Principles in surgery asepsis

Question 1

Important decisions need to be made long ______ administration of anesthesia
• Think informed consent as well as surgical plan

Answer 1

before

Question 2

What are the 2 basic necessities for surgery?

Answer 2

Visibility and Assistance

Question 3

• Adequate access
• Retraction of soft tissues
• Surgical flap creation
• Adequate light
• Surgical field free of excess blood/saliva/irrigant

Answer 3

• Visibility

Question 4

What type of stroke is used when incising tissue?

Answer 4

Use a firm continuous stroke

• No repetitive or tentative strokes

Question 5

When designing a flap, should the apex or base be wider?

Answer 5

Base should be wider

Question 6

Should the length or width of flap be greater?

Answer 6

• Length never twice the width of the base

Question 7

• Vertical releasing incisions should be made ______ teeth away from surgical site

Answer 7

one to two teeth away

Question 8

• Sulcular incision
• Releasing incision(s) created as needed for visibility
• 3 corner flap
• 4 corner flap

Answer 8

Envelope flap

Question 9

The following MOs are found in ___ cavity
• Aerobic gram + cocci (Strep viridans*)
• Actinomyces spp
• Anaerobic (Peptostrep, Prevotella, Fusobacterium, Porphyromonas)
• Candida spp.

Answer 9

Oral cavity

Question 10

The following MOs are found in ___ cavity
• Aerobic gram + cocci (strep spp.)
• Pediatrics: Haemophilus influenza
• Adults: Staphylococcus aureus

Answer 10

Nasal cavity

Question 11

• Microbes in oral cavity are held in check by what 4 mechanisms?

Answer 11

• Desquamation – rapid epithelial turnover
• Host immunologic factors:
• Dilution due to salivary flow
• Competition between oral organisms

Question 12

Are the majority of oral microflora pure aerobes or pure anaerobes?

Answer 12

Mixed flora

Question 13

• 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

Answer 13

Hepatitis virus

Question 14

• 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

Answer 14

Hepatitis virus

Question 15

_____
• Can be inactivated by iodophors, hypochlorite, glutaraldehyde (disinfectant),
heat sterilization, irradiation
• Resistant to alcohol, phenols, quaternary ammonium compounds

Answer 15

Hepatitis

Question 16

• 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!!

Answer 16

half

Question 17

• 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

Answer 17

HIV

Question 18

HIV infected patients w/ CD4 < _____/μL very susceptible to infections

Answer 18

200

Question 19

Is there a low or high risk of seroconversion of HIV from needle stick?

Answer 19

Low risk

Question 20

• Breakdown of living tissue by the action of the microorganisms and is usually accompanied by
inflammation

Answer 20

Sepsis

Question 21

• Avoidance of sepsis

Answer 21

Asepsis

Question 22

• Attempt to keep patients, staff, and objects as free as possible of agents that cause infection

Answer 22

• Medical Asepsis

Question 23

• Attempt to prevent microbes from gaining access to surgically created wounds

Answer 23

Surgical Asepsis

Question 24

• Reduction in the number of organisms capable of producing sepsis
• Variable state depending on agent used

Answer 24

Disinfection

Question 25

* Used on inanimate surfaces | * I. e. Sodium hypochlorite

Answer 25

Disinfectant

Question 26

* Used on living tissue | * I.e. Povidone surgical scrub

Answer 26

Antiseptic

Question 27

* Freedom from viable forms of microorganisms | * Absolute state (not variable as in disinfection)

Answer 27

Sterility

Question 28

• Reduction in the number of viable microorganisms to levels judged “safe” by public health standards

Answer 28

Sanitization

Question 29

* Reduction in the number of viable microorganisms | * Not connected with public health standards

Answer 29

Decontamination

Question 30

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)

Answer 30

HEAT

Question 31

What is the spore used to test the effectiveness of any heat system

Answer 31

Bacillus stearothermophilus

Question 32

Sterilization of packaged instruments is good for a maximum of _____ months and only if double wrapped

Answer 32

6 MONTHS

Question 33

``` • 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 ```

Answer 33

Dry heat

Question 34

* 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!

Answer 34

Moist heat

Question 35

``` ________ is concerned about preventing the spread of disease from: • Provider to patient • Patient to provider • Patient to patient • Operatory to house cleaning staff ```

Answer 35

Infection control

Question 36

• 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

Answer 36

Universal precautions

Question 37

``` • Gloves • Mask • Eyewear (with side shields) • Gown • Designed to protect staff from patient as well as patient from staff ```

Answer 37

PPE

Question 38

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

Answer 38

CLEAN

Question 39

Medications, allergies,and disease are actively taken in which questionaire?

Answer 39

Past med history

Question 40

How should the surgical handpiece be in regards to speed, torque, and exhaust?

Answer 40

High speed, high torque, and rear exhaust

Question 41

Can the minnesota retractor elevate tissue off bone?

Answer 41

No; can retract tissue off of bone after it has been elevated