1b- Infection Control in Surgical Practice 2020 updated Blackboa.pdf

Infection Control in the Surgical Practice Richard D’Innocenzo DMD,MD Clinical Professor Boston University Henry M. Goldman School of Dental Medicine Infection Control in the Surgical Practice  Communicable Pathogenic Organisms  Aseptic Techniques and Universal Precautions intervent...

Infection Control in the Surgical Practice Richard D’Innocenzo DMD,MD Clinical Professor Boston University Henry M. Goldman School of Dental Medicine Infection Control in the Surgical Practice  Communicable Pathogenic Organisms  Aseptic Techniques and Universal Precautions interventional procedures have an inherent tendency to transmit infections from a person to another big problem that can be minimize Communicable Pathogenic Organisms  Bacteria  Viral Organisms  Mycobacterial Organisms Bacteria  Upper respiratory tract flora  Maxillofacial skin flora  Nonmaxillofacial flora Upper Respiratory Tract Flora  Normal oral flora consists of aerobic, gram+ cocci, actinomycetes, anaerobic bacteria, and candidal species  The total # of organisms is held in check by: 1) rapid epithelial turnover with desquamation 2) host immunological factors 3) dilution by salivary flow 4) competition between oral organisms for available nutrients and attachment sites Upper Respiratory Tract Flora  The flora of the nose and paranasal sinuses consists primarily of gram + aerobic streptococci and anaerobes  Children may harbor Haemophilus influenzae  Adults have Staphylococcus aureus  The normal flora is limited by the presence of ciliated respiratory epithelium, secretory immunoglobulins, and epithelial desquamation Maxillofacial Skin Flora  Staph epidermidis and Cornyebacterium diphtheriae are the predominate species Nonmaxillofacial Flora  The region below the clavicles comprises a gradually increasing number of aerobic gram negative and anaerobic enteric organisms, especially moving toward the pelvis and unwashed fingertips  most bacteria colonies start as gram + but then progress to gram - Contemporary Oral & Maxillofacial Surgery 5th edition, Hupp, Ellis, Tucker Viral Organisms  Hepatitis viruses: A,B,C, and D are responsible for most infectious hepatitis  Hep A spread by contact with feces of infected individuals  Hep C spread by feces or contaminated blood  Hep B & D are spread by contact with any human secretions Hepatitis  Minute quantities of the virus is capable of transmitting the disease  Exceptionally resistant to desiccation and chemical disinfectants  Inactivate the virus by: halogen-containing disinfectants, formaldehyde, ethylene oxide gas, all types of properly performed heat sterilization, and irradiation  Barrier Protection as part of Universal Precautions Contemporary Oral & Maxillofacial Surgery 5th edition, Hupp, Ellis, Tucker HIV  Loses its infectivity once desiccated  Universal Precautions can be contributing with bad healing of pts  Coronavirus?? The term “coronavirus” refers to a large group of enveloped RNA based viruses known to affect birds and mammals, including humans. Coronaviruses are named for the spiky projections on their surface. These resemble the points on a crown. Corona means “crown” in Latin. There are hundreds of coronaviruses, but only seven are known to affect people. Four human coronaviruses only cause mild cold- or flu-like symptoms. There are four main sub-groupings of coronaviruses, known as alpha, beta, gamma, and delta. Three other coronaviruses pose more serious risks. Types of human coronaviruses People around the world commonly get infected with human coronaviruses with these four common human coronaviruses: 1. 229E (alpha coronavirus) 2. NL63 (alpha coronavirus) 3. OC43 (beta coronavirus) 4. HKU1 (beta coronavirus) Common human coronaviruses usually cause mild to moderate symptoms. Most people around the world will develop at least one of these viral infections over their lifetime. Those who contract these viruses are able to recover on their own most of the time Sometimes coronaviruses that infect animals can evolve and make people sick and become a new human coronavirus. (SARS, MERS, SARS-COV2)  Novel Coronavirus SARS-CoV-2 This transmission electron microscope image shows SARS-CoV-2, the virus that causes COVID-19, isolated from a patient in the U.S. Virus particles (round gold objects) are shown emerging from the surface of cells cultured in the lab. The spikes on the outer edge of the virus particles give coronaviruses their name, crown-like. Image captured and colorized at NIAID's Rocky Mountain Laboratories (RML) in Hamilton, Montana. Credit: NIAID Mycobacterial Organisms  Mycobacterium Tuberculosis  Transmitted