This free DANB ICE study guide walks through the highest-yield content on the exam, organized into the same four content areas DANB uses to build the test: Prevention of Disease Transmission (20%), Prevention of Cross-contamination (34%), Process Instruments and Devices (26%), and Occupational Safety and Administration Protocols (20%).[2]
And it’s interactive, not a wall of text: every module has built-in checkpoint quizzes, flashcards, and practice questions, so you learn by doing — not just reading. The clinical facts here are drawn straight from the primary sources the exam is built on — the guidance for dental settings.[3]
Read it module by module, test yourself at each checkpoint, then round out your prep with our practice test and flashcards. The ICE exam is a component of the , the , and the Certified Orthodontic Assistant (COA) credentials, and anyone may sit for it — there are no eligibility requirements for the ICE exam itself.[1]
DANB ICE Exam Snapshot
| Detail | DANB ICE exam |
|---|---|
| Questions | 75 multiple-choice (computer-adaptive) |
| Time limit | 60 minutes |
| Scoring | Scaled 100–900; passing standard 400 |
| Languages | English and Spanish |
| Delivery | Test center or online remote proctoring |
| Part of | CDA (ICE + RHS + GC), NELDA (AMP + RHS + ICE), COA (ICE + OA) |
| Eligibility | None to take the ICE exam |
| Built on | CDC dental infection-control guidance + OSHA 1910.1030 & 1910.1200 |
| Exam fee | ~$270 standard (dated anchor; verify on the DANB application) |
| Retake | Unlimited retakes; one-time 33% reapplication discount if you don't pass first |
The exam is weighted toward Prevention of Cross-contamination — about a third of the test — so spend your time accordingly:[2]
The ICE exam delivers 75 four-option multiple-choice questions. There is no separate published unscored-pretest count, so treat 75 as the number to prepare for.
You have 60 minutes — about 48 seconds per question. Read each stem fully, but keep moving; the test does not reward overthinking a single item.
Difficulty adapts to your answers, and every candidate sees the same percentage of questions from each of the four areas. The average candidate answers about half correctly, so a hard-feeling test is normal.
Module 1 · Prevention of Disease Transmission
Area I — 20% of the exam (about 15 questions). This module is the “why and who” of infection control: how diseases move from person to person, and the front-line defenses — standard precautions, hand hygiene, PPE, and immunization — that stop them. Everything in the later modules exists to break one of the links you’ll meet here.[3]
1.1 The Chain of Infection
Infection spreads only when six elements line up — the . An infectious agent (a such as HBV, HCV, or HIV, or another microorganism) leaves a reservoir through a portal of exit, travels by a mode of transmission, enters a new host through a portal of entry, and infects a susceptible host. Break any single link and the infection cannot occur — that is the entire strategy of dental infection control.[4]
The pathogen — bacterium, virus (e.g., HBV, HCV, HIV), or fungus — capable of causing disease.
Where the agent lives and multiplies — blood, saliva, plaque, contaminated water, or an infected person.
How the agent leaves the reservoir — saliva, blood, droplets, aerosols, or spatter generated during treatment.
How it spreads — direct contact, indirect contact (contaminated instruments/surfaces), droplet, or airborne.
How it enters a new host — broken skin, mucous membranes, a percutaneous (sharps) injury, or inhalation.
A person who can become infected — a patient or an oral-healthcare worker, especially if non-immune.
1.2 Standard Precautions & Hand Hygiene
are the foundation: treat every patient’s blood, saliva, and body fluids as potentially infectious, for every patient, because you cannot reliably identify who is infectious. They expand the older concept and cover hand hygiene, PPE, respiratory hygiene, sharps safety, safe injection practices, sterile instruments, and clean surfaces.[3]
The single most effective measure is . Use soap and water when hands are visibly soiled; otherwise a 60–95% alcohol-based hand rub is preferred for routine decontamination. Perform hand hygiene before and after every patient, before donning and after removing gloves, and after touching contaminated surfaces.[3]
1.3 Personal Protective Equipment (PPE)
puts a barrier between you and exposure: a fluid-resistant gown, a surgical mask, protective eyewear or a face shield, and gloves. Sequence matters — and the ICE exam tests it. Gloves go on last and come off first because they become the most contaminated. After doffing, perform hand hygiene immediately.[4]
- 1Gown — Fully cover the torso; fasten at the back.
