DANB ICE Exam Prep: 4-Week Study Plan and 50 Practice Questions
DANB's Infection Control (ICE) exam is 75 multiple-choice questions in 60 minutes, and you need a scaled score of 400 to pass. Start with where the points are on the current outline (effective March 12, 2025), then follow the day-by-day plan and practice with 50 original questions.
Your 4-week ICE study plan
45–60 minutes a day, five days a week.
Week 1: Disease transmission, then surfaces
| Day | Learn | Practice |
|---|---|---|
| 1 | Chain of infection; modes of transmission; standard vs. transmission-based precautions; respiratory hygiene; when a respirator is needed | Questions 1–4 |
| 2 | Hand hygiene: soap vs. alcohol rub, surgical hand antisepsis, nails, jewelry, lotions | Questions 5–6 |
| 3 | PPE: masks, eyewear, gloves, gowns, removal and hand hygiene; dental dam and high-volume evacuation for spatter | Questions 7–10 |
| 4 | Review: write the five links of the chain of infection from memory with one way to break each; redo any misses from Days 1–3 | Redo misses |
| 5 | Surfaces: clinical contact vs. housekeeping, barriers, disinfectant levels, clean-then-disinfect, blood spills, broken glass | Questions 11–17 |
Week 2: Cross-contamination
| Day | Learn | Practice |
|---|---|---|
| 6 | Tray setups: single-use devices, anesthetic cartridges, medication vials, aseptic technique | Questions 18–21 |
| 7 | Dental unit waterlines, water testing and surgical irrigation; evacuation line and trap maintenance from your textbook and the equipment instructions | Questions 22–24 |
| 8 | X-ray equipment and digital sensors; impression and appliance disinfection from your textbook and the product instructions | Question 25 |
| 9 | Regulated waste, sharps disposal and contaminated laundry | Questions 26–27 |
| 10 | Review: talk through a full operatory turnover out loud and name the product level for each surface; redo misses from Days 5–9 | Redo misses |
Week 3: Instrument processing
| Day | Learn | Practice |
|---|---|---|
| 11 | Critical, semicritical and noncritical items; transport; the four processing zones; cleaning and holding | Questions 28–31 |
| 12 | Packaging, hinged instruments, chemical indicators, pack labels; handpieces | Questions 32–33, 37 |
| 13 | Steam (gravity and prevacuum), dry heat and chemical vapor; loading and drying; unwrapped cycles; liquid chemical sterilants | Questions 34–36, 39 |
| 14 | Mechanical, chemical and biological monitoring; positive spore test response; storage and damaged packs | Questions 38, 40 |
| 15 | Review: draw the instrument workflow from dirty to sterile storage without notes; redo misses from Days 11–14 | Redo misses |
Week 4: OSHA, records and full review
| Day | Learn | Practice |
|---|---|---|
| 16 | Bloodborne Pathogens Standard: exposure control plan, engineering vs. work-practice controls, sharps, work-area rules, utility gloves | Questions 42, 44–47 |
| 17 | Hepatitis B vaccine, post-exposure steps, training, medical and training records, sharps injury log | Questions 41, 43 |
| 18 | Hazard Communication: labels, secondary containers, safety data sheets; which agency does what | Questions 48–50 |
| 19 | All 50 questions in 40 minutes, the real exam's pace (60 minutes ÷ 75 questions = 48 seconds each; 50 × 48 seconds = 40 minutes) | Questions 1–50 |
| 20 | Rework every miss until you can say why each wrong option is wrong; go through the final-48-hours checklist below | Redo misses |
Plan on 45–60 minutes a day, five days a week (about 15–20 hours total). Days are split roughly in proportion to the weights: 4 days on Domain I, 6 on Domain II, 5 on Domain III, 3 on Domain IV and 2 for mixed review. The weeks start with disease transmission because standard precautions and PPE come up again in every other domain.
For reading, use one current dental assisting textbook (DANB's reference list names Modern Dental Assisting, 14th edition) plus the free CDC Summary of Infection Prevention Practices in Dental Settings. Each day: read, then answer the listed questions without notes, then check every explanation.
Only a week left? Spend Days 1–2 on Domain II, Days 3–4 on Domain III, Day 5 on Domain I, Day 6 on Domain IV and Day 7 on all 50 questions timed plus your misses. Skim the rules sections below instead of reading whole chapters.
About two weeks? Do two plan days per study day and keep every topic.
New to dental work? Stretch it to 8 weeks: take two days for each plan day and read the matching textbook chapter first. DANB says many test-takers studied at least 1–2 months.
Using DANB's free ICE Study Guide Plan instead? It's still useful for chapter and course assignments, but the version on DANB's site describes a 100-question, 75-minute exam simulation and cites the 13th edition of Modern Dental Assisting. The current outline says 75 questions in 60 minutes and lists the 14th edition (older editions are fine if published within the past 5 years). Go by the outline.
This is our editorial plan built from DANB's published outline and weights, not a DANB requirement, and no plan guarantees a result. Sources: DANB Study Guides and ICE Study Guide Plan; DANB: Prepare for Exams; ICE Exam Outline, pp. 2 and 5.
| Questions | Time | To pass | Current fee | Eligibility | Where you test |
|---|---|---|---|---|---|
| 75 multiple choice | 60 minutes | Scaled score of 400 (scale runs 100–900) | $270 ($265 active military) | None | Pearson VUE test center or online proctored |
Sources: DANB ICE Exam Outline, pp. 1–2 and 10; 2026 ICE Application Packet, p. 9. Last verified October 26, 2026.
Where the points are
60% of ICE comes from two domains: keeping surfaces, water and equipment from carrying contamination between patients (34%), and processing instruments (26%). Give them the most time.
| Domain (weight) | What it covers | The rules people miss |
|---|---|---|
| II. Prevention of Cross-contamination (34%) | Treatment-area and lab disinfection, disinfectants, barriers, tray setups, waterlines, evacuation lines, x-ray equipment, impressions and appliances, waste | Barriers change every patient; low-level disinfectant unless there's visible blood, then intermediate (TB claim); water bottles alone don't fix waterlines; surgery needs sterile irrigant |
| III. Process Instruments and Devices (26%) | Transport, workflow, chemical agents, choosing and loading the sterilizer, packaging, storage, monitoring, malfunctions | Handpieces are always heat-sterilized; an internal indicator goes in every package; spore test at least weekly and with every implant load; what to do after a positive spore test |
| I. Prevention of Disease Transmission (20%) | How disease spreads, medical histories, hand hygiene, PPE, limiting aerosols and spatter | Same precautions for every patient; a surgical mask isn't a TB respirator; change a wet mask; eyewear needs solid side shields; hand hygiene is the last step after removing PPE |
| IV. Occupational Safety and Administration Protocols (20%) | OSHA Bloodborne Pathogens and Hazard Communication standards, CDC guidelines, EPA and FDA rules, exposure control plan, logs and records | 10 working days for the hepatitis B vaccine; annual plan review and training; 3-year training records; secondary-container labels; which agency does what |
Domain names and weights: DANB ICE Exam Outline, pp. 2–4. The outline lists topics and weights; it doesn't say which topics are harder.
The rules that get tested
ICE questions are built from a short list of references: CDC's 2003 dental infection control guidelines, CDC's 2016 summary of basic expectations, and the OSHA Bloodborne Pathogens and Hazard Communication standards, plus dental assisting textbooks (ICE Exam Outline, p. 5). CDC says the 2003 guidelines, though archived, still serve as the standard of practice for clinical dentistry. These are the rules worth knowing cold.
Domain I: Stopping transmission before it starts
- Chain of infection. Infection needs all five: a pathogen strong enough and plentiful enough, a reservoir, a mode of transmission, a portal of entry and a susceptible host. Break any one and transmission stops.
