AsepticTechnique OralSurgery(Moran).pdf

ASEPTIC TECHNIQUE IN ORAL SURGERY IHS Dental Updates 2011

Albuquerque, NM

Ken Moran, DDS

CONFERENCE THEME. CONTINUING ON THE PATH OF EXCELLENCE

ASEPTIC TECHNIQUE IN ORAL SURGERY

Questions to be Answered. What is this? Why does it matter? Does this really apply to me? Dont you think I already know all of this? Who cares anyway?


Topics to be covered. Definitions and common terms Infections and disease transmission CDC guidelines Standard Precautions Basic instrument handling and the aseptic field Errors in judgment Clinical recommendations


REMEMBER .NO MATTER

HOW INNOCENT A PATIENT APPEARS, YOU MUST TREAT

EVERYONE AS POTENTAILLY INFECTIOUS


Common Definitions Sterile No living organisms Aseptic Technique in which living pathogens are

absent Pathogensomething that is capable of causing disease Not all organisms are pathogens

Clean As aseptic as possible What we really have in oral surgery Patients host defenses make the difference We want to tax those host defenses as little as possible

COMMON DEFINITIONS

Infection A multiplication of undesirable microorganisms or

parasites within the body Three things are necessary for an infection to occur

Suitable host Virulent microorganism Sufficient number of microorganisms to overwhelm the host


I dont always fall asleep, but when I do, its usually during Dr. Morans lecture

INFECTIONS

Infections are caused by. Bacteria Viruses Fungi Protozoa Prions

BACTERIA

Ubiquitous found everywhere

Not all bacteria are pathogens (cause disease)

Patients have a normal flora non-pathogens (dont cause disease)

Examples are Strep, Staph, E. coli, Neisseria

BACTERIA

Oral Infections Caries Periodontal disease Abscesses

BACTERIA

Ludwigs Angina Very severe infection Life threatening

Post-op Multiple penroses

inserted into neck to drain infection

VIRUSES

Smallest form of life They are not cells Need a living cell to

replicate Examples.hepatitis

A, B, C, D, HIV, papilloma, herpes simplex (cold sores), common cold

VIRUSES

Herpes simplex Image of primary

herpetic gingivostomatitis

VIRUSES

Viruses of Special Concern HIV Hepatitis B Hepatitis C

VIRUSES OF SPECIAL CONCERN

HIV Human Immunodeficiency Virus Causes AIDS

Methods of acquiring IV drug use Unprotected sex Blood transfusion Fetal transmission

Result is severe suppression of the immune system

Fortunately treatment is available Very expensive Reliant upon a compliant patient

VIRUSES OF SPECIAL CONCERN -- HIV

Kaposis Sarcoma Hairy Leukoplakia

VIRUSES OF SPECIAL CONCERN -- HIV

EXPOSURE RISK FACTORS .

Deep injury Visible blood on the device Entry into an artery or vein Hollow bore Terminal illness in the source patient


Hepatitis B Transmission similar to HIV Multiple incidences of transmission from dentists/

oral surgeons to patients in past Probably none since 1987

A case of patient to patient transmission in 2003 In past, incidence of dentist/oral surgeons being

infected was relatively high now much lower Much better personal protection Hepatitis B vaccine

VIRUSES OF SPECIAL CONCERN-HEP B

Hepatitis B Vaccine Any health care worker who is at risk for exposure

should be vaccinated A series of three injections Must check for seroconversion

1-2 months after last dose of vaccine Test for anti-Hep B surface antigen


Hepatitis C Risk of transmission is relatively lower No reports of transmission from infected dental

health care professional to a patient or- from a patient to patient

BUT.There have been three reports of transmission from blood splashed to the eye

VIRUSES OF SPECIAL CONCERN-HEP C

Do not be the person on the right

Remember. There is no vaccine There is no cure Treatment is limited

FUNGI

Candida Most common fungus

found in the mouth Present in everyone Shows up as white

plaques, smooth red surface, or sore/angry surface

Usually opportunistic overgrowth in patients that are debilitated or medically compromised

FUNGI

Candida albicans Seen on the dorsum of

the tongue

PROTOZOA

A wide variety of single celled organisms

Larger than bacteria Examples.

Entamoeba (dysentery)

Plasmodium (malaria) Giardia (most common

cause of water-borne diarrhea)

PROTOZOA

Are a common cause of diarrhea and dysentery

PRIONS

A malformed protein Results in a brain that

looks like a sponge Examples.

Mad cow disease Chronic wasting

disease Creutzfeldt-Jacob

disease seen in humans

PRIONS

Kuru Disease of cannibals

DISEASE TRANSMISSION

So. .Now that we know what we can get, lets

talk about how we can get it.

MODES OF TRANSMISSION

Direct contact with blood or body fluids Indirect contact with a contaminated instrument

or surface Contact of the mucosa of the eyes, nose, or mouth

with droplets or splatter Inhalation of airborne microorganisms

MODES OF TRANSMISSION

Eliminate Cross Infection Patient to patient Patient to health care

worker Health care worker to

patient

Utilize the Concept of Standard Precautions

STANDARD PRECAUTIONS

This applies to all patients Includes organisms spread by.

Blood Body fluids Secretions Excretions (except sweat)

Remember that broken skin and mucous membranes are especially vulnerable

STANDARD PRECAUTIONS

Key Elements Hand washing Use of PPE

Gloves Masks Eye protection Gowns

Patient care equipment Environmental surfaces Injury prevention

Consider the concept of the Field

THE FIELD

Surgical Field Chase Field

FIELD

The Surgical Area About Which the Patient is the Center

FIELD

Patient Doctor Assistant Chair controls Light handles

Instruments Drapes/towels Breathing apparatus

Adjunctive areas Sink Hair Gowns Sleeves Etc.

