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Infection Control
Task Evaluation

HAND WASHING TASK EVALUATION FORM

 

Please add the student name as shown on the ID

Objective: The students will demonstrate the proper technique for handwashing before and after gloving.

Competency: The student will set up armamentarium and Students will be taught the proper technique for handwashing.

Practice Required: 3

Removed all jewelry, including watch and rings.

Used the foot electronic control to regulate the flow of water (If this was not available, used a paper towel to grasp the faucets to turn them off). Discarded the towel after use.

Used liquid soap, dispensed with a foot-activated or electronic device.

Vigorously rubber lathered hands together under a stream of water to remove surface Debris.

Put on protective clothing over the scrub uniform.

Dispensed additional soap and vigorously rubbed lathered hands together for a minimum of 10 seconds under a stream of water.

Used a paper towel to thoroughly dry hands and then the forearms.

Total Possible Points = 28 points

Minimum passing score = 28 points

If step is missed or minimum competency is not met, the evaluated procedure fails and must be repeated.

All Tasks are critical to the procedure Scoring:
1. Below basic skill level – No concept of skill.
2. Basic skill level – Minimum concept of skill, guidance needed.
3. Proficient skill level – Able to perform skill with minimal guidance.
4. Advanced skill level – Able to perform skill with no guidance.

PUTTING ON PPE TASK EVALUATION SHEET

Objective: The students will demonstrate the proper technique for putting on PPE prior to providing patient care.

Competency: The student will set up armamentarium and Students will be taught the proper technique for putting PPE.

Practice Required: 3

Put on protective clothing over the scrub uniform.

Put on a surgical mask and adjusted to fit.

Put on protective eyewear.

Hand washing technique

Place gloves on clean hands according to standard protocol

Total Possible Points = 20 points

Minimum passing score = 20 points

If step is missed or minimum competency is not met, the evaluated procedure fails and must be repeated.

All Tasks are critical to the procedure Scoring:
1. Below basic skill level – No concept of skill.
2. Basic skill level – Minimum concept of skill, guidance needed.
3. Proficient skill level – Able to perform skill with minimal guidance.
4. Advanced skill level – Able to perform skill with no guidance.

REMOVING PPE TASK EVALUATION FORM

Objective: The students will prepare the appropriate setup and will assist in the bonding of orthodontic brackets. The student will pass with a minimum score.

Competency: The student will set up armamentarium and Students will be taught the proper technique for removing PPE.

Practice Required: 3

Used a gloved hand grasp the opposite glove at the outside cuff. Pulled downward, turning the glove inside out while pulling it away from the hand.

For the other hand, used ungloved fingers to grasp the inside (uncontaminated area) of the cuff of the remaining glove. Pulled downward to remove the glove, turning it inside out.

Discarded the gloves into the waste receptacle.

Washed and thoroughly dried hands

Removed the eyewear by touching it only on the ear rest. Placed the eyewear on a disposable towel for proper cleaning and disinfecting

Slid fingers on each hand under the elastic strap in front of ears and removed the mask, ensuring that fingers contacted only the mask’s ties or elastic strap.

Discarded the mask into the waste receptacle.

Pulled the gown off, turning it inside out during removal.

Ensured that the contaminated outside surface of the gown did not touch underlying clothes or skin during removal.

Washed and thoroughly dried hands.

Total Possible Points = 40 points

Minimum passing score = 40 points

If step is missed or minimum competency is not met, the evaluated procedure fails and must be repeated.

All Tasks are critical to the procedure Scoring:
1. Below basic skill level – No concept of skill.
2. Basic skill level – Minimum concept of skill, guidance needed.
3. Proficient skill level – Able to perform skill with minimal guidance.
4. Advanced skill level – Able to perform skill with no guidance.

PLACING AND REMOVING SURFACE BARRIERS TASK EVALUATION SHEET

Objective: The students will demonstrate the proper techniques for placing and removing surface barriers.

Competency: The student will set up armamentarium and Students will be taught the proper techniques for placing and removing surface barriers. The use of all OSHA and PPE procedures will be practices without error.

Practice Required: 3

Washed and dried hands.

Assembled the appropriate setup

Select the appropriate surface barriers and placed each barrier over the entire surface to be protected.

Wore utility gloves to remove contaminated surface barriers.

 Very careful removed each cover.

Discarded the used covers into the regular waste receptacle.

