PRINCIPLES IN SURGERY & ASEPSIS Flashcards
Visibility
(3)
- Adequate access
- Adequate light
- Surgical field free of excess blood/saliva/irrigant
- Adequate access
(2)
- Retraction of soft tissues
- Surgical flap creation
Assistance!
* Sufficient familiarity with procedure to aid in anticipation of
surgeon’s needs
INCISIONS
(5)
- Sharp blade of proper size
- Use a firm continuous stroke
- Avoid vital structures
- Perpendicular incisions if planning to reapproximate structure
- Place in healthy tissue
- Sharp blade of proper size
- Contact with bone, repetitive use will dull blade
- Use a firm continuous stroke
- No repetitive or tentative strokes
- Avoid vital structures
(2)
- Mental foramen! Lingual nerve! Facial artery!
- Do not wear horse blinders!
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 —
base
twice
axial
twisted/stretched/crushed
tension
tearing
When possible axial blood supply is included
* — based flaps
Greater palatine a.
FLAP DESIGN
* Vertical releasing incisions should be made — teeth away from surgical site
* Avoid over (2)
* Rarely made over —
one to two
bony protuberances, vital structures
anterior maxilla
- Avoid over bony protuberances
- Canine eminence
- Avoid over vital structures
- Mental foramen, lingual ramus
- Rarely made over anterior maxilla
(3)
- Thinner tissue
- Harder to reapproximate
- Unaesthetic scarring
Envelope flap
(2)
- Sulcular incision
- Releasing incision(s) created as needed for visibility
- 3 corner flap
- 4 corner flap
COMMUNICABLE PATHOGENIC ORGANISMS
* Two most important pieces of information in any conflict
- Identity of the enemy
- Strengths and weaknesses of the enemy
COMMUNICABLE PATHOGENIC ORGANISMS
Strengths:
- Various means of survival that orgs use
COMMUNICABLE PATHOGENIC ORGANISMS
Weaknesses:
- Susceptibilities to chemical, biologic, physical agents
Upper respiratory tract flora:
* Oral
(4)
* Nasal
(1)
* Pediatrics:
* Adults:
- Aerobic gram + cocci (Strep viridans*)
- Actinomyces spp
- Anaerobic (Peptostrep, Prevotella, Fusobacterium, Porphyromonas)
- Candida spp.
- Aerobic gram + cocci (strep spp.)
Haemophilus influenza
Staphylococcus aureus
Microbes held in check by:
(4)
- Desquamation – rapid epithelial turnover
- Host immunologic factors:
- Dilution due to salivary flow
- Competition between oral organisms
Host immunologic factors:
(2)
- Salivary proteins (peroxidase, lysozyme, lactoferrin, histatin)
- Salivary immunoglobulin A (IgA), and immunoglobulin M (IgM) →produced by salivary gland B cells
Competition between oral organisms
(2)
- Nutrition
- Attachment sites
BIOGRAM OF OROFACIAL INFECTIONS
* Pure aerobes – –%
* Pure anaerobes – –%
* Mixed flora – –%
- Aerobes – –%
- Anaerobes – –%
5
25
70
20
80
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
B, C
desiccation and chemical disinfectants
C or D viruses
B
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)
Minute
recapping or removal of anesthetic needle or
scalpel blade
iodophors, hypochlorite, glutaraldehyde (disinfectant),
heat sterilization, irradiation
alcohol, phenols, quaternary ammonium compounds
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
half
shed
intact virus particles in secretions!!
