STERILISATION AND

DISINFECTION
Presented by,
Dr. Sreelekshmi J
Post Graduate
Dept of Oral and Maxillofacial Surgery
 CONTENTS
• Introduction
• History
• Terminologies
• Spaulding Classification of Medical Devices And Level of Disinfection
• Principles of Sterilization
• Methods of Sterilization
• Tests For Efficiency For Heat Sterilization
• Disinfectants
• Testing of Disinfectants
• Recent Advances in Sterilization and Disinfection
 INTRODUCTION

• Microorganisms are ubiquitous.

• Good infection prevention and control is essential to
ensure the safety of the patient undergoing any surgical
procedure in the operating theater.
• The surgical site infections (SSIs) constitute 20% of the
total hospital-acquired infections. Since these infections
are primarily acquired during the operative procedure
when the wound is still open, stringent protocols need to
be followed at this point to minimize their onset.
 HISTORY
First century BC
• Varo and Columella postulated that diseases were caused by invisible beings,
“animals minutia,” inhaled or ingested.
500 AD
• Sushruta instructed operating team members to clean and fumigate the operating
theater with vapors of certain disinfectants prior to all surgical procedures.
1493–1541
• Paracelsus, called the father of medicine, reformed pharmacopeia and introduced
compositions of lead, copper, sulfur, iron, and mercury.
1546
• Fracastorious proposed a “contagion vivum,” as the possible cause of infectious
diseases.
1827–1912
• Joseph Lister, “father of modern surgery,” demonstrated that antisepsis
could prevent infections; also known as “Listerian era.”
1889
• William Stewart Halsted introduced rubber gloves for his scrub nurse.
1882
• Robert Koch introduced the use of mercuric bichloride as antiseptic
agents and isolated the bacilli of tuberculosis.
1880s and 1890s
• Sterilization of instruments, hand washing, and the wearing of masks,
caps, gloves, and gowns was introduced.
 TERMINOLOGIES

Sterilization
• Sterilization is a process that destroys or removes all microbial life completely,
including spores by means of certain chemical or physical processes.
Disinfection
• Antimicrobial process to remove, destroy, or deactivate microorganisms on surfaces
or in liquids.
Disinfectant
• This is an agent, usually a chemical, applied on inanimate objects that destroys
microorganism in the vegetative form but not the spores.
Asepsis
• The state of being free from living pathogenic organisms.
 TERMINOLOGIES
Antisepsis
• It is the process in which microbial agents on a living surface are either killed or
their growth is arrested.
Antiseptic
• These are the substances applied on the living tissues to reduce the possibility of
infection, sepsis, and putrefaction by inhibiting the activity or growth of the
microorganisms.
Bioburden
• The occurrence of viable microorganisms on a surface or object before the
sterilization procedure.
Crossinfection
• The spread of infection from one person, object or place to another.
 Spaulding Classification of Medical Devices
And Level of Disinfection
• Critical: An instrument that has a direct contact with sterile tissues or vascular
system; such items are to be sterilized and made free from all microorganisms.
Examples are extraction forceps, scalpel blades, bone chisels, periodontal scalers,
surgical burs, needles.
• Semicritical: An instrument that does not usually penetrate the sterile tissues but
does come in contact with intact mucous membrane. These items are made free from
microorganisms by high-level disinfection. Examples include endoscopes, amalgam
condensers, air/water syringe, impression trays, dental hand piece, dental mirrors.
• Noncritical: An instrument that does not touch the patient directly or come in
contact with the intact skin only. These items may be cleaned or disinfected by low-
level disinfection. Examples include light arm/handles, dental chair, dental X-ray
equipment, chair side computers, chair switches.
 PRINCIPLES OF STERILISATION
• All used instruments should be thoroughly cleaned; all deposits of blood and debris
should be removed before sterilization.
• It is essential for the sterilizing agent (heat, steam and/or gas) to be in contact with
every surface of each item to be sterilized for the specified period of time at the
specified temperature.
• All sterilizing equipment must be regularly serviced and maintained by suitably
qualified engineers. Appropriate test must be applied to check temperature, humidity,
pressure, and gas content when appropriate; and which proves the elimination of
bacteria and spores.
• The manufacturer’s instructions should be strictly adhered to for its operation and
maintenance.
 Methods of Sterilisation

