ASEPTIC TECHNIQUES

INTRODUCTION
• The concept of asepsis is to prevent cross
contamination.
• All items that are touched by saliva coated hands
must be rendered free of contamination before
treating the next patient.
• Contamination can be controlled by using one of
the following methods:
– Clean & sterilize it.
– Protect surfaces by using disposable single use covers
(barriers).
– Use paper towel, tongs or plastic baggie over gloves to
briefly open cabinets & drawers.
 OPERATORY ASEPSIS
• Operatory surfaces that will be repeatedly touched
or soiled ---- best protected with barriers that are
discarded after use.
• Cleaning & disinfection of the equipment not
required until & unless the barrier gets torn or
comes off during treatment.
• Items used in the operatory can be divided into
three types:
– Critical items --- instruments that contact cut tissues or
penetrate into the tissues.
– Examples include all types of instruments like straight
elevator, currette etc.
– Clean & sterilize or use disposable items.
 Contd.
– Semi-critical items --- items handled by gloved hands
coated by blood/saliva or may touch mucosa
– Examples include air/water syringe tip, suction tips,
prophy angle & hand pieces.
– Must be removed for cleaning & sterilization unless
they are disposable or can be covered with barriers.
– Non-critical items --- items not touched during
treatment.
– Examples include environmental surfaces like chairs,
benches, floors, walls.
– Only contaminated items require cleaning &
disinfection.
 DISINFECTION
• Partial elimination of active growth stage bacteria
and inactivation of some viruses. The potential for
infections remains after disinfection.
 DISINFECTION
• Disinfection --- always a two step procedure.
– 1st step --- vigorous scrubbing of the surfaces & wiping
them clean.
– 2nd step --- wetting the surface with a disinfectant &
then leaving it for 10 minutes.
• Disinfectant should be active against polio,
coxsackie virus, mycobacterium species, common
respiratory viruses & common bacterial hospital
pathogens.
• These include dilute 5% hypochlorite in water,
plain dilute iodine soln, iodophor disinfectants,
79% ethyl alcohol sprays.
 PROCEDURE FOR CLEANING
INSTRUMENTS BEFORE STERILIZATION
 STERILIZATION
• Sterilization is defined as:
– Killing of all forms of life including the most
heat resistant forms, bacterial spores.
• For instruments that penetrate the tissues, this
provides control of spore forming tetanus & gas
gangrene species as well as all pathogens borne by
blood & secretions.
• For instruments used in body cavities that
routinely touch mucosa, sterilization provides a
margin of safety for assuring destruction of HB,
mycobacteria & other pathogenic bacteria &
viruses.
 Contd.
• Four accepted methods of sterilization are:
– Steam pressure sterilization (autoclave)
– Chemical vapor pressure sterilization
(chemiclave)
– Dry heat sterilization (dryclave)
– Ethylene oxide sterilization
STEAM PRESSURE STERILIZATION
(AUTOCLAVING)
• Involves use of steam at elevated pressure to
sterilize instruments.
• Two settings used:
– For light load of instruments
121 °C --- 15 lbs --- 15 min.
– For heavy load of instruments
134 °C --- 30 lbs --- 7 min.
• All metal items should be dry as moisture
evaporating from instruments can slow down the
heating process.
 Contd.
• Advantages ----
– Most rapid & effective method for sterilizing cloth
surgical packs & towel packs.
– Automated models are available with pre setting of
temperature & pressure.
• Disadvantages ----
– Items sensitive to high temperature cannot be sterilized.
– Rusts carbon steel burs & instruments.
• Sterilization of burs ----
– Burs submerged in a small amount of 2% sodium
nitrite soln.
– Place the container into the sterilizer & operate normal
sterilization cycle.
 Contd.
– Use sterilize forceps to place the burs into the bur
holder.
– Before use, any nitrite residue can be wiped away or
rinsed off with clean or sterile water.
 CHEMICAL VAPOR PRESSURE
STERILIZATION (CHEMICLAVING)
• Operate at 131 °C & 20 lbs pressure with a cycle
time of half an hour.
• Overloading of sterilizer should be avoided.
• Water left on instruments placed in the chamber
can defeat sterilization.
• Advantages ----
– Caron steel & other corrosion sensitive instruments can
be easily sterilized without corrosion.
• Disadvantages ----
– Temperature sensitive instruments can not be sterilized.
– Instruments must be lightly packaged in bags.
– Only dry instruments should be loaded.
 Contd.
– Towels & heavy cloth wrappings of surgical
instruments may not be penetrated so routinely use
biologic spore test before using such packs.
 DRY HEAT STERILIZATION
CONVENTIONAL DRY HEAT OVENS:
• Work at temperatures above 320 °F (160 °C) by
gravity convection. i.e. allow air to circulate by
gravity flow.
• Instruments must be placed at least 1 cm apart to
allow heated air to circulate.
• Approx 60-90 minutes required to sterilize a
medium load of lightly wrapped instruments in an
oven set at temperature range of 335-345 °F.
• More sterilization failures than any other type of
sterilizer.
 Contd.
SHORT CYCLE, HIGH TEMP. DRY HEAT
OVENS:
• Works on the principle of mechanical convection.
i.e. air circulates with a fan or blower.
• Sterilization time reduced to 6 minutes for
unwrapped & 12 minutes for wrapped
instruments.
• Operate at approx. 370-375 °F.
• Advantages ----
– Carbon steel instruments & burs do not corrode, rust or
loose their cutting edges.
– Industrial ovens provide large capacity at reasonable
price.
 Contd.
• Disadvantages ----
– Heat sensitive items can not be sterilized.
– Sterilization cycles prolonged at lower temperatures.
– Heavy loads of instruments, crowding of packs &
heavy wrapping easily defeat sterilization.
 ETHYLENE OXIDE
STERILIZATION
• Best method for sterilizing complex instruments &
delicate materials.
• Automatic devices sterilize items in several hours
& operate at elevated temperatures well below 100
°C.
• Less expensive devices operate overnight to
produce sterilization at room temperature.
• Porous & plastic materials absorb gas & require
aeration for 24 hours before it is safe to contact
skin or tissues.
 FAILURES IN STERELIZATION

