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OS and Pain Management 2 > PRINCIPLES IN SURGERY & ASEPSIS > Flashcards

PRINCIPLES IN SURGERY & ASEPSIS Flashcards

1
Q

Visibility
(3)

A
  • Adequate access
  • Adequate light
  • Surgical field free of excess blood/saliva/irrigant
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2
Q
  • Adequate access
    (2)
A
  • Retraction of soft tissues
  • Surgical flap creation
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3
Q

Assistance!
* Sufficient familiarity with procedure to aid in anticipation of

A

surgeon’s needs

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4
Q

INCISIONS
(5)

A
  • Sharp blade of proper size
  • Use a firm continuous stroke
  • Avoid vital structures
  • Perpendicular incisions if planning to reapproximate structure
  • Place in healthy tissue
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5
Q
  • Sharp blade of proper size
A
  • Contact with bone, repetitive use will dull blade
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6
Q
  • Use a firm continuous stroke
A
  • No repetitive or tentative strokes
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7
Q
  • Avoid vital structures
    (2)
A
  • Mental foramen! Lingual nerve! Facial artery!
  • Do not wear horse blinders!
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8
Q

FLAP DESIGN
* Apex never wider than —
* Length never — the width of the base
* When possible — blood supply is included
* Base should not be —
* Flap margin approximated over healthy bone without —
* Prevent flap —

A

base
twice
axial
twisted/stretched/crushed
tension
tearing

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9
Q

When possible axial blood supply is included
* — based flaps

A

Greater palatine a.

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10
Q

FLAP DESIGN
* Vertical releasing incisions should be made — teeth away from surgical site
* Avoid over (2)
* Rarely made over —

A

one to two
bony protuberances, vital structures
anterior maxilla

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11
Q
  • Avoid over bony protuberances
A
  • Canine eminence
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12
Q
  • Avoid over vital structures
A
  • Mental foramen, lingual ramus
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13
Q
  • Rarely made over anterior maxilla
    (3)
A
  • Thinner tissue
  • Harder to reapproximate
  • Unaesthetic scarring
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14
Q

Envelope flap
(2)

A
  • Sulcular incision
  • Releasing incision(s) created as needed for visibility
  • 3 corner flap
  • 4 corner flap
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15
Q

COMMUNICABLE PATHOGENIC ORGANISMS
* Two most important pieces of information in any conflict

A
  • Identity of the enemy
  • Strengths and weaknesses of the enemy
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16
Q

COMMUNICABLE PATHOGENIC ORGANISMS
Strengths:

A
  • Various means of survival that orgs use
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17
Q

COMMUNICABLE PATHOGENIC ORGANISMS
Weaknesses:

A
  • Susceptibilities to chemical, biologic, physical agents
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18
Q

Upper respiratory tract flora:
* Oral
(4)
* Nasal
(1)
* Pediatrics:
* Adults:

A
  • Aerobic gram + cocci (Strep viridans*)
  • Actinomyces spp
  • Anaerobic (Peptostrep, Prevotella, Fusobacterium, Porphyromonas)
  • Candida spp.
  • Aerobic gram + cocci (strep spp.)
    Haemophilus influenza
    Staphylococcus aureus
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19
Q

Microbes held in check by:
(4)

A
  • Desquamation – rapid epithelial turnover
  • Host immunologic factors:
  • Dilution due to salivary flow
  • Competition between oral organisms
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20
Q

Host immunologic factors:
(2)

A
  • Salivary proteins (peroxidase, lysozyme, lactoferrin, histatin)
  • Salivary immunoglobulin A (IgA), and immunoglobulin M (IgM) →produced by salivary gland B cells
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21
Q

Competition between oral organisms
(2)

A
  • Nutrition
  • Attachment sites
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22
Q

BIOGRAM OF OROFACIAL INFECTIONS
* Pure aerobes – –%
* Pure anaerobes – –%
* Mixed flora – –%
- Aerobes – –%
- Anaerobes – –%