PHYSICAL CHEMICAL
 Physical Agents
• Sunlight
• Drying
• Dry heat: flaming, incineration, hot air
• Moist heat: pasteurisation, boiling, steam under normal pressure, steam under
pressure
• Filtration: candles, asbestos pads, membranes
• Radiation
• Ultrasonic and sonic vibration
• Glass beads steriliser
 Chemical Agents

• Alcohols: ethyl, isopropyl, trichlorobutanol

• Aldehydes: formaldehyde, glutaraldehyde
• Dyes
• Halogens
• Phenols
• Surface-active agents
• Metallic salts
• Gases: ethylene oxide, formaldehyde, beta-propiolactone
PHYSICAL AGENTS
 SUNLIGHT

• Sunlight possesses appreciable bactericidal

activity.
• Plays an important role in the spontaneous
sterilisation that occurs under natural
conditions.
• The action is primarily due to its content of
ultraviolet rays.
 DRYING

• Moisture is an essential prerequisite for bacterial growth.

• Drying creates an environment unsuitable for bacterial growth.
• Unreliable method and has no effect on spores.
 DRY HEAT

1. Flaming
The flame of the Bunsen burner is employed
for a few seconds to sterilise the bacteriological
loop before removing a sample from a culture
tube and after preparing a smear.
2. Incineration
Incineration is an excellent method for rapidly destroying materials such as
soiled dressings, animal carcasses, bedding and pathological material.
Disposable hospital gowns and certain plastics are examples of materials
that may be incinerated.
3. Hot Air Oven
• Useful for sterilising dry powders and water-free oily substances, as well as
for many types of glassware, such as pipettes, flasks, forceps, scissors,
scalpels and glass syringes.
• Dry heat neither corrodes sharp instruments as steam often does, nor does it
erode the ground glass surfaces of nondisposable syringes.
 Hot Air Oven

Hot air sterilizer with automatic control of temperature (0 degree to 200 degrees)

• Spore testing should be done once a week to verify proper functioning of

the sterilizer with the help of Bacillus atrophaeus strips.
 Hot Air Oven

Advantages Disadvantages

1. Economical 1. Difficult to control

2. Does not rust metals
3. Easily monitored
4. Used for anhydrous oils and
powders
temperature
2. Slow penetration
3. Photos, textiles, rubber or
metal solder joints cannot be
used
 Glass Beads Sterilizer

• The media used are glass beads, molten metal or salt kept in a cup or crucible.
• The temperature achieved is of 220 C.o

• The method employs submersion of small instruments such as endodontic

files and burs, rotary instruments into the beads; and are sterilized in 10
seconds provided they are clean.
Glass Beads Sterilizer
 MOIST HEAT
• Kills microorganisms by denaturing their proteins.
• Denaturation is a change in the chemical or physical property of a protein.
• Can penetrate better than dry heat, hence kills the microorganisms rapidly at a
lower temperature than dry heat.
• Divided into 3 forms
• TEMPERATURE < 100℃
• TEMPERATURE = 100℃
• TEMPERATURE > 100℃
 TEMPERATURE < 100℃
• Pasteurization
• Vaccine Bath
• Water Bath
• Inspissation
• Low-temperature steam and formaldehyde (LTSF)
 PASTEURISATION
• To reduce the bacterial population of a liquid such as milk and
to destroy organisms that may cause spoilage and human
disease.
Holding Method Flash Ultra-
Pasteurisation Pasteurisation
62.9°C for 30 min 71.6°C for 15 s 82°C for 3 s
followed by
cooling quickly to
13°C or lower

• Destroy all non-sporing pathogens, such as mycobacteria,

brucellae and salmonellae.
MILK PASTEURISATION UNIT
 VACCINE BATH

• Bacterial vaccines are sterilised in special

vaccine baths at 60°C for 1 hour.
 WATER BATH
• Serum or body fluids containing coagulable proteins can be
sterilized by heating for 1 hour at 56 oC on several successive
days.
 INSPISSATOR

• Serum or egg media like LJ media

or Loeffler’s serum slope are
render by heating at 80-85 °C for 30 mins for 3
consecutive days.
 LOW TEMPERATURE STEAM AND
FORMALDEHYDE

• Sterilization is achieved at a low temperature (73ºC),

hence, it is suitable for heat sensitive equipment and
items with plastic components.
 TEMPERATURE = 100℃

• Boiling
• Tyndallisation
• Steam Sterilizer/ Koch’s or Arnold Steam Sterilizer
 BOILING
• Vegetative bacteria are killed at 90 to 100°C.
• Time taken:30 minutes.
Drawbacks
• Destruction of bacterial spores and
the inactivation of viruses cannot always be
assured.
• Cutting instruments become dull
by repeated boiling.
 TYNDALLISATION

• Also known as Intermittent Sterilisation/ Fractional Sterilisation.

