PRINCIPLES IN SURGERY & ASEPSIS Flashcards
1
Q
Visibility
(3)
A
- Adequate access
- Adequate light
- Surgical field free of excess blood/saliva/irrigant
2
Q
- Adequate access
(2)
A
- Retraction of soft tissues
- Surgical flap creation
3
Q
Assistance!
* Sufficient familiarity with procedure to aid in anticipation of
A
surgeon’s needs
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
5
Q
- Sharp blade of proper size
A
- Contact with bone, repetitive use will dull blade
6
Q
- Use a firm continuous stroke
A
- No repetitive or tentative strokes
7
Q
- Avoid vital structures
(2)
A
- Mental foramen! Lingual nerve! Facial artery!
- Do not wear horse blinders!
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
9
Q
When possible axial blood supply is included
* — based flaps
A
Greater palatine a.
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
11
Q
- Avoid over bony protuberances
A
- Canine eminence
12
Q
- Avoid over vital structures
A
- Mental foramen, lingual ramus
13
Q
- Rarely made over anterior maxilla
(3)
A
- Thinner tissue
- Harder to reapproximate
- Unaesthetic scarring
14
Q
Envelope flap
(2)
A
- Sulcular incision
- Releasing incision(s) created as needed for visibility
- 3 corner flap
- 4 corner flap
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
16
Q
COMMUNICABLE PATHOGENIC ORGANISMS
Strengths:
A
- Various means of survival that orgs use
17
Q
COMMUNICABLE PATHOGENIC ORGANISMS
Weaknesses:
A
- Susceptibilities to chemical, biologic, physical agents
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
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
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
21
Q
Competition between oral organisms
(2)
A
- Nutrition
- Attachment sites
22
Q
BIOGRAM OF OROFACIAL INFECTIONS
* Pure aerobes – –%
* Pure anaerobes – –%
* Mixed flora – –%
- Aerobes – –%
- Anaerobes – –%
A
5
25
70
20
80
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
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
25
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!!
26
WE CANNOT, AS PRACTICIONERS, ASSUME ALL PATIENTS ARE
DISEASE FREE →
Universal Precautions
27
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
* Causative agent of
Acquired Immunodeficiency Syndrome (AIDS)
28
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
29
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
30
HIV
* Same high risk individuals as with
Hepatitis B
31
HIV infected patients w/ CD4 < ---/μL very susceptible to infections
* Clinical diagnosis of AIDS given with CD4 < ---/μL
200
200
32
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
* High Risk Groups
(4)
* IV drug users
* Promiscuity
* Hemophiliacs
* Renal disease patients (Dialysis)
33
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
34
Low risk of sero-coverting after inadvertent needle stick
*---% versus ---% with HbV and HcV
0.3
6-30
35
Sepsis
* Breakdown of living tissue by the action of the microorganisms and is usually accompanied by
inflammation
36
Asepsis
* Avoidance of sepsis
37
Medical Asepsis
* Attempt to keep patients, staff, and objects as free as possible of agents that cause infection
38
Surgical Asepsis
* Attempt to prevent microbes from gaining access to surgically created wounds
39
Disinfection
(2)
* Reduction in the number of organisms capable of producing sepsis
* Variable state depending on agent used
40
Disinfectant
(2)
* Used on inanimate surfaces
* I. e. Sodium hypochlorite
41
Antiseptic
(2)
* Used on living tissue
* I.e. Povidone surgical scrub
42
Sterility
(2)
* Freedom from viable forms of microorganisms
* Absolute state (not variable as in disinfection)
43
Sanitization
* Reduction in the number of viable microorganisms to levels judged “safe” by public health
standards
44
Decontamination
(2)
* Reduction in the number of viable microorganisms
* Not connected with public health standards
45
METHODS OF REDUCING THE NUMBER OF VIABLE
ORGANISMS FROM A SURFACE
* Physical
(3)
* Heat
* Mechanical dislodgement
* Radiation
46
METHODS OF REDUCING THE NUMBER OF VIABLE
ORGANISMS FROM A SURFACE
Chemical
(3)
* Antiseptics
* Disinfectants
* Ethylene oxide gas
47
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)
48
Sterilization of packaged instruments is good for a maximum of --- and only if ---
6 MONTHS
double wrapped
49
DRY HEAT
* 320 ºF for 2 hours
50
DRY HEAT
Advantages:
(2)
* Will not damage rust susceptible or heat resistant
instruments
* Ease to use
51
DRY HEAT
Disadvantages:
(2)
* Take too long
* Damage to heat sensitive instruments
52
MOIST HEAT
* 250 ºF at 15 psi for 24 minutes
* Placed in steam under pressure (increases temp)
53
MOIST HEAT
Advantages
(3)
* Effectiveness
* Less timely
* Relative availability
54
MOIST HEAT
Disadvantages
(2)
* Dulls and rusts instruments
* Cost!
55
Levels of disinfection
* High
* Spores, TB, viruses, vegetative bacteria (glutaraldehyde)
56
Levels of disinfection
* Intermediate
* TB, viruses, vegetative bacteria (iodophors, bleach 1:5, alcohol 70%)
57
Levels of disinfection
* Low
* Vegetative bacteria (quaternary ammonium, phenols)
58
CHEMICAL DISINFECTION
(5)
* Formaldehyde 3%
* Gulteraldehyde 2% → HIGH
* Iodophors 1%
* Chlorox (5.25% NaOC1), diluted 1:5
* Isoporphyl alcohol (70% - 90%) → Evaporation!!
59
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
60
* Portal of Entry –
a path to susceptible host
61
* Susceptible Host –
no resistant to pathology
62
* Causative Agent –
Bacteria, fungi, virus
63
* Reservoir –
humans, environ
64
* Portal of Exit –
how agent leaves reservoir (GI tract, Respiratory, GU tract)
65
* Mode of Transmission –
mechanism of transmission from reservoir to host (Contact,
Airborne)
66
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
67
Personal Protective Equipment:
(4)
* Gloves
* Mask
* Eyewear (with side shields)
* Gown
68
PPE
Designed to
protect staff from patient as
well as patient from staff
69
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
70
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
71
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
72
MANAGEMENT OF SHARPS
* -- technique for recapping needle VERSUS protecting cardboard
Scoop
73
MANAGEMENT OF SHARPS
* --- blade placement and removal
15