- 2Mask — Secure over nose, mouth, and chin.
- 3Protective eyewear / face shield — Eyewear with solid side shields or a face shield.
- 4Gloves — Don last; extend over the gown cuffs.
- 1Gloves — Remove first — they are the most contaminated. Glove-to-glove, then skin-to-skin.
- 2Eyewear / face shield — Remove by the earpieces/headband, away from the face.
- 3Gown — Roll it inward, contaminated side in.
- 4Mask — Remove last by the ties/ear loops, not the front.
1.4 Immunizations & Exposure Protocol
Because hepatitis B is so transmissible occupationally, the is the primary protection for the dental team. Under OSHA, the employer must offer the three-dose series free to all employees with occupational exposure within 10 working days of assignment; an employee who declines signs a declination form but may receive it later at no cost.[5]
If an exposure happens — a needlestick or a splash to mucous membranes — act fast: wash the wound with soap and water (flush mucous membranes with water), report it under the office’s , and get a confidential medical evaluation including testing and if indicated, at no cost to the employee.[5]
Checkpoint · Module 1
Question 1 of 10
According to the CDC, which single practice is considered the most important measure for reducing the transmission of infectious agents in dental healthcare settings?
Module 2 · Prevention of Cross-contamination
Area II — 34% of the exam (about 26 questions). This is the single largest area, so it deserves the most study time. It covers how you keep contamination from spreading around the operatory and between patients: surface asepsis, the Spaulding classification that decides how every item is reprocessed, single-use items, aerosol control, and the dental unit waterlines.[3]
2.1 Surface Asepsis: Barriers & Disinfection
— light handles, switches, chairside controls, drawer handles — are touched during care and can transmit microorganisms. Protect them two ways: cover them with single-use changed between patients, or, if left uncovered, clean and them between patients with an EPA-registered hospital disinfectant.[3]
Don’t confuse these with — floors, walls, and sinks — which are not involved in patient care and are cleaned routinely with detergent or a low-level disinfectant.[4]
2.2 Spaulding Classification
The is the decision tree for how every patient-care item is reprocessed, based on its risk of transmitting infection. Memorize the three categories, what defines each, and how each is reprocessed — it is one of the most heavily tested ideas on the exam.[4]
2.3 Single-Use Items & Aseptic Technique
A — saliva ejectors, prophy angles, air/water syringe tips, plastic-handled instruments, and many burs — is used on one patient for one procedure and then discarded. SUDs are never reprocessed for reuse, because they are not designed to be cleaned and sterilized reliably.[3]
Aseptic technique keeps sterile and clean items uncontaminated during use: prepare tray setups in advance, use single-unit (unit-dose) dispensing so you don’t contaminate bulk supplies, and retrieve additional items aseptically (with sterile transfer forceps or overgloves) rather than reaching into a drawer with contaminated gloves.[4]
2.4 Aerosols, Spatter & Evacuation
Handpieces, ultrasonic scalers, and air/water syringes generate aerosols, droplets, and spatter that carry the patient’s oral fluids into the air and onto surfaces. Minimize them at the source: use a rubber dam where possible and high-volume evacuation (HVE), and protect the team with masks and eyewear and the operatory with surface barriers.[3]
Pre-procedural mouthrinses and proper patient positioning further reduce the microbial load that becomes airborne. The goal is to break the portal-of-exit and mode-of-transmission links before contamination ever reaches a surface or a colleague.[4]
2.5 Waterlines, Impressions & Waste
form biofilm when water sits in the narrow tubing, so water for non-surgical care must meet the EPA drinking-water standard of ≤ 500 CFU/mL. Treat, maintain, flush, and monitor the lines — and for oral surgery use sterile water or sterile saline, not the standard waterline.[3]
Dental unit water used for non-surgical care must meet the EPA drinking-water standard of ≤ 500 CFU/mL of heterotrophic bacteria. Stagnant waterlines form biofilm that far exceeds this.
Use a commercial DUWL treatment product, independent water reservoir, and/or filters per the manufacturer, and follow their protocol for shocking the lines to control biofilm.
