Oral surgery sheet # 2 - Omar Aln3emy

by **Shadi Jarrar** 11/10/2011, 1:04 am

http://www.4shared.com/document/8cDG7rSs/oral__surgery_2.html

بسم الله الرحمن الرحيم

This lec we will talk about the aseptic techniques ( sterilization and disinfection) in oral surgery.

Doc said we have to read the handout about aseptic that she gave us in the in the introduction course in summer.

Starting the 3^rd week u can bring your patient with u.. and the patient must be suitable to u.. always start with simple case like mobile and anterior teeth.

When we perform surgery while starting teeth extraction we violate the epithelium, and its well known that the epitheilim is the main barrier against microorganisms. So to perform surgery the dentist typically palpates the epithelial surface around the tooth.

During most surgical oral procedures the dentist's equipment become contaminated with patient's blood and saliva.. so u have to protect yourself and your patient.

We have reported cases that we have infections from

1^st the patient to the dentist (basic danger) like hepatitis B , HIV, and TB so we have to make barrier btw patient and dentist.

2^ND goal is to prevent contaminated btw patients and form patient to another patient.

3^rd from dentist to the patient.

Universal precautions should be followed all personals , all the times , all the patients . u must always protect yourself and apply barrier techniques.

This apply to all personal performing invasive procedures.

The dentistry procedures are from the most important invasive techniques. So wear the gloves all the time, put the mask, and eye goggles. It's all mandatory.

U can also put the shield.. u will get extra points.

So the uniform and the barrier techniques are very important.

U also must know the ecology of the oral cavity (the different kind of bacteria lives in the oral cavity).

Gram + streptococci is the main bacteria.

And we have actinomyces, anaerobes, and the Candida species.

We said that we have to know about oral cavity bacteria and nasal cavity also( bcz of anatomical relation and the maxillary sinus in relation to maxillary teeth) and facial skin bacteria and non facial skin bacteria.

In nasal cavity mostly we have streptococci and in children it’s the hemophilus influenza .

In the facial skin we have staph epidermidis that causes acne , staph aureus , cornybacteria diphtheria. In non facial skin we have E.coli , klebsiella , proteus all are aerobes. The anaerobic are enteric bacteria that are bacteroides fragilis.

We as dentists we use our hand. So we have to know that our hand touching facial and non facial skin like a patient hand in washing techniques .

Viral organisms are important for us also mainly hepatitis B and D viruses can spread by contacts with any human secretions (blood and saliva).

When we take the history from the patients we must be aware if the patient had taken blood transfusions so u have to be carful .

We don’t treat active hepatitis B. the problem is in carriers.

So be carful from needle stick injury may cause infection.

If it happens la sam7 allah u have to do 2 serological tests

1- hepatitis B surface antigen and antibody important for us lil vaccine.

2- hepatitis B core antigen or e antigen reflects the highly infective patient if it exceeds certain limits if it is less it means less chance to infections.

Hepatitis tests is important

2 point we have to know abt hepatitis : 1)its minute amount can cause infection

2)highly resistant to disinfection

We already said that we have to know abt the what are these mean? Sterilization , disinfection , asepsis ,and decontamination.

Sepsis means pathologic microorganisms can penetrate in to a barrier
(skin and epithelial barrier).

What are the difference btw asepsis and disinfection?

Asepsis: avoiding of sepsis in living tissue

Disinfection: avoiding of sepsis in animate or non living tissue.

Sterilization: absolute state 100% no microorganism. (ultimate goal).

Sanitization and decontamination : to reduce the load of microorganisms to accepted level.

Hepatitis virus is resistant to desiccation and disinfection.

High percentage of patients that we are dealing with are carrier to hepatitis so we have to consider all these patients are carrier to take ultra cautious.

We have about 560 patients have HIV.

HIV can be easily destroyed unlike Hepatitis B.

Fortunately Few of HIV patients shad or secrete the virus in the saliva.

TB mycobacteria is important in developed and developing countries.

Can be transmitted by aerosol during coughing , sneezing and talking.

Properly fitted mask can protect u.

TB is highly resistant to desiccation and chemical disinfectants.

TB don’t form spores.

Physical and chemical methods of sterilization and disinfection.

Dry and moist heat, filtration ,irradiation and ultrasound

Those are physical methods.

Medical asepsis attempt to reach free as possible to avoid sepsis.

Surgical asepsis attempt to prevent microbes from gaining access to surgical creative wounds.

Most common physical method used is autoclave.

We have to clean our instrument very well.

Heat sterilization

Dry heat causes oxidation

moist heat causes coagulation

moist is more efficient than dry heat bcz water conduction coefficient is more than air.

Moist causes rust.

We know about autoclave it is a pressurized heat.

How can we ensure that the method of sterilization are efficient?

By bringing the most resistant type of bacteria (spore forming bacillus stearothermophilus) and put it in culture inside the autoclave for example and watch if the culture still growing or not If its not so the sterilization method is efficient.

If u sterilize your instrument it will be variable for about 6 months (if u don’t use it).

The variability of sterilization depends on providing that an instrument sealed by double wrap.

U always have to check up the cycle of your autoclave, warm up time of the oven , heat conductivity of the material and air flow through the oven.

U also have to memorize the guide lines of dry heat and moist heat by heart

For dry heat..

121c for 12 hours

140c for 3 hours

170c for 1 hour

For steam heat

116c for 1 hour

138c for 1:30 min

So we conclude that the time in dry heat is longer and needs a higher temp.

Dry heat is very simple no complexity but in moist heat is more complex especially if it is autoclave (may causes rust)

Both dry and moist are available but we recommend the moist heat (autoclave)

Gaseous sterilization is very important especially in hospitals mainly ethylene oxide gas (most common used gas). It has a lethal actions of all types of viruses and bacteria even mycobacteria and spores. Its highly flammable so its mixed with CO2 or N to be used.

Used to sterilize large and small materials and the materials cannot be sterilized by heat (heat sensitive materials).

It’s a toxic gas so after sterilization with this gas u need to do aeration for 8-12 at 50c or 60c

Stainless steel instruments u can use autoclave to sterilize it and we can use disinfectant chemical materials with it also.

For chemical disinfectants we must know the concentration and the emersion time.

For formaldehyde 3%

Cidex 2% 10 min

Butadiene emersion time is 30 min

2 techniques clean & sterile methods

Clean method mean the dentist should follow during normal procedures like wearing uniform and scrubs and using the barrier technique as simple as that like gloves masks etc..

Sterile technique we stick to it as a surgent in the theatre (major surgery procedures happen in it)

For example when I want to do a facial operation or a major operation in the mouth we use idophore compound mainly iodine.. all the area should be cleaned with Iodine for example the skin or intra orally (high reduction of microorganisms).

Then we bring towels already sterilized with ethylene oxide.

1^st we wash our hands while wearing the scrub I wont let the scrub touch the sink.

So u need to wash your hand properly to the elbow with soap and iodine then dry it with sterilized towel then you wear a gown then wear a surgical gloves (double wrapped gloves) given by the 2^nd nurse (1^st nurse called sterile nurse).

Most manufacture surgical instrument are double wrapped except blades its one wrap..

Good luck

Omar Al-Neami

2^nd lec of surgery