INFECTION CONTROL IN OMFS
Dr. Rahul Tiwari – 2nd Yr. MDS – PG Student.Department of Oral & Maxillofacial Surgery.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 1
PRESENTING SEMINAR ON
CONTENTS
INTRODUCTION HISTORICAL RELEVANCETRANSMISSION OF INFECTION MODE OF TRANSMISSIONINFECTION CONCERN IN OMFSOBJECTIVES OF INFECTION CONTROLPERSONAL BARRIER PROTECTIONEMERGENCY & EXPOSURE INCIDENT PLANOPERATORY ASEPSIS
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 2
DISINFECTIONINSTRUMENT HANDLING & CLEANINGSTERILIZATIONMONITORS OF STERILIZATONSTORAGE OF STERILIZED ITEMS HANDPIECE ASEPSISCLINICAL WASTE DISPOSALCONCLUSION & REFERENCES.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 3
CONTENTS
4
Introduction Our bodies are amazing structures that defend us against infections under normal circumstances.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72
5
Body’s DefensesImmunity – resistant to pathogens and the disease they cause
If defenses are not functioning properly, person will become susceptible to invasion and infection.
Lines of DefenseSkin Normal floraStaying healthy
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72
INTRUDING BODY’S LINE OF DEFENSE
During any operative procedure, we are breaching body’s line of defense
Sterilization , Disinfection and Asepsis becomes important05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 6
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 7
History of Infectious Disease Prevention 3,000 BC – Egyptians use antiseptics such as
pitch or tar, resins and aromatics.
550 BC, Greek Infantry men known as hoplite
sometimes fought naked, pieces of clothing
carried into a wound by a penetrating sword or
spear point were more likely to cause infection.
460-377 BC Hippocratus used wine or boiled
water, for asepsis.
Holmes and Sommelweis
HolmesDemonstrated that fever was carried from patient to patient by doctors.
8
Sommelweis Also concluded
fever was a communicable disease.
The Hungerian Obstetrician Sir IGNAZ SOMMELWEIS & OLIVER HOLMES laid down general principles of asepsis
Made hand washing compulsory before any operative procedure
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72
9
Joseph Lister
Discovered how to use chemical antiseptics to control surgery related infections
Used antiseptics to disinfect surgical equipment and supplies
FATHER OF ANTISEPTIC SURGERY05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72
Joseph Lister
Lister began washing his hands before operating, and wearing clean clothes.
Lister also sprayed the air with carbolic acid to kill airborne germs.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 10
130-200 AD Galen A Greek distinguished physician boiled
instruments used in caring for wounds
1683, Anton van Leeuwenhoek, invents the microscope and
proves the existence of microorganisms.
1758 – the earliest recorded instance of the use of surgical
glove- Dr. Johann Julius Walbaum formed a glove from the
intestines of a sheep and used it to deliver babies
Indian connection-CHARAKA & SUSHRUTA used Boiling Water
(Ocimum sanctum, Mangifera Indica, Neem neem)
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 11
DEFINITIONSSTERILIZATION: Use of a physical or chemical
procedure to destroy all microorganisms including substantial numbers of resistant bacterial spores.
Sterilization means the destruction of all life forms. (Ronald B
Luftig)Sterilization is the process of killing or removing all
viable organisms. (MIMS –
PLAYFAIR)
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 12
Ref : C.P BAVEJA, Text book of microbiology, pg:-20-22,2nd edition, 2006Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-4-6, 3rd edition, 2005Ref ; Daniel M. Laskin, oral and maxillofacial surgery, pg:-346-355, vol 1, 2013
DISINFECTION: Destruction of pathogenic and other kinds of microorganisms by physical or chemical means. Disinfection is less lethal than sterilization, because it destroys the majority of recognized pathogenic microorganisms, but not necessarily all microbial forms (e.g., bacterial spores).
Disinfection is a process of removing or killing most, but not all, viable organisms.(MIMS-PLAYFAIR).
Disinfection refers to the destruction of pathogenic organisms.(Ronald B Luftig).