WOUND INFECTIONS

What can we do to decrease the incidence of wound infections?

WOUND INFECTIONS

Are primarily bacterial in nature Sources of these bacteria

Patient skin, mucosa, respiratory tract Surgeon/Assistant skin, respiratory tract, mucosa,

and existing infection Contaminated environment field, gloves,

instruments, etc


What is the single biggest individual thing that you, as a health care professional, can do to stop the spread of infection?


ANSWER.

PRACTICE PROPER HAND HYGIENE !

PROPER HAND HYGIENE

When should you clean your hands? If they are visibly

dirty After touching

contaminated objects with bare hands

Before and after patient treatment before putting on gloves and after taking them off

PROPER HAND HYGIENE--DEFINITIONS

Handwashing Washing hands with plain soap and water

Antiseptic Handwash Washing hands with water and soap or other

detergents containing an antiseptic agent

Alcohol Based Handrub Rubbing hands with an alcohol containing

preparation

Surgical Antisepsis Hand washing with an antiseptic soap or and alcohol

based handrub before operations by surgical personnel

PROPER HAND HYGIENE

The CDC says. Good--plain soap Better--antimicrobial

soap Best--alcohol based

hand rub

ALCOHOL BASED HANDRUBS

Best

ALCOHOL BASED HANDRUBS

Antimicrobial action is rapid and effective

Improved skin condition

Better access than a sink

Cannot use if hands are visibly soiled

Must not store near high temps or flames

Softeners and powders may build up

BENEFITS LIMITATIONS

HAND HYGIENE THOUGHTS

No artificial nails Keep fingernails short Avoid jewelry that

may tear gloves Prevent dry skin

Use lotions

Avoid certain products Mineral oil Petroleum based items


RED NECK CAT CARRIER


Personal Protective Equipment A major component of Standard Precautions Protect the skin and mucous membranes from

exposure to infectious materials Remove when leaving the treatment areas

PERSONAL PROTECTIVE EQUIPMENT

Masks Gloves Gowns Eye protection

Remember complete coverage

Side shields or- face shield

Shoe covers Hats


Remove when leaving treatment areas

Change mask between patients

Clean face protection between patients

Do not leave contaminated items around


GLOVES

Reduce contamination of the hands of health care workers

New pair for each patient

Remove after patient care

Remember .They are not a

substitute for hand washing!

GLOVES

Remember. ..Wear a new pair

for each doctor


Errors in Judgment. .We should all strive

to be as error free as possible

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

BAD GOOD

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

WRONG RIGHT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

NOT-SO-GOOD GOOD

ERRORS IN JUDGMENT

BAD WORSE

ERRORS IN JUDGMENT

ERROR IN JUDGMENT

ERRORS IN JUDGMENT

GROSS ERROR IN JUDGMENT

ASEPTIC TECHNIQUE IN ORAL SURGERY CLINICAL SUGGESTIONS

CLINICAL SUGGESTIONS

Scalpel Use Loading a handle Use of safety devices

Irrigation During Surgery Use of Foot Controls Oral Surgery Specifics


Scalpel handle loading Use an instrument NEVER use your

fingers!


Safety Scalpels Consider the use of a

specially designed device to decrease the chance of injury

Devices at right are single-use


Irrigation During Oral Surgery Use only sterile solutions and instruments Use only isotonic solutions Use a sufficient amount of irrigant

IRRIGATION DURING ORAL SURGERY

Use only sterile solutions --Tap water and specially treated dental water line

fluids are not acceptable Use only sterile devices --Monoject syringes and plastic cups are not

acceptable


GOOD BAD


Use Only Isotonic Solutions Have the same concentration of electrolytes as blood Prevents cell death Normal Saline is the choice

--Sterile Water is not acceptable


GOOD BAD


Use a Sufficient Amount of Irrigant During Surgery Do not be stingy You cannot use too much

>>>>Removes Debris >>>>Prevents overheating of the bone

IRRIGATION DURING ORAL SURGERY THE SOLUTION TO POLLUTION IS DILUTION

YOU CANNOT IRRIGATE TOO MUCH


Use of Foot Controls A big advantage over

hand controls Use for dental chairs

and faucet control

FOOT CONTROLS

BAD GOOD

ERRORS IN JUDGMENT

It is extremely important that you adequately wash your hands after using the bathroom

ERRORS IN JUDGMENT

Hand Washing (Doubtful Compliance) This Guy is Obviously

Guilty


Oral Surgery Specifics Oral Surgery Procedures Preprocedural Mouth Rinses Biopsy Specimens Extracted Teeth

ORAL SURGERY SPECIFICS

Microorganisms enter the body during oral surgery Minimize the risk to the patient

Use sterile surgical gloves during oral surgery Oral Surgery Procedures biopsies, perio procedures, implant

surgery, apical surgery, surgical extraction of teeth


Preprocedural Rinses Reduce the number of

microorganisms Controversial may

or may not work. Copious irrigation

with normal saline is probably more effective

Chlorhexidine gluconate 0.12%


Biopsy Specimen Placed in a 10%

formalin solution Use a biohazard label Use a leak proof

container Do not contaminate

the outside of the bottle


Extracted Teeth Are regulated medical

waste Can be given back to

the patient Do not incinerate

those containing amalgam


SUMMARY Remember what the

bad bugs are and how not to spread them

Use proper techniques and materials

Eliminate errors in judgment

AND REMEMBER.


.We are Continuing on the Path of Excellence

QUESTIONS

THANK YOU

Documents

AsepticTechnique OralSurgery(Moran).pdf