- Standard precautions apply to every patient, whatever their known or suspected infection status. Saliva has always been treated as potentially infectious in dentistry.
- Transmission-based precautions are extra steps for diseases spread by air, droplets or contact, such as TB, measles or chickenpox. Dental offices aren't usually set up for airborne precautions, so CDC says to reschedule non-urgent care until the patient isn't infectious, or refer urgent care to a setting that can manage it. A regular surgical mask doesn't protect you from TB; that takes a NIOSH-certified respirator such as an N95, used in a respiratory protection program with fit testing.
- Respiratory hygiene starts at the front door: signs asking people to cover coughs, tissues and no-touch bins, hand hygiene supplies in the waiting area, masks offered to coughing patients, and seating away from others.
- Hand hygiene. Soap and water when hands are visibly soiled; alcohol-based hand rub otherwise. Clean hands right before gloving and again right after removing gloves. Before surgical procedures (biopsies, implant surgery, surgical extractions), do a surgical hand scrub with a product that has persistent activity, then put on sterile surgeon's gloves.
- Skin, nails, jewelry. Keep nails short. Petroleum-based lotions can weaken latex gloves, so CDC limits them to the end of the workday. Jewelry shouldn't interfere with glove fit or integrity.
- PPE. Mask plus eye protection with solid side shields (or a chin-length face shield) whenever spray or spatter is likely. Change a mask between patients, and during treatment if it gets wet. Gloves are single-use: never washed and reused. A torn glove comes off, then hand hygiene, then new gloves. Remove PPE before leaving the work area; hand hygiene is always the final step.
- Aerosol and spatter. Dental dams and high-velocity evacuation are the work practices CDC names to minimize droplets, spatter and aerosol.
Sources: CDC 2003 Guidelines, pp. 2–3, 14–19; CDC Summary, pp. 6–9 and Checklist II.2; OSHA 29 CFR 1910.1030(d)(3).
Domain II: Surfaces, tray setups, water and waste
Cleaning, disinfection and sterilization aren't the same thing. Cleaning removes debris and always comes first, because leftover blood and saliva shield microbes. Disinfection kills most disease-causing microbes but not necessarily bacterial spores. Sterilization destroys all microbes, including large numbers of resistant spores.
| Level | What it kills | Where it's used in dentistry |
|---|---|---|
| Low-level (EPA-registered hospital disinfectant; OSHA also requires an HIV and HBV label claim when used on clinical contact surfaces) | Most vegetative bacteria, some fungi and viruses; can't be relied on for mycobacteria or spores | Clinical contact surfaces and noncritical items with no visible blood |
| Intermediate-level (hospital disinfectant with a tuberculocidal claim) | Vegetative bacteria, mycobacteria, most fungi and most viruses; not spores | Surfaces and noncritical items visibly contaminated with blood; digital sensors that can't take heat or high-level disinfection |
| High-level (FDA-cleared sterilant/high-level disinfectant, such as glutaraldehyde) | Vegetative bacteria, mycobacteria, fungi and viruses; not necessarily large numbers of spores | Only heat-sensitive semicritical items with no heat-tolerant or disposable alternative. Not for surfaces, and not as an instrument holding solution |
| Sterilization (heat for nearly everything in dentistry) | All microbes, including resistant spores | Critical items and heat-tolerant semicritical items |
- Clinical contact surfaces (light handles, bracket trays, chair switches, computer equipment) are either barrier-protected or cleaned and disinfected after each patient. Barriers change between patients. Use barriers especially on surfaces that are hard to clean.
- Follow the label for dilution and contact time, and don't use a disinfectant as a cleaner unless its label says it can be.
- Blood on a work surface is decontaminated right away or as soon as feasible, not at the end of the day. Broken glass that may be contaminated is picked up with a brush and dustpan, tongs or forceps, never by hand.
- Housekeeping surfaces (floors, walls, sinks) can be cleaned with soap and water, or cleaned and disinfected if visibly contaminated with blood.
- Tray setups. Single-use devices go on one patient and then in the trash. A dental anesthetic needle and cartridge are for one patient only; the cartridge syringe is cleaned and heat-sterilized between patients. Enter every medication vial with a new needle and new syringe, even for the same patient. A multidose vial that enters the operatory belongs to that patient and is discarded after use.
- Dental unit waterlines. Treatment water should meet the EPA drinking-water standard: 500 CFU/mL or less of heterotrophic bacteria. Independent water bottles alone aren't enough; the unit also needs a treatment method and routine monitoring as the manufacturer recommends. If a test is over the limit, treat per the instructions and retest right away. For surgical procedures, use sterile saline or sterile water delivered by a device that bypasses the unit (sterile bulb syringe, sterile single-use products or sterile tubing).
- Digital radiography sensors are semicritical: FDA-cleared barrier during use, then clean and heat-sterilize or high-level disinfect between patients. If the sensor can't tolerate either, at minimum clean and disinfect it with an intermediate-level product.
- Regulated waste (OSHA): liquid or semi-liquid blood or other potentially infectious materials (which include saliva in dental procedures), items that would release them if compressed, items caked with dried blood, and contaminated sharps. It goes in closable, leakproof containers that carry the fluorescent orange or orange-red biohazard label or are red. Final disposal follows state and local rules.
- Contaminated laundry is handled as little as possible, bagged where it was used (not sorted or rinsed there) and put in labeled or color-coded bags.
The outline also lists evacuation line and trap maintenance and impression and appliance disinfection. Those steps depend heavily on the equipment and material manufacturer's instructions, so learn them from your textbook chapter and your office's product instructions; our questions don't cover them.
Sources: CDC 2003 Guidelines, pp. 4–5, 20–23; CDC Summary, pp. 10–16; CDC Best Practices for Dental Unit Water Quality; OSHA 29 CFR 1910.1030(b), (d)(4), (g)(1)(i).
Domain III: Instrument processing
Classify by how the item is used.
| Category | Touches | Examples | Processing |
|---|---|---|---|
| Critical | Penetrates soft tissue or bone | Surgical instruments, periodontal scalers, scalpel blades, surgical burs | Heat sterilization |
| Semicritical | Mucous membranes or nonintact skin | Mouth mirror, amalgam condenser, reusable impression trays, handpieces | Heat sterilization (most are heat-tolerant). If heat-sensitive, replace it with a heat-tolerant or disposable version; if none exists, high-level disinfection at minimum. Handpieces: always heat-sterilize. |
| Noncritical | Intact skin only | X-ray tube head/cone, blood pressure cuff, facebow, pulse oximeter | Clean; if visibly soiled, clean and then disinfect with an EPA-registered hospital disinfectant (intermediate-level if visibly contaminated with blood); a disposable barrier is an option |
The workflow runs one way, dirty to clean: receiving, cleaning and decontamination → preparation and packaging → sterilization → storage.
- Transport contaminated instruments in a container placed at the point of use. Reusable sharps go in containers that are puncture-resistant, leakproof on the sides and bottom, and labeled or color-coded.
- Clean before sterilizing. Automated cleaning (ultrasonic cleaner, washer-disinfector) can be safer and more efficient than hand scrubbing and cuts your exposure to blood. If you must hand-scrub, wear puncture-resistant utility gloves, use a long-handled brush and never reach blindly into a sink of sharps. If cleaning has to wait, hold instruments in detergent, a disinfectant/detergent or an enzymatic cleaner. Never use glutaraldehyde as a holding solution.
- Package in materials made for your sterilization method, with hinged instruments open and unlocked. Put an internal chemical indicator in every package, plus an external one if the internal one can't be seen. Multiparameter indicators react to two or more conditions (such as time, temperature and steam) and are more reliable than single-parameter ones. Label packs with the sterilizer, the cycle or load number, the date and any expiration date.