Washed, disinfected, and removed utility gloves.

Washed and dried hands.

Final Infection.

Total Possible Points = 36 points

Minimum passing score = 36 points

If step is missed or minimum competency is not met, the evaluated procedure fails and must be repeated.

All Tasks are critical to the procedure Scoring:
1. Below basic skill level – No concept of skill.
2. Basic skill level – Minimum concept of skill, guidance needed.
3. Proficient skill level – Able to perform skill with minimal guidance.
4. Advanced skill level – Able to perform skill with no guidance.

PERFORMING TREAMENT ROOM CLEANING & DISINFECTION TASK EVALUATION SHEET

Objective: The students will demonstrate the proper technique for performing treatment room cleaning and disinfection.

Competency: The student will set up armamentarium and Students will be taught the proper routine procedure that meets stated protocols for the proper technique for performing treatment room cleaning and disinfection. The student will pass with a minimum score.

Practice Required: 3

 Assembled the appropriate setup. Wore the appropriate personal protective equipment.

Checked to see that the preclearing/disinfecting product had been correctly and was fresh. Read and followed the manufacturer’s instructions.

Sprayed the paper towel or gauze pad with the product and vigorously wiped the surface.

Sprayed a fresh paper towel or gauze pad with the product.

Allowed the surface to remain moist for the manufacturer’s recommended time.

Total Possible Points = 20 points

Minimum passing score = 20 points

If step is missed or minimum competency is not met, the evaluated procedure fails and must be repeated.

All Tasks are critical to the procedure Scoring:
1. Below basic skill level – No concept of skill.
2. Basic skill level – Minimum concept of skill, guidance needed.
3. Proficient skill level – Able to perform skill with minimal guidance.
4. Advanced skill level – Able to perform skill with no guidance.

SHARPS MANAGEMENT FOR BROKEN GLASS, NEEDLES AND ORTHODONTIC WIRE TASK EVALUATION SHEET

Objective: By following a routine procedure that meets stated protocols, the student will demonstrate the proper technique on sharps management for broken glass, needles and orthodontic wire.

Competency: The student will set up armamentarium and Students will be taught the proper technique on sharps management for broken glass, needles and orthodontic wire.

Practice Required: 3

While wearing all PPE, don utility gloves, take the syringe apart, and prepare it for sterilization.

Retract the piston to release the harpoon from the cartridge.

Removed from the cartridge from the syringe by retracting the thumb ring enough to release the cartridge. Turn the syringe until the cartridge is free.

Carefully remove the needle with the protective cap in place.

Carefully unscrew the needle.

Removed utility gloves, mask, and eyewear. Washed and dried hands.

BROKER GLASS AND ORTHODONTIC WIRE

Wore appropriate PPE

Always use mechanical means such as tongs, forceps, or a brush and a dust pan to pick up contaminated broken glassware; never pick up with hands even if gloves are worn.

Always use mechanical means such as tongs, forceps, or a brush and a dust pan to pick up contaminated broken glassware; never pick up with hands even if gloves are worn.

Removed utility gloves, mask, and eyewear. Washed and dried hands.

Total Possible Points = 44 points

Minimum passing score = 44 points

If step is missed or minimum competency is not met, the evaluated procedure fails and must be repeated.

All Tasks are critical to the procedure Scoring:
1. Below basic skill level – No concept of skill.
2. Basic skill level – Minimum concept of skill, guidance needed.
3. Proficient skill level – Able to perform skill with minimal guidance.
4. Advanced skill level – Able to perform skill with no guidance.

OPERATING THE ULTRASONIC CLEANER TASK EVALUATION SHEET

Objective: When provided with the appropriate materials, the student will demonstrate the proper technique for precleaning instruments before sterilization using the ultrasonic cleaner.

Competency: The student will set up armamentarium and Students will be taught the proper technique for precleaning and using ultrasonic cleaner. The use of all OSHA and PPE procedures will be practiced without error.

Practice Required: 3

Wore appropriate PPE.

Removed the lid from the container and checked the level of the solution.

Placed instruments or cassette into the basket.

Replaced the lid and turned the cycle to ON.

After the cleaning cycle, removed the basket and rinsed the instruments.

Emptied the basket onto the towel.

Replaced lid on the ultrasonic cleaner.

Total Possible Points = 28 points

Minimum passing score = 28 points

If step is missed or minimum competency is not met, the evaluated procedure fails and must be repeated.