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 13
Ref : C.P BAVEJA, Text book of microbiology, pg:-20-22,2nd edition, 2006Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-4-6, 3rd edition, 2005Ref ; Daniel M. Laskin, oral and maxillofacial surgery, pg:-346-355, vol 1, 2013
DEFINITIONS
DISINFECTANT: A chemical agent used on inanimate objects to destroy virtually all recognized pathogenic microorganisms, but not necessarily all microbial forms
(e.g., bacterial endospores). DECONTAMINATION: Is the process of removal of contaminating pathogenic microorganisms from the articles by a process of sterilization or disinfection. It is the use of physical or chemical means to remove, inactivate, or destroy living organisms on a surface so that the organisms are no longer infectious.
ASEPSIS: Is the employment of techniques (such as usage of gloves, air filters, uv rays etc) to achieve microbe-free environment
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 14
Ref : C.P BAVEJA, Text book of microbiology, pg:-20-22,2nd edition, 2006Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-4-6, 3rd edition, 2005Ref ; Daniel M. Laskin, oral and maxillofacial surgery, pg:-346-355, vol 1, 2013
DEFINITIONS
Antisepsis is the use of chemicals (antiseptics) to make skin or mucus membranes devoid of pathogenic microorganisms.
Bacteriostasis is a condition where the multiplication of the bacteria is inhibited without killing them.
Bactericidal is that chemical that can kill or inactivate bacteria. Such chemicals may be called variously depending on the spectrum of activity, such as bactericidal, virucidal, fungicidal, microbicidal, sporicidal, tuberculocidal or germicidal.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 15
Ref : C.P BAVEJA, Text book of microbiology, pg:-20-22,2nd edition, 2006Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-4-6, 3rd edition, 2005Ref ; Daniel M. Laskin, oral and maxillofacial surgery, pg:-346-355, vol 1, 2013
DEFINITIONS
TRANSMISSION OF INFECTION Infection transmission during dental
procedures is dependent on four factors:1. Source of infection – may be a patient or a
member of the dental team who is suffering from, or is a carrier of an infectious disease.
SOURCE
16
Patients suffering from acute infection
Patients in prodromal stage
carriers
known unknown
Ref ; C.P.Baveja, text book of microbiology, 2nd edition, pg:-49-50, 2006Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-33-35 , 3rd edition, 2005
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72
2. Means of transmission – Micro organisms capable of causing disease are present in human blood and saliva. Contact with blood or saliva may transmit such pathogenic organisms causing infection.
3. Route of transmission – Transmission may occur due to inhalation or inoculation.
4. Susceptible host – Is a person who lacks effective resistance to a particular micro organism. E.g immuno compromised patients, pregnant women and children.
17
Ref ; C.P.Baveja, text book of microbiology, 2nd edition, pg:-49-50, 2006Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-33-35 , 3rd edition, 2005 05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72
NOSOCOMIAL INFECTIONS
Hospital acquired infections
Study on efficacy of NI control projected by US CDC in 1970 to reduce NI
and it results approx. 32% reduction in NI in hospitals and health care units.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 18
STRATEGY TO ACHIEVE INFECTION CONTROLScreening
PPE
Aseptic techniques
Sterilization & disinfection
disposal
Laboratory asepsis05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 19
PERSONAL BARRIER PROTECTION
Personal protective equipment (PPE), or barrier precautions, are a major component of Standard precautions.
PPE is essential to protect the skin and the mucous membranes of personnel from exposure to infectious or potentially infectious materials.