- Sterilize by steam, dry heat or unsaturated chemical vapor, following the sterilizer manufacturer:
- Gravity displacement steam (most tabletop units) can trap cool air pockets if packs are packed wrong or the chamber is overloaded. Prevacuum sterilizers pump air out first; if one fails its air-removal test, don't use it until it's inspected and passes.
- Unsaturated chemical vapor causes less corrosion of carbon-steel instruments such as burs, but instruments must be dry first.
- Dry heat suits items moist heat would damage, but cycles are long.
- Load so the agent circulates freely. Let packs dry in the chamber, and don't handle them until they're cool and dry; wet packs wick bacteria in from hands.
- Unwrapped cycles need thorough cleaning first, mechanical and chemical monitoring every cycle, and aseptic transfer to the point of use. Critical instruments sterilized unwrapped are used right away, never stored. Implantable devices shouldn't be sterilized unwrapped, because they're held until the spore test result is known.
- Liquid chemical sterilants are almost never practical for sterilizing: items need sterile-water rinsing and aseptic handling, the process can't be checked with spore tests, and the chemicals are highly toxic.
- Store in covered or closed cabinets. Check every pack before use; reprocess anything wet, torn or punctured.
Monitoring, and what each result means
| Monitor | How often | What it tells you | If it fails |
|---|---|---|---|
| Mechanical (time, temperature, pressure readouts) | Every load | Whether the cycle reached its settings; often the first sign of a problem | Don't use the load |
| Chemical (internal and external indicators) | Inside every package; external when the internal can't be seen | The sterilizing agent reached inside the package. It doesn't prove sterility. | Don't use those instruments |
| Biological (spore test, with an unprocessed control from the same lot that should grow) | At least weekly, and every load with an implantable device | The cycle actually killed highly resistant spores; the most accepted method | See below |
After a positive spore test (with normal mechanical and chemical results): take the sterilizer out of service and review procedures; recall and quarantine any implantable items; repeat the spore test right away on the same cycle. If the repeat is negative and procedures were correct, return it to service. If it's positive again, keep it out of service until it's inspected or repaired and passes spore tests in three consecutive fully loaded cycles, and recall what you can from loads back to the last negative test.
Sources: CDC 2003 Guidelines, pp. 20–23; CDC Summary, pp. 12–14; CDC Best Practices for Sterilization Monitoring; OSHA 29 CFR 1910.1030(d)(2)(viii), (d)(4)(ii)(E).
Domain IV: OSHA, the agencies and the paperwork
Who does what
| Agency | Its role in dental infection control | Examples you'll see on ICE |
|---|---|---|
| OSHA | Enforceable worker-safety standards | Bloodborne Pathogens Standard (exposure control plan, hepatitis B vaccine, sharps, training, records); Hazard Communication Standard (labels, SDS) |
| CDC | Infection-prevention recommendations | 2003 dental guidelines and 2016 summary: hand hygiene, PPE, instrument processing, sterilization monitoring, waterlines, safe injections |
| EPA | Registers disinfectants and sets the drinking-water standard | "EPA-registered hospital disinfectant"; the 500 CFU/mL waterline benchmark |
| FDA | Clears medical devices and sterilants | Sterilizers, sterilant/high-level disinfectants, medical gloves, handpieces, sensor barriers |
Sources: CDC 2003 Guidelines, pp. 1–5, 18–22; CDC Summary, pp. 12–15; CDC Best Practices for Dental Handpieces.
Bloodborne Pathogens Standard (29 CFR 1910.1030)
| Requirement | The rule |
|---|---|
| Exposure control plan | Written; reviewed and updated at least annually and when tasks change; each review documents safer devices considered, with input from frontline staff |
| Controls | Engineering controls isolate or remove the hazard (sharps containers, self-sheathing needles). Work-practice controls change how a task is done (one-handed recapping). PPE covers what's left. |
| Hepatitis B vaccine | Made available at no cost, after training and within 10 working days of initial assignment; employees who decline sign the declination statement and can still get it later |
| Training | At initial assignment, then at least annually (within one year of the last), and when tasks change; free and during working hours |
| Records | Training records: 3 years. Medical records, including hepatitis B status: duration of employment plus 30 years, kept confidential |
| Sharps injury log | Required for employers who must keep OSHA injury and illness logs; records the device type and brand, the work area and how it happened |
| Sharps | Never bend, break or shear contaminated needles; recap only with a one-handed technique or mechanical device. Containers: closable, puncture-resistant, leakproof on sides and bottom, labeled or red, upright, near the point of use, not overfilled, closed before removal |
| Labels | Biohazard symbol, fluorescent orange or orange-red with contrasting lettering; red bags or containers may substitute |
| PPE | Provided, cleaned and replaced at no cost; removed before leaving the work area; hands washed right after removing gloves or other PPE. Utility gloves can be decontaminated and reused until they crack, peel, tear or puncture. |
| Work areas | No eating, drinking, smoking, cosmetics, lip balm or contact-lens handling where exposure is likely; no food stored where blood or saliva may be present |
After a needlestick or splash: wash the wound with soap and water or flush mucous membranes with water, then report it immediately. CDC says squeezing the wound hasn't been shown to help, and bleach or injecting antiseptic into the wound isn't recommended. OSHA requires the employer to make a confidential medical evaluation and follow-up available immediately.
Hazard Communication Standard (29 CFR 1910.1200)
- A written program with a list of the hazardous chemicals in the office.
- A safety data sheet (SDS) for each one, readily accessible on every shift. SDSs follow 16 sections in a fixed order. Know Section 2 (hazards), Section 4 (first aid), Section 7 (handling and storage) and Section 8 (exposure controls and PPE).
- Labels carry a product identifier, signal word ("Danger" for more severe hazards, "Warning" for less severe), hazard statements, pictograms and precautionary statements.
- Secondary containers must be labeled. The only exception: a portable container filled from a labeled one for the immediate use of the person who filled it, within that same shift.
- Training at initial assignment and whenever a new chemical hazard is introduced.
Records the outline expects you to know: the exposure control plan, sterilization logs (mechanical, chemical and biological results, kept as long as state and local rules require), training records, and a written response plan for reprocessing errors and other infection control breaches.
Sources: OSHA 29 CFR 1910.1030, paragraphs (b)–(h); OSHA 29 CFR 1910.1200, paragraphs (c), (e)–(h); CDC 2003 Guidelines, p. 14; CDC Summary, pp. 4–6, 13–14 and Checklist I.10.F.
Practice questions: 50 original ICE questions with explanations
Answer each question before opening the explanation. The set follows the outline's weights: 10 questions on Domain I, 17 on Domain II, 13 on Domain III and 10 on Domain IV.
These are original, unofficial practice questions written by Castleport Test Prep. They are not DANB exam questions. Your score is feedback on these 50 items only. It doesn't convert to DANB's scaled score or predict a pass.
Domain I: Prevention of Disease Transmission (Questions 1–10)
Question 1 · ICE-D1-01
A new dental assistant completes the hepatitis B vaccine series, and follow-up testing shows she is immune. Which link in the chain of infection is now broken for hepatitis B?
Show answer
Answer: C. Susceptible host
Why: CDC lists five conditions that must all be present for infection: a capable pathogen, a reservoir, a mode of transmission, a portal of entry and a susceptible host, meaning someone who isn't immune. Immunity removes the susceptible host.
Why not the others: Barriers, PPE and safe work practices target the mode of transmission and portal of entry; the vaccine doesn't change those. The reservoir is the infected source, such as a patient's blood.
Source: CDC: Guidelines for Infection Control in Dental Health-Care Settings, 2003, p. 2
Question 2 · ICE-D1-02
A patient's updated health history says she has HIV. She's scheduled for a routine composite restoration. Under CDC guidance, what changes about the infection control you use?