All Tasks are critical to the procedure Scoring:
1. Below basic skill level – No concept of skill.
2. Basic skill level – Minimum concept of skill, guidance needed.
3. Proficient skill level – Able to perform skill with minimal guidance.
4. Advanced skill level – Able to perform skill with no guidance.

STERILIZING DENTAL HANDPIECE TASK EVALUATION SHEET

Objective: When provided with the appropriate materials, the student will demonstrate the proper technique for preparing, cleaning, and sterilizing the dental handpiece.

Competency: The student will set up armamentarium and Students will be taught the proper technique for sterilizing the dental handpiece. The use of all OSHA and PPE procedures will be practiced without error.

Practice Required: 3

Wore appropriate PPE

With the bur still in the chuck, wiped any visible debris from the handpiece. Operated the handpiece for approximately 10-20 seconds.

Removed the bur from the handpiece and then removes the handpiece from the hose.

Used a handpiece cleaner recommended by the manufacturer to remove internal debris, and lubricated the handpiece according to the manufacturer’s recommendations.

Reattached the handpiece to an air hose, inserted a bur, and operated the handpiece to blow out the excess lubricant from the rotating parts.

Used a cotton-tipped applicator dampened with isoprophy alcohol to remove all excess lubricant from fiber optic interfaces and exposed optical surfaces.

Dried the handpiece and package it for sterilization.

Total Possible Points = 28 points

Minimum passing score = 28 points

If step is missed or minimum competency is not met, the evaluated procedure fails and must be repeated.

All Tasks are critical to the procedure Scoring:
1. Below basic skill level – No concept of skill.
2. Basic skill level – Minimum concept of skill, guidance needed.
3. Proficient skill level – Able to perform skill with minimal guidance.
4. Advanced skill level – Able to perform skill with no guidance.

AUTOCLAVING INSTRUMENTS TASK EVALUATION FORM

Objective: By following a routine procedure that meets stated protocols, when provided with the appropriate materials, the student will demonstrate the proper technique for preparing and autoclaving instruments.

Competency: The student will set up armamentarium and Students will be taught the proper technique for preparing and autoclaving instruments. The student will pass with a minimum score.

Practice Required: 3

Wore appropriate personal protective eyewear.

Dried the instruments.

Dipped non stainless instruments and burs in a corrosion inhibitor.

Placed the process indicator into the package. 

Packaged, sealed, and labeled the instruments.

Placed, bagged, and sealed items in the autoclave. 

Tilted glass or metal canisters at an angle. 

Placed larger packs at the bottom of the chamber. 

Did not overload the autoclave. 

Followed the manufacturer’s instructions.       

Checked the level of water. (If necessary, added more distilled water.)       

Set the autoclave controls for the appropriate time, temperature, and pressure.

At the end of the sterilization cycle, vented the steam into the room and allowed the contents of the autoclave to dry and cool.

Total Possible Points = 52 points

Minimum passing score = 52 points

If step is missed or minimum competency is not met, the evaluated procedure fails and must be repeated.

All Tasks are critical to the procedure Scoring:
1. Below basic skill level – No concept of skill.
2. Basic skill level – Minimum concept of skill, guidance needed.
3. Proficient skill level – Able to perform skill with minimal guidance.
4. Advanced skill level – Able to perform skill with no guidance.

STERILIZING INSTRUMENTS WITH UNSATURATED CHEMICAL VAPOR TASK EVALUATION FORM

Objective: When provided with the appropriate materials, the student will demonstrate the proper technique for precleaning instruments before sterilization using the ultrasonic cleaner.

Competency: The student will set up armamentarium and Students will be taught the proper technique for precleaning and using ultrasonic cleaner. The use of all OSHA and PPE procedures will be practiced without error.

Practice Required: 3

 

Wore appropriate personal protective eyewear.

Dried the instruments.

Wrapped the instruments.

Ensured that packages were not too large.

Loading and Operating the Chemical Vapor Sterilizer

Read and followed the manufacturer’s instructions.

Read and followed the Read the information on the MSDS for the chemical liquid.instructions.

Loaded the sterilizer.

Set the controls for the proper time and temperature.

Followed the manufacturer’s instructions for venting and cooling.

Checked the external process indicator for color change.

Total Possible Points = 40 points

Minimum passing score = 40  points

If step is missed or minimum competency is not met, the evaluated procedure fails and must be repeated.