The various barriers are gloves, masks, protective eye wear, surgical head cap, foot wear & overgarments
20
Ref : C.P BAVEJA, Text book of microbiology, pg:-20-22,2nd edition, 2006Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-4-12, 3rd edition, 2005Ref ; Daniel M. Laskin, oral and maxillofacial surgery, pg:-346-355, vol 1, 2013
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72
GLOVES All clinical personnel must wear treatment
gloves during all procedures. Types:1. Latex gloves2. Vinyl gloves3. Nitile gloves4. General purpose utility gloves
21
Ref ; Daniel M. Laskin, oral and maxillofacial surgery, pg:-346-355, vol 1, 2013Ref : Chitra Chakravathy, textbook of oral & maxillofacial surgery, pg:-12-13 ,2nd edition,201105/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72
PROTECTIVE GOWNS
22
Gown type Situation and RationaleCotton/linen, reusable or disposable,
long-sleeved isolation gownsUse if contamination of uniform or
clothing is likely or anticipated
Fluid resistant isolation gown or plastic apron over isolation gown
Use if contamination of uniform or clothing from significant volumes of
blood or body fluids is likely or anticipated (fluids may wick through
non-fluid resistant reusable or disposable isolation gowns)
impervious gowns e.g., Gortex® Fluid
Use if extended contact or large volume exposure (e.g., large volume blood loss during resuscitation of MVA victim or
surgical assist)
Ref ; Daniel M. Laskin, oral and maxillofacial surgery, pg:-346-355, vol 1, 2013Ref : Chitra Chakravathy, textbook of oral & maxillofacial surgery, pg:-12-13 ,2nd edition,201105/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72
PRECAUTIONS TO AVOID INJURY EXPOSURE
23
Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-24-26, 3rd edition, 2005Ref ; Daniel M. Laskin, oral and maxillofacial surgery, pg:-346-355, vol 1, 2013
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72
EMERGENCY & EXPOSURE INCIDENT PLAN
Management of exposure includes:A. General wound care and cleaning.B. Counseling of the exposed worker regarding blood
borne pathogens.C. Source patient testing for HBV,HCV and HIV
(consent required).D. Documentation of the incident and review.E. Post exposure assessment and prophylaxis for the
health care worker.F. Baseline and follow up serology of the worker.
24
Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-24-26, 3rd edition, 2005Ref ; Daniel M. Laskin, oral and maxillofacial surgery, pg:-346-355, vol 1, 2013Ref : Neelima malik, textbook of oral & maxillofacial surgery, pg:-70-101 ,2nd edition,2011
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72
HAND CLEANSERS
CHLORHEXIDINE BASED – these contain 2- 4% chlorhexidine gluconate with 4% isopropyl alcohol in a detergent solution with a pH of 5.0 to 6.5. They have broader activity for special cleansing(e.g: for surgery, glove leaks, or when clinician experiences injury). But it can be hazardous to eyes.
POVIDONE IODONE – contain 7.5-10% povidone iodine, used as a surgical hand scrub.
PARACHLOROMETEXYLENOL(PCMX) – these are bactericidal and fungicidal with 2% concentration. Non irritating and recommended for routine use.
ALCOHOL HAND RUBS- ethyl alcohol and isopropyl alcohol are widely used at 70% concentration. They are rapidly germicidal when applied to the skin.
25
Ref : C.P BAVEJA, Text book of microbiology, pg:-20-22,2nd edition, 2006Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-4-6, 3rd edition, 2005Ref ; Daniel M. Laskin, oral and maxillofacial surgery, pg:-346-355, vol 1, 2013Ref : Chitra Chakravathy, textbook of oral & maxillofacial surgery, pg:-12-13 ,2nd edition,201105/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 26
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 27
LEVEL SPECTRUM USE EXAMPLES
Low level Bacteria exceptmycobacteria not spores.Some fungi and someViruses.
Surfaces withoutblood
Quaternary ammoniums, some phenolics,some iodofors
Intermediatelevel
Mycobacteria, not spores.Most fungi and most viruses.
Surfaces withblood
Quaternary ammoniums with alcohol, chlorines, phenolics, iodofors
High level All microbes except spores
Immersion Glutaraldehyde, strong peroxides, ophthaldehyde
CHEMICALS FOR DISINFECTION
Ref: Cohen: Pathways of the Pulp, 9th Edition pg:-1-9,2007
INSTRUMENT PROCESSING
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 28
Ref: Cohen: Pathways of the Pulp, 9th Edition pg:-1-9,2007
Selection of packaging materials for sterilizationSteam sterilization cellulose, cotton/polyester cloths, window
packs, perforated rigid containers with bacterial filters, glass containers for liquids
Dry heat (hot air oven) Metal canisters and tubes of aluminium foil, glass tubes, bottles
ETO Paper & Plastic, perforated rigid containers with bacterial filters
Low temperature steam Paper, cloth
Radiation sterilization Polyethylene, PVC, polypropylene, foil.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 29
Ref: Cohen: Pathways of the Pulp, 9th Edition pg:-1-9,2007
ULTRASONIC CLEANERS AND SOLUTIONS
Ultrasonic cleaning is the safest and most efficient way to clean sharp instruments.