• Steam at 100°C for 20 mins on 3 successive days.
• For sterilisation of egg serum or sugar containing media which gets destroyed
at higher temperature of autoclave.
 STEAM STERILISER/ KOCH’S OR
ARNOLD STEAM STERILISER

• Used for media which are

decomposed at higher temperature
of autoclave.
• 100°C for 90 minutes.
 TEMPERATURE > 100℃
AUTOCLAVE
• Principle – Saturated steam under pressure(good penetrating power).
• Used to sterilise culture media, rubber material, gowns, dressing, gloves etc.
• Particularly useful for materials which cannot withstand higher temperature
of hot air oven.
Pressure Temperature Duration
15 psi 121.5℃ 15 mins

20 psi 126℃ 10 mins

30 psi 133℃ 03 mins

 AUTOCLAVE
ADVANTAGES DISADVANTAGES
1. Economical 1. Carbon steel gets damaged
2. Good penetration 2. Moisture retention
3. Short cycle time
4. Easily monitored
5. No special chemicals or
exhaust required
 Types Of Autoclaves

1.Downward (gravitation) displacement

sterilizer:
• This is nonvacuum type autoclave.
• Steam is self generated.

2.Steam sterilizers (autoclave) with

pre- and post vacuum processes—Class B type
 PREVACUUM AUTOCLAVE

• Draws air out of the sterilising chamber at the

beginning of the cycle.
• Saturated steam is then used at a temperature of
132−134°C at a pressure of 28 to 30 lb/in2.
• A vacuum pump operates at the end of the cycle
to remove the steam and dry the load.
ADVANTAGES:
• minimal exposure time for sterilization(4 min)
and the reduced time to complete the cycle.
 TESTS FOR EFFICIENCY FOR HEAT
STERILISATION
1. Thermocouple
2. Brown’s Test
3. Spore Testing
4. Autoclave Tape
 OZONE
• Ozone steriliser uses oxygen, water and electricity
to produce ozone within the steriliser and provide
sterilisation without producing harmful chemicals.
• Runs at lower temperature(25 – 35 C).
0
 FILTRATION

• Used to sterilize heat labile liquids like sera, sugar solutions

and antibiotic solutions.
• Bacteria free filtrate of Virus sample is obtained.
• TYPES:
a. Earthenware candles filters
b. Asbestos disc filters
c. Sintered glass filters
d. Membrane filters
e. Air filters
 Earthenware candles filters
Asbestos disc filter Sintered glass filters

Membrane filters
Air filters
 RADIATION
IONISING RADIATION
• X-rays, gamma rays, cosmic rays
• Cold sterilization
• High penetrating power
• Lethal to DNA
• Plastics, syringes, gloves, suture
materials, catheters.
NON-IONISING RADIATION
• Infrared radiation
• EM waves with wavelength longer than
visible light
• Rapid mass sterilisation of syringes and
catheters.
• Ultraviolet radiation
• Disinfecting entryways, wards, OTs.
• Do not penetrate liquids/ solids
• Damage human skin cells
RADIATION
ULTRASONIC AND SONIC VIBRATION
• Microorganisms vary in their sensitivity to them and survivors are found after
such treatment.
• Hence, this method is of no practical value in sterilisation and disinfection.
 HOT OIL BATH
• Used for sterilization of metallic instruments.
• At a temperature of 175ºC, submersion for 15 minutes is required for
sterilization.
DISADVANTAGES:
o poor penetration,
o poor sporicidal activity,
o presents a fire hazard,
o difficult to remove from instruments such as handpieces without
recontamination.
• Should not be used for hypodermic syringes or needles because of the danger
of oil embolization.
 CHEMICLAVE

• also called Harvey sterilizer.