WE CANNOT, AS PRACTICIONERS, ASSUME ALL PATIENTS ARE
DISEASE FREE →
Universal Precautions
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
* Causative agent of
Acquired Immunodeficiency Syndrome (AIDS)
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
36k
20k
115k
70k
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
* Not nearly as hardy as
Hepatitis B virus
* HIV desiccates easily and quickly,
* Dies once outside tissue fluids it is located in
HIV
* Same high risk individuals as with
Hepatitis B
HIV infected patients w/ CD4 < —/μL very susceptible to infections
* Clinical diagnosis of AIDS given with CD4 < —/μL
200
200
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
* High Risk Groups
(4)
- IV drug users
- Promiscuity
- Hemophiliacs
- Renal disease patients (Dialysis)
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
* Low number of — in blood of patients with HIV
* No transmission through — alone
* Low risk of — after inadvertent needle stick
virons
saliva
sero-coverting
Low risk of sero-coverting after inadvertent needle stick
*—% versus —% with HbV and HcV
0.3
6-30
Sepsis
- Breakdown of living tissue by the action of the microorganisms and is usually accompanied by
inflammation
Asepsis
- Avoidance of sepsis
Medical Asepsis
- Attempt to keep patients, staff, and objects as free as possible of agents that cause infection
Surgical Asepsis
- Attempt to prevent microbes from gaining access to surgically created wounds
Disinfection
(2)
- Reduction in the number of organisms capable of producing sepsis
- Variable state depending on agent used
Disinfectant
(2)
- Used on inanimate surfaces
- I. e. Sodium hypochlorite
Antiseptic
(2)
- Used on living tissue
- I.e. Povidone surgical scrub
Sterility
(2)
- Freedom from viable forms of microorganisms
- Absolute state (not variable as in disinfection)
Sanitization
- Reduction in the number of viable microorganisms to levels judged “safe” by public health
standards
Decontamination
(2)
- Reduction in the number of viable microorganisms
- Not connected with public health standards
METHODS OF REDUCING THE NUMBER OF VIABLE
ORGANISMS FROM A SURFACE
* Physical
(3)
- Heat
- Mechanical dislodgement
- Radiation
METHODS OF REDUCING THE NUMBER OF VIABLE
ORGANISMS FROM A SURFACE
Chemical
(3)
- Antiseptics
- Disinfectants
- Ethylene oxide gas
Sterilization with HEAT
(2)
- 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)
Sterilization of packaged instruments is good for a maximum of — and only if —
6 MONTHS
double wrapped
DRY HEAT
- 320 ºF for 2 hours
DRY HEAT
Advantages:
(2)
- Will not damage rust susceptible or heat resistant
instruments - Ease to use
DRY HEAT
Disadvantages:
(2)
- Take too long
- Damage to heat sensitive instruments
MOIST HEAT
- 250 ºF at 15 psi for 24 minutes
- Placed in steam under pressure (increases temp)
MOIST HEAT
Advantages
(3)
- Effectiveness
- Less timely
- Relative availability
MOIST HEAT
Disadvantages
(2)
- Dulls and rusts instruments
- Cost!
Levels of disinfection
* High
- Spores, TB, viruses, vegetative bacteria (glutaraldehyde)
Levels of disinfection
* Intermediate
- TB, viruses, vegetative bacteria (iodophors, bleach 1:5, alcohol 70%)
Levels of disinfection
* Low
- Vegetative bacteria (quaternary ammonium, phenols)
CHEMICAL DISINFECTION
(5)
- Formaldehyde 3%
- Gulteraldehyde 2% → HIGH
- Iodophors 1%
- Chlorox (5.25% NaOC1), diluted 1:5
- Isoporphyl alcohol (70% - 90%) → Evaporation!!
Infection control is concerned about preventing the spread of disease from:
(4)
- Provider to patient
- Patient to provider
- Patient to patient
- Operatory to house cleaning staff
- Portal of Entry –
a path to susceptible host
- Susceptible Host –
no resistant to pathology
- Causative Agent –
Bacteria, fungi, virus
- Reservoir –
humans, environ
- Portal of Exit –
how agent leaves reservoir (GI tract, Respiratory, GU tract)
- Mode of Transmission –
mechanism of transmission from reservoir to host (Contact,
Airborne)
UNIVERSAL PRECAUTIONS
- 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
Personal Protective Equipment:
(4)
- Gloves
- Mask
- Eyewear (with side shields)
- Gown
PPE
Designed to
protect staff from patient as
well as patient from staff
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
hallways/waiting areas
Wash
neck and waist tie
visibly soiled or damp
NONSTERILE
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
outpatient oral surgery
staff from patient as well as patient from staff
SURGICAL FIELD MAINTENANCE
(5)
- 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
MANAGEMENT OF SHARPS
* – technique for recapping needle VERSUS protecting cardboard
Scoop
MANAGEMENT OF SHARPS
* — blade placement and removal
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