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?

ASEPTIC TECHNIQUE IN ORAL

SURGERY
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

ASEPTIC TECHNIQUE IN ORAL

SURGERY
REMEMBER
.NO MATTER
HOW INNOCENT A
PATIENT APPEARS,
YOU MUST TREAT
EVERYONE AS
POTENTAILLY
INFECTIOUS

ASEPTIC TECHNIQUE IN ORAL

SURGERY
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

ASEPTIC TECHNIQUE IN ORAL

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

INFECTIONS
Infections

Bacteria
Viruses
Fungi
Protozoa
Prions

are caused by.

BACTERIA
Ubiquitous

found
everywhere
Not all bacteria are
pathogens (cause
disease)
Patients have a
normal flora nonpathogens (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

VIRUSES OF SPECIAL CONCERN

Hepatitis

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

VIRUSES OF SPECIAL CONCERN

Hepatitis

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

Instruments

Doctor

Drapes/towels

Assistant

Breathing

apparatus

Chair

controls
Light handles
Adjunctive

Sink
Hair
Gowns
Sleeves
Etc.

areas

ASEPTIC TECHNIQUE IN ORAL

SURGERY

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

ASEPTIC TECHNIQUE IN ORAL

SURGERY
What

is the single biggest individual thing that

you, as a health care professional, can do to stop
the spread of infection?

ASEPTIC TECHNIQUE IN ORAL

SURGERY
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

Washing hands with water and soap or other

detergents containing an antiseptic agent

Alcohol

Based Handrub

Rubbing hands with an alcohol containing

preparation

Surgical

Handwash

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

BENEFITS

LIMITATIONS

Antimicrobial

Cannot

action
is rapid and effective
Improved skin
condition
Better access than a
sink

use if hands
are visibly soiled
Must not store near
high temps or flames
Softeners and powders
may build up

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

ASEPTIC TECHNIQUE IN ORAL

SURGERY
RED NECK CAT CARRIER

ASEPTIC TECHNIQUE IN ORAL

SURGERY
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
Hats

covers

PERSONAL PROTECTIVE
EQUIPMENT
Remove

when leaving
treatment areas
Change mask between
patients
Clean face protection
between patients
Do not leave
contaminated items
around

PERSONAL PROTECTIVE
EQUIPMENT
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

ASEPTIC TECHNIQUE IN ORAL

SURGERY
Errors

in Judgment.
.We should all strive
to be as error free as
possible

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ASEPTIC TECHNIQUE IN ORAL

SURGERY

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT
BAD

GOOD

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT
WRONG

RIGHT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT
NOT-SO-GOOD

GOOD

ERRORS IN JUDGMENT
BAD

WORSE

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

ERRORS IN JUDGMENT

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

CLINICAL SUGGESTIONS
Scalpel

handle loading

Use an instrument
NEVER use your
fingers!

CLINICAL SUGGESTIONS
Safety

Scalpels

Consider the use of a

specially designed
device to decrease the
chance of injury
Devices at right are
single-use

CLINICAL SUGGESTIONS
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

IRRIGATION DURING ORAL

SURGERY
GOOD

BAD

IRRIGATION DURING ORAL

SURGERY
GOOD

BAD

IRRIGATION DURING ORAL

SURGERY
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

IRRIGATION DURING ORAL

SURGERY
GOOD

BAD

IRRIGATION DURING ORAL

SURGERY
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

CLINICAL SUGGESTIONS
Use

of Foot Controls

A big advantage over

hand controls
Use for dental chairs
and faucet control

FOOT CONTROLS
BAD

GOOD

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

CLINICAL SUGGESTIONS
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

ORAL SURGERY SPECIFICS

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%

ORAL SURGERY SPECIFICS

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

ORAL SURGERY SPECIFICS

Extracted

Teeth

Are regulated medical

waste
Can be given back to
the patient
Do not incinerate
those containing
amalgam

ASEPTIC TECHNIQUE IN ORAL

SURGERY
SUMMARY

Remember what the

bad bugs are and how
not to spread them
Use proper techniques
and materials
Eliminate errors in
judgment
AND REMEMBER.

ASEPTIC TECHNIQUE IN ORAL

SURGERY

.We are Continuing

on the Path of
Excellence

QUESTIONS

THANK YOU