Show answer
Answer: A. Nothing. The same standard precautions apply to every patient.
Why: CDC defines standard precautions as the minimum practices for all patient care, regardless of a patient's suspected or confirmed infection status. Patients with bloodborne infections can have no symptoms or not know they're infected, which is why the same precautions are used for everyone.
Why not the others: End-of-day scheduling isn't a CDC requirement for bloodborne infections. N95 respirators are for airborne precautions, such as suspected TB; HIV isn't spread through the air. Double-gloving and disposables aren't required for routine care.
Source: CDC Summary of Infection Prevention Practices in Dental Settings, p. 6; CDC 2003 Guidelines, pp. 2–3, 17
Question 3 · ICE-D1-03
A patient checking in for a cleaning is coughing and sneezing. Which response follows CDC's respiratory hygiene/cough etiquette recommendations?
Show answer
Answer: B. Offer a mask and tissues, point out hand hygiene supplies, and seat the patient as far from others as possible
Why: CDC's respiratory hygiene measures start at the point of entry: masks for coughing patients, tissues and no-touch bins, hand hygiene supplies near waiting areas, and seating symptomatic people away from others. The office can then decide whether non-urgent care should be rescheduled.
Why not the others: CDC's approach is to contain secretions and evaluate, not to turn someone away without any assessment. Putting the patient in an operatory early spreads contamination into a treatment area. Waiting until the patient is in the chair misses the waiting room, where others are exposed.
Source: CDC Summary, pp. 6–9
Question 4 · ICE-D1-04
A patient with suspected active tuberculosis needs urgent dental care, and the office will provide it. What respiratory protection should the treating staff wear?
Show answer
Answer: D. A NIOSH-certified particulate respirator, such as an N95, used within a respiratory protection program that includes fit testing
Why: TB spreads through tiny airborne particles. CDC says airborne precautions call for a NIOSH-certified respirator, and that respirators work only when they're used in a complete program with training and fit testing so they seal to the face.
Why not the others: Most surgical masks aren't certified respirators and don't adequately protect against TB, no matter how often they're changed or how many are stacked. A face shield blocks spatter, not airborne particles.
Source: CDC 2003 Guidelines, p. 17; CDC Summary, p. 6
Question 5 · ICE-D1-05
Before an implant surgery, what hand hygiene does CDC call for?
Show answer
Answer: A. A surgical hand scrub with an antimicrobial soap or alcohol-based surgical scrub with persistent activity, then sterile surgeon's gloves
Why: Implant surgery is a surgical procedure. CDC says to perform surgical hand antisepsis before putting on sterile surgeon's gloves, using products with persistent activity because bacteria can multiply in the moist space under gloves.
Why not the others: A routine wash with plain soap and exam gloves is for nonsurgical care. Hand rub is for hands, not gloves. Gloves never replace hand hygiene.
Source: CDC 2003 Guidelines, pp. 14–15 (Table 2); CDC Summary, p. 7
Question 6 · ICE-D1-06
An assistant's hands are chapped from frequent hand hygiene, and she wants to use a petroleum-based hand cream. According to CDC, when is that appropriate?
Show answer
Answer: D. Only at the end of the workday
Why: CDC notes that petroleum-based lotions can weaken latex gloves and make them more permeable, so lotions with petroleum or other oil emollients should be used only at the end of the workday.
Why not the others: Applying it before gloving is exactly the situation CDC warns about. Dry hands don't change how the lotion affects latex. Lotions aren't banned: CDC notes they're often recommended to ease dryness and glove-related dermatitis, and its caution is about petroleum- and oil-based products.
Source: CDC 2003 Guidelines, p. 16
Question 7 · ICE-D1-07
Halfway through a long crown preparation, your surgical mask feels damp from your breath. What does CDC recommend?
Show answer
Answer: D. Change it, even during treatment when possible.
Why: When a mask gets wet, more air flows around its edges instead of through the filter. CDC says to change a wet mask between patients, or even during treatment when possible.
Why not the others: No mask is rated for an appointment regardless of moisture. Lowering a mask exposes your nose and contaminates your hands. Disinfectant on a mask doesn't restore filtration and puts chemicals near your face.
Source: CDC 2003 Guidelines, p. 17; CDC Summary, Checklist II.2.C
Question 8 · ICE-D1-08
An assistant wants to wear her everyday prescription glasses, which have no side shields, as eye protection during ultrasonic scaling. Which statement is correct?
Show answer
Answer: C. She needs eyewear with solid side shields, or a chin-length face shield, along with a mask.
Why: OSHA requires masks combined with goggles, glasses with solid side shields or chin-length face shields whenever splashes or spatter can reach the eyes, nose or mouth. Ultrasonic scaling creates spray, and spatter can get in around the sides of ordinary glasses.
Why not the others: Impact resistance doesn't stop spatter from the sides. A mask protects the nose and mouth, not the eyes. Eye protection depends on the spray or spatter risk, not on whether the procedure is surgical.
Source: OSHA 29 CFR 1910.1030(d)(3)(x); CDC 2003 Guidelines, p. 17
Question 9 · ICE-D1-09
During a restorative procedure, you notice a tear in your glove. What should you do?
Show answer
Answer: C. Remove the torn glove, perform hand hygiene, then put on a new glove
Why: CDC says to remove gloves that are torn, cut or punctured and perform hand hygiene before regloving. OSHA requires disposable gloves to be replaced as soon as feasible when torn or punctured.
Why not the others: Covering a torn glove leaves contaminated skin underneath. Gloves aren't washed or treated with hand rub; washing can create tiny holes that let liquid through. Waiting until the procedure ends leaves your hand exposed.
Source: CDC Summary, Checklist II.2.D.f; CDC 2003 Guidelines, pp. 15, 18; OSHA 29 CFR 1910.1030(d)(3)(ix)(A)
Question 10 · ICE-D1-10
You've finished a procedure and removed your gloves, gown, eyewear and mask in the correct order. What is always the final step?
Show answer
Answer: A. Perform hand hygiene
Why: CDC says hand hygiene is always the final step after removing and disposing of PPE, because hands can be contaminated during removal. OSHA requires handwashing immediately, or as soon as feasible, after removing gloves or other PPE.
Why not the others: Reusable eyewear is cleaned per the manufacturer, but that doesn't replace hand hygiene. Gloves are for patient care and contaminated tasks, not for walking out of the operatory. The sterilization log records processing, not PPE removal.
Source: CDC Summary, p. 8; OSHA 29 CFR 1910.1030(d)(2)(v)
Domain II: Prevention of Cross-contamination (Questions 11–27)
Question 11 · ICE-D2-01
The light handle wasn't covered by a barrier during a routine exam, and there's no visible blood on it. What does CDC expect before the next patient?
Show answer
Answer: B. Clean it, then disinfect it with an EPA-registered hospital disinfectant
Why: CDC says clinical contact surfaces that aren't barrier-protected are cleaned and disinfected with an EPA-registered hospital disinfectant after each patient. You'd step up to an intermediate-level (tuberculocidal) product if the surface were visibly contaminated with blood.
Why not the others: Clinical contact surfaces are handled between patients, not at day's end. High-level chemicals like glutaraldehyde are toxic and aren't meant for environmental surfaces. Soap and water alone is for housekeeping surfaces, not clinical contact surfaces.
Source: CDC Summary, pp. 14–15; CDC 2003 Guidelines, pp. 20, 23
Question 12 · ICE-D2-02
Your office is choosing a low-level hospital disinfectant for clinical contact surfaces. According to CDC's guidelines, what label claim does OSHA require such a product to carry, besides EPA registration as a hospital disinfectant?
Show answer
Answer: B. A claim of effectiveness against HIV and hepatitis B virus
Why: CDC explains that OSHA requires low-level hospital disinfectants used on clinical contact surfaces to also carry a label claim for potency against HIV and HBV.
