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Dental nurse revision (301-311) > 303 - prevention and control of infection. > Flashcards

303 - prevention and control of infection. Flashcards

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1
Q

What is pathology?

A

Study of disease - disease is condition of suffering from illness.

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2
Q

What are many disease caused by?

A

Contamination of body cells by microscopic living organisms.

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3
Q

What is microbiology?

A

The study of different microorganisms and how they live/function.

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4
Q

What are pathogens?

A

Organisms that have capability of producing a disease.

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5
Q

What is a non-pathogen?

A

Organisms that do not cause disease.

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6
Q

What are the 3 main groups of pathogenic microorganisms?

A
  • Bacteria
  • Viruses
  • Fungi
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7
Q

What is bacteria?

A
  • Microscopic single cell organism
  • Survives as inactive spore when it can’t grow/reproduce.
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8
Q

What is a virus?

A

Ultramicroscopic organism that lives within cell wall of other organisms.

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9
Q

What is Fungi?

A

Type of microscopic plant organism that grows across cells and tissues.

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10
Q

What are prions?

A
  • Not living microorganisms
  • Type of special infectious protein that can cause disease.
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11
Q

What disease’s has prions caused?

A

‘Mad cow disease’ and its variant, Creutzfeldt-Jakob disease (CJD).

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12
Q

Types of bacteria, and their shape?

A
  • Cocci: circular microorganism. Colonies in cluster are staphylococci, chains are streptococci.
  • Bacilli: rod shaped with pointed ends, rounded end is Lactobacilli.
  • Spirochacetes: spiral shaped like helix.
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13
Q

How do you remove risk of bacterial infection on dental instruments?

A
  • Sterilise instruments
  • Use once and discard if single use.
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14
Q

What are anaerobic bacteria?

A

Bacteria in oral cavity that has adapted to exist in low oxygen level - deep in caries or in a pocket.

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15
Q

What are antibiotics taken for?

A
  • To kill bacteria causing severe illness
  • Kills some helpful bacteria naturally found in body.
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16
Q

What are bactericidal agents?

A

Chemicals used to clean externally (work surfaces) to kill bacteria.

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17
Q

What are bacteriostatic agents?

A

Chemicals used to clean externally, do not kill bacteria but prevent them reproducing and multiplying.

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18
Q

What is Streptococcus mutans?

A

Initial infective bacterium found in dental caries.

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19
Q

What is Lactobacillus?

A

Later colonisation of established carious lesion as deeper tooth tissue becomes infected.

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20
Q

What are
- Actinomyces
- P gingivalis,
- Prevotella intermedia
- Treponema denticola
- Fusobacterium nucleatum
- Campylobacter rectus

A

Periodontal disease, bacterial infection of supporting structure of teeth.

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21
Q

What is staphylococci?

A

Skin boils and gingival boils, impetigo.

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22
Q

What is Bacillus fusiformis and Borellia vincentii.

A

ANUG (acute necrotising ulcerative gingivitis) - periodontal infection when OH is poor.

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23
Q

Where do viruses live?

A

Within cells of other organisms.

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24
Q

What do viruses exist as?

A

A protein capsule that contains chemicals a virus needs to reproduce.

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25
Q

What is Hepatitis A, B, C?

A

A various inflammatory liver disease.

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26
Q

What is HPV (human papillomavirus)

A

Linked to oral cancer

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27
Q

What is Herpes varciella?

A

Chickenpox, affects area supplied by trigeminal nerve and torso.

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28
Q

What is HIV (human immunodeficiency virus)

A

AIDS, blood borne and fatal viral infection.

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29
Q

What is herpes zoster?

A

Shingles, painful blistering skin rash

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30
Q

What is Herpes simplex type 1?

A

‘cold sores’: blister lesions on lips, highly infectious in initial stage if touched.

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31
Q

What is Epstein-Barr virus?

A

Glandular fever, swollen lymph glands.

