question

what are the steps for a vaccine to get approved

answer

1. has to be safe 2. has to elicit an immune response 3. actually prevent disease

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Tdap

answer

Tetanus toxoid-diptheria-aceulluar pertussis (whooping cough). Newly licensed vaccine: Feb 2006 ACIP recommended ... for health-care personnel as soon as feasible. can be used in adults.

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Papilloma vaccine

answer

Gardasil 2006. 3 doses. Girls and women 9-26 years of age for the prevention of diseases caused by HPV types 6,11 & 16,18. Cervical cancer (down 70%) types 16,18 Genital warts (down 90%) types 6,11

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Influenza vaccine "Flu shot"

answer

viral mutations require yearly vaccination. immunity develops in 2 weeks. first vaccinations in 1945. ACIP recommendations 2010: flu vaccine for all persons 6 months and older.

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it is especially important for the following groups to get the flu shot

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pregnant women, children under 5 (and especially if under 2), older than 50, people of any age with certain chronic medical conditions, residents of a long-term care facility, close contact with people at risk, health care workers "herd immunity"

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definition of vaccine

answer

biologic preparation that improves immunity to a particular disease.

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prophylactic vaccine

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(before) to prevent or ameliorate the effects of a future infection

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therapeutic vaccine

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boosts the immune system to target existing disease. (i.e. HIV, cancer-on the horizon)

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What are Bloodborne Pathogens? BBP

answer

pathogenic microorganisms present in blood, or other potentially infectious material (OPIM) that are able to cause disease in humans.

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Other Potentially Infectious Material (OPIM)

answer

cerebrospinal fluid, synovial fluid, peritoneal fluid, pericardial fluid, pleural fluid, semen, vaginal secretions, breast milk, amniotic fluid

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Not considered OPIM

answer

tears, feces, urine, sweat, vomit, saliva, nasal secretions, and sputum UNLESS visibly contaminated with blood. In dental practice assume saliva is contaminated with blood.

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Bloodborne viruses such as HBV, HCV, and HIV are:

answer

1. transmissible in health care settings 2. Can produce chronic infection 3. Are often carried by persons unaware of their infection

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How are BBPs commonly transmitted at work?

answer

1. CUTS OR PUNCTURES with contaminated sharp objects 2. SPLASHES TO MUCOUS MEMBRANES (linings of eyes, nose, mouth). your mucous membranes are permeable, allow pathogens to pass through 3. contamination of BROKEN OR NON-INTACT SKIN (wounds, chapped skin, rashes)

question

Factors influencing Occupational risk of blood borne virus infection:

answer

1. frequency of infection among patients 2. risk of transmission after a blood exposure (depends on type of virus: how easy is it to get virus?) 3. type and frequency of blood contact

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Factors that must be present for DHCP to transmit blood borne illness

answer

1. VIREMIA 2. INJURY or other condition that allows direct exposure to their blood or other infectious bodily fluids 3. ENTRY of DHCP blood or infectious body fluids to gain access to a patient's wound, traumatized tissue, mucous membrane, or other portal of entry.

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Standard Precautions

answer

Cornerstone of exposure prevention. Any and all human blood or OPIM is treated as infectious use: 1. safe practices: Change the manner of preforming tasks 2. safety equipment (engineering controls): isolate or remove the hazard 3. Personal Protective Equpiment

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Big 3 viruses

answer

Hepatitis B (HBV), Hepatitis C (HCV), and Human Immunodeficiency Virus (HIV).

question

HBV

answer

Viral liver disease causing severe liver damage (cirrhosis), liver cancer, and potentially death. 1.25 million chronically infected americans. 30% infected individuals show no symptoms. there is a vaccination

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Occupational Hepatitis B Exposures

answer

1. Needle sticks are a real concern. 30% of people exposed to infected blood via needlestick become infected. Very easy to get (mot infectious BBP). 2. Can be transmitted by surface contact with dried blood or OPIM (lives longer than 1 week on surfaces) 3. Many people have no idea how they became infected 4. Risk of infection from blood/OPIM splash onto non-intact skin or mucous membranes...greater risk than other BBPs.

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How to prevent HBV infections at work:

answer

1. Get vaccinated (OSHA BBP standards require that employees with potential exposure be offered the vaccine at no cost) 2. Use standard precautions 3. Cleaning/ Disinfection is important because the virus can survive on surfaces.

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HBV vaccination

answer

Given in 3 doses. Test for adequate antibodies 1-2 months after 3-dose series. if inadequate response, repeat the 3 doses and retest for antibodies. Give to babies the day they're born, started in 1991.

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Chain of infection for HBV

answer

Vaccination stops susceptible host, pathogen and source. PPE stops entry Careful with sharps and clean operatory stops mode.

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Hepatitis C virus (HCV)

answer

another viral liver disease that can cause severe liver damage, liver cancer, and potentially death. 1.6 million have been infected with HCV, 3.2 million are chronically infected.

