Exam 1 Flashcards
healthcare associated infections (HAI):
an infection acquired during the delivery of healthcare in any setting
*broad term that reflects the uncertainty of where a pathogen may have been acquired
chain of infection requires what 3 things?
- source or resevoir (sufficient #’s of pathogen)
- susceptible host
- mode of transmission
aerosols
-liquid or solid particles less than 50 micrometers
-small enough to stay airborne for extended period of time
splatter
-mixture of air, water, and/or solid substances larger than 50 micrometers
-visible to the naked eye
-airborn briefly –> limited penetration into respiratory system
-travle in bullet-like trajectory
droplets & droplet nuclei
-0.5-1 micrometers
-can settle in pulmonary alveoli
-high level of risk of infection in dentistry
what are the three modes of transmission?
- direct
- indirect
- respiratory
direct transmission
pathogens transferred b/w individuals with no intermediate
what percentage of nuclei in dental office is smaller than 5 microns in size?
95%
indirect transmission
pathogens transferred b/w individuals via an intermediate
respiratory transmission
pathogens transferred from droplets or droplet nuclei (inhalation)
virulence
ability to cause infection & damage
-easily colonizes
-grows rapidly
-produces harmful substances
-evades/counter body’s defenses
what are the 2 types of resistance?
- innate
- acquired
innate resistance
physical (skin, mucous membranes)
mechanical (secretions, cilia)
chemical (stomach acid)
acquired resistance
cell-mediated (antibodies)
immunity
condition of being able to resist a particular disease; especially through preventing development of a pathogenic microorganism
stages of infection
- incubation
- prodromal
- acute or spread of illness
- convalescent or decline
incubation stage of infection
time b/w exposure & apparent symptoms
prodromal stage of infection
time b/w appearance of initial symptoms & full development
acute or period of illness stage of infection
signs & symptoms are most obvious; specific & severe
convalescent or decline stage of infection
of pathogens decreases and symptoms decrease; host is susceptible to secondary infection
sanitization
process of physical cleaning to reduce the quantity of microbes & bioburden
-use of disinfectant & paper towels on surfaces
-use of soap & brush on instruments
-ultrasonic on instruments
should be used before sterilization &/or disinfection
sterilization
destruction of all microbial forms (including spores)
-heat (what we use)
-filtration
-radiation
-chemical (used for heat sensitive instruments)
antiseptics
substance that stops or slows down the growth of microorganisms; used on living tissue
*30% solution better than 100%
disinfection
less lethal than sterilization
*target for cubicle prep
what are the 3 levels of disinfection?
- high-level
- intermediate level (dual quaternaries)
- lower-level
high-level disinfectants
used for heat-sensitive instruments (endoscopes); kills all pathogens but not all spores; extended contact
intermediate level disinfectants (dual quaternaries)
cavicide or caviwipes
*what we use
lower-level disinfectants
used for floors & walls
Spaulding’s Classification System
categorizes patient care items by their potential risk of infection
Spaulding’s classification rankings
critical
semi-critical
non-critical
critical items
penetrate soft & hard tissues or the vascular system & confer a high degree of risk for infection if contaminated with pathogens; must be sterilized
-explorers, scalpels, burs, scalers
semi-critical items
contact, but do not penetrate; non-sharp items that enter the oral cavity; must be heat-sterilized (if heat-sensitive must minimally undergo high-level disinfection)
-amalgam condensers, mirrors, reusable impression trays
non-critical items
items that do not enter the oral cavity but may be touched; require disinfection or plastic barrier
-counter tops, chair controls, light handles, keyboard
standard precautions
treat everyone as infectious regardless of suspected or confirmed infection
3 types of controls:
- administrative
- engineering
- work-practice
administrative controls
policies, procedures & enforcement measures targeted at reducing risk of infection
ex: postponing nonemergent procedures
engineering controls
devices that isolate or remove the risk of exposure
ex: sharps containers
work-practice controls
procedures that reduce likelihood of exposure by altering the manner in which task is performed
ex: one-handed scoop technique for recapping a needle
regulated waste defined by OSHA
blood or other potentially infection material (OPIM) in liquid or semi-liquid state; items caked with blood or OPIM; contaminated sharps
what goes in red biohazard bag @ umkc?
