Therapy - General infection theory
The most effective way of disease control is to prevent infection, confusingly often referred to by the term infection prevention. (Better the term infection prevention could be used.) In health care, many special circumstances play a role in the correct application of measures that prevent contamination. The Infection Prevention guideline for oral care practices (KNMT 2016) applies to the situation in oral care.
However, if a contamination has occurred, treatment can be done with the help of different therapies. Preventive therapy is aimed at preventing infestation from developing into inflammation. When an inflammation or disease has developed, a 'real' medical treatment is usually necessary. There is then a choice of measures that aim to tackle the source of the disease (causal therapy) and measures that only eliminate the symptoms of the disease (symptomatic therapy). After this, these three types of therapy are further elaborated.
Preventive therapy can be applied at different levels, focusing on an individual and as a general measure. The most commonly used methods are described below.
Individual preventive measures
Individual preventive measures are:
- Administer antibiotics prior to bloody surgery in the mouth in patients who are at increased risk of heart infection due to certain heart defects. The bacteria that enter the bloodstream through the intervention during a so-called bacteremia will then have no chance to colonize the fragile tissue of the damaged heart muscle. This measure is known as endocarditis prophylaxis.
- Increase resistance. In case of weakened persons, the nutritional status may need to be improved with the help of dietary supplements or a diet. Training and exercise must further increase the condition and an effort must be made to strike the right balance between rest and effort.
- Vaccination against expected pathogens. Immunity can be obtained by artificial administration of dead or attenuated antigen, after which the body will actively produce antibodies and store them in memory cells.
Growth restriction of the number of germs
Growth limitation of the number of germs is known as preserving. This slows the growth and multiplication of possibly present micro-organisms. It should be explicitly stated that the growth is not prevented, so that with proper conservation there is still an end date for the safe use of materials and foodstuffs. Always work according to the FIFO system: first in, first out.
Various preservation methods can be used for the storage of injection liquids, rinsing liquids and bonding:
- Cooling (possibly freezing). Many materials from the practice stock must be stored in the refrigerator. This applies even to some unopened packages, but almost always to packs that have already been opened.
- Addition of natural preservatives (acid, salt) or chemical additives.
- Drying of material. A dishcloth that is dried immediately after use (on the heating) is safer than a dishcloth that stays moist all day during summer temperatures.
- Dust-free storage of cleaned objects or instruments.
Reduction in the number of disease germs
- Thinning. Simple hand washing is an extremely effective method to reduce the transfer of bacteria. In the medical situation, however, the hands must be washed so often that the skin can not tolerate it. Use of a hand disinfectant is then recommended for hand hygiene. Materials and instruments can also show a significant reduction in the number of microorganisms by (rinsing) as a first step in making them fully suitable for reuse.
- Disinfection (disinfection). This is a chemical or thermal process that aims to reduce the number of germs. Disinfection can be applied to hands, surfaces, utensils and instruments. For this it is necessary that the design and properties of materials are tailored to disinfection.
Design that is unsuitable for adequate disinfection
Design and materials are excellent for disinfection
Disinfection is also used for injuries and prior to surgical procedures. The number of microorganisms in the wound environment is then reduced in such a way that no more ignition can be expected. In dentistry, the mouth can be rinsed with chlorhexidine before a surgical procedure to reduce the number of microorganisms in the oral cavity. Also after a dental trauma or a gum operation for a week can be rinsed with chlorhexidine to prevent postoperative wound infections.
Fortunately, it is not the case that transmission of germs always has to be prevented for 100% in the fight against infections. By means of cleaning or diluting, supplemented with disinfection, the number of living germs in dental practice can normally be reduced sufficiently to be able to speak of a safe treatment method.
- Dry out. Almost all microorganisms need water in order to live, just like humans do. In the absence of it, they (almost all) die. However, it usually takes a long time before germs dry out. When the first patient is next after several weeks of closing the oral care practice, most (possibly) remaining microorganisms on the treatment unit will have died a natural death in the meantime. However, this is not an effective measure in the fight against germs when it comes to the micro-organisms left behind by the patient directly treated for it.