Discharge water and air for at least 20–30 seconds after each patient (and run lines several minutes at the start of the day) to physically reduce contaminants from handpieces, syringes, and ultrasonic scalers.
Test the water periodically per the manufacturer and CDC to confirm it stays ≤ 500 CFU/mL. For oral surgical procedures, use sterile water or sterile saline with an appropriate delivery device — not the standard waterline.
Contaminated impressions, bite registrations, and appliances must be rinsed, cleaned, and disinfected with an EPA-registered intermediate-level product compatible with the material before they go to the lab or back to the patient. Most dental waste is ordinary trash; only — blood-soaked items, extracted teeth, and — needs special handling.[4]
Checkpoint · Module 2
Question 1 of 10
According to the Spaulding classification, dental instruments that contact mucous membranes but do not penetrate soft tissue or bone (e.g., mouth mirrors, amalgam condensers) are categorized as:
Module 3 · Process Instruments and Devices
Area III — 26% of the exam (about 20 questions). This module follows a reusable instrument from a bloody tray to a sterile, ready-to-use package, and shows how you prove the sterilizer actually worked. The order of the steps — and the rule that cleaning must come before sterilization — are central.[3]
3.1 The Instrument Processing Cycle
Reprocessing moves in one direction, from the contaminated (dirty) area to the clean and sterile areas, and follows a fixed sequence: transport and precleaning, cleaning, packaging, sterilization, and storage. You cannot sterilize what isn’t clean — residual shields microorganisms from the sterilant, so cleaning always comes first.[3]
Transport contaminated instruments to the processing area in a covered, leak-proof container. Hold in a presoak/enzymatic solution if cleaning is delayed so debris doesn't dry on.
Remove all bioburden by automated means first — an ultrasonic cleaner or instrument washer/washer-disinfector — rather than hand scrubbing, which risks percutaneous injury. Rinse and inspect for visible debris.
After cleaning and drying, package instruments in FDA-cleared sterilization pouches or wraps with an internal chemical indicator, and label with the sterilizer/load and date so sterility can be tracked.
Load the sterilizer without overpacking and run the validated cycle (steam autoclave, unsaturated chemical vapor, or dry heat). Heat-tolerant critical and semicritical items are heat-sterilized.
Allow packages to dry, then store sterilized, wrapped instruments in a clean, dry, closed area. Sterility is event-related: a package stays sterile until its wrap is torn, wet, or compromised.
3.2 Cleaning, Packaging & Sterilization Methods
Clean by automated means whenever possible — an or instrument washer/washer-disinfector — rather than hand scrubbing, which risks a sharps injury. After cleaning and drying, package instruments in FDA-cleared pouches or wraps with an internal , and label with the load and date.[4]
Heat is the preferred sterilant for heat-tolerant items. The three common methods are steam (autoclave), unsaturated chemical vapor, and dry heat. Devices that attach to air/water lines, such as handpieces, retract oral fluids internally, so surface disinfection cannot reach inside — they must be cleaned, lubricated per the manufacturer, and heat-sterilized between every patient.[3]
| Method | How it works | Notes |
|---|---|---|
| Steam (autoclave) | Saturated steam under pressure | Fast and economical; can corrode/dull unprotected carbon-steel instruments |
| Unsaturated chemical vapor | Heated chemical (alcohol/formaldehyde) vapor under pressure | Less corrosion than steam; needs ventilation; instruments must be dry |
| Dry heat | Sustained high temperature, no moisture | Won't rust/corrode; long cycle at high temperature; for heat-tolerant items |
3.3 Sterilization Monitoring & Storage
Three kinds of monitoring confirm a sterilizer is working: mechanical (time, temperature, pressure gauges/printouts), chemical (color-change indicators), and biological (). Only the biological (spore) test proves that the cycle actually killed microorganisms; mechanical and chemical monitoring confirm only that the package was exposed to the cycle.[3]
The CDC recommends spore-testing each sterilizer at least weekly and with every load containing an implant. Steam and chemical-vapor sterilizers use Geobacillus stearothermophilus spores; dry-heat sterilizers use Bacillus atrophaeus. After sterilization, store wrapped packages in a clean, dry, closed area — sterility is event-related, lasting until the wrap is torn, wet, or otherwise compromised.[4]
Checkpoint · Module 3
Question 1 of 10