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32
Q

What is paramyxovirus?

A

Mumps, viral infection of parotid salivary glands.

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33
Q

What is Coxsackievirus?

A

Hand, foot and mouth disease - painful blistering in oral cavity and palms of hands/soles of feet.

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34
Q

Where do fungi live?

A

The outer surface of the body like, skin, oral cavity lining, nails and surface of eye.

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35
Q

What is the main fungal infection in dentistry?

A

Candida Albicans

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36
Q

Appearance of acute oral candidosis (oral thrush)

A

removable white film, underlying red sore patches on soft tissue of oral cavity.

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37
Q

Chronic oral candidosis (denture stomatitis)

A
  • beneath denture and removable appliance
  • reddened, painless area under palatal section of appliance
  • Raised moisture level beneath appliance and poor appliance hygiene.
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38
Q

Angular chelitis

A

Candida infection that involves angles of mouth, appear as localised area of inflamed, cracked skin.

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39
Q

What are the effects of disease on the body?

A
  • infection/inflammation
  • ulceration
  • oral white/red patches
  • formation of cyst
  • formation of tumor
  • congenital/developmental defect
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40
Q

What are the five signs of inflammation?

A
  • heat
  • swelling
  • pain
  • redness
  • loss of function
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41
Q

What is infection?

A

The invasion of body cells by pathogens resulting in a inflammatory response.

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42
Q

Examples of dentally relevant infections:

A
  • Dental caries
  • Periodontal disease
  • Herpes simplex
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43
Q

What is stomatitis?

A

General inflammatory condition affecting oral cavity.

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44
Q

Who is usually affected by stomatitis?

A
  • Elderly and denture wearers
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45
Q

What is an ulcer?

A
  • A shallow break in the skin or mucous membrane
  • Leaves a raw, painful circular base that may bleed
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46
Q

Recurrent ulcerations

A

Affects 20% population, patient may have nutritional deficiencies

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47
Q

Ulceration due to systemic disease

A

diseases that affect digestive system exhibit oral ulceration
- Crohn’s disease
- Ulcerative colitis
- Coeliac disease
- Inflammatory bowel disease

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48
Q

What are the causes of oral white patches?

A

Oral candidosis

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49
Q

What is Leukoplakia?

A

a white patch with no obvious local cause
premalignant
associated with smoking/heavy alcohol intake

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50
Q

What is Erythroplakia?

A

a red patch on oral mucosa
sinister sign of premalignancy of soft tissue

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51
Q

What is a cyst?

A

an abnormal sac of fluid within body tissue developed over period of time

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52
Q

Examples of dentally related cysts?

A
  • Dentigerous cyst: around impacted/unerupted tooth
  • periapical cyst: around tooth apex
  • trauma to minor salivary gland = mucocele
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53
Q

What is a tumour?

A

a swelling within the body tissue due to uncontrolled and abnormal growth of body cells.

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54
Q

What is a benign tumour?

A

A swelling that causes no harm other than displace its surrounding structures.

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55
Q

What is a malignant tumour?

A

A swelling that invades and damages its surrounding structures.

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56
Q

Examples of dentally relevant tumours?

A
  • squamous cell carcinoma
  • osteosarcoma of mandible/maxilla
  • salivary gland tumours
  • lymphoma
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57
Q

What is a congenital/developmental defect?

A

An inherited condition or genetic mutation that produces illness or condition present at birth.

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58
Q

Examples of dentally relevant defects

A
  • cleft lip/palate
  • congenital absence of some teeth (hypodontia)
  • defect of tooth formation (amelogenseis imperfecta)
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59
Q

What are the bodies 3 lines of defence against attack by pathogens?

A
  • Skin and mucous membranes are physical barriers
  • Surface secretions onto skin or mucous membranes dilute and neutralise the pathogen e.g. saliva, sweat and tears.
  • inflammatory response within body tissues if skin/mucous membranes are breached
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60
Q

Who is most likely to suffer when attacked by pathogens and why?