Why not the others: A sporicidal claim belongs to sterilants. A tuberculocidal claim is what makes a product intermediate-level, needed when a surface is visibly bloody, not for routine low-level use. Household cleaners aren't EPA-registered hospital disinfectants.
Source: CDC 2003 Guidelines, p. 5 (definition of low-level disinfectant)
Question 13 · ICE-D2-03
After the patient leaves, the plastic barrier on the chair switch looks perfectly clean. What should you do?
Show answer
Answer: C. Remove it and place a new barrier before the next patient
Why: CDC recommends barriers for clinical contact surfaces, especially hard-to-clean ones like chair switches, and says to change them between patients. Contamination isn't always visible.
Why not the others: "Looks clean" isn't the standard. Barriers are disposable covers, not surfaces to disinfect and reuse. Layering barriers leaves the contaminated one in place.
Source: CDC Summary, p. 15 and Checklist II.7.B
Question 14 · ICE-D2-04
Which surface can routinely be cleaned with soap and water, as long as it isn't visibly contaminated with blood?
Show answer
Answer: A. The operatory floor
Why: CDC classifies floors, walls and sinks as housekeeping surfaces. They carry less risk than clinical contact surfaces and can be cleaned with soap and water, or cleaned and disinfected if visibly contaminated with blood.
Why not the others: Chair controls, bracket trays and light handles are touched during care, so they're clinical contact surfaces that need a barrier or cleaning and disinfection between patients.
Source: CDC Summary, pp. 14–15
Question 15 · ICE-D2-05
Your office's surface product is labeled as both a cleaner and a disinfectant. When you wipe down a clinical contact surface between patients, what's the right sequence?
Show answer
Answer: D. Clean the surface first, then apply the product again and leave it wet for the label's contact time
Why: CDC says cleaning should always come before disinfection, because blood, saliva and debris shield microorganisms from the disinfectant. Contact time comes from the product label.
Why not the others: A single pass can't both remove debris and then disinfect a clean surface. Wiping the product off immediately cuts the contact time short. Disinfecting before cleaning means the disinfectant hits a dirty surface.
Source: CDC Summary, p. 14; CDC 2003 Guidelines, p. 21
Question 16 · ICE-D2-06
During an extraction, a few drops of blood land on the counter beside the tray. When should that spot be decontaminated?
Show answer
Answer: A. Immediately or as soon as feasible, cleaning first and then using an intermediate-level (tuberculocidal) hospital disinfectant
Why: OSHA requires overtly contaminated surfaces to be decontaminated immediately or as soon as feasible. CDC calls for an intermediate-level disinfectant when a surface is visibly contaminated with blood, after cleaning.
Why not the others: The end of the day is far too late for a visible spill. Soap and water doesn't disinfect. Dried blood still needs decontamination; drying doesn't make it safe.
Source: OSHA 29 CFR 1910.1030(d)(4)(ii)(A); CDC Summary, p. 15
Question 17 · ICE-D2-07
An anesthetic cartridge shatters on the floor after use. How should the glass be picked up?
Show answer
Answer: D. With a brush and dustpan, tongs or forceps
Why: OSHA says broken glassware that may be contaminated must not be picked up directly with the hands; it's cleaned up by mechanical means such as a brush and dustpan, tongs or forceps.
Why not the others: Gloves, even doubled, don't stop glass from cutting skin. A paper towel in your hand is still picking it up by hand.
Question 18 · ICE-D2-08
A disposable prophy angle was used for a two-minute polish and looks clean. What should happen to it?
Show answer
Answer: C. Discard it
Why: Most single-use devices have no reprocessing instructions. CDC says to use them on one patient only and dispose of them appropriately.
Why not the others: Sterilizing, disinfecting or soaking a single-use device for reuse ignores its labeling. Without validated instructions, nothing confirms it can be reprocessed safely. (Reusable prophy angles are a different item; those are heat-sterilized.)
Source: CDC Summary, p. 12 and Checklist II.6.A
Question 19 · ICE-D2-09
Local anesthetic was given with a dental cartridge syringe. After the patient leaves, what happens to each part?
Show answer
Answer: C. Needle and cartridge are used for that patient only; the syringe is cleaned and heat-sterilized before the next patient
Why: CDC says not to use the needle or anesthetic cartridge for more than one patient, and to make sure the dental cartridge syringe is cleaned and heat-sterilized before use on another patient.
Why not the others: A partly used cartridge has been in contact with one patient's injection and can't go to another. A reusable cartridge syringe is processed, not thrown away, and surface disinfection isn't enough for it.
Source: CDC Summary, pp. 10–11 (note on local dental anesthesia)
Question 20 · ICE-D2-10
A multidose vial of medication was brought into the operatory for a sedation case. What should happen to it after the procedure?
Show answer
Answer: B. Treat it as that patient's vial and discard it after use
Why: CDC says multidose vials used for more than one patient should stay in a centralized medication area. If a multidose vial enters the immediate treatment area, it's dedicated to that one patient and discarded right after use.
Why not the others: Once a vial has been in the operatory, it may be contaminated, so it can't go back for other patients. Wiping the septum doesn't change that. The 28-day dating rule applies to multidose vials kept and used properly, not ones that entered a treatment area.
Source: CDC Summary, p. 11
Question 21 · ICE-D2-11
During a sedation case, the dentist needs a second dose from the same medication vial for the same patient. How should it be drawn?
Show answer
Answer: D. With a new needle and a new syringe
Why: CDC says medication containers are entered with a new needle and new syringe every time, even when getting more medication for the same patient. Reentering with a used syringe has caused patient-to-patient infections when the vial was later used for someone else.
Why not the others: Any reused needle or syringe can contaminate the vial. "Same patient" doesn't make it safe, because the vial's contents may later reach other patients.
Source: CDC Summary, pp. 10–11
Question 22 · ICE-D2-12
Your office switched its dental units to independent water bottles filled with distilled water. Does that by itself meet CDC's expectations for treatment water?
Show answer
Answer: B. No; the units still need a waterline treatment method and routine monitoring per the manufacturer
Why: Biofilm grows in the narrow tubing regardless of the water poured in. CDC says independent reservoirs alone aren't sufficient; units need a system that treats water to 500 CFU/mL or less, monitored as the manufacturer recommends.
Why not the others: Clean source water doesn't stop biofilm in the lines. Emptying bottles nightly doesn't treat the lines either. Sterile water is required for surgical procedures, not for all routine treatment.
Source: CDC Summary, p. 15; CDC Best Practices for Dental Unit Water Quality
Question 23 · ICE-D2-13
A routine waterline test for one unit comes back above 500 CFU/mL of heterotrophic bacteria. What does CDC recommend?
Show answer
Answer: A. Treat the unit per the manufacturer's instructions and retest right after treatment
Why: CDC's guidance for a failed test is to treat the unit according to the product instructions and retest immediately. Retesting confirms the treatment worked.
Why not the others: Flushing without retesting leaves you guessing. The 500 CFU/mL standard covers routine treatment water; surgery has a stricter requirement (sterile irrigant). CDC mentions replacing lines only if a unit stays resistant to treatment over time.
Question 24 · ICE-D2-14
The dentist is placing an implant. What should be used as the coolant and irrigant?
Show answer
Answer: D. Sterile saline or sterile water through a delivery device that bypasses the dental unit
Why: Implant surgery is a surgical procedure. CDC says to use sterile saline or sterile water, delivered with a sterile bulb syringe, sterile single-use products or sterile tubing that bypasses the unit.
Why not the others: Water meeting 500 CFU/mL is fine for routine care but isn't sterile. Even sterile water in a unit's reservoir passes through lines that can't be reliably sterilized. Tap water isn't sterile, and suturing doesn't change that.
