Exam 1 Flashcards
1
Q
healthcare associated infections (HAI):
A
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
2
Q
chain of infection requires what 3 things?
A
- source or resevoir (sufficient #’s of pathogen)
- susceptible host
- mode of transmission
3
Q
aerosols
A
-liquid or solid particles less than 50 micrometers
-small enough to stay airborne for extended period of time
4
Q
splatter
A
-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
5
Q
droplets & droplet nuclei
A
-0.5-1 micrometers
-can settle in pulmonary alveoli
-high level of risk of infection in dentistry
6
Q
what are the three modes of transmission?
A
- direct
- indirect
- respiratory
7
Q
direct transmission
A
pathogens transferred b/w individuals with no intermediate
8
Q
what percentage of nuclei in dental office is smaller than 5 microns in size?
A
95%
9
Q
indirect transmission
A
pathogens transferred b/w individuals via an intermediate
10
Q
respiratory transmission
A
pathogens transferred from droplets or droplet nuclei (inhalation)
11
Q
virulence
A
ability to cause infection & damage
-easily colonizes
-grows rapidly
-produces harmful substances
-evades/counter body’s defenses
12
Q
what are the 2 types of resistance?
A
- innate
- acquired
13
Q
innate resistance
A
physical (skin, mucous membranes)
mechanical (secretions, cilia)
chemical (stomach acid)
14
Q
acquired resistance
A
cell-mediated (antibodies)
15
Q
immunity
A
condition of being able to resist a particular disease; especially through preventing development of a pathogenic microorganism
16
Q
stages of infection
A
- incubation
- prodromal
- acute or spread of illness
- convalescent or decline
17
Q
incubation stage of infection
A
time b/w exposure & apparent symptoms
18
Q
prodromal stage of infection
A
time b/w appearance of initial symptoms & full development
19
Q
acute or period of illness stage of infection
A
signs & symptoms are most obvious; specific & severe
20
Q
convalescent or decline stage of infection
A
of pathogens decreases and symptoms decrease; host is susceptible to secondary infection
21
Q
sanitization
A
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
22
Q
sterilization
A
destruction of all microbial forms (including spores)
-heat (what we use)
-filtration
-radiation
-chemical (used for heat sensitive instruments)
23
Q
antiseptics
A
substance that stops or slows down the growth of microorganisms; used on living tissue
*30% solution better than 100%
24
Q
disinfection
A
less lethal than sterilization
*target for cubicle prep
25
what are the 3 levels of disinfection?
1. high-level
2. intermediate level (dual quaternaries)
3. lower-level
26
high-level disinfectants
used for heat-sensitive instruments (endoscopes); kills all pathogens but not all spores; extended contact
27
intermediate level disinfectants (dual quaternaries)
cavicide or caviwipes
*what we use
28
lower-level disinfectants
used for floors & walls
29
Spaulding's Classification System
categorizes patient care items by their potential risk of infection
30
Spaulding's classification rankings
critical
semi-critical
non-critical
31
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
32
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
33
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
34
standard precautions
treat everyone as infectious regardless of suspected or confirmed infection
35
3 types of controls:
1. administrative
2. engineering
3. work-practice
36
administrative controls
policies, procedures & enforcement measures targeted at reducing risk of infection
ex: postponing nonemergent procedures
37
engineering controls
devices that isolate or remove the risk of exposure
ex: sharps containers
38
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
39
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
40
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
41
CDC guidelines intended to _____
prevent infection transmission
42
ultrasonic cleaners
uses high frequency sound waves & cavitation to loosen and remove debris
43
autoclave
steam under pressure; most dependable & economical; most common; dulls cutting edges & rusts
44
flash sterilizers
steam; not intended to be used solely
45
dry heat
super high heat for long time; does not dull edges or rust; long cycle, poor penetration; handpiece won't tolerate
46
chemiclave
steam under pressure with chemical vapor; short cycle & less corrosion; chemical vapor hazardous
47
latex reactions:
1. contact dermatitis
(irritant or allergic)
2. latex allergy
48
irritant contact dermatitis
not an allergic rxn; least-threatening type; usually due to repeated exposure; dry, itchy, burning areas
49
allergic contact dermatitis
type IV delayed rxn; may result from allergy to chemical used in manufacturing; more severe than irritant
50
latex allergy
type I (immediate) hypersensitivity rxn; rxn's may include nose, eye & skin
51
how to minimize latex reactions?
-dry hands before donning gloves
-use latex-free gloves
-use powder-free gloves
52
monitoring sterilization
"spore testing"; should be done weekly
53
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
54
what is the #1 cause for failed spore test?
overloading of machine
55
ergonomics
science of fitting jobs to the people who work them
56
3 P's to fitness in the operatory:
1. posture
2. positioning
3. periodic stretching
57
order of donning PPE
1. gown
2. glasses
3. mask
4. gloves
58
order of doffing PPE
1. gloves
2. glasses
3. gown
4. mask
59
how often should you purge water lines?
30 sec every morning and b/w each patient
60
vital signs are the best way to prevent what?
medical emergencies
61
what are the 4 classical signs of infection?