solid waste soaked or saturated with blood or saliva; contaminated sharps; anesthetic carpules; scalpel blades; surgically removed tissue
CDC guidelines intended to _____
prevent infection transmission
ultrasonic cleaners
uses high frequency sound waves & cavitation to loosen and remove debris
autoclave
steam under pressure; most dependable & economical; most common; dulls cutting edges & rusts
flash sterilizers
steam; not intended to be used solely
dry heat
super high heat for long time; does not dull edges or rust; long cycle, poor penetration; handpiece won’t tolerate
chemiclave
steam under pressure with chemical vapor; short cycle & less corrosion; chemical vapor hazardous
latex reactions:
- contact dermatitis
(irritant or allergic) - latex allergy
irritant contact dermatitis
not an allergic rxn; least-threatening type; usually due to repeated exposure; dry, itchy, burning areas
allergic contact dermatitis
type IV delayed rxn; may result from allergy to chemical used in manufacturing; more severe than irritant
latex allergy
type I (immediate) hypersensitivity rxn; rxn’s may include nose, eye & skin
how to minimize latex reactions?
-dry hands before donning gloves
-use latex-free gloves
-use powder-free gloves
monitoring sterilization
“spore testing”; should be done weekly
what do you do if spore test is failed?
take machine out of service, review usage protocols & re-test machine
if re-test fails then machine needs to be inspected
what is the #1 cause for failed spore test?
overloading of machine
ergonomics
science of fitting jobs to the people who work them
3 P’s to fitness in the operatory:
- posture
- positioning
- periodic stretching
order of donning PPE
- gown
- glasses
- mask
- gloves
order of doffing PPE
- gloves
- glasses
- gown
- mask
how often should you purge water lines?
30 sec every morning and b/w each patient
vital signs are the best way to prevent what?
medical emergencies
what are the 4 classical signs of infection?
- calor (heat)
- dolor (pain)
- rubor (redness)
- tumor (swelling)
4 types of infection:
- viral
- bacterial
- fungal
- parasitic
viral infection
parasitic & require a host cell
ex: influenza, herpes (HSV), HPV, and HIV
bacterial infection
single-cell microorganisms
ex: strep throat, E. coli, MRSA, tuberculosis
fungal infection
yeast & mold
ex: ringworm, thrush, histoplasmosis
parasitic infection
live on or in host; no oral manifestations
ex: malaria, lice, tapeworm
what are the 4 vital signs?
- temperature
- pulse
- respirations
- blood pressure
temperature
can take oral, axillary, or rectal; lowest @ 6am and highest between 4-6pm
what is the average oral temp?
98.6
what is the temperature of a fever?
100.4 degrees or higher
what is the temperature of a low-grade fever?
99.6-100.3 degrees
pulse
heart rate or # of times your heart beats per minute
what are the three places you can take a pulse?
- radial (wrist)
- brachial (inside of elbow)
- carotid (neck)
what is a normal pulse?
60-100 bpm
tachycardia
pulse rate is greater than 100 bpm
bradycardia
pulse rate is less than 60 bpm
what are normal respirations?
12-20 breaths per minuteb
bradypnea
slow breathing; less than 12 breaths/min
tachypnea
fast breathing; more than 20 breaths/min
systolic pressure
higher #; refers to the pressure inside the artery when heart contracts
diastolic pressure
lower #; refers to the pressure inside the artery at rest and filling with blood
is systolic or diastolic pressure associated with higher risk of stroke and heart disease?
higher systolic pressure
pulse pressure
difference b/w systolic and diastolic pressure; force that the heart generates each time it contracts
normal or safe pulse pressure
less than 45 mmHg
risk factor pulse pressure
greater than 60 mmHg
normal blood pressure
less than 120/80 mmHg
elevated blood pressure
120-129/80 mmHg
hypertension stage 1
130-139/80-89 mmHg
hypertension stage 2
140 or higher/90 or higher mmHg
hypertensive crisis
higher than 180/higher than 120 mmHg
systolic hypertension
systolic pressure higher than 130 but diastolic is under 80
*most common type in people over 65
hypertension risk factors
race
-non-hispanic blacks (42%)
-non-hispanic whites (28%)
-hispanics (26%)
-non-hispanic asians (25%)
post-menopausal women more likely due to lack of estrogen
how to use manual blood pressure cuff
- place bottom edge of cuff about 1 inch above antecubital fossa
- inflate cuff about 20-30 mmHg above normal systolic
- pressure release valve turned to allow needle to fall at rate of 2-3 mmHg/sec
- systolic recorded at point where beating sounds (Korotkoff sounds) first heard
- diastolic recorded at point where Korotkoff sounds completely disappear
common mistakes using manual BP cuff
cuff too big/loose= low reading
cuff too small/tight= high reading
crossed legs= high reading
how many life-threatening emergencies will a dentist experience?