An ultrasonic cleaning device should provide fast and thorough cleaning without damage to instruments; have a lid, well-designed basket, and audible timer; and be engineered to prevent electronic interference with other electronic equipment
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 30
Physical agents:1. Sunlight2. Drying3. Dryheat: flaming,
incineration, hot air 4. Moist heat:
pasteurization, boiling, steam under pressure, steam under normal pressure.
5. Filtration: candles asbestos pads, membranes
6. Radiation7. Ultrasonic and sonic
vibrations
Chemical agents:1. Alcohols: ethyl, isopropyl,
trichlorobutanol2. Aldehydes:
formaldehyde, glutaraldehyde
3. Dyes4. Halogens5. Phenols 6. Surface-active agents7. Metallic salts8. Gases: ethylene oxide,
formaldehyde, beta propiolactone.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 31
Agents used in sterilization
The four accepted methods of sterilization are :A. Steam pressure sterilization (autoclave) B. Chemical vapor pressure sterilization-
(chemiclave)C. Dry heat sterilization (dryclave) D. Ethylene oxide sterilization
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 32
Ref : C.P BAVEJA, Text book of microbiology, pg:-20-30,2nd edition, 2006Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-24-26, 3rd edition, 2005
STEAM PRESSURE STERILIZATION (AUTOCLAVING)
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 33
Advantages of Autoclaves. Autoclaving is the most rapid and effective method for sterilizing cloth surgical packs and towel packs.
Is dependable and economicalSterilization is verifiable.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 34
Ref : C.P BAVEJA, Text book of microbiology, pg:-20-30,2nd edition, 2006Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-24-26, 3rd edition, 2005
Disadvantages of Autoclaves. Items sensitive to the elevated temperature cannot be autoclaved.
Autoclaving tends to rust carbon steel instruments and burs.
Instruments must be air dried at completion of cycle.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 35
Ref : C.P BAVEJA, Text book of microbiology, pg:-20-30,2nd edition, 2006Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-24-26, 3rd edition, 2005
CHEMICAL VAPOR PRESSURE STERILIZATION (chemiclaving)
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 36
Advantages1. Carbon steel and
other corrosion-sensitive instruments are said to be sterilized without rust.
2. Relatively quick turnaround time for instruments.
3. Load comes out dry.
4. Sterilization is verifiable.
Disadvantages1. Items sensitive
to the elevated temperature will be damaged. Vapor odor is offensive, requires aeration.
2. Heavy cloth wrappings of surgical instruments may not be penetrated to provide sterilization.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 37
Ref : C.P BAVEJA, Text book of microbiology, pg:-20-30,2nd edition, 2006Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-24-26, 3rd edition, 2005
DRY HEAT STERILIZATION
Conventional Dry Heat Ovens Short-Cycle, High-Temperature Dry Heat Ovens
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 38
Advantages1. Carbon steel
instruments and burs do not rust, corrode, if they are well dried before processing.
2. Industrial forced-draft hot air ovens usually provide a larger capacity at a reasonable price.
3. Rapid cycles are possible at high temperatures.
4. Low initial cost and sterilization is verifiable.
Disadvantages1. High temperatures
may damage more heat-sensitive items, such as- rubber or plastic goods.
2. Sterilization cycles are prolonged at the lower temperatures.
3. Must be calibrated and monitored
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 39
Ref : C.P BAVEJA, Text book of microbiology, pg:-20-27,2nd edition, 2006Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-29-35, 3 rd edition, 2005
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 40
METHOD TEMPERATURE(ºc) HOLDING TIME(MINS)
AUTOCLAVE 121 15
126 10
134 3
HOT AIR OVEN 160 45
170 18
180 7.5
190 1.5
ETHYLENE OXIDE STERILIZATION (ETO)
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 41
MOBILE FUMIGATOR
Advantages:1. Operates
effectively at low temperatures
2. Gas is extremely penetrative
3. Can be used for sensitive equipment like handpieces.
4. Sterilization is verifiable
Disadvantages:1. Potentially
mutagenic and carcinogenic.
