Mouth for the next patient

Hands of medical personnel,contamination of the contents of the oral cavity of patients are the most important factor in the transmission of cross-infection in dentistry. For jewelry and watch on his hands, cracked varnish on nails during operation should be critical not only in terms of safety, but also because they do not allow for a thorough cleaning and antiseptic hand during operation.

Studies carried out in health facilities of St. Petersburg showed that in a doctor's surgery dental clinic change gloves after patients was carried out in 36.7% of cases, wash gloves and antiseptic treatment of the patient after receiving 63.3% of cases. This was due to the insufficient number of gloves allocated staff.

Objects surrounding the patients are in the dental office can be divided into three groups:

I. Critical items: (before starting work with the patient must be sterile). These include tools, whose surface normally penetrate into the damaged skin or mucosa, the pulp (needles, scalpels, probes, burs and endodontic instruments) or items whose surfaces bordered with sterile instruments (instruments and trays, etc.).

II. Polukriticheskie items: (after each patient undergo sterilization or high-level disinfection). These include items whose surfaces in the ordinary course of treatment does not penetrate the oral mucosa: dental mirrors, lugs to the drill, suction devices, etc.

III. Noncritical items: (exposed low-level disinfection). These include items whose surfaces do not come into contact with the mucous membrane of the patient. This surface dental chairs, pens and lighters dental fittings, control buttons, medical diagnostic equipment, medical cabinets, doors, floors, walls, etc.

Risk factors for PSI in providing dental care. For the development of septic infections in dental patients must have a reservoir or source of microorganisms, certain transmission mechanism and a susceptible host. Risk of purulent infection in dental patients is associated with a number of factors such as the nature of the endogenous and exogenous. Endogenous risk factors include:

· advanced age of patients and related chronic diseases. Chronic diseases tend to lower the general resistance of the body and increase the risk of complications. Pay particular attention to diseases such as diabetes and chronic inflammatory processes of any localization, cardio vascular pathology, obesity, etc.;

· poor hygienic condition of the oral cavity: deep caries, periodontal disease and other diseases of the mouth;

· long-term use of certain medications, adverse effects on the immune system (corticosteroids, antibacterial broad-spectrum drugs, cytostatics, etc.).

Increasing the number of PSI with increasing age of the patients may be due to the natural mechanism of weakening the body's defenses. Currently, the percentage of elderly patients increases, therefore, the problem of nosocomial infections is becoming increasingly important. So the analysis of the age structure of surgical patients the dental clinic of the main contingent consisted of persons older than 60 years (58%), of which 46% had periodontitis and 15% - with periodontitis.

In case of purulent-septic complications in dental patients need to conduct surveillance and to identify risk factors for this complication, as well as to carry out control measures. These include early detection and isolation of patients with PSI, a record of all forms, including not heavy to further prevent the spread of infection.

Prevention of nosocomial infections. Medical professionals are increasingly aware of the need for preventive measures to avoid transmission from patients to staff as well as to prevent the spread of infection in the health care setting. Especially because the dental admission are increasingly common in immunosuppressed patients (suffering from somatic diseases; persons receiving radiotherapy and chemotherapy, are registered in drug treatment, cancer, TB dispensaries) that make up the high-risk groups as transmission of infection, so and susceptibility thereto. Therefore, the physician must consider each patient as a potential carrier of infection and to take all measures to prevent its spread.

Possibility of cross-contamination in the outpatient reception at the dentist requires special care for all medical personnel and strict observance of the rules of asepsis, antisepsis, and careful personal hygiene. The basic principles of all dental services must be purity, sterility and disinfection. Hygienic condition of any medical institution is determined primarily by the staff working in it. However, not enough attention is paid to training of medical staff maintain hygienic regime. Strict rules must be followed for admission to work medical personnel (paramedics suspended from work with displays of weeping dermatitis, pyogenic or ekzemnymi with skin lesions on the hands, especially to the elbows).

Paradoxically, the introduction into medical practice of powerful antimicrobial agents indirectly contributed to the expansion of nosocomial infections. Uncontrolled and uncritical use of antibiotics and chemotherapeutic agents has led to the formation of multi-drug resistant strains of microorganisms that have found their place in the hospital environment and are a constant source of danger for both patients and staff. A new generation of doctors and paramedical staff too hoped to omnipotent antimicrobial agents and began to pay much less attention to asepsis in the mistaken belief it outdated and not very important moment in modern medicine.

