STERILIZATION AND

DISINFECTION
 CONTENTS

• Historical Relevance
• Terminologies 
• Methods Of Sterilization & Disinfection
• Asepsis- Medical( Clinical) And Surgical Asepsis
• Basics About OT Design 
• Operating Room Protocols
• Principals Of Asepsis
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.

 JOSEPH LISTER
• Discovered how to use chemical antiseptics to control surgery related
infections

• Used antiseptics to disinfect surgical equipment and supplies

• Lister began washing his hands before operating, and wearing clean
clothes.
•  Lister also sprayed the air with carbolic acid to kill airborne germs.
• 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

 TERMINOLOGIES
Sterilization - It is the process of destruction or removal of all
microorganisms from article, surface or medium, including spores.

Disinfection- Disinfection describes a process that eliminates many or

all pathogenic microorganisms, except bacterial spores, on inanimate
objects . it is a process which reduces the number of viable
microorganisms to an acceptable level but may not inactive some
viruses and bacterial spores
• Antiseptic
• A chemical that is applied to living tissues such as skin or
mucous membrane to reduce the number of
microorganisms present by inhibition of their activity or
destruction.
Item category Potential risk of Method of
disease transmission decontamination

CRITICAL Very high to high Sterilization

Penetrates soft tissue, contact bone, enter
into /contact blood stream or other
normally sterile tissues/body cavities

SEMICRITICAL Moderate Sterilization or high-level

Contact mucous membrane or non intact disinfection
skin but will not penetrate soft
tissue/contact bone/blood stream/ sterile
tissue

NONCRITICAL Low to none Intermediate to low level

Contact intact skin disinfection or simple
1.Clinical contact cleaning
2.Clinical surroundings/environment/ house
keeping surfaces
Who is at risk
CATEGORY I:
Tasks involving exposure to blood, body fluid or tissues.
eg. Dentist, dental hygienist, dental assistant, lab. technician.

CATEGORY II:
Tasks involving non-routine exposure to blood, body fluids or tissues.
eg. Clerical workers etc.

CATEGORY III:
Tasks not involving exposure to blood, body fluids or tissues.
eg. Office receptionist etc.

The ADA and OSHA guidelines advise that all category I and II staff be trained in
infection control practices and be vaccinated against Hepatitis B.
 Factors affecting sterilization and disinfection
• Types of organisms
• Number of organisms
• Concentration of the agent
• Presence of organic material (e.g., serum, blood)
• Nature (composition) of surface to be treated
• Contact time
• Temperature
• pH
• Biofilms

Russell AD. Bacterial resistance to disinfectants: present knowledge

and future problems. J. Hosp. Infect. 1998;43:S57-68.
 Instrument Processing
The overall process consists of-

Presoaking

Pre-cleaning

Corrosion control: drying.

Packaging

Sterilization

Sterilization monitoring

Handling processed instruments

 INSTRUMENT PROCESSING AREA
• Use a designated processing area to control
quality and ensure safety
• Divide processing areas into work areas
• Receiving, cleaning and decontamination
• Preparation and packaging
• sterilization
• storage

Storage areas should be dust proof, dry, well ventilated and easily accessible for routine
dental use.
Sterile materials should be stored at least 8-10 inches from the floor, at least 18 inches from
the ceiling, and at least 2 inches from the outside walls.
Items should be positioned so that packaged items are not crushed, bent, crushed,
compressed or punctured.
ULTRASONIC & SONIC VIBRATIONS
• Ultrasonic cleaning depends upon cavitation, the rapid
formation and violent collapse of minute bubbles or cavities in
a cleaning liquid.
PHYSICAL AGENTS
• SUNLIGHT
• DRYING
• DRY HEAT
• MOIST HEAT
• FILTRATION
• RADIATION
 SUNLIGHT
• Possesses Bactericidal Activity
• Due to UV rays

DRYING
-Deleterious effect on many bacteria
-Unreliable
-Spores are unaffected
DRY HEAT
• MECHANISM OF ACTION:­
• Protein Denaturation
• Oxidative damage
• Toxic effect of elevated level of electrolytes

ADVANTAGE -CAN BE EASILY EMPLOYED.