2. Requires aeration chamber ,cycle time lasts hours
3. Usually only hospital based.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 42
Ref : C.P BAVEJA, Text book of microbiology, pg:-20-30,2nd edition, 2006Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-24-26, 3rd edition, 2005
OTHER STERILIZATION METHODS
Gamma radiationDry-Heat Sterilizers
Liquid Chemicals Performic Acid Filtration Microwave U.V radiationFlash sterilization
Glass Bead “Sterilizer”
Vaporized Hydrogen Peroxide
Formaldehyde Steam Gaseous Chlorine Dioxide
Vaporized Peracetic Acid
Infrared radiationOxygen plasma sterilization
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 43
Ref : C.P BAVEJA, Text book of microbiology, pg:-20-27,2nd edition, 2006Ref: Cohen: Pathways of the Pulp, 9th Edition pg:-1-9,2007
Ozone sterilization is the newest low-temperature sterilization method recently introduced in the US and is suitable for many heat sensitive and moisture sensitive or moisture stable medical devices
Ozone sterilization is compatible with stainless steel instruments.
Ozone Parameters • The cycle time is approximately 4.5 hours, at a temperature of 850F – 940F.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 44
Ref: Cohen: Pathways of the Pulp, 9th Edition pg:-1-9,2007
ozone
Various new methods of sterilization are under investigation and development.
1. Peroxide vapor sterilization - an aqueous hydrogen peroxide solution boils in a heated vaporizer and then flows as a vapor into a sterilization chamber containing a load of instruments at low pressure and low temperature
2. Ultraviolet light - exposes the contaminants with a lethal dose of energy in the form of light. The UV light will alter the DNA of the pathogens. Not effective against RNA viruses like HIV.
Product made with antimicrobial copper alloy (brases & bronzes) destrots a wide range of organism in a short period of time. US environment protection agency has approved this.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 45
NEW METHODS OF STERILIZATION
Ref : C.P BAVEJA, Text book of microbiology, pg:-20-27,2nd edition, 2006Ref: Cohen: Pathways of the Pulp, 9th Edition pg:-1-9,2007
NEWER TECHNIQUES
Electrospun Poly(lactic acid) (PLA) Fiber Alignment for Biomedical Applications
New disinfection methods include a persistent antimicrobial coating that can be applied to inanimate and animate objects (Surfacine), a high-level disinfectant with reduced exposure time (orthophthalaldehyde), and an antimicrobial agent that can be applied to animate and inanimate objects (superoxidized water).
New sterilization methods include a chemical sterilization process for endoscopes that integrates cleaning (Endoclens), a rapid (4-hour) readout biological indicator for ethylene oxide sterilization (Attest), and a hydrogen peroxide plasma sterilizer that has a shorter cycle time and improved efficacy
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 46
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 47
HANDPIECE SURFACE CONTAMINATION CONTROL
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 48
Ref : Cross infection control, journal of dental nursing, pg:-392-397, vol 9, no.7, july 2013
Surgical hand piece sterilization
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 49
Should DoRemove bur and disconnect handpiece from chair.
Wipe handpiece with alcohol.Locate appropriate hole and spray lube for 2-3 seconds.
Attach handpiece to swivel unit and insert bur.
Run handpiece for 30 seconds to eliminate lube.
Wipe handpiece with alcohol.05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 50
Should DoInsert in autoclave bag…….paper on at least one side of bag.
Load in autoclave with cellophane side down.
Remove from autoclave immediately after all cycles are complete.
Always allow cooling to room temperature, paper side up.
Do not force cool with water or other means.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 51
Should not doDo not immerse hand piece in any solvent, cleaner or ultrasonic solution.
Do not clean hand piece in ultrasonic cleaners or dry heat sterilizers.
Do not exceed temperature of 135°C.Do not use chemical disinfectants, when combined with heat of the autoclave, disinfectants may significantly reduce hand piece life
Do not use all cellophane bags05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 52
Important points to remember
1) The patient is the center of the sterile field.