Source: CDC Best Practices for Dental Unit Water Quality; CDC Summary, pp. 7, 15
Question 25 · ICE-D2-15
A digital sensor was covered with an FDA-cleared barrier during a full-mouth series. Its manufacturer says it can't be heat-sterilized or high-level disinfected. After you remove the barrier, what's the minimum before the next patient?
Show answer
Answer: B. Clean it, then disinfect it with an intermediate-level (tuberculocidal) EPA-registered hospital disinfectant
Why: CDC treats digital sensors as semicritical. The preferred processing is cleaning plus heat sterilization or high-level disinfection; when a sensor can't tolerate that, CDC's minimum is the barrier plus cleaning and intermediate-level disinfection between patients.
Why not the others: Barriers reduce contamination but don't eliminate it, so a new barrier alone skips the disinfection step. Soap and water isn't disinfection. Hand rub is made for skin, not devices.
Source: CDC Summary, p. 12 and Checklist II.6.S
Question 26 · ICE-D2-16
After an extraction, you have gauze so saturated that it would release liquid blood if squeezed. Under OSHA's Bloodborne Pathogens Standard, where does it go?
Show answer
Answer: C. A closable, leakproof regulated-waste container that is red or carries the biohazard label
Why: OSHA defines items that would release blood if compressed as regulated waste. Regulated waste goes in closable, leakproof containers labeled with the biohazard label or colored red. Final disposal follows state and local rules.
Why not the others: Regular trash isn't allowed for regulated waste. Sharps containers are for items that can penetrate skin. OSHA's label must be fluorescent orange or orange-red with the biohazard symbol in a contrasting color; handwritten tape doesn't meet that.
Source: OSHA 29 CFR 1910.1030(b), (d)(4)(iii)(B)–(C), (g)(1)(i)
Question 27 · ICE-D2-17
A reusable patient bib towel and a cloth lab coat are soiled with blood at the end of a procedure. How does OSHA say to handle them?
Show answer
Answer: A. Bag them where they were used, without sorting or rinsing, in bags that are labeled or color-coded
Why: OSHA requires contaminated laundry to be handled as little as possible, bagged at the location where it was used and not sorted or rinsed there, and carried in bags that are labeled or color-coded. The employer is responsible for laundering PPE at no cost to the employee.
Why not the others: Rinsing and shaking spread contamination. A lab coat worn as PPE is laundered by the employer, not taken home.
Domain III: Process Instruments and Devices (Questions 28–40)
Question 28 · ICE-D3-01
The procedure is over, and the tray holds contaminated instruments, including a scaler and an explorer. How should they get to the sterilization area?
Show answer
Answer: A. In a puncture-resistant, leakproof, labeled or color-coded container placed at the point of use
Why: CDC says to place instruments in an appropriate container at the point of use to prevent injuries during transport. OSHA requires reusable contaminated sharps to go in containers that are puncture-resistant, leakproof on the sides and bottom, and labeled or color-coded.
Why not the others: A towel doesn't stop a scaler from puncturing someone. Hand-to-hand passing multiplies the chances of a stick. Rinsing at chairside adds handling and splashing outside the processing area.
Source: CDC 2003 Guidelines, p. 21; OSHA 29 CFR 1910.1030(d)(2)(viii)
Question 29 · ICE-D3-02
Which order matches the flow through an instrument processing area?
Show answer
Answer: D. Receiving, cleaning and decontamination → preparation and packaging → sterilization → storage
Why: CDC divides the processing area into those four sections so instruments move one way, from contaminated to sterile, without crossing back into clean areas.
Why not the others: Debris left on instruments interferes with sterilization, so cleaning always comes before sterilizing. Packaging comes after cleaning so you aren't sealing debris inside the pouch.
Source: CDC 2003 Guidelines, p. 21; CDC Summary, Checklist II.6.O
Question 30 · ICE-D3-03
You can't clean a cassette of instruments right away. What should they be held in so debris doesn't dry on them?
Show answer
Answer: C. A puncture-resistant container with detergent, a disinfectant/detergent or an enzymatic cleaner
Why: CDC says soaking in one of these keeps patient material from drying and makes cleaning easier and faster, and the puncture-resistant container protects whoever handles it.
Why not the others: CDC specifically says not to use a liquid chemical sterilant/high-level disinfectant such as glutaraldehyde as a holding solution. Leaving instruments dry lets debris harden. A sink full of sharps you can't see invites a stick, and plain water isn't one of the holding options CDC lists.
Source: CDC 2003 Guidelines, pp. 21, 23
Question 31 · ICE-D3-04
A reusable item touches the patient's mucous membranes, but it melts in the sterilizer. What does CDC recommend?
Show answer
Answer: B. Replace it with a heat-tolerant or disposable version if one exists; if not, at minimum use high-level disinfection
Why: An item that touches mucous membranes is semicritical. CDC says heat-sensitive semicritical items should be replaced with heat-tolerant or disposable alternatives, and if none are available, processed with high-level disinfection at minimum.
Why not the others: Low-level disinfection is for noncritical items that touch only intact skin. A shortened cycle isn't a validated sterilization method. A barrier alone doesn't reprocess a semicritical item.
Source: CDC Summary, p. 12; CDC 2003 Guidelines, p. 20
Question 32 · ICE-D3-05
While packaging a surgical cassette, how should hinged instruments such as hemostats be placed?
Show answer
Answer: B. Open and unlocked
Why: CDC says to process hinged instruments open and unlocked, so the sterilizing agent can reach the surfaces inside the hinge and jaws.
Why not the others: Any locked or closed position leaves surfaces the steam or vapor may not contact. Gauze wrapping isn't a substitute for an opened hinge.
Source: CDC 2003 Guidelines, p. 21; CDC Summary, Checklist II.6.F
Question 33 · ICE-D3-06
Between patients, how should a low-speed handpiece motor and its reusable prophy angle be processed?
Show answer
Answer: D. Cleaned and heat-sterilized according to the manufacturer's instructions
Why: CDC says handpieces and their attachments, including low-speed motors and reusable prophy angles, should always be heat-sterilized between patients. Their internal parts become contaminated during use.
Why not the others: CDC specifically rules out surface disinfection, barrier protection and high-level disinfection for handpieces, because none of them reach internal components. Alcohol and flushing don't sterilize anything.
Source: CDC Summary, p. 12; CDC: Best Practices for Dental Handpieces
Question 34 · ICE-D3-07
Your office sterilizes carbon-steel burs in an unsaturated chemical vapor sterilizer. What advantage does that method have for burs, and what must you do first?
Show answer
Answer: C. It causes less corrosion of carbon steel than steam; instruments must be dry first
Why: CDC explains that unsaturated chemical vapor causes less corrosion of carbon-steel instruments such as burs because little water is present during the cycle, and that instruments should be dry before sterilizing.
Why not the others: Chemical vapor is a heated, pressurized process, and wet instruments defeat its low-water advantage. Every sterilization method is monitored with mechanical, chemical and biological indicators.
Source: CDC 2003 Guidelines, p. 22
Question 35 · ICE-D3-08
Your prevacuum steam sterilizer fails its daily Bowie-Dick air-removal test before the first processed load. What should happen?
Show answer
Answer: D. Stop using it until it's inspected by sterilizer maintenance personnel and passes the test
Why: Prevacuum sterilizers pump air out before steam enters; air left in the chamber blocks steam contact. CDC says a sterilizer that fails its air-removal test shouldn't be used until it's inspected and passes.
Why not the others: A longer cycle doesn't fix air that isn't being removed. Wrapped loads are the most likely to trap air. A spore test from earlier in the week doesn't cover a problem found now.