DISADVANTAGE -POOR PENETRATION

POWER.
1)FLAMING

• The articles are passed on the Bunsen flame. articles are

made red hot
• Articles Sterilized:
• Inoculating loop of wires.
• Forceps.
• Spatulas.
• Mouths of culture tubes.
2)HOT AIR OVEN

• Louis Pasteur discovered in 1986

• Compartments with perforated trays & fans
• The temperature is 160 C for 1 hour
• Preserve sharp edges of cutting instnunents
Articles to be sterilized
• Scissors
• Scalpels
• Glass syringes
• Swabs
• Liquid paraffin
• Dusting powder
• Fats & Grease
• Glassware
• Forceps
PRECAUTION TO BE OBSERVED WHEN USING A
HOT AIR OVEN:
• Temp. should not exceed 180°c because glass ware kept inside for
sterilization will get a smoky appearance & paper wrapper used to
cover the articles will get charred.
• The glassware kept inside should be totally dry or they will break.

• No sudden cooling of the hot air oven.

• N o over loading of hot air oven.

STERILISATION CONTROL

• BROWNE'S TUBE use routinely.

• Green color indicates proper sterilization

• Nontoxigenic strains of CLOSTRIDIUM TETANI

• Spores germination indicates improper sterilization
GLASS BEAD STERILISER

• Heat transfer device

• Glass beads & Salt

• ARTICLES STERILISED:
• Endodontic Files & Burs

• Temperature is 220°c
• Time is 10 sec.
MOIST HEAT
• MECHANISM OF ACTION:
• -Denaturation of proteins
• -Coagulation of proteins

• TEMPERATURE BELOW 100°C

• TEMPERATURE AT 100°C
• TEMPERATURE ABOVE 100°C
TEMPERATURE BELOW 100°C

a) Pasteurization
• Holder's process (63°C for 30min)

• Flash process (72°C for 15-20 sec)

• Destroys - mycobacterium, salmonella & also Brucella.

• Coxiella burnetii survive Holder method.
• LJ media and other media which contain sugar & gelatin are stelilized
in Inspissator at 80-85°C for ½ an hour on 3 successive days.-
Inspissation

• Vaccine for non sporing bacteria-Heat inactivated in special vaccine

baths at 60°C for one hour.
 TEMPERATURE AT 100°C

o(a)Boiling:

o Vegetative Bacteria killed at 90-100°c

o Time required is 10-30 min

o Not effective for Sporing Bacteria

o Sterilization promoted by use of 2% Na bicarbonate

(b) Tyndallisation -

• For media containing sugar or gelatin exposure of steam at

100°c for 20 min for 3 successive days.

(c) Koch or Arnold steamer

• Exposure with steam at 100°c for 90 min ensures sterilization

TEMPERATURE ABOVE 100°C
• Steam under Pressure (AUTOCLAVE)

• Principle: Water boils when pressure equals to surrounding

atmosphere.
• Saturated steam has penetrative power
• In Downward displacement air in the chamber is forced downward
and out through the bottom discharge outlet.

• Prevaccum high temperature

• most modern
• less time to sterilize a single load.
• Air is extracted from the chamber before admitting steam.
• Table top models are available
Autoclave time-
• ARTICLES STERILISED:

• Surgical Instruments
• Lab equipments
• Metallic syringes.
• All culture media except media containing sugar & gelatin.
STERILISATION CONTROL
• Spores of Bacillus stearothermophilus

• Autoclave tapes

• Agents use to avoid corrosive action of steam :

• --Ammonia (Craford & Oldenburg)
• --2°/o Na nitrite (Bertolotti & Hurst)
• --Dicyclohexylammonium nitrate (ADT)
RADIATION

• 2 types

• Non ionizing radiation.