When sterilizing a dental handpiece, it is crucial to follow the manufacturer's instructions primarily because:
Module 4 · Occupational Safety & Administration Protocols
Area IV — 20% of the exam (about 14 questions). This module is the regulatory backbone: the two OSHA standards that make infection control a legal requirement, how chemicals and waste are managed safely, the records a practice must keep, and which federal agency does what.[5]
4.1 OSHA Bloodborne Pathogens Standard
OSHA’s Bloodborne Pathogens Standard (29 CFR 1910.1030) is the legal heart of dental infection control. It requires a written — reviewed and updated at least annually — plus engineering and work-practice controls, free PPE, the free HBV vaccine, post-exposure evaluation and follow-up, labeling, training, and recordkeeping.[5]
Engineering controls include sharps containers and safer (self-sheathing) devices; work-practice controls include never recapping needles two-handed and using a one-handed scoop technique when recapping is unavoidable. go straight into a puncture-resistant, leak-proof, labeled sharps container.[5]
4.2 Hazard Communication & SDS
OSHA’s Hazard Communication Standard (29 CFR 1910.1200)— “HazCom” or the employee right-to-know — governs the hazardous chemicals in the office (disinfectants, sterilants, processing solutions). It requires a written hazard communication program, a chemical inventory, proper labeling of containers (including secondary/working containers), employee training, and a for every hazardous chemical.[6]
An SDS is a standardized 16-section document from the manufacturer describing a chemical’s hazards, safe handling and storage, required PPE, and emergency/first-aid measures. Every team member must know where the SDS collection is kept and be able to find one quickly.[6]
4.3 Programs, Records & Agency Roles
A compliant practice documents its infection-prevention and safety program: the ECP, training records, sterilization logs (mechanical, chemical, and spore-test results), HBV vaccination and declination records, the sharps injury log, and any infection-control breaches with corrective action. These records are part of the program’s quality assurance.[5]
Finally, know who governs what — the exam loves agency-role questions:
| Agency | Role |
|---|---|
| OSHA | Sets and ENFORCES worker-safety regulations (Bloodborne Pathogens, Hazard Communication) |
| CDC | Issues infection-control recommendations and guidance (not a regulator itself) |
| EPA | Registers surface disinfectants and water/chemical products |
| FDA | Clears and regulates devices: sterilizers, sterilization packaging, gloves, and barriers |
Checkpoint · Module 4
Question 1 of 10
When developing an Exposure Control Plan (ECP), which of the following is NOT required by OSHA's Bloodborne Pathogens Standard?
How to Use This Study Guide
A study guide is a map, not the whole territory — use it alongside the primary sources (the CDC summary and OSHA standards) and our practice tools, not on its own. Study by weight: give the most time to Prevention of Cross-contamination (the largest area), then instrument processing, then disease transmission and occupational safety.
- 1
Read a module here
Work through one content area at a time so related concepts reinforce each other — start with Disease Transmission, then give Cross-contamination the most time.
- 2
Take the checkpoint
The 10-question check at the end of each module exposes what didn't stick.
- 3
Drill the gaps
Send your weak area straight into the free practice test and flashcards.
- 4
Bookmark & space it out
Come back over several days. Short, spaced sessions beat one long cram.
DANB ICE Concept Questions
Common DANB ICE concepts the exam tests. Tap any card for a short, exam-ready answer backed by an official source (DANB, the CDC, or OSHA) — then test yourself on them as flashcards.
DANB ICE Glossary
Quick definitions for the terms you’ll see most on the DANB ICE exam:
- bioburden
- The number of microorganisms and amount of organic debris on an item before sterilization or disinfection; it must be removed by cleaning first because it shields microorganisms from the sterilant.
- biological indicator
- A spore test using Geobacillus stearothermophilus (steam/chemical vapor) or Bacillus atrophaeus (dry heat) — the only monitoring that confirms a sterilizer actually killed microorganisms.
- bloodborne pathogen
- A disease-causing microorganism carried in blood or other potentially infectious materials — for example hepatitis B (HBV), hepatitis C (HCV), and HIV.
- CDA
- Certified Dental Assistant — the DANB credential earned by passing three component exams: Infection Control (ICE), Radiation Health and Safety (RHS), and General Chairside Assisting (GC).