A
  • Elderly: function of body cells not as efficient
  • Young children: immune system not functioning fully/not developed acquired immunity to certain pathogens
  • Debilitated: immunocompromised patients as they have underlying illness so immune system can’t fight pathogen well.
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61
Q

In the dental workplace, how can pathogen microorganisms breach the skin or mucous membrane and gain entry?

A
  • Direct contact: bodily fluids like saliva, blood, vomit.
  • Airborne droplets: sneezing, coughing or spitting.
  • Direct entry: damaged skin, or cuts, grazes.
    Aerosol spray: created during use of dental handpieces and water sprays - spray blood/saliva into atmosphere.
  • inoculation injury: piercing of skin with contaminated instrument like needlestick injury.
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62
Q

How does tissue repair after an inflammatory response?

A

New leucocytes remove damaged/dead tissue and lay temp layer of repair cells.

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63
Q

What is natural immunity?

A

present from birth by being randomly inherited

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64
Q

What is passive immunity?

A

present from birth and inherited directly from mothers pool of antibodies/antitoxins

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65
Q

What is acquired immunity?

A

creation of necessary antibodies/antitoxins by leucocytes during initial pathogen attack. These remain in body for life.

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66
Q

Vaccination to produce acquired immunity

A

harmless dose of pathogen given to stimulate leucocytes to develop antibodies/antitoxins without actual disease developing.

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67
Q

What is a leuococyte?

A

white blood cells

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68
Q

what are erythrocytes?

A

red blood cells

69
Q

What must dental staff be vaccinated against?

A
  • Hepatitis B
  • MMR
  • Tuberculosis and whooping cough
  • Poliomyelitis
  • Diphtheria and tetanus
  • Chickenpox (not naturally immune)
  • Meningitis
70
Q

How do you avoid infection by microorganisms?

A
  • staff vaccination
  • ppe during treatment and cleaning
  • use of single use disposables
  • correct decontamination/sterilisation of instruments
  • correct cleaning of clinical area
  • thorough hand washing
71
Q

What are dental caries?

A

bacterial infection of hard tissue in tooth

72
Q

what is periodontal disease?

A

bacterial infection of the gingivae and periodontal supporting tissues

73
Q

what is oral thrush?

A

a fungal infection of the oral soft tissues

74
Q

what is a periapical abscess?

A

bacterial infection of the tooth pulp, abscess forms at apex

75
Q

what is a periodontal abscess?

A

a bacterial infection in a periodontal pocket causing abscess formation

76
Q

what are aphthous ulcers?

A

ulceration of oral soft tissues not related to infection

77
Q

what is herpetic ulceration?

A

viral infection of oral soft tissue causing ulceration

78
Q

what is acute necrotising ulcerative gingivitis?

A

acute bacterial infection of gingivae causing ulceration

79
Q

what is a dental cyst?

A

cyst formation associated with tooth, unerupted or erupted

80
Q

what is an alveolar bone cyst?

A

cyst formation within jaw bone

81
Q

what is periocoronitis?

A

acute bacterial infection of soft tissue associated with partially erupted tooth, especially lower third molars (8)

82
Q

what is localised osteitis?

A

bacterial infection of bony walls of extraction socket (dry socket)

83
Q

what is cellulitis?

A

bacterial infection spreading from tooth into surrounding deep soft tissue structures

84
Q

what is a cleft palate?

A

developmental defect of palate where two bony halves don’t join completely during embryonic development

85
Q

what is oral cancer?

A

malignant tumour that usually affects oral soft tissues initially, can spread to underlying tissues if not treated.

86
Q

What parts of the body does oral cancer affect?

A

-lip
-tongue
-floor of mouth
-gingiva
oral soft tissues

87
Q

What is the cancer that affects tonsils and oropharynx region?

A

oropharyngeal cancers

88
Q

what is oropharyngeal cancer caused by?