Source: CDC: Steam Sterilization (Bowie-Dick test)
Question 36 · ICE-D3-09
A steam sterilizer cycle just ended, and the pouches inside are still damp. What should you do?
Show answer
Answer: A. Let them dry inside the chamber, and don't handle them until they're cool and dry
Why: CDC explains that hot, wet packs act as wicks, drawing in moisture and bacteria from hands, so packs should dry in the chamber before they're handled.
Why not the others: Removing, patting or storing damp packs all involve handling them while they can still wick contamination through the packaging.
Source: CDC 2003 Guidelines, p. 22
Question 37 · ICE-D3-10
Which internal chemical indicator gives the more reliable sign that steam sterilization conditions were met inside a package?
Show answer
Answer: B. A multiparameter internal indicator that reacts to two or more conditions, such as time, temperature and steam
Why: CDC explains that single-parameter indicators show only one condition, while multiparameter indicators react to two or more and give a more reliable indication that sterilization conditions were met.
Why not the others: External tape only shows a package went through a cycle. A temperature-only indicator can change color even if time or steam contact fell short. No chemical indicator proves sterility; only biological indicators directly test killing.
Source: CDC Summary, p. 13; CDC 2003 Guidelines, p. 22
Question 38 · ICE-D3-11
For the weekly spore test, you incubate the processed biological indicator with a control indicator from the same lot that was not run through the sterilizer. What result should the control show?
Show answer
Answer: A. Growth (positive), showing the spores were alive and the incubation worked
Why: CDC says the control indicator comes from the same lot, isn't processed, and should yield positive growth. If the control grows and the processed indicator doesn't, the cycle killed the spores.
Why not the others: A control with no growth would mean the spores or incubation were bad, so the test result couldn't be trusted. CDC recommends a matching control with each spore test, so it isn't optional.
Source: CDC Best Practices for Sterilization Monitoring; CDC 2003 Guidelines, p. 22
Question 39 · ICE-D3-12
A critical instrument was sterilized in an unwrapped cycle. What should happen to it?
Show answer
Answer: C. Transfer it aseptically to the point of use right away
Why: CDC says critical instruments sterilized unwrapped should be moved immediately, with aseptic technique, to where they'll be used, and should never be stored unwrapped.
Why not the others: An unwrapped instrument becomes contaminated once it's exposed to air, so storing it, or wrapping it afterward, doesn't keep it sterile. Implantable devices aren't recommended for unwrapped cycles, because they should be held until the spore test is known.
Source: CDC 2003 Guidelines, p. 22
Question 40 · ICE-D3-13
While setting up, you find a sterilized pouch with a small tear in it. Its internal indicator shows the correct color change. What do you do?
Show answer
Answer: D. Reprocess the contents: clean, repackage and heat-sterilize them before use
Why: CDC says to inspect wrapped packages before use and reprocess the contents of any pack that's wet, torn or punctured. The indicator shows what happened in the sterilizer; it can't show what happened after the package was damaged.
Why not the others: A correct color change doesn't make a torn package sterile. Tape doesn't restore sterility. Surface disinfectant doesn't sterilize critical or semicritical instruments.
Source: CDC Summary, p. 13
Domain IV: Occupational Safety and Administration Protocols (Questions 41–50)
Question 41 · ICE-D4-01
A newly hired assistant will have occupational exposure to blood and saliva. Under OSHA, what must the employer do about hepatitis B vaccination?
Show answer
Answer: C. Make the vaccine series available at no cost, after bloodborne pathogens training and within 10 working days of initial assignment
Why: OSHA's Bloodborne Pathogens Standard sets this timing and requires no cost to the employee. The exceptions are someone already vaccinated, someone shown to be immune, or someone for whom the vaccine is medically contraindicated. An employee who declines signs OSHA's declination statement and can still get the vaccine later.
Why not the others: OSHA puts the obligation on the employer to offer the vaccine, not on the employee to arrive vaccinated. A one-year wait and an exposure-only offer both miss the 10-working-day requirement.
Source: OSHA 29 CFR 1910.1030(f)(1)–(2)
Question 42 · ICE-D4-02
How often must the office's written exposure control plan be reviewed and updated under OSHA?
Show answer
Answer: A. At least annually, and whenever tasks or procedures that affect exposure change
Why: OSHA requires at least an annual review and update, plus updates for new or changed tasks and positions. Each review must reflect new technology and document that safer medical devices were considered.
Why not the others: Five years, incident-only and inspection-only reviews all fall short of the annual requirement.
Source: OSHA 29 CFR 1910.1030(c)(1)(iv)
Question 43 · ICE-D4-03
Your office keeps bloodborne pathogens training records and employee medical records, including hepatitis B vaccination status. Which retention periods does OSHA require?
Show answer
Answer: B. Training records 3 years; medical records for the duration of employment plus 30 years
Why: OSHA requires training records to be kept for 3 years from the training date and medical records for at least the duration of employment plus 30 years. Medical records must also be kept confidential.
Why not the others: The other options shorten or swap the two periods.
Source: OSHA 29 CFR 1910.1030(h)(1)–(2)
Question 44 · ICE-D4-04
The sharps container in an operatory has reached its fill line. What's the correct next step?
Show answer
Answer: D. Close it, then remove and replace it
Why: OSHA requires sharps containers to be replaced routinely and not allowed to overfill, and to be closed immediately before removal so nothing spills or sticks out.
Why not the others: Pressing contents down or moving sharps between containers is exactly the kind of handling that causes needlesticks; OSHA prohibits opening or emptying reusable sharps containers by hand in any way that risks a stick. Leaving a full container open invites overfilling.
Question 45 · ICE-D4-05
Which of these is an engineering control under OSHA's Bloodborne Pathogens Standard?
Show answer
Answer: B. A self-sheathing anesthetic needle
Why: OSHA defines engineering controls as devices that isolate or remove the hazard, such as sharps containers, self-sheathing needles and sharps with built-in safety features. CDC names self-sheathing anesthetic needles as an example in dentistry.
Why not the others: One-handed recapping and removing burs first are work-practice controls; they change how the task is done. Eyewear is PPE.
Source: OSHA 29 CFR 1910.1030(b) (definitions); CDC Summary, pp. 9–10
Question 46 · ICE-D4-06
An assistant applies lip balm while standing at the instrument processing counter. Under OSHA's Bloodborne Pathogens Standard, this is:
Show answer
Answer: D. Prohibited in work areas where occupational exposure is reasonably likely
Why: OSHA prohibits eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses in work areas where there's a reasonable likelihood of occupational exposure. Instrument processing is one of those areas.
Why not the others: The rule is about the location, not glove status, how recently the counter was cleaned or the product's scent.
Source: OSHA 29 CFR 1910.1030(d)(2)(ix)
Question 47 · ICE-D4-07
Your heavy-duty utility gloves for instrument cleaning are intact but contaminated after a cleaning session. Under OSHA, can they be reused?
Show answer
Answer: A. Yes, after they're decontaminated, as long as they aren't cracked, peeling, torn or punctured
Why: OSHA allows utility gloves to be decontaminated for reuse if their integrity isn't compromised, and requires them to be discarded when they crack, peel, tear, puncture or show other deterioration.
Why not the others: Exam and surgical gloves are the single-use ones. Contaminated utility gloves are decontaminated before reuse. Utility gloves aren't patient-care gloves.
Source: OSHA 29 CFR 1910.1030(d)(3)(ix)(B)–(C); CDC 2003 Guidelines, p. 18 (Table 3)
Question 48 · ICE-D4-08
Each morning, an assistant pours concentrated disinfectant from its original labeled jug into a spray bottle that the whole team uses for the rest of the week. Under OSHA's Hazard Communication Standard, the spray bottle:
Show answer
Answer: B. Must be labeled with the product identifier and hazard information
Why: OSHA requires workplace containers of hazardous chemicals to be labeled. The only exemption is a portable container filled from a labeled one for the immediate use of the person who filled it, within that shift. A shared bottle used all week doesn't qualify.