- chain of infection
- The six linked elements required for an infection to spread — infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Breaking any one link stops transmission.
- chemical indicator
- A heat- or chemical-sensitive marking that changes color when a sterilization parameter is met; confirms exposure to the cycle but does not prove sterility.
- clinical-contact surface
- A surface touched during patient care (light handles, switches, chairside controls, drawer handles) that can become contaminated and transmit microorganisms if not barrier-protected or disinfected.
- DANB
- Dental Assisting National Board — the national certifying body that develops and awards DANB exams, including the Infection Control (ICE) exam.
- dental unit waterline (DUWL)
- The narrow tubing carrying water to handpieces, syringes, and ultrasonic scalers; non-surgical water must meet ≤ 500 CFU/mL, and biofilm in untreated lines must be controlled.
- disinfection
- A process that kills most disease-causing microorganisms on inanimate surfaces but not necessarily all bacterial spores; levels are low, intermediate (tuberculocidal), and high.
- EPA
- Environmental Protection Agency — registers surface disinfectants and water-line/chemical products used in the dental setting.
- exposure control plan (ECP)
- The written OSHA-required plan describing how a practice eliminates or minimizes employee exposure to bloodborne pathogens; reviewed and updated at least annually.
- FDA
- Food and Drug Administration — clears and regulates sterilizers, sterilization packaging, and medical devices such as gloves and barriers.
- hand hygiene
- Handwashing with soap and water (when hands are visibly soiled) or use of a 60–95% alcohol-based hand rub — the single most effective measure for preventing the transmission of infection.
- HBV vaccine
- The hepatitis B vaccine series, which OSHA requires the employer to offer free to employees with occupational exposure within 10 working days of assignment.
- housekeeping surface
- Floors, walls, and sinks not directly involved in patient care; cleaned with detergent/water or a low-level disinfectant on a routine schedule.
- ICE
- Infection Control Exam — the DANB exam (75 multiple-choice questions, 60 minutes) covering disease transmission, cross-contamination, instrument processing, and occupational safety. It is a component of the CDA, NELDA, and COA certifications.
- intermediate-level disinfectant
- An EPA-registered, tuberculocidal hospital disinfectant used on clinical-contact surfaces and on heat-sensitive noncritical items.
- NELDA
- National Entry Level Dental Assistant — a DANB credential earned by passing the AMP, RHS, and ICE component exams.
- OSHA
- Occupational Safety and Health Administration — the federal agency that sets and enforces worker-safety regulations, including the Bloodborne Pathogens and Hazard Communication standards.
- post-exposure prophylaxis (PEP)
- Medical treatment given after an occupational exposure (e.g., a needlestick) to reduce the risk of infection; its timing can be critical, so exposures are reported immediately.
- PPE
- Personal protective equipment — gloves, surgical mask, protective eyewear/face shield, and a protective gown/clinic attire — worn to create a barrier against exposure to blood, saliva, and spatter.
- regulated medical waste
- Blood-soaked or saturated items, extracted teeth, and sharps that require special handling and disposal; most dental waste is NOT regulated waste.
- Safety Data Sheet (SDS)
- A standardized 16-section document from the chemical manufacturer describing a hazardous chemical's hazards, handling, PPE, and first-aid measures; kept readily accessible under OSHA HazCom.
- scaled score
- A score reported on DANB's 100–900 range that adjusts for exam difficulty; 400 is the passing standard on the ICE exam.
- sharps
- Needles, scalpel blades, orthodontic wires, burs, and broken glass capable of penetrating skin; placed in a puncture-resistant, leak-proof, labeled sharps container.
- single-use (disposable) device
- An item (SUD) intended to be used on one patient during a single procedure and then discarded — never reprocessed for reuse.
- Spaulding classification
- A system that sorts patient-care items by infection risk — critical (sterilize), semicritical (sterilize or high-level disinfect), and noncritical (clean and low- to intermediate-level disinfect).
- standard precautions
- The minimum infection-prevention practices applied to the care of all patients, all of the time — treating every patient's blood, saliva, and body fluids as potentially infectious regardless of known infection status.
- sterilization
- A validated process that destroys ALL microorganisms, including bacterial spores; required for critical and heat-tolerant semicritical instruments.