1. calor (heat)
2. dolor (pain)
3. rubor (redness)
4. tumor (swelling)
62
4 types of infection:
1. viral
2. bacterial
3. fungal
4. parasitic
63
viral infection
parasitic & require a host cell
ex: influenza, herpes (HSV), HPV, and HIV
64
bacterial infection
single-cell microorganisms
ex: strep throat, E. coli, MRSA, tuberculosis
65
fungal infection
yeast & mold
ex: ringworm, thrush, histoplasmosis
66
parasitic infection
live on or in host; no oral manifestations
ex: malaria, lice, tapeworm
67
what are the 4 vital signs?
1. temperature
2. pulse
3. respirations
4. blood pressure
68
temperature
can take oral, axillary, or rectal; lowest @ 6am and highest between 4-6pm
69
what is the average oral temp?
98.6
70
what is the temperature of a fever?
100.4 degrees or higher
71
what is the temperature of a low-grade fever?
99.6-100.3 degrees
72
pulse
heart rate or # of times your heart beats per minute
73
what are the three places you can take a pulse?
1. radial (wrist)
2. brachial (inside of elbow)
3. carotid (neck)
74
what is a normal pulse?
60-100 bpm
75
tachycardia
pulse rate is greater than 100 bpm
76
bradycardia
pulse rate is less than 60 bpm
77
what are normal respirations?
12-20 breaths per minuteb
78
bradypnea
slow breathing; less than 12 breaths/min
79
tachypnea
fast breathing; more than 20 breaths/min
80
systolic pressure
higher #; refers to the pressure inside the artery when heart contracts
81
diastolic pressure
lower #; refers to the pressure inside the artery at rest and filling with blood
82
is systolic or diastolic pressure associated with higher risk of stroke and heart disease?
higher systolic pressure
83
pulse pressure
difference b/w systolic and diastolic pressure; force that the heart generates each time it contracts
84
normal or safe pulse pressure
less than 45 mmHg
85
risk factor pulse pressure
greater than 60 mmHg
86
normal blood pressure
less than 120/80 mmHg
87
elevated blood pressure
120-129/80 mmHg
88
hypertension stage 1
130-139/80-89 mmHg
89
hypertension stage 2
140 or higher/90 or higher mmHg
90
hypertensive crisis
higher than 180/higher than 120 mmHg
91
systolic hypertension
systolic pressure higher than 130 but diastolic is under 80
*most common type in people over 65
92
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
93
how to use manual blood pressure cuff
1. place bottom edge of cuff about 1 inch above antecubital fossa
2. inflate cuff about 20-30 mmHg above normal systolic
3. pressure release valve turned to allow needle to fall at rate of 2-3 mmHg/sec
4. systolic recorded at point where beating sounds (Korotkoff sounds) first heard
4. diastolic recorded at point where Korotkoff sounds completely disappear
94
common mistakes using manual BP cuff
cuff too big/loose= low reading
cuff too small/tight= high reading
crossed legs= high reading
95
how many life-threatening emergencies will a dentist experience?
1-2
*becoming more likely due to increase in life expectancy
96
categories of emergencies
1. minor
2. intermediate
3. major
97
minor emergency
simple faint
98
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
99
intermediate emergency
need O2 and repositioning
100
major emergency
referral to MD or hospital (ER)
101
ways to determine medical risks
medical history questionnaire
physical evaluation
dialogue history
medical consultation (if necessary)
ASA classification
102
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
103
ASA I classification
normal healthy patient, non-smoking, no or minimal alcohol use
104
ASA II classification
patient with mild systemic disease, current smoker, pregnancy, obesity, well-controlled DM/HTN, mild lung disease
105
ASA III classification
patient with severe systemic disease, poorly controlled DM/HTN, COPD undergoing regularly scheduled dialysis
106
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)
107
ASA V classification
moribund patient who is not expected to survive 24 hours without an operation
108
ASA VI classification
declared brain dead patient whose organs are being removed for donor purposes
109
signs of anxiety
increased BP & pulse
trembling
diaphoresis
restlessness
hyperventilation
dilated pupils
110
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
111
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
112
how long does it take to fully recover from syncope?
24 hours
113
vasovagal syncope
sudden, rapid drop in HR and BP which leads to fainting
*primary cause of syncope
114
orthostatic hypotension
decrease in systolic BP of 20mmHg or decrease in diastolic of 10mmHg within 3 minutes of standing
115
early manifestations of syncope
warmth
loss of color
sweating
nausea
BP @ baseline
tachycardia
116
late manifestations of syncope
yawning
difficulty breathing
pupillary dilation
cold hands & feet
dizziness
loss of consciousness
hypotension
bradycardia
117
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
118
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
119
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
120
goals of chairside dental assisting
-provide patient comfort and quality care
-reduce chair time
-minimize stress and fatigue during complicated dental procedures
121
right handed operator work area
8-12 oclock
122
left handed operator work area
12-4 oclock
123
transfer zone
in front of mouth @ chin level
*parallel transfer*
dentist must signal
dentist should not have to move
124
what should you supply at the beginning of every procedure?
mirror and explorer
125
oral evacuation
keeps mouth free of saliva, debris, and water; retracts tongue and cheek; reduce bacterial aerosol caused by handpiece
126
two grasps of oral evacuation
1. pen grasp
2. palm-thumb grasp
127
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