• uses chemical solution containing 0.23 percent
formaldehyde, 72.38 percent ethanol (ethylmethyl,
Ketone solution), acetone, ketone, water and other
alcohols.
• required combinations of temperature and pressure
are 127 to 132ºC/270ºF at 20 to 40 psi for 30
minutes.
• suitable for handpieces, burs—carbon steel and
diamond, orthodontic wires, bands, pliers, etc.
 CHEMICLAVE

ADVANTAGES DISADVANTAGES

1. Short time cycles 1. Instruments must be dry

2. Limits rust on high carbon steel 2. Damages textiles and liquids
3. Easily monitored 3. Costly
4. Unpleasant odour
5. Good ventilation required
CHEMICAL AGENTS
 DISINFECTANTS

PROPERTIES OF AN IDEAL DISINFECTANT

• Broad spectrum
• Fast acting
• Non toxic
• Non allergic
• Surface compatibility
• Easy to use
• Non corrosive
• Odorless and economical
 DISINFECTANTS

Mode of action:

• Protein coagulation

• Disruption of cell membrane

• Removal of sulphydryl groups.

 ALCOHOLS

Ethanol and isopropyl alcohol –

• Disinfectant and antiseptic
• Gram positive bacteria targeted
• Denaturing protein
• Maximum effect – 10 min contact , 70% conc (Spaulding)
 ALCOHOLS
ADVANTAGES DISADVANTAGES

Rapidly bactericidal Not sporicidal

Virucidal and fungicidal Damages plastic and rubber

Economical Flammable
 ALDEHYDES

2% Glutaraldehyde
• Effective against vegetative bacteria, spores, viruses, fungi.
• Used on metal, bronchoscopes, porcelains.
• Toxic and irritating, rinsed with sterile water or alcohol.
 ALDEHYDES
Aqueous Formaldehyde ( Formalin ):
• Active against amino group in protein molecule.
• 10% formalin + 0.5% sodium tetraborate used to
sterilize clean metal instruments.
• Instruments can be sterilised by placing them
in a 20% solution of formaldehyde in 70% alcohol
for 18 h.
• Bactericidal, sporicidal, lethal against viruses
• Noxious odour
• Min 18-30 hours is necessary
 PHENOLS
• Used for disinfection of walls, floors , plastics
• Corrosive to living tissues
• Cell membrane damage
• Unique action, that it keeps working
for longer period after initial application, known as
“Residual Activity”
• They are not sporicidal at room temperature
• Example : Carbolic acid
 PHENOLS
ADVANTAGES DISADVANTAGES
• Broad Spectrum • Damages ocular tissues
• Tuberculocidal • May contain certain metals
• Biodegradable
 IODOPHOR COMPOUNDS

• Oldest antiseptic
• Potent germicidal effect
• Concentration used:
• 7.5% Povidone Iodine for scrubbing
• 10% Povidone Iodine for painting
 QUARTERNARY AMMONIUM
COMPOUNDS

• Benzalkonium chloride (Zephiran) was

commonly used both as an antiseptic and
a disinfectant.
• It is not effective against spores, viruses
and M. tuberculosis.
 GAS

FORMALDEHYDE GAS
• Widely used in operation theatres
• Generated by adding 150 g of KMnO4 to 280 mL formalin for every 1000 cu ft
(28.3 cu m) of room volume.
• Heat resistant vessels should be used.
• After starting generation of formaldehyde vapour, the doors should be sealed
and left unopened for 48 h.
FORMALDEHYDE
 ETHYLENE OXIDE GAS (ETO)

• Ethylene oxide gas is an alkaline, non-corrosive

agent, highly penetrative that infiltrates packaged
medical devices to kill bacteria, spores and viruses.
• Causes alkylation of protein molecules.
• Excellent sterilizer of heat sensitive items like
plastic, rubber.
• Ideal for electric equipment, flexible fiber
endoscopes and photographic equipment.
 BETAPROPIOLACTONE (BPL)

• Condensation product of ketone and

formaldehyde with a boiling point of 163°C.
• More efficient than formaldehyde.
• Rapid biocide action.
• Carcinogenic and low penetrating power.
 RECENT VAPOR PHASE
DISINFECTANTS
1. Hydrogen Peroxide
Used to decontaminate biological safety cabinets.
2. Peracetic Acid
It is an oxidising agent
One of the high level disinfectants
Used in plasma sterilizers.
 TESTING OF DISINFECTANTS

