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Sterilization and Disinfection in the Operating Room: Ensuring Safe Surgical Practices
INTRODUCTION
Sterilization and disinfection are essential components of any surgical procedure, including injections and dental surgeries, to ensure patient safety and successful outcomes. Maintaining aseptic conditions during operations is crucial, as it helps prevent infections, complications, and patient discomfort. This essay explores the significance of maintaining a sterile environment in the operating room to avoid post-surgical complications and discusses the vital procedures and precautions to be taken.
THE IMPORTANCE OF STERILIZATION AND DISINFECTION
In modern dental implant surgeries, which are often elective outpatient procedures, it is imperative to provide patients with a clean and secure operating environment. These surgeries are typically performed under local, regional, or general anesthesia without the need for extended hospitalization. To create a sterile environment conducive to successful surgery, several critical factors must be considered.
ESSENTIAL PROCEDURES AND OPERATIONS IN THE OPERATING ROOM
Preparing the Surgical Field
Before commencing surgery, the surgical table should be meticulously prepared. It should be covered with sterile drapes and equipped with essential materials such as gloves, towels, sponges, and disinfectant solutions. To ensure a clean surface, any surface debris or loose skin should be removed from the patient’s skin through gentle scrubbing with medicated soap and sterile water. The scrubbing process should be circular, moving from the center to the periphery of the surgical field. Afterward, the area should be dried using sterile materials like disposable paper towels. Sterile sponges and disinfectant agents are then used to sanitize the patient’s skin.
In some hospitals, the surgical field is marked from the center outward and allowed to air dry. The surgeon should then don sterile attire and gloves and proceed to drape the patient to isolate the surgical field and maintain patient warmth. Once the patient is appropriately anesthetized, the surgery can commence.
Surgeon’s Attire
One of the primary sources of contamination during surgery is the surgical team, including the surgeon and operating room technicians. Preventing skin microorganisms from reaching the surgical site is crucial. All surgical personnel should wear sterile disposable caps and masks to minimize the risk of introducing bacteria-laden droplets or mucus from the nose and oral cavity, as well as dandruff from hair and scalp, into the operating room environment.
To reduce the risk of contamination from garments shedding lint and dust, sterile disposable gowns should be worn. Latex gloves, preferred for their dust-free nature, should be replaced if they develop any punctures or damage. Maintaining aseptic conditions throughout the surgical team’s attire is crucial for patient safety.
Operating Room Environment
The operating room environment itself can be a source of postoperative infections. External sources of bacteria may include operating technicians, anesthesia equipment, surgical tables, lights, walls, floors, furniture, instruments, air quality, and even insects. Specific areas within the operating room may become heavily contaminated due to challenges in sterilization, disinfection, and cleaning. Maintaining a homogeneous, waste-free surface on the operating room floor is advisable.
THE PURPOSE OF STERILIZATION AND DISINFECTION
Sterilization and disinfection are vital components of surgical procedures. Autoclaves play a pivotal role in generating humid heat in the form of saturated steam under pressure, providing essential elements for sterilization and disinfection. Rapid sterilization is necessary for instances where an instrument is unintentionally omitted from the surgical pack or dropped on the floor. Small steam sterilizers are highly effective for emergency sterilization compared to less effective cold sterilization methods.
Sterilization procedures typically involve washing the instrument with warm soapy water before placing it unpacked in a perforated metal tray inside the sterilizer. Steam is then introduced, and the temperature should reach 131°C (270°F) with a steam pressure of 27 PSI. After three minutes, the steam is released, and the instrument is ready for use. Temperature sensors or organic indicators should be consistently used to monitor sterilizer efficiency.
MAINTENANCE AND CARE OF INSTRUMENTS
Maintaining strict hygienic conditions is essential for preventing postoperative infections and cross-contamination between patients. Surgical instruments used for implantation must undergo rigorous sterilization procedures and controls. Disinfection and sterilization aim to eliminate or remove all living microorganisms, which can be achieved through physical methods like dry or moist heat or chemical agents such as ethylene oxide, formaldehyde, and alcohol.
Prior to sterilization, thorough cleaning of instruments is required, especially after they have been used on a patient. Proper cleaning is essential, as an item that cannot be cleaned adequately cannot be effectively sterilized. Instruments with complex shapes, like surgical burs, require special attention, as they can harbor microbes that may be inoculated directly into patients during procedures. Sterilization methods should be applied to these instruments rather than relying solely on disinfection.
Proper hand hygiene is crucial for the surgical team. Hand scrubbing with disinfectant agents effectively removes transient flora, although resident flora can be more challenging to eliminate. Optimal hand scrubbing should take five to ten minutes and use antiseptic agents like iodophor, chlorhexidine, or hexachlorophene. Scrubbing and rinsing should be repeated after three minutes.
SUMMARY
Surgical procedures, including dental implantations, carry inherent risks, with postoperative infections being one of the most common complications. The current healthcare landscape, marked by concerns about blood-borne pathogens, infections, rising hospitalization costs, and increased scrutiny of surgical practices, necessitates strict adherence to safe and sterile surgical protocols. These protocols are essential for minimizing infection risks and achieving successful surgical outcomes.
CONCLUSION
While maintaining the safety of surgical equipment is essential, traditional sterilization methods like steam sterilization are not suitable for delicate and complex instruments used in implantation procedures. Alternative methods, such as electron-beam sterilization, sterilization filtration, ultraviolet and X-ray irradiation, ionizing irradiation, and peracetic acid, should be considered for oral implant instruments. These methods offer practical solutions for achieving effective sterilization and ensuring patient safety during dental implant surgeries.