- Heating. Many germs can be killed in a very low temperature rise. The body makes use of this by using fever as a weapon in the fight against pathogens. Heat is also successfully applied outside the body to combat germs. Especially the use of humid heat is very effective.
- Personal hygiene in the form of good hand hygiene and general body care, clean sanitary facilities and hygienic handling of instruments.
The 'polite coughing with your hand in front of your mouth' should be replaced from the point of view of good hand hygiene by coughing and sneezing in the hollow of the bent elbow.
Politely coughing makes indirect infection possible
Recommended posture for sneezing or coughing to prevent indirect contamination through the hands
The causal therapy is aimed at eliminating the invaded microorganism by rinsing, disinfecting or killing it.
- Rinse out the germs. When someone has gotten something in the eye, there must be a lot of rinsing with the help of an eyewash (must be present in every dental practice as prescribed by the health and safety department). In case of a skin injury involving contaminated material, the wound must always be rinsed with plenty of running water (puncture accident, bite injury or abrasion in the street).
- Disinfection of the damaged or infected site (lesion). Disinfection can be applied to superficial infections, such as skin wounds and also infections in the mouth. For the first application, use is usually made of 70% alcohol or povidone iodine. In case of problems in the mouth, the patient can rinse with hydrogen peroxide 3% or with a chlorhexidine solution.
- Medication to kill pathogens. A distinction must be made between the different types of microorganisms, because they each require their own pesticide.
- Antibiotics can be used in bacterial infections. These substances damage the cell wall of bacteria, causing them to die. In broad lines there are two types of antibiotics: broad spectrum and narrow spectrum antibiotics.
With broad spectrum is meant that the antibiotic can be used for combating a large amount of different bacteria. This is useful when it is not known exactly which bacterium caused the infection. When the precise nature of the bacterium is known, however, an antibiotic with a narrow spectrum can be administered, which is specifically directed against that one bacterium. It is preferable to use as many narrow spectrum antibiotics as possible, due to the increasing problem that bacterial strains may develop insensitivity (resistance) to this type of medication. Often there is already multi-resistance. Examples are MRSA (methicillin-resistant Staphylococcus aureus) and VRE (vancomycin-resistant enterococci) In such a case of resistance, the pathogen can no longer be controlled in time, because it only becomes apparent after a few days that the antibiotic used does not work. a next (hopefully appropriate) remedy also takes time and thus there is a lot of delay in the healing process with serious or even fatal consequences for the patient.
- Antibiotics can not be used for virus diseases, because viruses do not have a cell wall. Therefore, in case of an infectious disease caused by a virus, special (and expensive) virus inhibitors will have to be used. These agents are only suitable for one type of virus and often show serious side effects. The use of virus inhibitors is limited. Most patients with viral infections have to 'just' look, with all the consequences (such as spreading the virus!).
- Fungal infections are usually controlled with antifungal preparations (antimycotics), such as miconazole and nystatin. The drugs should be used for a long time, even until long after the clinical signs of the infection have disappeared.
Symptomatic (palliative) therapy only attempts to relieve the clinical signs of the disease or inflammation, such as pain, fever or itching.
- Pain. Pain relief can be achieved with painkillers (analgesics). Pain management is a commonly used therapy. As an additional effect, the patient will sleep better and generally feel more comfortable, which benefits the healing indirectly.
- Fever. Control of fever in infectious diseases is not always desirable. Fever is in itself an effective tool in the fight against germs, because many bacteria die because of the temperature rise. The use of antipyretics (antipyretics) therefore limits the influence of the full revolving immune system. Yet there are some circumstances where fever control is urgently needed. In case of fever the heart and the lungs have to work harder (12% more oxygen is required per degree of temperature rise). In people with a weak heart, serious problems can arise if the body temperature is a few degrees higher than normal. They should therefore often use antipyretic medications for fever. Even in small children who have had fever attacks, it is recommended to fight the fever to prevent a new attack of febrile convulsions.
- Itching. Some diseases cause an itchy rash locally or over the entire body. The itching is usually controlled locally using menthol powder or menthol cream based on antihistamines. Sometimes medications are prescribed that have to be taken.