A

majority by human papillomavirus (HPV)

89
Q

what does oral cancer initially start as in soft tissues?

A

squamous cell carcinoma

90
Q

tobacco habits

A

tobacco products contain chemicals that can cause cancer and are seen as risk factors e.g. betel quid

91
Q

high alcohol consumption

A

alcohol is a solvent for carcinogens - easier entry into deeper layer of soft tissues.

92
Q

what is a carcinogen?

A

substances that increase your risk of cancer

93
Q

what makes you more at risk of squamous cell carcinoma?

A

smoking and drinking excessively

94
Q

how is sunlight linked to squamous cell carcinoma?

A

it affects the lower lip in fair skinned people

95
Q

what is the link between diet and squamous cell carcinoma?

A

diet low in fresh fruit and vegetables

96
Q

genetics link to squamous cell carcinoma

A

some people are genetically predisposed to developing it

97
Q

how does the dental team prevent oral cancer and improve survival rate?

A
  • up to date with CPD and early detection of oral cancer
  • soft tissue examination at every recall
  • refer suspicious lesions appropriately
98
Q

what should be raised suspicious if found during an examination?

A

-painless ulcer no obvious cause, failing to heal after 3 weeks
-presence of red or red/white patch more than 3 weeks
-growth of soft tissues producing lump more than 3 weeks
-persistent unexplained lump in neck

99
Q

who do you refer to when you find something suspicious?

A

local oral and maxillofacial unit, urgent 2 week referral

100
Q

what should the dentist consult with if patients admit tobacco use?

A

ASK: record smoking status
ADVISE: best way of quitting
ACT: build confidence, refer to stop

101
Q

what is the general advice for pts who drink regularly and wish to seek help and advice?

A

-dont drink more than 14 units PW
-spread the 14 units over 3 days or more
-regular drinking increase risk
-try have several alcohol-free days
-pregnant women avoid drinking

102
Q

what are the oral health effects from alcohol and tobacco use?

A
  • develop oral precancerous lesions
  • periodontal disease
  • poor wound healing
  • tendency to develop ‘dry socket’
  • stained teeth
    -halitosis
  • tooth erosion
  • dental and facial trauma
103
Q

what are the general health effects from alcohol and tobacco use?

A
  • heart disease
  • stroke
  • respiratory disease
  • other cancers e.g. throat, lung, stomach
104
Q

what is herpes?

A

group of viruses that affect oral soft tissues

105
Q

what is herpes simplex 1?

A

primary infection in childhood, acute inflammation of oral soft tissues (gingivostomatitis) - painful ulcers

106
Q

what is herpes labialis?

A

recurrent condition occurs after initial primary herpes simplex, ‘cold sore’, occurs on lip
appear when stressed, had recent ‘cold’

107
Q

what is herpes zoster?

A

shingles - occurs as reactivation of virus in patients previously affected by chickenpox

108
Q

what area of body can shingles affect?

A

trigeminal nerve (face and oral cavity) and skin of torso

109
Q

what is human immunodeficiency virus (HPV)

A

a virus that is the causative agent of fatal condition, AIDS.

110
Q

what is oral candidiasis?

A

extensive fungal infection of oral cavity with heavy coatings of white ‘thrush’ lesions on tongue/palate

111
Q

what is kaposi’s sarcoma?

A

characteristic tumour of AIDS sufferers - occur as purplish brown lesion on palate and skin

112
Q

what is oral hairy leukoplakia?

A

oral white patch, distinct microscopic appearance on biopsy - premalignant
linked to HIV

113
Q

what is diabetes?

A

disorder affecting pancreas characterised by concentration of glucose in blood resulting in inability of body cells metabolising glucose correctly

114
Q

what is type 1 diabetes

A

insulin dependent

115
Q

what is type 2 diabetes

A

non-insulin dependent

116
Q

how does diabetes affect oral cavity?