- surface barrier
- A single-use, fluid-resistant cover placed over a clinical-contact surface that is hard to clean, removed and replaced between patients.
- ultrasonic cleaner
- A device that uses high-frequency sound waves (cavitation) in solution to remove debris from instruments — an automated cleaning method that reduces hand scrubbing and sharps injuries.
- universal precautions
- An earlier concept that all human blood and certain body fluids be treated as infectious; standard precautions expand on and replace it.
Free DANB ICE Study Materials & Resources
Everything you need to pass the DANB ICE exam is free here — no paywall, no sign-up. This guide is the foundation; pair it with the rest of our free DANB ICE study materials for active recall, timed practice, and last-minute review:
- DANB ICE Practice Test — full-length, timed, exam-style questions with explanations.
- DANB ICE Flashcards — active-recall decks for the high-yield facts.
DANB ICE Study Guide FAQ
The Infection Control (ICE) exam has 75 multiple-choice questions and a 60-minute time limit. It is computer-adaptive, so questions adjust to your answers, and every candidate sees the same percentage of questions from each of the four content areas. DANB does not publish a separate unscored-pretest count, so treat 75 as the number to know.
The ICE exam is scored on a scaled range of 100 to 900, and the passing standard is a scaled score of 400. Because the exam is computer-adaptive and criterion-referenced, your result is reported as a scaled score rather than a raw percentage of questions correct.
Four content areas: Prevention of Disease Transmission (20%) — chain of infection, standard precautions, hand hygiene, and PPE; Prevention of Cross-contamination (34%, the largest) — surface asepsis, barriers, the Spaulding classification, and waterlines; Process Instruments and Devices (26%) — the cleaning-to-storage processing cycle and sterilization monitoring; and Occupational Safety and Administration Protocols (20%) — OSHA Bloodborne Pathogens and Hazard Communication, recordkeeping, and agency roles.
The ICE exam is a component of three DANB certifications: the Certified Dental Assistant (CDA), which requires ICE plus RHS and General Chairside Assisting (GC); the National Entry Level Dental Assistant (NELDA), which requires AMP plus RHS and ICE; and the Certified Orthodontic Assistant (COA), which requires ICE plus the Orthodontic Assisting (OA) exam. ICE itself has no eligibility requirements.
As a dated anchor, the standard ICE exam fee is about $270, which includes a nonrefundable application fee; military and some state rates differ. If you do not pass on the first try, DANB offers a one-time 33% discount on reapplication. Fees change, so verify the current amount on the DANB application before registering.
Study the primary sources the exam is built on: the CDC's 2016 Summary of Infection Prevention Practices in Dental Settings and the 2003 Guidelines for Infection Control in Dental Health-Care Settings, plus OSHA's Bloodborne Pathogens Standard (1910.1030) and Hazard Communication Standard (1910.1200). This guide distills all four into the DANB content areas.
Study by weight. Prevention of Cross-contamination is the largest area at 34%, so spend the most time on surface asepsis, the Spaulding classification, and waterlines. Then learn instrument processing and sterilization monitoring (26%), disease transmission and PPE (20%), and OSHA occupational safety (20%). After each module here, drill our free DANB ICE practice questions and flashcards.
Yes — the full guide, the glossary, the concept questions, the practice questions, and the flashcards are 100% free with no account required.
References
- 1.Dental Assisting National Board (DANB). “Infection Control (ICE) Exam — Overview, Format & Exam Outline.” DANB. ↑
- 2.Dental Assisting National Board (DANB). “ICE Exam Outline and References (effective March 12, 2025).” DANB. ↑
- 3.Centers for Disease Control and Prevention (CDC). “Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care.” CDC. ↑
- 4.Centers for Disease Control and Prevention (CDC). “Guidelines for Infection Control in Dental Health-Care Settings — 2003 (MMWR Vol. 52, RR-17).” CDC. ↑
- 5.Occupational Safety and Health Administration (OSHA). “Bloodborne Pathogens Standard (29 CFR 1910.1030).” OSHA. ↑
- 6.Occupational Safety and Health Administration (OSHA). “Hazard Communication Standard (29 CFR 1910.1200).” OSHA. ↑
Sources for the concept answers
Every answer in the DANB ICE concept questions above is drawn from an official primary source:
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