In the hospital should be made strict accounting and registration of cases of nosocomial infections. Necessary to study the composition of pathogens and their biological properties, follow the circulation of hospital strains, to identify the causes that contribute to the formation of permanent carriers of such strains.

Intensification of scientific and technical progress in dentistry and the emergence of new forms of dental care requires the development and implementation of evidence-based interventions and improve the forms of organization of work for the sanitary and epidemiological well-being in health care settings as outpatient and inpatient profile. Increasing the number of outpatient dental clinics profile and the associated large number of medical personnel and patients leads to an increase in the frequency of contacts between them, the possibility of microbial contamination of air, surfaces of equipment, tools and the hands of personnel. Under the conditions of receiving outpatient dental patients when we are continuously large numbers of cases, there are two problems:

· the risk of cross-infection patients

· the risk of occupational exposure to health workers providing dental care.

The spread of infections in dentistry can not be viewed in isolation from the overall epidemiological situation in the country. Universally observed increase in the incidence of hepatitis B and C, HIV, etc. population increases the risk of nosocomial infection and vnutriambulatornogo patients and health care workers of occupational infection. Therefore, in the dental facilities of special importance prevention of nosocomial infections at all stages of care.

Underestimating the importance of preventive measures in the protection of their own health - one of the characteristics of domestic dentistry. Only in the last decade, dentists are increasingly aware of the need for full preventive measures to avoid transmission from patients to staff and preventing the spread of infection in the dental office.

At present there is a need for infection control in dentistry, including effective organizational system, preventive and anti-epidemic measures aimed at the prevention of nosocomial infections in all phases of patient care.

An integrated approach to the problem of nosocomial infections in dentistry and maxillofacial surgery includes clinical, immunological, epidemiological, microbiological and hygienic aspects and allows time to identify risk factors and implement appropriate preventive and control measures.

The emergence of antibiotic-resistant microorganisms, as well as microorganisms that are resistant to disinfectants, exacerbates the problem of combating nosocomial infections in dentistry necessitates the development and introduction of new and effective methods of disinfection and sterilization.

Illustrative material:

Leterature:

Main:

1. Борисов Л.Б. Медицинская микробиология, вирусология, иммунология. - М.: МИА, 2001.- 734 с.

2. Табаева А.А. Микробиология поражений полости рта при стоматологических и инфекционных заболеваниях. Учебное пособие. – Алматы, 2006. -127с

3. Медициналық микробиология, Алматы, 2011.-683б Рамазанова Б.А, Кудайбергенұлы К.К редакциялаумен.

4. Ричард Дж.Ламонт., Роберт А.Берне., Мерилин С.Лантц., Дональд Дж.Лебланк., перевод с английского В.К. Леонтьева. Микробиология и иммунология для стоматологов. Практическая медицина. Москва 2010.- 502с.

5. Jacquelyn G Black “Microbiology”,7 ^th ,WILEY,2010,p.846

Additional:

1. Воробъев А.А., Кривошеин, Широбоков В.П. Медицинская и санитарная микробиология. – М.: Издательский центр «Академия», 2003. – 464 с.

2. Коротяев А.И, Бабичев С.Л. Медицинская микробиология, иммунология и вирусология. - СПб.: Спец.лит, 2000.- 591 с.

3. Тец В.В. Руководство к практическим занятиям по медицинской микробиологии, вирусологии и иммунологии. – М., 2002

4. Компьютерная программа “Диаморф” - “Медицинская микробиология” - атлас-руководство по бактериологии микологии, протозоологии и вирусологии под редакцией акад. проф.Воробьева А.А.

Test questions (feedback):

1. Give the definition of nosocomial infections.

2. What is the relevance of nosocomial infections in dentistry?

3. List the main etiological agents of nosocomial infections in dentistry.

4. Name the ways and factors of transmission of nosocomial infections.

5. Which activities should be carried out for the prevention of nosocomial infections in institutions dental profile?