A

xerostomia - cleansing and lubricating saliva reduced
poor wound healing - peripheral blood supply reduced
infection as peripheral vascular disease and peripheral neuropathy result in reduced blood flow

117
Q

what is epilepsy?

A

electrical activity in brain becomes suddenly and temporarily disrupted, results in seizure

118
Q

what side effect does the drug for epilepsy (Epilim) have?

A

gingival hyperplasia - gingival tissue overgrowth

119
Q

what is bulimia?

A

an eating disorder where the sufferer follows periods of compulsive overeating and periods of self-induced vomiting/fasting

120
Q

what are the oral effects of vomiting?

A

enamel erosion: severe pitting and enamel loss, vomit is acidic
soft tissue burns: acidic vomit causes burns

121
Q

what is crohn’s disease?

A

chronic inflammatory disease, affects part of GIT, shows orally as ulcerations

122
Q

what is ulcerative colitis?

A

chronic inflammatory disease, affects colon and rectal areas of GIT, shows orally as aphthous ulcers

123
Q

what is coeliac disease?

A

absorption disorder of small intestines, intolerance to cereal protein gluten, shows orally as ulceration, glossitis and stomatitis

124
Q

what are antibiotics?

A

drugs used to specifically fight against infection by bacteria

125
Q

what are anaerobes?

A

bacteria that live in oxygen-poor areas

126
Q

what are aerobic bacteria?

A

bacteria thrive of living in oxygen- rich environment

127
Q

what are side effects of antibiotics?

A

nausea, vomiting, diarrhoea

128
Q

what are the allergic reactions from antibiotics?

A
  • sensitivity reactions to colour dyes used in capsulated antibiotics
  • full anaphylaxis e.g. from penicillin’s
129
Q

how do antibiotics interact with other drugs?

A

prevented from working properly or produce serious side effects

130
Q

what is antibiotic resistance?

A

the overuse of antibiotics allows resistant strains of bacteria to evolve, these are not killed by usual antibiotics.
Bacteria becomes resistant over prolonged period or repeatedly - justify their use.

131
Q

what antibiotics are recommended when a pt is suffering from an acute or chronic dento-alveolar infection or periodontal abscess.

A

amoxicillin
metronidazole
clarithromycin or erythromycin

132
Q

how is amoxicillin given?

A

500mg 3x daily for up to 5 days

133
Q

how is metronidazole given?

A

safe alternative to amoxicillin - 400mg 3x daily up to 5 days

134
Q

how is clarithromycin/erythromycin given?

A

250mg 2x daily up to 5 days - safe alternative to penecillin

135
Q

other than antibiotics, what operational measures are taken for ANUG?

A

scaling and appropriate oral hygiene instructions.
chlorhexidine mouthwash

135
Q

what antibiotics are given for ANUG and pericoronitis?

A

metronidazole
amoxicillin

136
Q

what measures taken for pericoronitis?

A

cleaning the area
irrigate with warm salt water
mouthwash (peroxyl)

137
Q

why do some implant manufacturers recommend antibiotics during placement of implants?

A

to prevent:
postoperative infections
pain
peri-implantitis

138
Q

what implants are given after implant placements?

A

amoxicillin: 2g taken (4 500mg capsules)
clindamycin: for pt allergic to penicillin, dose of 600mg ( 4 150mg capsules)

both taken 1 hour preoperatively

139
Q

what are antivirals?

A

drugs used against infections caused by virus

140
Q

what antivrial is given for herpes labialis? (coldsores)

A

aciclovir antiviral cream
apply to lesion 5x daily for 5-10 days

141
Q

what are antifungals?

A

drugs used against fungal infections

142
Q

what antifungal is given for infections causing oral thrush?

A

lozenges
pastilles
oral gel

143
Q

what antifungals are prescribed as capsules?

