Principles in surgery asepsis Flashcards
Important decisions need to be made long ______ administration of anesthesia
• Think informed consent as well as surgical plan
before
What are the 2 basic necessities for surgery?
Visibility and Assistance
- Adequate access
- Retraction of soft tissues
- Surgical flap creation
- Adequate light
- Surgical field free of excess blood/saliva/irrigant
• Visibility
What type of stroke is used when incising tissue?
Use a firm continuous stroke
• No repetitive or tentative strokes
When designing a flap, should the apex or base be wider?
Base should be wider
Should the length or width of flap be greater?
• Length never twice the width of the base
• Vertical releasing incisions should be made ______ teeth away from surgical site
one to two teeth away
- Sulcular incision
- Releasing incision(s) created as needed for visibility
- 3 corner flap
- 4 corner flap
Envelope flap
The following MOs are found in ___ cavity
• Aerobic gram + cocci (Strep viridans*)
• Actinomyces spp
• Anaerobic (Peptostrep, Prevotella, Fusobacterium, Porphyromonas)
• Candida spp.
Oral cavity
The following MOs are found in ___ cavity
• Aerobic gram + cocci (strep spp.)
• Pediatrics: Haemophilus influenza
• Adults: Staphylococcus aureus
Nasal cavity
• Microbes in oral cavity are held in check by what 4 mechanisms?
- Desquamation – rapid epithelial turnover
- Host immunologic factors:
- Dilution due to salivary flow
- Competition between oral organisms
Are the majority of oral microflora pure aerobes or pure anaerobes?
Mixed flora
- B, C most concerning to practitioners
- Very hardy, highly resistant to desiccation and chemical disinfectants
- Immunization for HbV DOES NOT protect for C or D viruses
- To get Hep D, you must be Hep B positive
Hepatitis virus
• Minute quantities capable of spreading disease (105-107 virons/mL blood)
• Common means of inoculation during recapping or removal of anesthetic needle or
scalpel blade
• Can be inactivated by iodophors, hypochlorite, glutaraldehyde (disinfectant),
heat sterilization, irradiation
• Resistant to alcohol, phenols, quaternary ammonium compounds
Hepatitis virus
_____
• Can be inactivated by iodophors, hypochlorite, glutaraldehyde (disinfectant),
heat sterilization, irradiation
• Resistant to alcohol, phenols, quaternary ammonium compounds
Hepatitis
• Only ____ of the people that have hepatitis have signs and symptoms of the disease
• Some individuals who have completely recovered from disease (no s/s) continue to shed
intact virus particles in secretions!!
half
- Not nearly as hardy as Hepatitis B virus
- HIV desiccates easily and quickly,
- Dies once outside tissue fluids it is located in
- Same high risk individuals as with Hepatitis B
- HIV infected patients w/ CD4 < 200/μL very susceptible to infections
- Clinical diagnosis of AIDS given with CD4 < 200/μL
HIV
HIV infected patients w/ CD4 < _____/μL very susceptible to infections
200
Is there a low or high risk of seroconversion of HIV from needle stick?
Low risk
• Breakdown of living tissue by the action of the microorganisms and is usually accompanied by
inflammation
Sepsis
• Avoidance of sepsis
Asepsis
• Attempt to keep patients, staff, and objects as free as possible of agents that cause infection
• Medical Asepsis
• Attempt to prevent microbes from gaining access to surgically created wounds
Surgical Asepsis
- Reduction in the number of organisms capable of producing sepsis
- Variable state depending on agent used
Disinfection
- Used on inanimate surfaces
* I. e. Sodium hypochlorite
Disinfectant
- Used on living tissue
* I.e. Povidone surgical scrub
Antiseptic
- Freedom from viable forms of microorganisms
* Absolute state (not variable as in disinfection)
Sterility
• Reduction in the number of viable microorganisms to levels judged “safe” by public health
standards
Sanitization
- Reduction in the number of viable microorganisms
* Not connected with public health standards
Decontamination
Sterilization with ____
• Spore of Bacillus stearothermophilus is used to test the effectiveness of any heat system
• Moist heat (protein coagulation) is more efficient at killing bacteria than dry heat (oxidation of
cell protein)
HEAT
What is the spore used to test the effectiveness of any heat system
Bacillus stearothermophilus
Sterilization of packaged instruments is good for a maximum of _____ months and only if
double wrapped
6 MONTHS
• 320 ºF for 2 hours • Advantages: • Will not damage rust susceptible or heat resistant instruments • Ease to use • Disadvantages: • Take too long • Damage to heat sensitive instruments
Dry heat
- 250 ºF at 15 psi for 24 minutes• Placed in steam under pressure (increases temp)
- Advantages
- Effectiveness
- Less timely
- Relative availability
- Disadvantages
- Dulls and rusts instruments
- Cost!
Moist heat
\_\_\_\_\_\_\_\_ is concerned about preventing the spread of disease from: • Provider to patient • Patient to provider • Patient to patient • Operatory to house cleaning staff
Infection control
• The only answer to protection from all pathogens
• Should always be employed on EVERY patient regardless of if the patient has a known
communicable disease
• IF YOU ALWAYS DO A TASK, IT WILL EVENTUALLY BECOME SECOND NATURE
• So when it is not performed, something feels wrong
Universal precautions
• Gloves • Mask • Eyewear (with side shields) • Gown • Designed to protect staff from patient as well as patient from staff
PPE
A ____ technique is the most commonly used infection control practice in outpatient
oral surgery
• Absolute sterility is almost impossible to achieve
• What field are we working on?
• Clean technique protects staff from patient as well as patient from staff
CLEAN
Medications, allergies,and disease are actively taken in which questionaire?
Past med history
How should the surgical handpiece be in regards to speed, torque, and exhaust?
High speed, high torque, and rear exhaust
Can the minnesota retractor elevate tissue off bone?
No; can retract tissue off of bone after it has been elevated
