non-critical items only
- Semi-critical and critical items (Correct answer)
- Critical items only
- All items regardless of contact
Correct answer: Semi-critical and critical items
Both critical items (penetrate tissue/bone) and semi-critical items (contact mucous membranes) require sterilization. Heat-sensitive semi-critical items need high-level disinfection at minimum.
Critical items: surgical burs, scalpels, forceps, implant components—MUST be heat sterilized. Semi-critical: dental mirrors, condensers, impression trays—should be sterilized; if heat-sensitive, high-level disinfection minimum. Non-critical (X-ray head, BP cuff): intermediate or low-level disinfection. Most dental instruments are critical or semi-critical.
Question 2: What is the correct order of the instrument reprocessing workflow?
- Sterilization, Cleaning, Packaging, Storage
- Transport, Cleaning, Rinsing/Inspection, Packaging, Sterilization, Storage (Correct answer)
- Packaging, Sterilization, Cleaning, Storage
- Cleaning, Storage, Sterilization, Distribution
Correct answer: Transport, Cleaning, Rinsing/Inspection, Packaging, Sterilization, Storage
The unidirectional flow prevents cross-contamination: transport from point of use through cleaning, inspection, packaging, sterilization, to sterile storage.
The reprocessing area should be physically divided into contaminated (receiving/cleaning) and clean (inspection/packaging/sterile storage) zones. Contaminated instruments travel in covered puncture-resistant containers. Mechanical cleaning is preferred. Inspection identifies residual debris before sterilization.
Question 3: What distinguishes high-level disinfection from sterilization?
- No practical difference
- High-level disinfection kills all organisms except high numbers of bacterial spores; sterilization destroys all microbial life including spores (Correct answer)
- High-level disinfection is stronger
- Sterilization is chemical; high-level disinfection is physical
Correct answer: High-level disinfection kills all organisms except high numbers of bacterial spores; sterilization destroys all microbial life including spores
Sterilization eliminates ALL microbial life including all bacterial spores. High-level disinfection eliminates most but not necessarily all spores in high numbers.
Sterilization achieves complete elimination of all life forms. High-level disinfection (e.g., 2% glutaraldehyde for 20+ minutes) kills bacteria, viruses, fungi, mycobacteria, and some spores but not necessarily all when present in large numbers. HLD is reserved for heat-sensitive semi-critical items only.
Question 4: Which chemical indicator class should be placed inside every sterilization package?
- Class 1 (external only)
- Class 4 (multi-variable) or Class 5 (integrating) internal indicator (Correct answer)
- Class 2 (Bowie-Dick test)
- No internal indicator needed if external indicators are used
Correct answer: Class 4 (multi-variable) or Class 5 (integrating) internal indicator
Internal Class 4 or Class 5 indicators verify that the sterilant actually penetrated the packaging and reached the instruments inside.
Class 1 external indicators only distinguish processed from unprocessed packages. Internal indicators verify steam actually penetrated packaging. Class 5 integrators respond to all critical parameters and correlate with BI performance. Packaging defects or overloading can prevent adequate penetration even when external indicators change color.
Question 5: What is flash sterilization and when is it appropriate in a dental office?
- The preferred routine method
- An abbreviated cycle for unwrapped instruments needed urgently, not for routine use or implantable items (Correct answer)
- UV light instant sterilization
- A high-speed method replacing standard cycles
Correct answer: An abbreviated cycle for unwrapped instruments needed urgently, not for routine use or implantable items
Immediate-use steam sterilization is a shortened cycle for emergencies when no sterile spare is available. Not for routine use, convenience, or implantable devices.
IUSS parameters: 270°F for 3 min (prevacuum) or 10 min (gravity) for unwrapped, non-porous items. Limitations: no wrapped storage, difficult to monitor with BIs, must use immediately. The CDC says it should never substitute for purchasing sufficient instruments. Emergency use only when an instrument is dropped and no backup exists.
Question 6: How should heat-sensitive semi-critical dental items be reprocessed?
- Wipe with alcohol and air dry
- High-level disinfection using FDA-cleared chemical at specified contact time (Correct answer)
- Microwave for 5 minutes
- Soak in warm soapy water overnight
Correct answer: High-level disinfection using FDA-cleared chemical at specified contact time
Heat-sensitive semi-critical items require high-level disinfection with FDA-cleared solutions like glutaraldehyde or OPA at manufacturer-specified times.
Process: thorough cleaning, complete immersion in FDA-cleared HLD (2.4% glutaraldehyde ≥20 min, OPA ≥12 min), rinsing with sterile/filtered water, drying, proper storage. The CDC recommends using heat-tolerant alternatives or single-use disposables whenever possible. MEC test strips must be used before each use of the solution.
DANB ICE Infection Prevention & Sterilization 2
According to the Spaulding classification, which categories of dental instruments require sterilization?