A

fluconazole: difficult fungal infections
nystatin: oral suspension/lozenges
amphotericin: 10mg lozenges
miconazole: oral gel

144
Q

what are analgesics?

A

drugs used primarily to relieve pain
should avoid during pregnancy

145
Q

what are the frequently used analgesics?

A

paracetamol: has antipyretic properties - reduce body temp, can cause liver damage
ibuprofen: NSAID and analgesic, can cause stomach ulcers if used excess
aspirin: acts as anticoagulant CANT give after surgical procedures

146
Q

principles of ‘chain of infection’

A

infection agent: cause of virus
reservoir: can be person/animal/plant - what pathogen of infectious agent attaches to
portal of exit: microorganism exits through coughing, sneezing, blood transmission, urinary tract
route of transmission: how pathogen passes from one to another e.g. direct/indirect/AGP transmission
portal of entry: when pathogen enters other hosts body through, eyes, nose, mouth
susceptible post: person at risk, risk depends on general health and immune system

147
Q

what are the routes of transmission of infectious diseases?

A

direct
indirect
AGP (aerosol generating procedures)

148
Q

what is direct cross infection?

A

person in direct contact with contaminated person
through sneezing, coughing, physical contact

149
Q

what is indirect cross infection?

A

person that has never been in direct contact with person, infected through contaminated instruments or surfaces

150
Q

what is aerosol generating procedures?

A

medical and patient care procedures that result in production of airborne particles.

151
Q

how does pregnancy affect susceptibility to infection?

A

immune system protects mum and baby, works harder than usual
different parts are enhanced, some are not needed and are suppressed
balance to prevent infection

152
Q

how does immunocompromised affect susceptibility to infection?

A

immune system is weak
e.g. someone with HIV, cancer patient
prone to getting pathogens

153
Q

how does age affect susceptibility to infection?

A

immune system weaker
medical conditions - catch infections quicker

154
Q

how does medical treatment/illness affect susceptibility to infection?

A

e.g. cancer affects immune system - risk of catching infections
cautious of where they go to not catch illness

155
Q

what is the basic principle of infection control?

A

to assume that any patient may be infected with any micro-organism and can pose infection risk

156
Q

why is medical history taken and updated every visit?

A

to identify majority problems

157
Q

what is a carrier?

A

an individual who is infected by a micro-organism but shows no sign of disease, unaware of risk to others

158
Q

how do dental staff apply good basic personal hygiene?

A

regular hand washing to remove microorganisms and reduce risk of cross-infection

159
Q

how is good basic infection control achieved?

A

cover wounds with waterproof dressing
wear non-latex gloves
clear blood and bodily fluids using appropriate spillage kit
follow correct procedure for safe disposal of contaminated waste and sharps

160
Q

what does best practice dictate that good general infection is achieved by?

A

up to date written infection policy in place
standard precautions used for all patients
correct cleaning of clinical area
correct cleaning/disposal of instrument/handpieces
validation, maintenance and testing of decontamination equipment

161
Q

how is personal infection control followed by staff?

A

clinical staff vaccinated against HEP B
staff immunised against current common illnesses
follow correct hand-cleaning procedures
use all PPE appropriately
all inoculation injuries dealt with immediately

162
Q

what does social cleanliness mean?

A

clean to a social acceptable standard for personal hygiene but not disinfected/sterilised

163
Q

what does disinfection mean?

A

process used to kill or inactivate bacteria and fungi but not spores or some viruses

164
Q

what does sterilisation mean?

A

process of killing all micro-organisms and spores to produces asepsis - using autoclaves

165
Q

what does asepsis mean?

A

absence of all living pathogenic micro-organisms

166
Q

what does decontamination mean?

A

combination of processes used to remove contamination from reusable items so they are safe for further use

167
Q

what stages does decontaminate involve?

A

cleaning
disinfection
inspection
packaging
dispose of single-use items
sterilisation
transport
storage

168
Q
A

Dental nurse revision (301-311) (11 decks)

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