A

5
25
70
20
80

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23
Q

Hepatitis Virus
* Hepatitis (2) most concerning to practitioners
* Very hardy, highly resistant to (2)
* Immunization for HbV DOES NOT protect for —
* To get Hep D, you must be Hep – positive

A

B, C
desiccation and chemical disinfectants
C or D viruses
B

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24
Q

HEPATITIS VIRUS
* — quantities capable of spreading disease (105-107 virons/mL blood)
* Common means of inoculation during (3)
* Can be inactivated by (5)
* Resistant to (4)

A

Minute
recapping or removal of anesthetic needle or
scalpel blade
iodophors, hypochlorite, glutaraldehyde (disinfectant),
heat sterilization, irradiation
alcohol, phenols, quaternary ammonium compounds

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25
Q

HEPATITIS VIRUS
* 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

A

half
shed
intact virus particles in secretions!!

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26
Q

WE CANNOT, AS PRACTICIONERS, ASSUME ALL PATIENTS ARE
DISEASE FREE →

A

Universal Precautions

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27
Q

HUMAN IMMUNODEFICIENCY VIRUS (HIV)
* Causative agent of

A

Acquired Immunodeficiency Syndrome (AIDS)

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28
Q

Research centers in US underfunded
* Physicians at the CDC were routinely denied funding requests
* Six years into the Regan Administration — Americans diagnosed with AIDS, > — died from it
* JUST TWO YEARS LATER when Reagan left office — Americans diagnosed with AIDS, > — died from it

A

36k
20k
115k
70k

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29
Q

HUMAN IMMUNODEFICIENCY VIRUS (HIV)
* Not nearly as hardy as

A

Hepatitis B virus
* HIV desiccates easily and quickly,
* Dies once outside tissue fluids it is located in

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30
Q

HIV
* Same high risk individuals as with

A

Hepatitis B

31
Q

HIV infected patients w/ CD4 < —/μL very susceptible to infections
* Clinical diagnosis of AIDS given with CD4 < —/μL

A

200
200

32
Q

HUMAN IMMUNODEFICIENCY VIRUS (HIV)
* High Risk Groups
(4)

A
  • IV drug users
  • Promiscuity
  • Hemophiliacs
  • Renal disease patients (Dialysis)
33
Q

HUMAN IMMUNODEFICIENCY VIRUS (HIV)
* Low number of — in blood of patients with HIV
* No transmission through — alone
* Low risk of — after inadvertent needle stick

A

virons
saliva
sero-coverting

34
Q

Low risk of sero-coverting after inadvertent needle stick
*—% versus —% with HbV and HcV

A

0.3
6-30

35
Q

Sepsis

A
  • Breakdown of living tissue by the action of the microorganisms and is usually accompanied by
    inflammation
36
Q

Asepsis

A
  • Avoidance of sepsis
37
Q

Medical Asepsis

A
  • Attempt to keep patients, staff, and objects as free as possible of agents that cause infection
38
Q

Surgical Asepsis

A
  • Attempt to prevent microbes from gaining access to surgically created wounds
39
Q

Disinfection
(2)

A
  • Reduction in the number of organisms capable of producing sepsis
  • Variable state depending on agent used
40
Q

Disinfectant
(2)

A
  • Used on inanimate surfaces
  • I. e. Sodium hypochlorite
41
Q

Antiseptic
(2)

A
  • Used on living tissue
  • I.e. Povidone surgical scrub
42
Q

Sterility
(2)

A
  • Freedom from viable forms of microorganisms
  • Absolute state (not variable as in disinfection)
43
Q

Sanitization

A
  • Reduction in the number of viable microorganisms to levels judged “safe” by public health
    standards
44
Q

Decontamination
(2)

A
  • Reduction in the number of viable microorganisms
  • Not connected with public health standards
45
Q

METHODS OF REDUCING THE NUMBER OF VIABLE
ORGANISMS FROM A SURFACE
* Physical
(3)

A
  • Heat
  • Mechanical dislodgement
  • Radiation
46
Q

METHODS OF REDUCING THE NUMBER OF VIABLE
ORGANISMS FROM A SURFACE
Chemical
(3)