1. Minimum Inhibitory Concentration(MIC)

2. Rideal Walker Test
3. Chick Martin Test
4. Capacity Test(Kelsey and Sykes Test)
5. In-use test
 APPROACHES TO DISINFECTING
SURFACES
• Spray – wipe – spray technique:
 APPROACHES TO DISINFECTING
SURFACES
• Wipe- discard – wipe technique :
MATERIALS METHODS
Metal instruments Gamma, infrared radiation
Swabs Autoclave
Sharps Hot air oven, 5% cresol
Pre packed syringes Gamma radiation, ethylene oxide
Sutures Autoclave
Pre packed gloves Ethylene oxide
Surgical dressings Autoclave
Pharmacological products Autoclave, hot air oven
Culture media Autoclave
Rubber, plastics Glutaraldehyde
Laboratories, OTs UV radiation, Formaldehyde
 RECENT ADVANCES IN
STERILIZATION AND DISINFECTION
TECHNOLOGY
• Pulsed light (PL) technology is an emergent and rapid method for the
sterilization/disinfection of surfaces via using short duration pulses of white light.
• Advantage - After the sterilization/disinfection it does not leave any kind of
residues and this method is faster.
• Gas plasma have been widely used for the inactivation of microorganism.
Several types of gases like nitrogen, oxygen, helium, argon, xenon and air are
utilized as a source of plasma.
Low temperature sterilization (LTS) has invaded the operation theatre (OT) because
many components of advanced minimally invasive surgical (MIS) instruments,
including robotic surgery equipment, have zero tolerance for high temperature steam
sterilizers.
ETO gas sterilisation requires prolonged aeration times besides being mutagenic,
carcinogenic, irritant to the eye, skin and airway, and can cause neurological, liver
and kidney damage. Gas plasma sterilization is safe, quick and requires no aeration.
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 (ortho-phthalaldehyde), and an antimicrobial agent
that can be applied to animate and inanimate objects (superoxidized water).
SURGICAL ASEPSIS
 SURGICAL ASEPSIS

• Attempt to prevent microbes from gaining

entry into surgically created wounds.
• Minimizes post op infection.
• 25% of infections develop from surgical
wounds.
 PRE-PROCEDURAL MOUTHWASH

• Antimicrobial mouth rinse used by patients

before a dental procedure.
• Advantages:
- Reduces airborne transmission and surface
contamination.
- Reduces transmission of microbes from the oral
cavity to other internal organs.
- Prophylactic mouth rinse.
 CHLORHEXIDINE

• It is a bisbiguanide.
• It is bacteriostatic and bactericidal at a higher
concentration.
• It is cationic and gets attracted to the negatively
charged bacterial cell wall.
• Gets adsorbed immediately in through the cell wall.
• Integrity of wall is affected.
• Leakage of lower molecular weight components.
 POVIDONE IODINE

• No significant plaque inhibitory activity when used as

1% mouthwash.
• Unsatisfactory in long term use as significant amount
of this compound is absorbed by oral cavity.
• Certain studies show it can reduce inflammation and
progression of periodontal diseases.
• In clinical practice, a 30- or 60-s pre-procedural rinse
of 0.50/1% PVP-I could be beneficial to reduce the risk
of cross-infection in healthcare settings.
• Low substantivity.
 PREPARATION OF SURGICAL SITE

• Presurgical scrub
• Draping the patient
• Circumoral prep
 PRESURGICAL SCRUB

• Done to reduce the resident flora as well as

transient flora.
• Scrub should begin in the centre and move
outward concentrically.
• All procedures are accompanied by pre
surgical scrub.
 DRAPING THE PATIENT

• It helps isolate the surgical area from the other parts

of the body.
• It isolates from non sterile operating room and
personnel.
• Usually a double layered drape is used. Single layer
sufficient for minor procedures.
 POST SURGICAL ASEPSIS

Wound management:
• Wound should be carefully inspected.
• Dressing should be done using sterile gloves.
• Post operative instructions for wound care should
be given to the patient.
 FUMIGATION OF OPERATION THEATRE

