DANB ICE cheat sheet

Chain of infection: infectious agent → reservoir → portal of exit → mode of transmission → portal of entry → susceptible host; breaking any one link prevents transmission.

Standard precautions apply to every patient regardless of known diagnosis, whenever contact with blood, all body fluids and secretions (except sweat), nonintact skin, or mucous membranes is possible.

Alcohol-based hand rub: apply and rub until dry, about 20–30 seconds; use soap and water for 40–60 seconds when hands are visibly soiled or after exposure to spore-formers (C. difficile, norovirus).

PPE sequence: gown → mask/respirator → eye protection → gloves; remove in reverse order with gloves last, then perform hand hygiene.

Droplet precautions: particles >5 µm traveling about 3 ft - mask plus eye protection for close contact. Airborne precautions: particles <5 µm that stay suspended - N95, negative-pressure room, door closed.

Sharps rule: never recap, bend, break, or hand-remove needles; place immediately in a closable, puncture-resistant, leakproof, biohazard-labeled container.

Aerosol-generating procedures (ultrasonic scaler, air polisher, high-speed handpiece, air-water syringe) require high-volume evacuation plus a surgical mask and face shield.

Gloves never substitute for hand hygiene; perform hand hygiene before donning and immediately after removing gloves.

Key bloodborne pathogens in dentistry: HBV (most transmissible; stable on dried surfaces ≥7 days), HCV, and HIV; HBV is vaccine-preventable.

Spaulding classification: critical = enters sterile tissue, bone, or vasculature → sterilize; semicritical = contacts mucous membrane or nonintact skin → sterilize or high-level disinfect; noncritical = intact skin only → low-level disinfect or barrier.

Clinical contact surfaces (light handles, chair switches, bracket trays, drawer pulls) receive a barrier or clean-and-disinfect with an EPA-registered intermediate-level (tuberculocidal) disinfectant between patients.

Housekeeping surfaces (floors, walls, sinks) require detergent and water or a low-level disinfectant; disinfect only after visible contamination has been cleaned away.

Disinfectant efficacy depends on contact time: the surface must stay visibly wet for the full manufacturer-labeled time to achieve the claimed kill.

A compromised barrier is treated as an uncovered surface: remove barrier, clean, disinfect, then place a new barrier.

Dental unit waterlines: flush 20–30 seconds between patients and at the start of the day; an EPA-registered treatment keeps heterotrophic plate counts ≤500 CFU/mL for nonsurgical care.

Suction/evacuation lines: flush with water, then draw the manufacturer-specified detergent/disinfectant through the line; use a disposable single-patient suction tip.

Regulated medical waste = blood-saturated or dripping items and sharps → red bag or rigid biohazard container; saliva-soaked gauze, gloves, and masks are nonregulated.

Radiographic sensors and phosphor plates: fresh barrier for each patient, disinfect after barrier removal, and never set a contaminated item on the exposure switch.

Sterilization destroys all microbial life including spores; disinfection reduces pathogens but may spare spores - critical and semicritical items are heat-sterilized whenever the item tolerates it.

Sequence: transport in a closed container → clean (ultrasonic with enzymatic detergent, rinse, dry) → inspect → package and label → sterilize → monitor → store in a closed cabinet.

Steam autoclave: gravity displacement about 121 °C (250 °F) at 15–20 psi for 30 minutes, or 132 °C (270 °F) for 4 minutes; follow the sterilizer manufacturer's validated cycle.

Load configuration: hinged instruments open, chamber not overloaded, packages not touching chamber walls, mixed metal/porous loads only as the manufacturer permits.

Three monitoring levels: mechanical (gauge/printout), chemical (external process indicator plus internal indicator), biological (spore test) - only the biological indicator proves sterilization.

Steam BI organism is Geobacillus stearothermophilus; dry-heat BI organism is Bacillus atrophaeus. Run at least weekly and with every implant load; a failed BI triggers recall to the last passing load.

High-level disinfection of heat-sensitive semicritical items: glutaraldehyde 2.0–3.4% (≥20 minutes at 20–25 °C) or ortho-phthalaldehyde; test minimum effective concentration and ventilate the area.

Single-use disposable items (needles, blades, plastic matrix bands, designated burs) are never reprocessed.

Package label must carry date of sterilization, sterilizer/cycle identifier, and preparer; event-related shelf life applies only while the package remains dry and intact.

OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) requires a written Exposure Control Plan, reviewed and updated at least annually and whenever tasks or technology change.

HBV vaccination: offered free within 10 working days of assignment to exposure-prone duties; declination must be in writing, and the vaccine may be accepted later at no cost.

Post-exposure protocol: wash the wound with soap and water without squeezing, flush splashes, report immediately, document source and route, and obtain evaluation/post-exposure prophylaxis promptly.

Training is required at initial assignment and annually; training records are kept 3 years, medical and exposure records are kept for duration of employment plus 30 years, both confidential.

PPE is employer-provided at no cost, including laundering of reusable gowns; gloves never substitute for hand hygiene or engineering controls.

Hazard Communication Standard requires an accessible Safety Data Sheet for every hazardous chemical on site (disinfectants, glutaraldehyde, amalgam, etchants).

Regulated waste program: labeled biohazard containers, sharps containers closed and replaced at three-quarters full, waste manifests retained per state law.

Respiratory protection for suspected or confirmed tuberculosis and aerosol-generating procedures: annually fit-tested N95, negative-pressure room, door closed, symptom screening.

Employees with exudative or weeping lesions on the hands are reassigned away from direct patient contact until the condition resolves.