A
  • Antiseptics
  • Disinfectants
  • Ethylene oxide gas
47
Q

Sterilization with HEAT
(2)

A
  • 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)
48
Q

Sterilization of packaged instruments is good for a maximum of — and only if —

A

6 MONTHS
double wrapped

49
Q

DRY HEAT

A
  • 320 ºF for 2 hours
50
Q

DRY HEAT
Advantages:
(2)

A
  • Will not damage rust susceptible or heat resistant
    instruments
  • Ease to use
51
Q

DRY HEAT
Disadvantages:
(2)

A
  • Take too long
  • Damage to heat sensitive instruments
52
Q

MOIST HEAT

A
  • 250 ºF at 15 psi for 24 minutes
  • Placed in steam under pressure (increases temp)
53
Q

MOIST HEAT
Advantages
(3)

A
  • Effectiveness
  • Less timely
  • Relative availability
54
Q

MOIST HEAT
Disadvantages
(2)

A
  • Dulls and rusts instruments
  • Cost!
55
Q

Levels of disinfection
* High

A
  • Spores, TB, viruses, vegetative bacteria (glutaraldehyde)
56
Q

Levels of disinfection
* Intermediate

A
  • TB, viruses, vegetative bacteria (iodophors, bleach 1:5, alcohol 70%)
57
Q

Levels of disinfection
* Low

A
  • Vegetative bacteria (quaternary ammonium, phenols)
58
Q

CHEMICAL DISINFECTION
(5)

A
  • Formaldehyde 3%
  • Gulteraldehyde 2% → HIGH
  • Iodophors 1%
  • Chlorox (5.25% NaOC1), diluted 1:5
  • Isoporphyl alcohol (70% - 90%) → Evaporation!!
59
Q

Infection control is concerned about preventing the spread of disease from:
(4)

A
  • Provider to patient
  • Patient to provider
  • Patient to patient
  • Operatory to house cleaning staff
60
Q
  • Portal of Entry –
A

a path to susceptible host

61
Q
  • Susceptible Host –
A

no resistant to pathology

62
Q
  • Causative Agent –
A

Bacteria, fungi, virus

63
Q
  • Reservoir –
A

humans, environ

64
Q
  • Portal of Exit –
A

how agent leaves reservoir (GI tract, Respiratory, GU tract)

65
Q
  • Mode of Transmission –
A

mechanism of transmission from reservoir to host (Contact,
Airborne)

66
Q

UNIVERSAL PRECAUTIONS

A
  • 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
67
Q

Personal Protective Equipment:
(4)

A
  • Gloves
  • Mask
  • Eyewear (with side shields)
  • Gown
68
Q

PPE
Designed to

A

protect staff from patient as
well as patient from staff

69
Q

INFECTION CONTROL PRACTICES
* Do not wear PPE in
* — hands before and after donning gloves
* Use — when wearing gown
* Change gown when —
ONCE GLOVES ARE ON, DO NOT TOUCH — THINGS

A

hallways/waiting areas
Wash
neck and waist tie
visibly soiled or damp
NONSTERILE

70
Q

SURGICAL STAFF PREPARATION
* A CLEAN technique is the most commonly used infection control practice in
* Absolute sterility is almost impossible to achieve
* What field are we working on?
* Clean technique protects

A

outpatient oral surgery
staff from patient as well as patient from staff

71
Q

SURGICAL FIELD MAINTENANCE
(5)

A
  • Use flat stand (Mayo stand) or large
    easily cleanable table
  • Use sterilized instruments
  • Waterproof sterile towels/napkins
  • Lay instruments on platform
  • Open edges of packages in sterile
    fashion
72
Q

MANAGEMENT OF SHARPS
* – technique for recapping needle VERSUS protecting cardboard

A

Scoop

73
Q

MANAGEMENT OF SHARPS
* — blade placement and removal

A

15

OS and Pain Management 2 (10 decks)

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