• Ionizing radiation.
A) Non Ionizing radiation

• U. V. rays:
• Bring down the number of
microorganism present in air.
• Sterilization of Operation Theaters
and biological safety cabinets.
• Disadvantage: Low-penetrating
power.
B) Ionizing Radiation:

• X Rays, Gamma Rays, Cosmic Rays

• cold sterilization.
• very high penetrating power.
• lethal to DNA and other cell constituents
• effective for heat labile items
• Articles sterilized:
• Syringes
• swabs
• Catheters
• Needles
• Oils
• Grease
• Cannulas
• Metal foils
• Culture plates
FILTRATION
• Used to sterilize heat labile liquids like sera, sugar solutions.
• Bacteria free filtrate of Virus

• TYPES:
(a)Caodles filters
(b)Asbestos disc filters.
(c)Sintered glass filters
(d)Membrane filters.
(a)Candle filters:
-- Use for purification of water
Types:
--Unglazed ceramic filters
--Diatomaceous earth fillers

(b)Asbestos filters:
--Disposable
--High adsorbing capacity
--Alkalinize filtered liquids
--Carcinogenic potential
-- e.g- Seitz &Sterimat filters
c)Sintered glass filters:
--Heat fusing finely powdered glass particles
--Low absorptive
--Brittle & expensive

(d)Membrane filters:
--Made from Cellulose esters
--Pore diameter 0.22mm used widely
--Used in:
-- water purification sterilization & sterility testing
-- preparation of solution for parental use
SURGICAL HAND PIECE STERILIZATION
 SHOULD Do
• Remove 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.
• Insert 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.
SHOULD NOT DO

• Do 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 bags
 CHEMICAL AGENTS

• Alcohols

• Aldehydes

• Dyes
• Halogens
• Phenols
• Gases
• Surface active agents
• Metallic salts
ALCOHOLS

• Isopropyl alcohol and ethyl alcohol

• Used as skin antiseptics
• Act by denaturing the protein
• No action on spores
• 60% to 70% conc. is used
• Methyl alcohol effective against fungal spores
• It is toxic & inflammable
ALDEHYDES

• Formaldehyde (formalin)
• Glutraldehydes
I.Formaldehyde:

• Bactericidal ,fungicidal & sporicidal.

• 10% formalin & 0.5% Na tetraborate use to sterilise clean metal
instruments.

• Use:
• Instruments & heat sensitive catheters
• Fumigate wards, sick rooms , laboratories
• Irritant & toxic when inhaled

• Nullified by use of ammonia vapour

GLUTARALDEHYDE
• Action similar to formaldehyde.

• Effective against bacteria(tubercle bacilli) , Hepatitis B, C and HIV

& fungi

• It is less toxic and irritant to the eyes and skin than formaldehyde

• Used for beat sensitive materia1s, rubber, plastic, metal

instuments & porcelain
• ARTICLES STERILISED:

• Corrugated rubber anesthetic tubes

• Face masks

• Plastic endotracheal tubes

• Metal instruments

• Polythene tubing
BIGUANIDES
• Chlorhexidine gluconate

• 0.5% in 70% alcohol or 4% detergent as an preoperative

scrub

• 0.2% for suppression of plaque( mouthwash)

 DYES
• Aniline Dyes And Acridine Dyes
• Skin & wound antiseptics
• Bacteriostatic in high concentrations.
• Aniline dyes in use are-
• brilliant green
• malachite green
• crystal violet.
• More active against gram positive organisms
• Lethal effect on bacteria is due to reaction with the acid groups in the
bacterial cell
HALOGENS

• Iodine in aqueous and alcoholic solution is used widely as a skin

disinfectant.
• Bactericidal

• Active against the tubercle bacteria and viruses.

• Iodophores are more active than the aqueous or alcoholic solutions

of iodine.
• BETADINE-
• lodophore (povidone + iodine)
• Povidone- surface active agent

• "this agent should be kept out of fresh wound and

should be kept only to scrub skin surface"
• Chlorine and its compounds are used as disinfectants in water supplies,
swimming pools, food and dairy industries.
• Chlorine is used as hypochlorites.
• Bactericidal
• Wide spectrum of action against viruses.
• The organic chloramines are used as antiseptics for dressing wounds.
 PHENOLS

• They are obtained by distillation of coal tar b/w 170 C - 270 C

Precipitate protein cell membrane damage

cause cell lysis release cell content

Eg. Lysol and cresol .
They are not effective against spores .
GASES

• Ethylene oxide
• Highly penetrating gas
• Highly inflammable.

