M SHARIQ SOHAIL3RD YEAR BDS

009

CROSS INFECTION CONTROL IN ORAL

SURGERY

Infection control measures aim to ensure the protection of those who might be vulnerable to acquiring an infection both in the general community and while receiving care due to health problems, in a range of setting.

NEED FOR INFECTION CONTROL PROTOCOLS??

1)First, to perform surgery, the dentist typically violates an epithelial surface the most important barrier against infection.

2)Second, during most oral surgical procedures, the dentist, assistants, and equipment become conta- minated with the patient’s blood and saliva.

COMMUNICABLE PATHOGENIC ORGANISMS:

Includes bacteria ,mycobacteria , viruses and fungi.

BACTERIAS

The viral organisms that cause the most difficulty are the hepatitis B and C viruses and human immunodefficiency virus(HIV).

Hepatitis A is spread by contact with feces of infected person.Hepatitis C virus may spread through contaminated feces or by contaminatd blood.Hepatits B and D viruses are spread by contact with any human secretions.

VIRAL ORGANISMS

HUMAN IMMUNODEFICIENCY VIRUS (HIV): 1)Because of relatively inability to survive outside the host organisms HIV acts in a fashion similar to other agents of sexually transmitted diseases(Requires direct contact)

2)All patients infected with HIV infection who have C4+ T lymphocyte counts of less than 200/microL should be treated by doctors and staff free of clinically evident infectious disease.

MYCOBACTERIAL ORGANISMS:

1)The only mycobacterial organism of significance to most dentists is mycobacterium tuberculosis.

2)TB is transmitted primarily through exhaled aerosols that carry M tuberculosis from the infected lungs of one individual to the lungs of another individual. As through breathing, speaking, coughing, sneezing.

1)Terminologies 2)concepts 3)Techniques of instrument sterilization. a)Sterilization by Heat b)Sterilization with gas. 4)Techniques of instruments disinfection. 5)Operatory disinfection. 6)Surgical staff preparation. 7)Post surgical Asepsis.

ASEPTIC TECHNIQUES

1)SEPSIS: Is the breakdown of living tissue by the action of microorganims and is usually accompained by inflammation.

2)ANTISEPTIC AND DISINFECTANT: Both refer to substance that can prevent the multiplication of organisms capable of causing infection.The difference is that antiseptics are applies to living tissue, whereas disinfectants are designed only for use ininanimate object.

3)STERILITY AND SANITIZATION: Sterility is the freedom from viable forms of microorganisms. Sanitization is the reduction of the number of viable microorganisms to levels judged safe by public health services.

TERMINOLOGIES

Chemical and physical agents are the two principal means of reduction the number of microbes on a surface.

1)Physical: Heat, Radiation and Mechanical dislodgment.

2)Chemical: Antiseptics, Disinfectants, Ethylene oxide gas

*The microbes have variable ability to resist to chemical or physical agents. The micro organisms most resistant to elimination are bacterial endospores.Therefore in general any method of sterilization that kills endospoers is also capable of eliminating bacteria viruses, mycobacteria, fungi and parasites.

CONCEPTS

The three methods available for instrument sterilization are dry heat,moist heat, and ethylene oxide gas.

1)DRY AND MOIST HEAT:

TECHNIQUES OF INSTRUMENT STERILIZATION

2)STERILIZATION WIT H GAS: 1) Ehytlene oxide is a gas at room temperature, and can readily diffuse through porous materials, such as plastic and rubber.

2)At 50C ethylene oxide is effective for killing all organisms,including spores,within 3 hours.

Many dental instruments cannot withstand the temperatures required for heat sterilization.Therefore, if sterilization with gas is not available and absolute sterility is not required,chemical disinfection can be performed.

1)LOW: Reduces overall number of vegetative microorganims but donot destroy tubercle bacilli or bacterial spores.Agents used are phenolic disfectants and quaternary ammonium compound. Application on environmental surfaces.

2)INTERMEDIATE: kill vegetative microorganisms including mycobacterium tuberculosis, and inactivates most viruses.Agents used are Alcohols, Hypochlorite, Iodine and idophor disinfectants. Application on floor, operation tables etc

3)HIGH: Kills vegetative microorganisms and inactivates viruses, but not necessarily high number of bacterial spores.Agents used are Hydrogen peroxide, Gluteraldehyde, Formaldehyde. Application on on medical devices.

TECHNIQUES OF INSTRUMENT DISINFECTION

Any surface that a patient or patients secretions contact is a potential carrier of infectious organisms.

The operatory can be disinfected in two basic ways: a)first to wipe all surfaces with a disinfectant solution. b)second is to cover surfaces with protective shields that are changed between each patient.

Many chemical disinfectants including chlorine compounds and gluteraldehyde, can prevent transfer of the hepatitis virus when used on surfaces in certain conc.(0.2% for chlorine and 2% for gluteraldehyde)

OPERATORY DISINFECTION

The two basic types of personnel asepsis 1) The clean technique. 2) The sterile technique.

SURGICAL STAFF PREPARATION

1)WOUND MANAGEMENT: Wound should be inspected or dressed by hands that are covered with fresh,clean gloves.

2)SHARPES MANAGEMENT: During and after surgery, contaminated materials should be disposed of in such a way that the staff and other patients will not be infected.

POST SURGICAL ASEPSIS

REFERENCE:

Contemporary Oral and Maxillofacial surgery byJAMES R. HUPP, EDWARD ELLIS MYRON R.TUCKER

THANKYOUANY QUESTIONS???