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Definitions

Antiseptic- a chemical that is applied to living tissues such as

skin or mucous membrane to reduce the number of micro-
organisms present through inhibition of their activity or
destruction.

Disinfectant- a chemical used on nonvital objects to kill surface

vegetative pathogenic organisms, but not necessarily spore
forms or viruses.

Sterilization- a process by which all microbial forms are

destroyed
mleansing of the Instruments
6 It is a pre requisite for effective disinfection or sterilization. It removes
visible contamination but does not necessarily destroy micro-organisms.
6 These debris such as blood, saliva & necrotic materials, form a
protective covering for micro-organisms & prevent penetration of
sterilizing medium.
6 Hence instruments should be thoroughly clean before sterilization.

mleansing agents
Soaps
Detergents
Fat solvent solutions
Ultrasonic devices
Soaps & Detergents
6 mommonly used aids in cleansing the instruments.

6 Soaps are salts of fatty acids.

6 Detergents are synthetic compounds.

6 Both act by reducing the surface tension on the instrument surface

causing emulsification of the contaminants, which are then removed in the
rinsing phase.

6 Both these are very limited antibacterial activity especially against gram
positive organisms.
Fat solvent agents
6 Acetone, Xylene & Ether are sometimes used in cleaning
6 They are relative expensive, caustic to living tissues & probably less
effective in overall cleaning ability than soaps & detergents
6 These solutions should be thoroughly rinsed from the instrument
surfaces prior to use because of their caustic nature to the living tissues

Ultrasonic mleaning Devices

6 The instruments such as bone burs or bone files, where solid particles
are wedged into small crevice, require time consuming & careful
scrubbing, with stiff wire brush.
6They can be better managed by ultrsonic cleaning devices.
6 These devices act by converting electrical energy into vibratory sound
waves, which then pass through soap solution containing instruments.
Disinfectants

Alcohols
6Alcohols are overused as disinfectants, but their appropiate use is as
antiseptic

6 Alcohols possess some anti-bacterial activity, particularly against gram

positive organisms, but they are ineffective against spores & viruses.

6They act by denaturing bacterial proteins.

6Ethanol & Isopropyl alcohol are commonly used alcohols.

6Alcohols require 10 minutes of contact with the organism for effective

action.

6They are more effective at 70% concentration than compared to higher

concentration, because water speeds up the denaturing process.
6Disadvantage
a. They evaporate very quickly, when applied on the instruments, thus do
not function effectively as disinfectants.

b. They are corrosive to carbon steel instruments.

c. Rubber articles when soaked in alcohol, absorb alcohol, when they

come in contact with living tissues, they can cause reaction.
Aqueous Quaternary Ammonium mompounds
6Benzalkonium chloride is most commonly used quaternary compound.

6It is used as both disinfectant & antiseptic.

6It is bactericidal effective against gram positive bacteria & certain gram
negative bacteria.

6It is ineffective against spores & viruses.

6It acts altering the permeability of bacterial cellwall & thus permiting
escape of phosphorous & nitrogen.

6It also causes protein denaturation.

Ôhenols
6Ôhenols are one of the oldest group of disinfectant.

6Ôhenols are active against bacteria, fungi & many viruses, but inacitve
against spores.

6These are often used for disinfection of walls, floors & furniture.

6They can corrode certain metals such as brass, aluminum & carbon
steel. They can also cause damage to plastics.
Aldehyde mompounds
6Formaldehyde (aqueous solution, formalin) & glutaraldehyde are very effective
disinfectants.

6Formalin because of its noxious odour & requirement of a18-30 hours of contact for
effective action, is not in common use.

6Glutaraldehyde requires 10 hours contact for its cidal action.

6It is effective against vegetative bacteria, spores, fungi & viruses.

6It acts by alkylation.

6It is toxic & irritating & thus not used on certain surfaces as furnitures, walls & floors.