• Action is due to alkylation of the amino, carboxyl, hydroxyl,

sulfhydryl groups in protein molecules
• Mixing with carbon dioxide or nitrogen 10% eliminates explosive
tendency

• Mutagenic & carcinogenic

• ARTICLES STERILISED:
• --Heart-lung machine
• --Respirators
• --Sutures
• --Dental equipments
• --Glass,metal & paper surface
Formaldehyde gas
• Fumigation of operation theatres and other rooms.

• After sealing the windows and other outlets, formaldehyde gas is

generated by adding 150 gms of KMNO4 to 280ml formalin for
every 1000cu. Ft of room volume.

• Doors open after 48 hrs

TESTING OF DISINFECTANTS

• RIEDAL WALKER TEST:

• Suspension of typhoid bacilli added with phenol & disinfectant
tested

• CHICK MARTIN TEST:

• Modified technique
• Disinfectant act in presence of organic matter
 ASEPSIS

• MEDICAL ASEPSIS
• SURGICAL ASEPSIS
MEDICAL ASEPSIS

• Clean technique - based on maintaining cleanliness to

prevent spread of microorganisms
• Keep office clean:
• Reception room clean, well lit, and ventilated
• Keep furniture in good repair
• Strict "no food or drink" policy
SURGICAL ASEPSIS

• Keep the surgical environment completely free of all

microorganisms.
• Sterile technique used for even minor operation or injections.
• Object is either sterile or not sterile; if unsure then it is not
sterile.
Disease
Cross infection
Work restriction Duration

Hepatitis A Restrict from patient contact, contact Until 7 days after onset of jaundice
with patient’s environment, and food-
handling.
Hepatitis B

Personnel with acute or chronic No restriction

hepatitis B surface antigenemia who do
not perform exposure-prone procedures
Personnel with acute or chronic Do not perform exposure-prone Until hepatitis B e antigen is negative
hepatitis B e antigenemia who perform invasive procedures
exposure-prone procedures
Hepatitis C No restrictions on professional activity.
HCV-positive health-care personnel
should follow aseptic technique and
standard precautions.
Hands (herpetic whitlow) Restrict from patient contact and contact Until lesions heal
with patient’s environment.
Tuberculosis
Active disease Exclude from duty Until proved non-infectious
PPD converter No restriction

Viral respiratory infection, acute febrile Consider excluding from the care of Until all symptoms resolve
patients at high risk
CROSS INFECTION CONTROL PROTOCOLS

In 1996 CDC (Centre for Disease Control USA) and the Hospital
Infection Control Practice Advisory Committee (HICPAC) introduced
infection control precautions.

▪ Standard

▪ Additional
Patient screening- Medical history at each visit
Patient with known active pulmonary TB or those who have suspicion of TB, should not be
provided elective dental care (According to CDC-2005 guidelines and as followed by ADA)
Standard precautions are insufficient to prevent transmission of the bacterium. Elective dental
treatment should be deferred until the patient has been declared noninfectious by a physician.
Urgent dental care for a person with suspected or active tuberculosis should be provided in a
facility that has the capacity for airborne infection isolation and has a respiratory protection
program in place.

When treating a patient with active disease, dental health care personnel should use
respiratory protection (e.g., fitted, disposable N-95 respirators). Standard surgical face masks
are not adequate to protect against tuberculosis transmission.

Personal protection-
1. Hand hygiene
2. Protective clothing
3. Barrier protection
4. Immunization procedures
OT DESIGN

Ideal theatre should have:

-Pressure release dampers
-Minimum fixtures , shelves
-Doors should be closed properly
-Windows should be sealed properly
-Flooring should have no gaps
-Painted surface should be finish
-Walls preferably rounded
National Accreditation Board for Hospitals and
Healthcare Providers

• OT Size and Occupancy:

Standard OT size of 20' x 20' x 1O'

Standard occupancy of 5-8 persons
 VENTILATION
Proper ventilation will minimize risk of infection by:
-Filtration of supplied air
-Dilution of contaminated air
-Preventing entry of contaminated air from outside

TYPES:

(1) Conventional or Plenum type

(2)Laminar flow type

• Laminar flow ventilation was first pioneered by Charnley
in the 1960s and 1970s
• Laminar type use in modern operation theatres
• AIR CHANGE RATE:
• -Conventional maintains at rate of 20 air changes per hour
• -Laminar maintains at rate of 300 air changes per hour
• THE REVISED GUIDELINES FOR AIR CONDITIONING IN OPERATION
THEATRES (NABH-2010)
• I. Air Change Per Hour.
• Minimum total air changes should be 25
• The fresh air component of the air change is required to be
minimum 4 air changes out of total minimum 25 air changes.
• II. Air Velocity: The vertical down flow of air coming out of the
diffusers should be able to carry bacteria carrying particle load away
from the operating table. The airflow needs to be unidirectional and
downwards on the OT table.
• Ill. Positive Pressure: There is a requirement to maintain positive
pressure differential between OT and adjoining areas to prevent
outside air entry into OT.
• The minimum positive pressure recommended is 15 Pascal
(0.05 inches of water)
AIR QUALITY

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

Therefore A continuous flow of highly filtered ‘bacteria-free’ air is

recirculated under positive pressure into the operating field and air
contaminants generated during surgery are directed towards exhaust
vent.
TEMPERATURE & HUMIDITY
• The temperature should be maintained at 21 +/- 3 °C inside
the OT all the time

• Corresponding relative humidity between 40 to 60% though

the ideal is considered to be 55%.

• Appropriate devices to monitor and display these conditions in

the OT should be present
OPERATING ROOM PROTOCOLS
• Should be as small as possible . It consist:
• Yourself the surgeon
• Your assistant, when you need one
• The scrub nurse responsible for the instruments
• The circulating nurse to fletch and carrry
• The anaesthetist
• Preoperative showering with hexachlorophene has shown
reduction in wound infection.

• Short preoperative hospital stay reduces pathogenic bacteria

on skin and nasal carrier state.
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.
 PATIENT SKIN PREPARATION
• 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
• MATERIALS COMMONLY USED
• The iodophors (e.g., povidone-iodine), alcohol­containing
products, and chlorhexidine gluconate are the most commonly
used agents.

• Alcohol is readily available, inexpensive, and remains the most

effective and rapid-acting skin antiseptic.
• Aqueous 70% to 92% alcohol solutions have germicidal
activity
DRAPING THE PATIENT

•Once a drape has been positioned, it should not be repositioned.

•The surgeon should maintain 12" away from the
•O.R. table when performing the draping procedure
•Surgeon should not reach across an undraped O.R. table in order to perform
a draping procedure.
• Non perforating towel clips should be used to keep towels or drapes

• Beckhaus towel clip

• Pinchter type towel clip

PRE-OPERATIVE HAND SCRUB

• Dunphey & Way recommends 10 min for srubbing technique

• Hexachlorophene compounds
• Povidone iodine 7.5°/4,
• 2.5% Chlorhexidine in 70% alcohol
• In some comparisons of the two antiseptics when used as
preoperative hand scrubs, chlorhexidine gluconate achieved
greater reductions in skin microflora than did povidone-iodine
and also had greater residual activity after a single application
Hand washing is the simplest, most effective measure for preventing nosocomial
infections

Surgical hand preparation –key steps

Keep nails short and pay attention to them when washing your hands – most microbes
on hands come from beneath the fingernails.

Do not wear artificial nails or nail polish.

Remove all jewellery (rings, watches, bracelets) before entering the operating theatre.

Wash hands and arms with a non-medicated soap before entering the operating theatre
area or if hands are visibly soiled.
• The first scrub of the day should include a thorough cleaning
underneath fingernails usually with a brush.

• After performing the surgical scrub, hands should be kept up and

away from the body (elbows in flexed position) so that water runs
from the tips of the fingers toward the elbows.

• Sterile towels should be used for drying the hands and

forearms before wearing sterile gown and gloves.
 GOWNING
• Hold the gown away from your body, high enough to be well above
floor
• Allow it to drop open, put your arms into the arm holes while keeping
your arms extended
• Then flex your elbows and abduct your arms
• Wait for circulating nurse to help you
• She will grasp the inner sides of the gown at each shoulder and pull
them over your shoulders
GLOVING
Minimize the risk of health care personnel acquiring infections from patients

Prevent transmission of microbial flora from the dental personnel to the

patient

Prevent painful and transmissible herpetic infections to fingers and

hands[whitlow]

New pair of gloves for each patient.Look for visible defects immediately after
wearing.