All Tasks are critical to the procedure Scoring:
1. Below basic skill level – No concept of skill.
2. Basic skill level – Minimum concept of skill, guidance needed.
3. Proficient skill level – Able to perform skill with minimal guidance.
4. Advanced skill level – Able to perform skill with no guidance.

STERILIZING INSTRUMENTS WITH DRY HEAT TASK EVALUATION FORM

Objective: By following a routine procedure that meets stated protocols, when provided with the appropriate materials, the student will demonstrate the proper technique for preparing and sterilizing instruments with dry heat

Competency: The student will set up armamentarium and Students will be taught the proper technique for preparing and sterilizing instruments with dry heat. The student will pass with a minimum score.

Practice Required: 3

Wrapping the Instruments

Wore appropriate personal protective eyewear.

Dried the instruments before wrapping

 Opened hinged instruments

Wrapped instruments.

Loading and Operating the Dry Heat Sterilizer

Read and followed the manufacturer’s instructions.

Loaded the instruments into the dry heat chamber.

 Set the time and temperature.

Did not place additional instruments in the load once the sterilization cycle had begun.

Allowed the packs to cool before handling.

Checked the indicators for color change.

Total Possible Points = 40 points

Minimum passing score = 40  points

If step is missed or minimum competency is not met, the evaluated procedure fails and must be repeated.

All Tasks are critical to the procedure Scoring:
1. Below basic skill level – No concept of skill.
2. Basic skill level – Minimum concept of skill, guidance needed.
3. Proficient skill level – Able to perform skill with minimal guidance.
4. Advanced skill level – Able to perform skill with no guidance.

STERILIZING INSTRUMENTS WITH CHEMICAL LIQUID STERILANTS TASK EVALUATION FORM

Objective: By following a routine procedure that meets stated protocols, when provided with the appropriate materials, the student will demonstrate the proper technique for preparing and sterilizing instruments with chemical sterilant.

Competency: The student will set up armamentarium and Students will be taught the proper technique for preparing and sterilizing instruments with chemical sterilants. The student will pass with a minimum score.

Practice Required: 3

Preparing the Solution

Wore utility gloves, a mask, eyewear, and protective clothing when preparing, using, and discarding the solution.

Wore utility gloves, a mask, eyewear, and protective clothing when preparing, using, and discarding the solution.

Prepared the solution for use as a sterilant. Labeled the containers with the name of the chemical, date of preparation, and any other information relating to the hazards of the product.

Covered the container and kept it closed unless putting instruments in or taking them out.

Using the Solution

Precleaned, rinsed, and dried items to be processed.

Placed the items in a perforated tray or pan. Placed the pan in the solution, and covered the container. Or as an alternative, used tongs.

Ensured that all items were fully submerged in the solution for the entire contact time.

Rinsed processed items thoroughly with water and dried. Placed items in a clean package.

Total Possible Points = 32 points

Minimum passing score = 32  points

If step is missed or minimum competency is not met, the evaluated procedure fails and must be repeated.

All Tasks are critical to the procedure Scoring:
1. Below basic skill level – No concept of skill.
2. Basic skill level – Minimum concept of skill, guidance needed.
3. Proficient skill level – Able to perform skill with minimal guidance.
4. Advanced skill level – Able to perform skill with no guidance.

COLD STRILIZATION OF INSTRUMENTS TASK EVALUATION SHEET

Objective: When provided with the appropriate materials, the student will demonstrate the proper technique for preparing and cold sterilization of instruments.

Competency: When provided with the appropriate materials, the student will demonstrate the proper technique for preparing and cold sterilization of instruments.

Practice Required: 3

When provided with the appropriate materials, the student will demonstrate the proper technique for preparing and cold sterilization of instruments.

 Precleaned, rinsed, and dried items to be process.

Places the items in the perforated tray to pan. Placed the in a solutions, and covered the container. Or as an alternative, used tongs.

Ensured that all items were fully submerged in the solution for the entire contact time.

Raised process items thoroughly with water and dried. Placed items in a clean package.

Tested the glutaraldehyde concentration of the solution with chemical test kit.

Replaced the solution as indicated on the solution instructions. When replacing the used solution, discarded all of the used solutions.

Cleaned to container with detergent, rinsed with water, dried and filled with new solution.