6It may be used on metals, rubber, plastics & porcelain.

6Thes instruments should be thoroughly rinsed with sterile water to remove compound,
prior to contact with tissues.
Öethods of Sterilization
Öost commonly employed methods of sterilization are
6 Öoist Heat
a) Boiling Water
b) Steam Heat
c) Oil

6 Dry Heat
6 Gas
6 Irradiation
Boiling Water
6Boiling water maintains & conducts heat extremely well.

6Its kills micro-organisms by coagulation of proteins.

6It provides temp. of 100 c.

6Exposure to this temp. for 10 mins kills bacteria & exposure of

24 hours kills spore forms.

6It is ineffective against viruses.

Steam Heat
6 Steam sterilization involves heating water to generate steam in a closed
chamber called autoclave, producing moist heat that rapidly kills micor-
organisms.
6 It is the most practical, quickest, safest, effective method of
sterilization.
6It kills by coagulation of proteins.

6 Advantages
a. High penetrating capacity
b. Transfer of large amount of heat to the surface of instruments

6 Disadvantages
a. Blunting & corrosion of sharp instruments
b. Damage of certain rubber goods
6Two types of Autoclave are available
a. Standard Autoclave-
At 15 psi pressure, temp. 121c, time 10-12 mins.
b. Flash Autoclave-
At 29.4psi pressure, temp. 134c, time 3mins.

6 Instruments to be sterilized are packed before sterilization to maintain

the sterility till they open when required
6 Öaterials used to pack can be fabric, paper, muslin cloth pouches,
nylon bags & paper wrap cassettes.
6 These material allow adequate penetration of steam for adequate
sterilization
6 To prevent corrosion of the instruments ammonia or
dicyclohexylammonium nitrite can be added to the autoclave
6 Addition of 2% sodium nitrate is also effective in preventing corrosion
Test for Efficiency
6Spore testing- can be done once a week with spore of Geobacillus
Stearothermophillus

6Thermocouple- it is thermometric testing. 1st recording taken from

thermocouple inside the test pack. 2nd recording taken from chamber
drain. This provide good guide about the speed of penetration

6Autoclave tape- this is a tape printed with sensitive ink, that changes
colour at specific temperature.
Oil
6Hot Oil baths have been used to sterilize metallic instruments.

6Oil can reach a temp. of 175 c.

6Submerging instruments at this temp. for 15 mins is necessary for

sterilization.

6Oil has poor penetration & poor sporicidal activity.

6It is difficult to remove oil from instruments, especially from hand

pieces.

6It should never be used to sterilize syringes or needles with fear of oil
embolism`
Dry Heat
6Hot Air Oven may be used for instruments that will not be damaged by
high temperature.

6It requires 160c for 2 hours to accomplish sterilization.

6This long period is required due to poor penetrating property of hot air
& poor conductance of heat by dry air.

6Dry heats kills by dehydration & oxidation.

6Advantage of this method is that sharpness of the cutting instruments is

maintained.

6Disadvantage carbon steel instruments lose their hardness during dry

heat.
Gas
6Ethylene oxide gas at temp. above 10.8c

6It kills organisms by alkylation.

6It is used to sterilize instruments that cannot withstand temp. but it highly
toxic & can blister on contact with living tissues.

6It is highly flammable, but this property can be controlled by mixing with
carbon dioxide.

6Other gas used for sterilization is formaldehyde, but it is less popular

than ethylene oxide
Irradiation
6Radiation are of two types
a. Ionising radiation
b. Non-ionising radiation

6 Ionising radiation such as X-rays, Gamma rays & High speed Electrons
6 Have high penetrating properties & commonly used in industries.
6 Used to sterilize disposable materials such as needles, suture materials,
cannulas & pharmaceuticals.

6 Non-ionising radiations such as ultraviolet light is used to purify air in

operating room.
6 It has no penetrating ability & is limited to air sterilization &
preparation of immunizing antigens.
Antiseptics
6An antiseptic is a chemical disinfectant that is diluted, to be safe for
application on living tissues.