Remove gloves that are torn, cut or punctured.

Change gloves hourly during long operative procedures .

Do not wash, disinfect or sterilize gloves for reuse.
Face mask

• Prevent inhalation of contaminated aerosols .

• Composed of synthetic material to filter out 95% of particles of
size 0.3 mm in diameter.
• Can be dome shaped
• Change masks between patients particularly if wet ( useful life
is thought to be 30-60 min).
• Secured with
• Elastic band
• Ear loops
 ASEPTIC ENVIRONMENT
The principle is to minimize bacterial contamination , especially, in the
vicinity of operating table ; the concept of zones is useful , and must be
employed.
Outer and general access zone- patient reception area and general office.
Clean or limited access zone- the area between reception & general office
and corridors & staff room.
Restricted access zone- for those properly clothed personnel engaged in
operating theatre activities, anesthetic room.
Aseptic or operating zone- the operation the
•
Only sterile items are used within the sterile field

• Sterile persons are gowned and gloved

• Tables are sterile only at table level
• Sterile persons touch only sterile items or areas
• Unsterile persons avoid reaching over the sterile field
• The edges of anything that encloses sterile contents are considered
unsterile
• The sterile field is created as close as possible to the time of use
• Sterile areas are continuously kept in view
• Sterile persons keep well within the sterile area
• Break of the integrity of microbial barriers results in contamination
Points to remember
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.

Needle stick injury

It is a percutaneous piercing wound typically

set by a needle but possibly by other
instrument

•Considered an occupational hazard

•Average risk of transmission - HIV(0.3%) ,HEPATITIS - B (22-31%) ,
HCV (1.8-3%)
•Injuries can happen with other sharp instruments as well.
• Affected area should be rinsed and washed thoroughly with soap and water
• Bleed the area for 3-5 minutes.
• Practice to milk out “more blood” is controversial.
• Disinfect with 10% povidone iodine diluted with 3 parts of water or with 0.5%
hypochlorite solution
• Labtests:- take a blood sample for baseline titres
• You and your patient will probably both need blood taken for serological
testing for hepatitis B surface antigen (HBsAg), and HIV as soon as possible
• Depending on your immunization status you may need to have a course of
HBV vaccine and a dose of hep B immunoglobulin.
• If a significant exposure to HIV has occurred, retroviral drug prophylaxis
should be offered promptly. Use of such post exposure prophylaxis is not to
be treated lightly and expert guidance should be sought
 CDC guidelines

Step 1 : determine the exposure code-

Code1 - small volume of infected substance (few drops)
Code2 – large volume of infected substance (major splash), prick with thin bore needle.
Code 3 – percutaneous exposure with large bore hollow needle visibly soiled with blood

Step 2 : determine HIV status code

Code1 – Low titre
Code2 - High titre
Code UNKNOWN - Status of patient unknown

Step 3 : Match exposure code with status code

Exposure code 1, status code 1 - exposure prophylaxis may not be warranted
Exposure code 1, status code 2 – consider basic regimen
Exposure code 2, status code 1 – recommend basic regimen
Exposure code 2, status code 2 - recommend expanded regimen. High risk of HIV transmission
Exposure code 3, status code 1 / 2 – recommend expanded regimen. High risk .
Status unknown – Exposure prophylaxis basic regimen

Basic regimen Expanded regimen

4 weeks of- Basic regimen plus either-
Zidovudine - 600mg/day Indinavir - 800mg qid
Lamivudine - 150mg twice daily Nelfinavir - 750mg tds
Consens, B needle stick guidelines-2010 Who guidelines 2020 Cdc guidelines-2005
 If the patient is known or suspected HBV carrier.

prophylactic

Clinician never had vaccination Clinician have been vaccinated

If Ab titre is more then 100

HBIG within 48 hr. IU/L
Course of HB vaccination Within the previous yr. No further action

Low Ab titer Booster dose

THANK YOU