1-2
*becoming more likely due to increase in life expectancy
categories of emergencies
- minor
- intermediate
- major
minor emergency
simple faint
trendelenburg position
used to increase blood flow to the head; body is laid supine or flat with 15-30 degree incline with feet elevated above the head
used in minor emergencies
intermediate emergency
need O2 and repositioning
major emergency
referral to MD or hospital (ER)
ways to determine medical risks
medical history questionnaire
physical evaluation
dialogue history
medical consultation (if necessary)
ASA classification
goals of physical evaluation
evaluate if…
-ability to psychologically and/or physically tolerate stress or procedure
-treatment modification needed
-psychosedation indicated
-which sedation method indicated?
-any contradictions to pre-medications used
ASA I classification
normal healthy patient, non-smoking, no or minimal alcohol use
ASA II classification
patient with mild systemic disease, current smoker, pregnancy, obesity, well-controlled DM/HTN, mild lung disease
ASA III classification
patient with severe systemic disease, poorly controlled DM/HTN, COPD undergoing regularly scheduled dialysis
ASA IV classification
patient with severe systemic disease that is a constant threat to life, recent (less than 3 months) MI heart attack, TIA (mini stroke)
ASA V classification
moribund patient who is not expected to survive 24 hours without an operation
ASA VI classification
declared brain dead patient whose organs are being removed for donor purposes
signs of anxiety
increased BP & pulse
trembling
diaphoresis
restlessness
hyperventilation
dilated pupils
stress reduction protocol
oral sedation- pm & am
intraoperative sedation
effective pain control- local anesthesia
am appointment
time factor- short appointments
post-op RX
post-op phone call
syncope
transient loss of consciousness due to hypoperfusion of the brain & is characterized by rapid onset & spontaneous resolution; usually evoked by emotional stress associated with fear or pain
how long does it take to fully recover from syncope?
24 hours
vasovagal syncope
sudden, rapid drop in HR and BP which leads to fainting
*primary cause of syncope
orthostatic hypotension
decrease in systolic BP of 20mmHg or decrease in diastolic of 10mmHg within 3 minutes of standing
early manifestations of syncope
warmth
loss of color
sweating
nausea
BP @ baseline
tachycardia
late manifestations of syncope
yawning
difficulty breathing
pupillary dilation
cold hands & feet
dizziness
loss of consciousness
hypotension
bradycardia
hyperventilation
to breath at an abnormally rapid rate –> increasing rate of loss of CO2 –> causes respiratory alkalosis due to decreased partial pressure of CO2 in blood
signs and symptoms of hyperventilation
rapid & shallow breathing
rapid pulse & respirations
confusion
dizziness
cold hands
tightness in chest, pain
carpal-pedal spasms; can lead to seizures
tingling or numbness of hands and lips
management of hyperventilation
terminate procedure
position comfortably (usually upright)
reassure patient
no oxygen
breathe into paper bag or headrest cover; cupped breaths
count to 10 between breaths
valium 5mg IM or IV in severe cases
goals of chairside dental assisting
-provide patient comfort and quality care
-reduce chair time
-minimize stress and fatigue during complicated dental procedures
right handed operator work area
8-12 oclock
left handed operator work area
12-4 oclock
transfer zone
in front of mouth @ chin level
parallel transfer
dentist must signal
dentist should not have to move
what should you supply at the beginning of every procedure?
mirror and explorer
oral evacuation
keeps mouth free of saliva, debris, and water; retracts tongue and cheek; reduce bacterial aerosol caused by handpiece
two grasps of oral evacuation
- pen grasp
- palm-thumb grasp
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