Why not the others: The original jug's label doesn't travel with the spray bottle. Labeling isn't limited to flammables. A date gives no hazard information.
Question 49 · ICE-D4-09
You need to know which gloves and eye protection to wear when mixing a new chemical. Which section of its safety data sheet has that information?
Show answer
Answer: C. Section 8, Exposure controls/personal protection
Why: OSHA fixes the order of the 16 SDS sections. Section 8 covers exposure controls and personal protection, including PPE.
Why not the others: Section 2 describes the hazards, Section 4 covers first aid after an exposure, and Section 11 covers toxicology. None of them is where PPE selection lives.
Source: OSHA 29 CFR 1910.1200(g)(2)
Question 50 · ICE-D4-10
Two chemical labels use different signal words. What does "Danger" tell you compared with "Warning"?
Show answer
Answer: B. The hazard is more severe
Why: OSHA's Hazard Communication Standard uses two signal words: "Danger" for more severe hazards and "Warning" for less severe ones.
Why not the others: Signal words show severity, not a hazard type like flammability (pictograms and hazard statements do that). They don't indicate which agency regulates the product or whether it has expired.
Source: OSHA 29 CFR 1910.1200(c) (definition of signal word)
How to use your results
Tally misses by domain, not just your total. If one domain holds most of them, go back to that week of the plan and reread the matching rules section above. You've learned a rule when you can explain why the right answer is right and why your choice was wrong.
Don't compare your percentage here with DANB's results. DANB's exam is computer adaptive, and DANB says the average candidate answers about 50% of questions correctly on the real thing. A domain with 10 questions is too small a sample to measure your ability precisely; treat it as a pointer to what to restudy. Practicing at the real pace matters more: try all 50 in 40 minutes.
For the actual screens and navigation, DANB offers a free demo exam from its Prepare for Exams page.
How the ICE exam is scored
- Computer adaptive testing (CAT). Your result depends on the difficulty of the questions you answer correctly, not a percentage. Every candidate gets the same percentage of questions from each domain. DANB says the average candidate answers around 50% correctly, so a run of hard questions is normal (ICE Exam Outline, p. 2).
- Scaled score. Reported from 100 to 900; 400 passes. It's neither a number correct nor a percent correct, and you aren't graded against other candidates (ICE Exam Outline, p. 10). There's no "you need X out of 75" target.
- Pretest questions. A small number of unscored pretest questions are mixed in, and you can't tell which they are (Candidate Handbook, p. 13).
- Answer everything. You must answer all questions to get a pass/fail result (Candidate Handbook, p. 14), and once you submit an answer you can't go back to it (DANB: Prepare for Exams).
- Acronyms are provided. DANB gives you its full acronym list during the exam (ICE Exam Outline, p. 7). Know what CDC, OSHA, SDS, DUWL, BI and OPIM mean in practice; don't spend time memorizing the list.
The final 48 hours
- Redo your misses, not the whole set. Say out loud why each wrong option is wrong.
- Reread the four tables above: disinfection levels, item categories, monitoring and who does what.
- Rehearse five sequences: turning over an operatory, the instrument workflow, the positive spore test response, the needlestick response and labeling a secondary container.
- Drop any flashcard that conflicts with CDC or OSHA. Third-party decks are sometimes wrong or outdated.
- Check your ID. It must be current, government-issued, with photo and signature, and the name must match your DANB account exactly. Temporary IDs aren't accepted (Candidate Handbook, p. 9).
- Testing online? Run Pearson VUE's system test on the computer you'll use, clear your desk, and plan to finish check-in no later than 15 minutes after your start time, or the exam counts as missed. No breaks are allowed online (Handbook, pp. 7–8, 10).
- Sleep. Don't start a new resource the night before.
Registering and exam day
- Apply online through your DANB account (or by mail or email). There are no eligibility requirements. The $270 fee includes a $75 nonrefundable application fee (2026 ICE Application Packet, p. 9).
- Schedule within 60 days. Once your application is approved, you have 60 days to schedule and take the exam with Pearson VUE. Schedule right away; appointments can be limited (Packet, p. 4).
- Choose how to test. Same price either way. At a test center, breaks need proctor approval and the clock keeps running. Online, no breaks are allowed and you need a private room with a closed door (Candidate Handbook, p. 8).
- Rescheduling. Test-center appointments can be changed up to 24 hours before; online appointments up until the start time (Packet, p. 4).
Want ICE in another language? DANB offers a Modern Spanish version of the national ICE exam, and its language-information page also lists national ICE in Vietnamese. Check the current application materials before selecting a language.
After the exam
- Results post to your online DANB account within 1–3 business days. Passed results and certificates are also mailed within 2–4 weeks (Handbook, p. 14).
- Didn't pass? There's no limit on retakes. You reapply and pay the full fee. Some states require more education after failed attempts (Handbook, p. 4).
- Think there was a scoring error? Request hand scoring within 7 calendar days after results post (Handbook, p. 14).
What passing ICE gets you
Passing ICE earns a DANB Infection Control certificate. ICE is also a component of three DANB certifications (ICE Exam Outline, p. 1):
| Certification | Exams required |
|---|---|
| NELDA (National Entry Level Dental Assistant) | AMP, RHS, ICE |
| CDA (Certified Dental Assistant) | RHS, ICE, GC, all passed within a five-year period |
| COA (Certified Orthodontic Assistant) | OA, ICE |
CDA five-year rule: 2026 CDA Application Packet, p. 3.
What ICE lets you do at work depends on your state. DANB says passing its exams conveys authority to perform duties only in states that recognize those exams as meeting their dental assisting requirements (ICE Exam Outline, p. 10). Check DANB's state requirements and confirm with your state dental board.
Watch out for outdated ICE info
- "100 questions in three parts." Some prep pages still describe an older version of the exam. The current outline: 75 questions, four domains, 60 minutes.
- 100-question practice "exams." A practice bank can be any length, but the real ICE exam is 75 questions in 60 minutes. Practice at that pace.
- DANB's own study plan. Its exam simulation step describes 100 questions in 75 minutes and cites the 13th edition of Modern Dental Assisting. Follow the outline effective March 12, 2025.
- Explanations of scoring from prep companies. Go by DANB's own description: a scaled score based on the difficulty of the questions you answer correctly (ICE Exam Outline, pp. 2, 10).
Related Castleport resources
- DANB CDA exam prep: an 8-week plan for all three CDA exams (GC, RHS, ICE)
- Free DANB CDA practice test
- DANB CDA exam requirements: pathways, CPR and fees
- Dental assistant certification: which credential you need and how states differ
Sources
Last verified: October 26, 2026. DANB exam format, fee/window, scoring, language availability, and the CDC/OSHA rules used in the study content and practice set were rechecked against the sources below.
DANB
- Infection Control (ICE) exam page
- ICE Exam Outline and References (effective March 12, 2025)
- 2026 ICE Application Packet (updated May 15, 2026)
- 2026 CDA Application Packet (updated May 13, 2026)
- 2026 Candidate Handbook (updated June 22, 2026)
- Study Guides and ICE Study Guide Plan
- Prepare for Exams
- State requirements
CDC
- Guidelines for Infection Control in Dental Health-Care Settings — 2003 (MMWR 52, RR-17)
- Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care (October 2016) and its overview page
- Best Practices for Sterilization Monitoring in Dental Settings
- Best Practices for Dental Unit Water Quality
- Best Practices for Dental Handpieces
OSHA
- Bloodborne Pathogens, 29 CFR 1910.1030 (official OSHA regulation text)
- Hazard Communication, 29 CFR 1910.1200 (as amended effective July 19, 2024)
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