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Occupational infections with HCV

answer

1. Needle sticks primary route of infection. 2% of people exposed to infected blood from a needle stick become infected. 2. Survives up to 4 days on surfaces. 3. Risk of infection from blood/OPIM splash onto non-intact skin or mucous membranes-lower risk than HBV.

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How to prevent HCV infections at work:

answer

1. Standard precautions 2. No vaccine 3. Treatment difficult-no post exposure treatment generally given

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Occupational risk of HCV transmission among HCP;

answer

1. Inefficiently transmitted by occupational exposures 2. Hollow-bore needles (IV, dentistry) 3. Three reports of transmission from blood splash to eye 4. Report of simultaneous transmission of HIV and HCV after non-intact skin exposure.

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HCV infection in dental health care settings

answer

1. prevalence of HCV infection among dentists similar to that of general population (1-2%) 2. no reports of HCV transmission from infected DHCP to patients or from patient to patient. 3. Risk of HCV transmission appears very low

question

Chain of infection for HCV

answer

No vaccine to stop susceptible host, pathogen or source. PPE stops entry Careful with sharps and clean operatory stops mode

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HIV

answer

attacks immune system. Destroys white blood cells and leaves patient immune suppressed and susceptible to infections and certain tumors. many people show no symptoms for years. Eventually leads to Acquired Immune Deficiency Syndrome (AIDS).

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Occupational HIV infections:

answer

1. Risk of getting HIV after: Needle stick exposure 0.3% (1 in 300) Mucous membrane exposure 0.09% (1 in 1000) 2. Risk of infection from splash onto non-intact skin unknown (low) 3. Not transmitted by surface contact with dried blood. Virus does not survive on surfaces outside the body.

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How do you prevent HIV infections at work?

answer

Standard precautions ONLY

question

Risk factors for HIV transmission after percutaneous exposure to HIV infected blood:

answer

You must have: 1. deep injury 2. visible blood on device 3. needle placed in artery or vein 4. terminal illness in source patient (high viral content)

question

Risk of becoming infected from a needle stick accident

answer

1. Hepatitis B: 30% (300 people/1000 needle sticks) 2. Hepatitis C: 2% (20 people/1000 needle sticks) 3. HIV: 0.3% (3 people/1000 needle sticks)

question

Workplace specific controls to protect against BBP exposure

answer

1. Safety equipment (engineering controls) 2. Work practices 3. PPE

question

Safety equipment (engineering controls)

answer

Isolate or remove the hazard. ex; sharps container, medical devices with prevention features (e.g. self-sheathing needles) a type of workplace specific control to protect against BBP exposure

question

Work practices

answer

Change the manner of performing tasks. ex: using instruments instead of fingers to retract or palpate tissue, one handed needle recapping, turning burs around. a type of workplace specific control to protect against BBP exposure

question

What to do in case of a needle stick incident

answer

1. remove contaminated PPE 2. wash exposed area with soap and running water (use antibacterial soap if possible) 3. if blood/body fluid is splashed in eye or mucous membrane, flush the affected area with running water for 15 minutes. 4. report all exposures to supervisor 5. Gather info: Hepatitis/HIV status of patient (if not known request testing) 6. go to UAB employee health for testing 7. Follow up as needed

question

Staphylococcus aureus

answer

"staph". common bacteria of skin and nose (30% have in nose). common cause of skin infections. Can cause pimples and styes. resistant to Beta-lactam antibiotics (the penicillin family: penicillin, amoxicillin, cephalosporins)

question

(MRSA) Methicillin-resistant Staphylococcus aureus

answer

Resistant to penicillin and another class of antibiotics (usually methicillin which is not a beta-lactam AB). "superbug". looks like: abscesses, pustular lesions, "boils", pimple, "spider bite", cellulitis

question

Why antibiotic resistance?

answer

1. indiscriminate use of antibiotics 2. Noncompliance with infection control practices 3. Antibiotics in food products

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HA-MRSA (Healthcare Associated)

answer

Common in healthcare facilities especially in the sick. treat with IV vancomycin (must be checked into the hospital)

question

CA-MRSA (Community Acquired)

answer

Infection in people who have not been recently hospitalized. May have unique biologic properties. Usually susceptible to non-penicillin AB, but culture and sensitivity tests are needed. DEFINITION: MRSA culture in outpatient setting or first 48 hours of hospitalization and patient lacks risk factors for HA MRSA (hospitalization, surgery, long-term care, dialysis, indwelling devices, history of MRSA)

question

who gets CA MRSA

answer

1% are colonized with MRSA 5% health care workers carry MRSA Close skin to skin contact, cuts or abrasions, contaminated items, crowded living conditions, poor hygiene. Athletes, military recruits, children, prisoners. Can be carried by pets, and has been found on the surface of pork meat.

question

Outbreaks of MRSA in the community

answer

various settings: sports participants, inmates in correctional facilities, military recruits, daycare attendees, native americans, alaskan natives, men who have sex with men, tattoo recipients, hurricane evacuees in shelters.

