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Objectives
Difference between OR sterile technique & clean technique used in clinic. Be able to perform surgical hand scrub, gown & glove. Be able to set up an instrument tray for dental extractions. Be able to maintain a clean surgical field.

Principles of Asepsis

Sterilization
Sterility: Freedom from viable forms of microorganism. Antiseptics: applied to living tissue. Disinfectant: applied to inanimate objects.

Chemical agents
Antiseptics Disinfectants Ethylene oxide gas

Usually too toxic for direct tissue application.

Sepsis: living tissue breakdown by inflammatory process of microorganisms.

Physical agents
Heat Mechanical dislodgement Radiation

Instrument Sterilization

HEAT STERILZATION

Heat
Dry Moist
Water/ moisture can transfer heat better than air Steam has more stored energy Pressurized steam allows superheating
Antimicrobial effect

Dry
Oxidizes cell proteins Long 121C (250 F) for 6-12 hr Low Low

Moist
Denatures cell proteins Short 121C (250 F) for 24 min. High High

Time necessary to achieve sterilization Equipment complexity and cost Tendency to dull or rust instruments

Gaseous

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Gaseous Sterilization

Instrument Disinfection
Glutaraldehyde ( Cidex) Iodophores (Betadine) Chlorine compounds ( Clorox) Formaldehyde

Ethylene oxide:
Alkylating agent Flammable, ( mix w/ 90% CO2 or Freon) Used at room temp (used for porous, rubber, plastic material) Highly toxic , need long aeration time Not very practical for a dental practice

SURGICAL SET-UP
IN THE OPERATING ROOM: UNDER GENERAL ANESTHESIA AND STERILE TECHNIQUE AND IN THE OFFICE: UNDER LOCAL ANESTHESIA AND STERILE (CLEAN) TECHNIQUE

SURGICAL SET-UP

Sterile (clean) technique used in the office under local anesthesia and sedation

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Instrument set up

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Sterilization
Tests of sterilization equipment. Colorcoded packaging is made of paper and cellophane; test areas on package change color on exposure to sterilizing temperatures or to ethylene oxide gas

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Gloving

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Surgical set up in the Operating Room sterile technique

Surgical site preparation

discard sponge when lateral margins have been reached. repeat. prevent irritating antiseptic agents from contact with eyes (can cause corneal abrasions) protect eyes with eye ointment (e.g., Lacri-Lube). protect internal ear with cotton ball. open sterile towel and place over preparation site to dry it. the prepared surgical site to be "painted" with antiseptic sponge sticks .

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Surgical site preparation

Facial, neck, and other skin sites Use antiseptic agents for preparation.

iodophor compounds leg, Betadine). chlorhexidme gluconate (eg, Hibiclens').

Use sterile gloves. Technique.

proceed from center of surgical site to lateral aspects in circular motion.

Scrubbing
Mechanisms Mechanical action of brush. Residual antiseptic agents. iodophor compounds (eg, Betadme). hexachlorophene (eg, pHisoHex). chlorhexidine (eg, Hibiclens).

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Important considerations before scrubbing hands and arms

Surgical scrub techniques

30 strokes per surface scrub technique

Clean beneath nails (trim nails short). Make sure hair is completely covered. Put on mask. Remove rings and watch.

fingers/thumb have four surfaces interwebbing of each finger ventral, dorsal, and lateral surface of hand four surfaces of the forearm to 2 in. above elbow progress from fingers to elbow repeat opposite hand and arm rinse both, keeping hands and arms elevated above waist, allowing water to drain off elbow

Time technique is the most common (long = 10 min, short = 3 min Final rinse: rinse arms so that the water runs from the hands down to the elbows

Drying technique

Nurse or technician will hand sterile towel to right hand. Dry both hands and one arm well, progressing up from hand to elbow using one end and side of towel. Use opposite end for the other arm, following the same procedure. Because drying towel is sterile, do not let it touch nonsterile items such as scrub cloths, surgical tables, etc. Discard soiled towel into linen receptacle

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