primarily through exhaled aerosols that carry M. Tuberculosis bacilli from the infected lungs of an individual they don't form spores, but they are highly resistant to desiccation and most chemical disinfectants the best way is heat and chemical Aseptic Techniques and Universal Precautions Universal Precautions  Developed to address the inability of health care providers to specifically identify all patients with communicable diseases  Based on protection of self, staff, and patients from contamination by using barrier techniques when treating all patients as if they all had communicable disease. Universal Precautions  Include all doctors and staff who come in contact with patient blood or secretions, whether directly or in aerosol form, wear barrier devices: Face mask, eye protection, and gloves  Also includes decontaminating or disposing of all surfaces that are exposed to patient blood, tissue or secretions  Avoid contaminating objects/surfaces with contaminated gloves or instruments Covid-19  PPE Use In Treatment Center Areas ◼ N95 ◼ Faceshield ◼ Cap ◼ Gown ◼ Shoe coverings/Booties ◼ Gloves Terminology  Asepsis: refers to the avoidance of sepsis  Medical asepsis: the attempt to keep patients, health care staff, and objects as free as possible of agents that cause infection  Surgical asepsis: the attempt to prevent microbes from gaining access to traumatic surgically created wounds Terminology  Antiseptic & disinfectant: prevent the multiplication of organisms capable of causing an infection. Antiseptics are applied to living tissue & disinfectants are designed for use on inanimate objects  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 standards  Decontamination: similar to sanitization but in local set up General Methods of Reducing the Number of Viable Organisms from a Surface Physical Chemical Heat Antiseptics Mechanical Disinfectants dislodgement Ethylene oxide gas Radiation Bacterial Endospores are the Most Resistant to Elimination Techniques of Instrument Sterilization  Sterilization with heat Dry heat can damage metalic instruments Moist heat ❑ Gaseous Sterilization Sterilization with heat  Dry Heat: Advantage – relative ease of use and the unlikelihood of damaging heat-resistant instruments. Disadvantage- the time necessary and the potential damage to heat-sensitive equipment  Moist Heat: More efficient than dry heat for sterilization because it is effective at much lower temperatures and requires less time. Advantages – its effectiveness, speed, and the relative availability of office proportioned autoclaving equipment. Disadvantage – tendency of moist heat to dull and rust instruments and the cost of autoclaves  It has been shown that 6 months after sterilization, the possibility of organisms entering sterilization bags increases  Some feel it could be longer as long as the bags are properly handled  All sterilization items should be labeled with an expiration date that is no longer than 6 – 12 months Contemporary Oral & Maxillofacial Surgery, Hupp, Ellis, Tucker Gaseous Sterilization  Destroy enzymes and other vital biochemical structures  Ethylene oxide  50 degree C 3 hours  Advantages: for sterilizing porous material, large equipment, and material sensitive to heat and moisture  Disadvantages: need special equipment, and the length of sterilization and aeration time Gaseous Sterilization  Because ethylene oxide is highly toxic to animal tissue, equipment exposed to ethylene oxide must be aerated for 8 to 12 hours at 50 degree C to 60 degree C, or at ambient temperatures for 4 to 7 days Technique of Instrument Disinfection  Chemical disinfectants: classified by level of biocidal activity (low, intermediate and high)  Quaternary ammonium compounds are not recommended for dentistry, because they are not effective against hepatitis B virus and become inactivated by soap and anionic agents Surgical Field Maintenance  The goal is to prevent any organism from the surgical staff or other patients from entering the patient’s wound Surgical Staff Preparation  Hand & arm preparation  Clean technique  Sterile technique Irrigation of Wound  Only sterile water or sterile saline should be used to irrigate open wounds Postsurgical Asepsis  Wound Management: only dress wounds with clean gloves.  Sharps Management: Sharps injuries can be prevented by using the local anesthetic needle to scoop up the sheath after use, taking care never to apply or remove a blade from a scalpel handle without an instrument, and disposing of used blades, needles, and other sharp disposable items into rigid, well-marked receptacles for contaminated sharp objects. Contemporary Oral & Maxillofacial Surgery, Hupp, Ellis, Tucker