question

FIVE "Cs" of CA MRSA transmission

answer

1. Contact (direct skin to skin contact) 2. Cleanliness 3. Compromised skin integrity 4. Contaminated objects and environment 5. Crowded living

question

Recommendations to Prevent MRSA infections in athletics

answer

Stress the importance of hand washing and hygiene Keep wounds covered and dispose of bandages properly Eliminate sharing of equipment and personal items Stress clean facilites

question

Prevention

answer

1. Wash your hands 2. Keep wounds covered 3. Avoid contact with other's wounds or bandages 4. Keep personal items personal 5. Shower after athletic games and practices 6. Sanitize linens 7. Killed by alcohol (including alcohol hand sanitizers) and bleach 8. Use antibiotics appropriately 9. Get vaccinations

question

How long should environmental surfaces be visibly wet for when using Caviwipes?

answer

3 minutes

question

VRSA

answer

Vancomycin resistant Staphylococcus aureus, 2002, no treatment

question

Preventing Transmission (CDC COMMENTS)

answer

1. Exclusion of patients from school, work, sports activities, etc should be reserved for those that are unable to keep the infected skin covered with a clean, dry bandage and maintain good personal hygiene.! 2. In general, it is not necessary to close schools to "disinfect" them when MRSA infections occur.! 3. In ambulatory care settings, use standard precautions for all patients (hand hygiene before and after contact, barriers such as gloves, gowns as appropriate for contact with wound drainage and other body fluids).! 4. Persons with skin infections should keep wounds covered, wash hands frequently (always after touching infected skin or changing dressings), dispose of used bandages in trash, avoid sharing personal items.! 5. Uninfected persons can minimize risk of infection by keeping cuts and scrapes clean and covered, avoiding contact with other persons' infected skin, washing hands frequently, avoiding sharing personal items. !

question

Office policy, 3 options:

answer

1. cover and keep clean (no liquid seeping through clothes) 2. physician clearance 3. eradication therapy (wipe you completely of staph, must be negative)

question

Dorsum of tongue

answer

top side of tongue

question

hard palate

answer

firm, covered by gingiva, has rugae

question

pharynx

answer

behind soft palate

question

elevated midline of hard palate

answer

palatine raphe

question

stensen's duct

answer

opens on inside of cheek near maxillary molars

question

alveolar mucosa

answer

lines floor of vestibule OR loosely attached

question

Fordyce's spots

answer

sebaceous glands on inside of cheek

question

melanin

answer

dark pigment on attached gingiva

question

gingiva between teeth

answer

interdental papillae

question

palatal tissue bump between teeth 8 and 9

answer

incisive papilla

question

vibrating line

answer

junction of hard and soft palate

question

whartons's duct openings

answer

on the anterior floor of mouth where the pica sublingualis meet

question

labial frenum

answer

attaches lip to mucosa covering jaw (upper and lower)

question

ventral surface of tongue

answer

underside of tongue

question

oral cavity

answer

mouth

question

retromolar pad

answer

elevation of tissue distal to mandibular last molar

question

maxillary tuberosity

answer

elevation of tissue distal to maxillary last molar

question

filiform papillae

answer

hair-like papillae covering two thirds of dorsum of tongue

question

torus mandibularis

answer

ride of bone lingual to mandibular premolars

question

attached gingiva

answer

tightly attached-pink color

question

fauces

answer

opening from oral cavity to pharynx

question

nasolabial groove

answer

diagonal grooves from nostrils to corner of mouth

question

labiomental groove

answer

horizontal depression below lower lip

question

sublingual gland

answer

mucous salivary glands beneath anterior third of the tongue

question

submandibular gland

answer

large serous salivary gland beneath posterior third of the tongue

question

plica sublingualis

answer

fold in floor of mouth beneath tongue

question

uvula

answer

hangs downward in center of soft palate

question

plica fimbriata

answer

delicate fold on each side of ventral surface of the tongue

question

foliate papilla

answer

on lateral surfaces of tongue near posterior third

question

circumvallate papillae

answer

8-12 circular papillae arranged in a "V" shape

question

alveololingual sulcus

answer

space between mandibular teeth and tongue

question

palatine tonsils

answer

located between anterior and posterior pillars in the throat

question

retromylohyoid curtain

answer

mucous membrane between anterior pillar and pterygomandibular fold

question

What are the 3 things necessary to have for a vaccine to get approved

answer

1. has to be safe 2. has to elicit an immune response 3. has to actually prevent disease

question

fungiform papillae

answer

sparse round mushroom-shaped papillae on dorsum of tongue

question

fovea palatini

answer

located just posterior to vibrating line

question

parotid gland

answer

serous salivary gland just in front of ear

question

philtrum

answer

vertical depression on upper lip

question

commissure

answer

at the corners of the mouth where the lips join

question

exostosis

answer

bulbous protuberance on facial side of mandible in premolar region

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