Preoperative Health Status Evaluation and Infection Control in the Surgical Practice

Lecture given 7/28/2026

what does a medical history include?

biographic data, chief complaint, history of chief complaint, medical history, review of systems

biographic data

patient’s full name, address, age, gender, occupation, marital status, and PCP

assess the patient’s reliability

chief complaint

in patient’s own words

helps establish priorities

clarifies why they desire treatment

history of chief complaint

patient to describe the history of the present complaint or illness

its first appearance, any changes since the first appearance

description of pain should include: onset, intensity, duration, location, and radiation, as well as what worsens or mitigates it

consitiutional symptoms: fevers, chills, lethargy, anorexia, malaise, and weakness associated with the chief complaint

medical history

health history forms

baseline health history database: hospitalization, surgeries, illnesses, trauma, medications, allergies, health related habits, last medical check up

family history

should be updated on a yearly basis

review of systems

a sequential, comprehensive method of eliciting patient symptoms on an organ system basis

it may reveal undiagnosed medical conditions unknown to the pt

should be guided by pertinent answers obtained from the history

if IV sedation or GA planned, the CV, respiratory, and nervous systems should be reviewed

dentist is expected to perform a quick review of the head, ears, eyes, nose, mouth, and throat on every patient

physical examination

focuses on the oral cavity and to a lesser degress on the entire maxillofacial region

accurate description- not a diagnosis

starts with the signs

physical evaluation involves: inspection, palpation, percussion, and auscultation

pulse

rate, rhythm

character- form the individual pulse wave, may have diagnostic value in valvular disease

volume- full or weak (thready)

condition of vessel wall

ASA I

normal, healthy pt

ASA II

a pt with mild systemic disease or significant health risk factor

ASA III

a pt with severe systemic disease that is not incapacitating

ASA IV

a pt with severe systemic disease that is a constant threat to life

ASA V

a moribund pt who is not expected to survive without the operation

ASA VI

a declared brain-dead pt whose organs are being removed for donor purposes

options for the practitioner if the pt is NOT ASA I or ASA II

modifying routine tx plans by anxiety reduction measures, pharmacologic anxiety control techniques, increased pt monitoring, or a combination of these

obtain a med consult

refuse to treat pt in the ambulatory setting

referring the pt to an oral and maxillofacial surgeon

SOAP note

subjective

objective

assessment

plan

communicable pathogenic organisms

bacterial, viral organisms, mycobacterial organisms

bacteria

upper respiratory tract flora

maxillofacial skin flora

nonmaxillofacial flora

mycobacterial organisms

m. tuberculosis is not prevalent in US/CAN

transmitted primarily through exhaled aerosols that carry bacilli from the infected lungs of an individual

droplets are produced by those with untreated TB during breathing, coughing, sneezing, and speaking

transmission possible via inadequate sterilization

m. tuberculosis organisms do not form spores, but they are highly resistant to desiccation and to most chemical disinfectants

surgical N95 respirator masks, heat, ethylene oxide, and irradiation

viral organisms

hepatitis viruses: A, B, C, and D are responsible for most infectious hepatitis

hep A spread by contact w/ feces of infected individuals

hep C spread by feces or contaminated blood

hep B and 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

HIV

loses its infectivity once desiccated

universal precautions

Coronavirus

a large group of enveloped RNA based viruses known to affect birds and mammals, including humans

what are the types of human coronaviruses?

229E, NL63, OC43, HKU1

universal precautions

developed to address the inability of health care providers to specifically identify all pts with communicable diseases

based on protection of self, staff, and pts from contamination by using barrier techniques when treating all pts as if they all had communicable diseases

include all drs and staff who come in contact with pt blood or secretions, whether directly or in aerosol form, wear barrier devices like face mask, eye protection, and gloves

also includes decontaminating or disposing of all surfaces that are exposed to pt blood, tissue, or secretions

avoid contaminating objects/surfaces with contaminated gloves or instruments

covid-19 PPE used in treatment center areas

N95, faceshield, cap, gown, shoe coverings/booties, gloves

asepsis

refers to the avoidance of sepsis

medical asepsis

the attempt to keep pts, 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

antiseptic and disinfection

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

the freedom from viable forms of microorganisms

sanitization

the reduction of the number of viable microorganisms to levels judged safe by public health standards

decontamination

similar to santization

physical methods of reducing the number of viable organisms from a surface

heat, mechanical dislodgment, radiation

chemical methods of reducing the number of viable organisms from a surface

antiseptics, disinfectants, ethylene oxide gas

what types of bacteria are most resistant to elimination?

bacterial endospores

techniques of instrument sterilization

sterilization with heat- dry or moist

gaseous sterilization

dry heat

advantage- relative ease of use and the unlikelihood of damaging heat-resistant instruments

disadvantages- 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 relative availability of office proportioned autoclaving equipment

disadvantages- tendency of moist heat to dull and rust instruments and the cost of autoclaves

how long after sterilization can organisms enter sterilization bags?

6 mo

gaseous sterilization

destroy enzymes and other vital biochemical structures

ethylene oxide

50 degrees C for 3 hrs

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

what needs to happen after ethylene oxide sterilization?

it is highly toxic to animal tissue so equipment must be aerated for 8-12 hrs at 50 degree C to 60 degree C or at ambient temperatures for 4-7 days

chemical disinfectants

classified by level biocidal activity (low, intermediate, or high)

quaternary ammonium compounds are not recommended for dentistry because they are not effective against hep B virus and become inactivated by soap and anionic agents

irrigation of wound

only sterile water or sterile saline should be used to irrigate open wounds

surgical staff preparation

hand and arm preparation

clean technique

sterile technique

postsurgical asepsis

wound management- only dress wounds with clean gloves

sharps management- scoop up method to sheath sharps after use