Alcohols
6They are weak antiseptic, with limited antibacterial activity.
6They are frequently used for skin antisepsis prior to needle puncture.
6Ethyl alcohol & isopropyl alcohol.

Aqueous Quaternary Ammonium mompounds

6Benzalkonium mhloride is used as skin antiseptic.
6Its antimicrobial activity is restricted only to gram-positive organisms
6Thus they are of limited use.
Iodophor mompound
6These are most effective antiseptics.

6In these iodine is mixed with polyvinyl pyrolidone,(betadine) organic

surface-active agent.

6Their activity is by release of iodine from complex. This iodine kills the
bacteria by oxidizing microbial protoplasm.

6These compounds exhibit an effective activity against most bacterias,

spores, viruses, & fungi.

6Iodophor compounds build up on the skin after successive scrubs & this
provides long lasting activity.
Operating Room Ôrocedures
6Operating room is a clean environment in which surgery is performed,
but it is not sterile.
6The operating room provide a safe, efficient & user friendly
environment.
6The walls, ceiling & floor are regularly disinfected by fumigation
640% formalin is used as fumigator.
6Air is filtered by an ultraviolet device to reduce the bacterial count.

6Only operating personnels are allowed to enter the operating room

6Before entering, they change into scrub suits & put on cap, mask &
special ot slippers or shoes.
6mare should be taken not to touch any sterile clothings or instruments.
Hand Scrub
6Hand scrub is 1st step toward aseptic surgical technique.
6It is the most important & successful method of controlling the spread of
infection in the hospital.

6Ôurpose of hand scrub is two folds-

a. To remove the superficial contaminants & loose epithelium
b. To reduce the bacterial counts.
Scrubbing technique

Trim the fingernails & clean with

disposable nail files.

Scrub each fingers & interfinger webbing`

Scrub the palm, forearm upto 2 inch above
the elbow.

Rinse the excess of soap & antiseptic

Sterile towel is used to dry the hands.
One hand is dried with one side of the
towel.
Other hand is dried with the other side
of the towel.
Drying is from fingers to elbow.
Gloves
6Two types gloves are available
a. Latex glove
b. Rubber glove

6 Latex glove are more commonly used glove.

6 If surgeon allergic to latex, rubber gloves can be used.
6 Rubber gloves are thinner & provide better tactile sensation.
Gloving technique

Right hand grasps inside cuff surface of left glove.

Left glove is pulled into place.

Gloved fingers of left hand are inserted into
cuff(outer surface) of right glove.

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muff of left glove is unfolded`
Ôreparation of the surgical site
6Ôreparation of surgical site is important to reduce contamination.
6It can be done by presurgical scrub with antiseptic solution.
6Iodophor solution is most effective solution for skin preparation.
6Lubricating ointment is applied on the eye & eye is tapped.
6Auditory meatus is plugged with guaze.
6Hair from the surgical site is shaved just prior to scrubbing the skin.

Ôrinciple of scrubbing
6Should begin in the centre & extend concentrically to the pheriphery.
6Once the centre has been scrubbed, it should not be touched with same
quaze.
6Fresh sterile quaze should be used & should begin again from the centre.
6Skin preparation should take about 5 mins.
Draping the patient
6The purpose of draping the patient is to isolate the surgical area from other parts of the
body & also from nonsterile operating equipments & personnel.
6Draping steps are as follows:

Ôatient·s head placed on sterile sheet covered

by two towels.

Towels are used to drape patient·s head

Additional towels are placed on the
sides to isolate the surgical area.
Towel clips are used to stabilize the
towels.
Reference
6Oral and Öaxillofacial Surgery Vol.1- Daniel Laskin
6Textbook of Öicrobiology- Anantnarayan
6Essential of Öedical Ôharmacology- K D Tripathi