• Wrong Packaging Material

• Over-filled Sterilizer

• Altering the Sterilization Cycle

• Mechanical Problem
MONITORING OF STERILIZATION
• Effective instrument sterilization is assured by
routine monitoring & has become a standard of
care.
• Sterilization monitoring has four components:
– A sterilization indicator on the instrument bag, stamped
with the date it is sterilized.
– Daily color change process indicator strips.
– Weekly biologic spore test.
– Documentation note book.
STERILIZATION INDICATORS &
DATE
• Sterilization indicators are marked with heat
sensitive dyes that change color easily upon
exposure to heat or sterilization chemicals.
• Important to identify & differentiate sterilized &
un-sterilized packs.
• Used alone, these are not an adequate measure of
sterilization conditions.
• If not used, packs need to be sterilized again 1, 6,
12 months depending on the time of wrap &
manufacturer’s claims.
 PROCESS INDICATOR STRIPS
• Provide inexpensive, qualitative, daily monitor of
sterilizer function, operation & heat penetration
into packs.
• Place the strip into every surgical pack & in at-
least one operative instrument pack in the center
of each load.
• Can identify breakdowns & gross overloading.
• However, it is not an accurate measure of
sterilization time & temperature exposure.
 BIOLOGIC MONITORING
STRIPS
• Accepted weekly monitoring test of adequate time
& temperature exposure.
• Spores dried on absorbent paper strips are
calibrated to be killed when sterilization
conditions are reached.
DOCUMENTATION NOTEBOOK
• In a notebook, affix a single dated, initialed,
indicator strip to a sheet or calendar for each
workday, followed by weekly spore strip report.
• Provides valuable sterilization documentation.