1. ELECTRIC BOILER FUMIGATION METHOD

• For each 1000 cubic feet of the volume of OT 500
ml of formaldehyde (40% solution) is added in 1000
ml of water in an electric boiler.
• Room is sealed and boiler is left for 45 minutes after
which boiler is switched off without entering the
room.
• Room is sealed for 48 hours.
2. POTASSIUM PERMANGANATE METHOD
• For every 1000 cubic feet 450 grams of
Potassium Permanganate is added to 500 ml of
formaldehyde(40% solution). This is divided
equally and kept in separate bowls in various
locations.
• This will cause auto boiling and generate
fumes.
• After the initiation of formaldehyde vapour ,
room is sealed for 48 hours .
 CLEANING OF OPERATION THEATRE

• Frequent cleaning of walls and roof is not required. These areas should not be
disturbed unnecessarily.
• It should be cleaned only when visibly soiled or dust is accumulated. Ceiling
fans should not be used as it causes aerosol spread.
• Floor gets contaminated quickly. It should be cleaned with vacuum cleaner
and wet cleaning techniques.
• Broom should not be used as it increases the bacterial flora in the
environment.
 CLEANING OF OPERATION THEATRE

• Simple detergent reduces flora by 80%.

• Addition of disinfectant reduces to 95%.
• Chemicals should be used when
contaminated with blood or body fluids.
(Sodium Hypochlorite).
INFECTION CONTROL
 RATIONALE FOR INFECTION CONTROL

To prevent spread of infection from:

• Patient to dental team
• Dental team to patient
• Patient to patient
• Dental office to community
• Community to patient
• Dental team to family
 GOAL OF INFECTION CONTROL

• To reduce the dose of micro organisms that

may be shared between individuals or between
individuals and contaminated surfaces.
 CDC RECOMMENDATIONS
Standard precautions :
• All steps taken to prevent transmission of diseases through bodily fluids. It
includes:
• Educating and protecting dental health care personnel.
• Preventing transmission of blood borne pathogens.
• Hand hygiene.
• Personal Protective Equipment :
-gloves
-eyewear
-masks
-protective clothing
Contact precautions :
• Used in addition to standard precautions.
• For patients infected with epidemiologically significant organisms
transmitted by direct contact.

Universal precautions :
• Universal precautions all patients are considered to be possible carriers of
blood borne pathogens.
• These are infection control techniques which were recommended following
the AIDS outbreak in the 1980s.
 HAND HYGIENE

• Hands are one of the most important sources of micro organism in

disease spread.
• 2 types of microbial flora on hand:
1) Resident skin flora : Reside in deeper layer of skin
2) Transient skin flora : Reside on outer layer of skin
 TYPES OF HAND HYGIENE
METHOD AGENT DURATION
Routine hand wash Water and antimicrobial soap 15 seconds

Antiseptic hand wash Water and antimicrobial soap 40-60 seconds

Antiseptic hand rub Alcohol based hand rub Until the agent is dry

Surgical hand rub Water and antiseptic agents 2-6 mins

 HAND HYGIENE AGENTS

• Alcohols
• Chlorhexidine(2% - 4%)
• Phenolics
• Triclosan
• Quarternary ammonium compounds
 SURGICAL HAND WASH

Steps:
• Antimicrobial agent is to be applied on the hands and in circular motion.
• The rubbing should be done for a period of 3–5 min.
• Each arm is to be washed separately at the level of elbow, starting at the
fingertips.
• Sterile towel is used to dry the fingertips up to the elbow.
 BARRIER TECHNIQUES
• Useful where the chances of spread of infection are
higher.
a. Head cover
b. Masks
c. Scrub suits and cover gowns
d. Surgical gowns
e. Gloves
 HEAD COVER

• Prior or during the procedure, all facial and

head hair should be tied properly and covered
by means of head covers.
• Ideally head covers should be disposable and
made of soft, nonporous cloth like material.
• If one has long hair, the hair should be tied in a
bun.
 MOUTH MASKS

• Infectious diseases spread through airborne route.

