Surgicai Staff Preparationa
The preparation of the operating team for surgery differs
according to the nature of the procedure being performed
and the location of the’ surgery. The two basic types of
personnel asepsis to be discussed are (1) the clean technique
and (2) the sterile technique. Antiseptics are used
during each of the techniques, so th.ey are discussed firs.
Iodophors, such as polyvinylpyrrolidone-iodine
(povidone-iodine) solution, have the broadest spectrum
of antiseptic action, being effective for both grarn-posittve
and gram-negative bacteria, most viruses, M. tuberculosis
organisms, spores, and fungi.
Iodophors are usually formulated in a 1% iodine solution.
The scrub form has an added anionic detergent.
lodophors are preferred over noncompounded solutions
of iodine because they-are much less toxic to tissue than
free iodine and more water soluble. However, iodophors
are contraindicated for use on individuals ‘scnsttive to
iodinated materials, those with untreated hypothyroidism,
and pregnant women. Iodophors exert their
effect over a period of several minutes, so the solution
should remain in contact with the surface for at least a
few minutes for maximal effect.
FIG. 5-7 Surgeon ready for office oral surgery, wearing clean gown
over street clothes, mask over nose and mouth, cap covering scalp
hair, clean gloves, and shatter-resistant eye protection. Nondangling
earrings are acceptable in clean technique.
Dentists should wear gloves whenever they arc providing
dental care. \\’hen the clean technique is used, the
hands can be washed with antiseptic soap and dried on a
disposable towel before gloving. Glows should be sterile
and put an using an appropriate technique to maintain
sterility of the external surfaces. The technique of sterile
self-gloving is illustrated in Fig. 5-8.
In general, eye protection should be worn whenblood or
saliva are dispersed, such as when high-speed cutting equipment
is used (see l-ig. 5-7j. A mask should be used whenever
aerosols are created or a surgical wound is to be made.
In most cases-it is not absolutely necessary to prepare
the operative site when using the clean technique. llowever,
when surgery in the .oral cavity is performed, theperioral skin may be decontaminated with toe same solutions
used to scrub the hands and the oral cavity prepared
by brushing or rinsing ‘with chlorhexidine gluconate
(O.12’h» or an alcohol-based mouthwash. These procedures
will reduce the amount of skin or oral mucosal contamination
of the wound and decrease the microbial load
of any aerosols made while using high-speed drills in the
mouth. The dentist may desire to drape the patient to
protect the patient’s clothes, to keep objects from accidentally
entering the patient’s eyes, and to decrease
suture contamination should it fall across an uncovered,
unprepared part of the patient’s body.
The surgical hand and arm scrub is another means of
lessening till’ chance of contaminating a patient’s wound.
,\lthuu.~ll ,tenlL’ gloves are worn, gloves can be torn
cespcciall;: when using high-speed drills or working
around wires), thereby exposing the surgeon’s skin. By
proper scrubbing with antiseptic solution, the surface
bacterial level of the hands and arms is greatly reduced.
Most hospitals have a surgical scrub protocol that
should be followed when performing surgery in those
institutions .. ‘\ltl1ough several acceptable methods can be
used, standard to most techniques is the use of an antiseptic
soap ~l lution, a modcratelv stiff brush, and a’ fin-
.geruatl cu ancr, The hands and f~rearms are wetted in a
scrub sink, and the hands are kept above the level of the
elbows after wetting until the hands and arms are dried.
Then more antiseptic soap is applied and vcruhbiru; is
begun, with repeated firm strokes of the scruli brush on
everv surface of the hands and arms up to npproxuu.itclv
.) ern below the elbow, Scrub techniques based on tl e
number of strokes to each surface are more reliable than
FIG. 5-8 Technique of sterile self-gloving. A, Fingers of right
hand are placed into right glove; fingers of left hand hold interior
edge of cuff. B, Right hand slowly pushes into glove, while left
hand pulis glove on hand. Cuff of right glove is left unturned at
this stage. C, Right hand is placed inside cuff of left glove, and left
hand is then placed into opening of left glove. Care is taken not to
allow right hand to touch interior of left glove. Right hand remains
only on exterior surface of left glove. 0, Left hand slowly pushes
into left glove, while right hand helps to push glove on opposue
hand. After fingers of left hand are completely in place, right hand
turns- cuff down onto forearm, taking care not to let right glove
touch any nonsterile surface. E, Fingers of left fully gloved hand
are inserted into ‘cuff of right glove and are used to turn that cuff
down, which completes self-gloving procedure
a set timefor scrubbing. An individual’s scrub technique
should follow a routine that has been designed to ensure
that’ no forearm or hand surface is left improperly pre-
,pared. An example of an acceptable surgical scrub technique
is shown in Chapter 31.
Wounds management. A few principles of postsurgical
‘care are useful to prevent the spread of pathogens.
Wounds should Be inspected or dressed by hands that are
covered with fresh, clean gloves, When several” patients
are waiting, those without infectious problems should be
seen first, and those with problems such as a draining
abscess should be seen afterwards.
Taikng care never to apply or remove a blade from a scalpel
handle without an instrument (Fig. 5-9, A); and disposing
of used blades, needles, and other sharp disposable items
into rigid, well-marked receptacles specially designed for
contaminated sharp objects (Fig.’ 5-9, B). For environmental
protection, contaminated supplies should be discarded
in properly labeled bags and removed by a reputable
hazardous waste management company.
– FIG. 5-9 A”Scoop technique for resheathing needle. B, Self-resheathinq needle. C, Proper disposal of
sharp, disposable supplies into well-marked, rigid container to prevent accidental inoculation of office
staff or cleaning workers with contaminated debris.
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