Total Possible Points = 44 points

Minimum passing score = 44 points

If step is missed or minimum competency is not met, the evaluated procedure fails and must be repeated.

All Tasks are critical to the procedure Scoring:
1. Below basic skill level – No concept of skill.
2. Basic skill level – Minimum concept of skill, guidance needed.
3. Proficient skill level – Able to perform skill with minimal guidance.
4. Advanced skill level – Able to perform skill with no guidance.

PERFORMING BIOLOGICAL MONITORING TASK EVALUATION SHEET

Objective: Students will demonstrate the proper technique for performing biological monitoring.

Competency: The student will set up armamentarium and Students will be taught the proper technique for biological monitoring. The use of all OSHA and PPE procedures will be practiced without error.

Practice Required: 3

When wearing all PPE placed all the strip in the bundle of instruments and sealed the package

Placed the pack with the strip in the center of the sterilizer load.

Placed the remainder of the package instruments into the sterilizer, and processed the load through a normal sterilization cycle.

Removed utility gloved, mask, and eyewear. Washed and dried hands.

 Recorded the date of the test; the type of sterilizer, the cycle, temperature, and time; and the name of the person operating the sterilizer.

Removed and process strip after the load was sterilized.

Mailed the process spore strip to the monitoring service.

Total Possible Points = 28 points

Minimum passing score = 28 points

If step is missed or minimum competency is not met, the evaluated procedure fails and must be repeated.

All Tasks are critical to the procedure Scoring:
1. Below basic skill level – No concept of skill.
2. Basic skill level – Minimum concept of skill, guidance needed.
3. Proficient skill level – Able to perform skill with minimal guidance.
4. Advanced skill level – Able to perform skill with no guidance.

CREATING AN APPROPRIATE LABEL FOR A SECONDARY CONTAINER TASK EVALUATION FORM

Objective: By following a routine procedure that meets stated protocols, the student will demonstrate the proper technique for using information from a material safety data sheet (MSDS) to complete a chemical label for a secondary container.

Competency: The student will set up armamentarium and Students will be taught the proper technique for using information from a material safety data sheet (MSDS) to complete a chemical label for a secondary container.

Practice Required: 3

Wrote the manufacturer’s name and address on the label.

Wrote the name of the chemical(s) on the label.

Wrote the appropriate health hazard code in the blue triangle.

Wrote the appropriate flammability and explosion hazard code in the red triangle

Wrote the appropriate reactivity code in the yellow triangle.

Wrote the appropriate specific hazard warning in the white triangle.

Total Possible Points = 24 points

Minimum passing score = 24 points

If step is missed or minimum competency is not met, the evaluated procedure fails and must be repeated.

All Tasks are critical to the procedure Scoring:
1. Below basic skill level – No concept of skill.
2. Basic skill level – Minimum concept of skill, guidance needed.
3. Proficient skill level – Able to perform skill with minimal guidance.
4. Advanced skill level – Able to perform skill with no guidance.

DISINFECTING AN ALGINATE IMPRESSION, BITE REGISTRATION AND PROSTHETIC APPLIENCES TASK EVALUATION FORM

Objective: The students will demonstrate the proper technique for disinfecting an alginate impression, bite registration and prosthetic appliances.

Competency: The student will set up armamentarium and Students will be taught the proper routine procedure that meets stated protocols for the proper technique for disinfecting an alginate impression, bite registration and prosthetic appliances. The student will pass with a minimum score.

Practice Required: 3

Assembled the appropriate setup.

Wore the appropriate personal protective eyewear.

Gently cleaned the impression, bite registration and prosthetic appliances

Rinsed the impression, bite registration and prosthetic appliances and removed excess water.

Sprayed the impression, bite registration and prosthetic appliances thoroughly with disinfectant.

Wrapped the impression, bite registration and prosthetic appliances loosely in a plastic bag for the recommended contact time.

After sufficient contact time, rinsed the impression, bite registration and prosthetic appliances

Total Possible Points = 24 points

Minimum passing score = 24 points

If step is missed or minimum competency is not met, the evaluated procedure fails and must be repeated.

All Tasks are critical to the procedure Scoring:
1. Below basic skill level – No concept of skill.
2. Basic skill level – Minimum concept of skill, guidance needed.
3. Proficient skill level – Able to perform skill with minimal guidance.
4. Advanced skill level – Able to perform skill with no guidance.

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