• Prevention of transmission of infectious agents.
• Protection from the splashes and sprays.
• The masks, which are disposable in nature, are always
preferred.
• Made of synthetic fibers, must be flat with two or
three pleats that expand to cover the area up to chin,
and should have filters of polypropylene or polyester.
 PROPERTIES OF AN IDEAL MASK

• Does not come in contact with nostrils

or lips
• Non irritant
• Easy to place and remove
• High bacterial filtration rate
• Does not fog the eyewear
 SCRUB SUITS AND COVER GOWNS

• Protect the transmission of any infectious agent present on

the regular clothing from the operating personnel to the
patient or any other personnel.
• Simple design
• Comfortable
• Easy to clean and wash
• Economical
• Easily replicable if damaged
• Minimal place for the contaminants to hide.
 SURGICAL GOWNS

• Loose pair of clothing to be worn over the scrub suits or cover gowns at
the time of the surgery.
• Protect both the patient and the operating personnel from transfer of
microorganisms, blood or body fluids, and another particulate matter.
 GLOVES

• Protect the operator from infection by

bacteria and viruses from patient’s
blood.
• Protect from blood-borne viruses.
• Prevent wound from becoming
contaminated with the surgeon’s skin
flora.
 TYPES OF GLOVES

• Patient examination gloves

- Examination, non surgical procedures,
laboratory procedures
- Non sterile
- Single use
• Surgical gloves
- Surgical procedures
- Sterile
- Single use

• Non medical gloves

- House keeping procedures, handling
contaminated sharps and materials
- Sanitize after use
Putting on sterile gloves by open gloving technique
Putting on sterile gloves by closed gloving technique
 EYEWEAR

• To prevent inadvertent exposure to contaminated

body fluids.
• To prevent physical injury.
• Prevent infection from aerosolized microbes.
• In case of accidental exposure, eyes are washed
immediately.
DONNING
OF
SURGICAL
GOWN
DISPOSAL OF BIOMEDICAL WASTE
WASTE METHOD OF
DISPOSAL
Syringes, vials, ampules Autoclaving and
chemical treatment
Items contaminated with blood, Incineration and deep
human anatomical waste burial
Sharp waste Autoclaving
Chemical treatment
Destruction
Drugs , chemicals used in Disposal in secured
disinfection landfill
 COVID-19 DISINFECTION GUIDELINES
• Availability of hand sanitizer/hand wash upon entering the premises/clinic.
• Patient should be given head cap, examination gloves,3 ply mouth mask and
foot cover when entering the premises/clinic. Mask should be removed only
while treatment.
• Patient should be asked not to touch any surfaces and be seated in one place
only until called inside the operatory.
• During the treatment, operator should wear PPE like head cap, masks(N95+3
ply mask), face shield, gown, gloves(double gloving) and foot cover.
• Post treatment disinfection should be carried out in the operatory before next
patient.
• Cleaning should be done from the least soiled to the most
soiled areas, higher to lower level so that debris fall on the
floor, which should be cleaned last.
• Multiple floor mopping should be followed. First with
detergent followed by 0.2% - 0.5% Sodium Hypochlorite.
• For aerosol generating procedures, high volume suction or
VacStation should be used.
• Operatory should be well ventilated. Positive air flow
should be there from behind the operator towards the patient.
• Waiting areas should also be disinfected by using spray
machines.
• Proper sterilization of instruments has to be done to prevent cross
contamination.
• Additionally, HEPA filtration system and UV- C light system can be used to
disinfect the operatory.
The C-UVC unit significantly reduced TPC and VPC related to OR traffic in a
highly controlled OR setting. They recommend placing the C-UVC unit closer to
potential sources of contamination for maximum efficacy. This preliminary study
has established a foundation for future studies to prospectively assess the ability of
CUVC units to reduce surgical site contamination during live TKA and THA cases.
Preoperative cleansing of the patient's skin with chlorhexidine-alcohol is
superior to cleansing with povidone-iodine for preventing surgical-site
infection after clean-contaminated surgery.
 CONCLUSION

• Sterilization and asepsis are just as important for the success of any surgical
procedure as is the technique and skills of the operator.

• As new, more resistant bacteria emerge, the field of sterilization evolves as

well.

• Prevention is always better than cure.

 REFERENCES

• AOMSI TEXTBOOK
• Textbook of Microbiology for Dental Students – CP Baveja – Fifth Edition
• Textbook of Oral and Maxillofacial Surgery – S M Balaji – Third Edition
• Textbook of Oral and Maxillofacial Surgery – Neelima Anil Malik – Third
Edition
• Articles
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