2) Keep hands at waist level and in sight at all times.
3) Keep hands away from the face.
4) Never fold hands under arms.
5) Gowns are considered sterile in front from chest to level of sterile field, and the sleeves from above the elbow to cuffs. Gloves are sterile.
6) Sit only if sitting for entire procedure.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 53
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 54
THE THEATRE
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 55
National Accreditation Board for Hospitals and Healthcare Providers
OT Size: Standard OT size of 20’ x 20’ x 10’ Occupancy: Standard occupancy of 5-8 persons at any given point Non adherent ,nonporous surfaces- OT WALL CLADINGS Rounded corners
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 56
AIR QUALITY
Air Filtration: The air quality at the supply i.e. at grille level should be Class 1000
Class 1000 means a cubic foot of air must have no more than 1000 particles
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 57
PREPARATION OF
SURGERY
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 58
Principles Of Aseptic Technique
1. Only sterile items are used within the sterile field 2. Sterile persons are gowned and gloved 3. Tables are sterile only at table level 4. Sterile persons touch only sterile items or areas 5. Unsterile persons avoid reaching over the sterile field 6. The edges of anything that encloses sterile contents are considered
unsterile 7.The sterile field is created as close as possible to the time of use 8. Sterile areas are continuously kept in view 9. Sterile persons keep well within the sterile area 10. Break of the integrity of microbial barriers results in contamination
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 59
Preoperative showering with hexachlorophene has shown reduction in wound infection.
Short preoperative hospital stay reduces pathogenic bacteria on skin and nasal carrier state.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 60
Pre-operative hair removal Shaving a patient’s skin before surgery may
raise the risk of an infection. In its guidelines for preventing surgical site
infections, the Centre for Disease Control recommends that hair should not be removed unless it will interfere with the operation.
When shaving is necessary, electrical clippers should be used.
Preferably immediately before surgery Shaving with a razor blade causes microscopic
nicks in the skin that can become bacterial breeding grounds.
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 61
Before the skin preparation of a patient is initiated, the skin should be free of gross contamination (i.e., dirt, soil, or any other debris)
The patient’s skin is prepared by applying an antiseptic in concentric circles, beginning in the area of the proposed incision and medial to lateral.
The prepared area should be large enough to extend the incision or create new incisions or drain sites
Patient skin preparation
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 62
DRAPING THE PATIENT
Turban draping
Commercially available drapes
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 63
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 64
Wet your hands, apply a little soap or forearms to 5cm above your elbows for one complete minute
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 65
Gowning
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 66
Gloving
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 67
68
Hazardous Waste management
Hazardous waste products include:Blood and blood productsBody fluids and tissueCultures VaccinesSharpsGlovesSpeculaInoculating loopsPaper product contaminated with body fluids
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72
CLINICAL WASTE DISPOSAL
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/7269
YELLOW BAG RED BAG BLUE BAG BLACK BAG ORANGE BAG
•Human anatomical waste•Animal waste•Microbiology and biotechnology waste•Solid waste( items contaminated with body fluids)
•Microbiology and biotechnology waste•Solid waste (tubings, iv catheters)
•Waste sharps•Solid waste (tubings, iv catheters)
•Discarded medicines and cytotoxic drugs•Incineration ash•Chemicals used in disinfection & insecticides
• Animal and slaughter house waste
Ref. Guidelines on HIV testing, National AIDS Control Organization (NACO), march 2007, pg :-32 Ref. Preventive and social medicine, K.PARK, pg.738-739, 22nd edition, 2013
CONCLUSION & REFERENCES
“Strictly following the protocols of sterilization & disinfection will results in high success rate and decrease in surgical infections & postoperative complications ”
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 70
1. Anantnarayan-Textbook of Microbiology
2. LJ Peterson-Cotemporary Oral & Maxillofacial Surgery
3. Laskin-Textbook of Oral & Maxillofacial Surgery
4. Fonseca-vol-2, edition 3
“There Is No Compromise with SterilityIt’s either Sterile or Unsterile.”
Take home message…….
05/02/2023 RT/5/INFECTION CONTROLL IN OMFS/72 71