In this lesson we will look at how to set up for surgical procedures in the dental setting using the aseptic (sterile) technique. This involves setting up and maintaining a sterile field with pre sterilised instruments and consumables such as drapes, suction attachments and barriers, as opposed to using unsterilised consumables on a regular bib. Even the paper towels used for dry hands after surgical hand preparation are prepackaged and sterilised. Some procedures where a sterile field is required are implant surgery, surgical extractions and maxillofacial surgery. The aseptic technique is not required for general dental procedures.
Pre sterilised kits are available for each surgical procedure. The kits contain all consumables required for surgery in a sterile pack, including drapes, suction tips, suction covers, barriers etc.
GUIDANCE FOR USE OF ASEPTIC TECHNIQUE
Please note that assisting during aseptic process should not be performed unless you have been trained by a team lead or other suitably trained and experienced Dental Boutique team member.
These videos are a guide only and do not cover all potential situations. They form a foundation in the concept of performing hand hygiene for surgical procedures, and the setting up and maintaining of a sterile (aseptic) field.
Note that the consumables/items/instruments used for setting up an aseptic field are different to general use items. Everything is sterile, including drapes, gowns, gloves, barriers, etc. They come in pre-sterilised packs and must be opened and laid out using a certain technique so that they do not come into contact with non-sterilised surfaces.
The aseptic setup process can be performed by one person, but assisting during a surgical procedure under aseptic conditions requires an extra assistant to be available to act as a runner or scout.
Below is a video demonstrating surgical handwashing technique prior to surgical procedures. It is different to standard handwashing/hand hygiene. Products that are used for surgical hand preparation include Skinman 90, which is an alcohol-based hand rub containing not less than 90% alcohol, and chlorhexidine-based hand wash. According to the new Standards (2023), use of 90% alcohol-based hand rub is preferable for surgical hand preparation if hands are not visibly soiled. Surgical hand rub technique instructions are below as well:
Below is a video demonstrating the correct way to don surgical PPE whilst maintaining an aseptic field:
The image on the left shows the correct stance for someone who is wearing surgical PPE in an aseptic state. Note that the hair is covered with a hair net, full PPE is worn, and the arms are held close to the sides with hands clasped together in front.
Hands may also be held in front at chest/waist height; however, they must always be kept visible and must not touch areas of the gown considered non-sterile.
These areas of the gown include the area around the neck and under the arms/sides – this is due to the possibility of sweat contamination. Likewise the lower third and the back of the gown are not considered sterile as they are often out of site and unexpected contamination is possible.
NOTE: ONCE YOU HAVE SCRUBBED IN (PERFORMED SURGICAL HAND HYGIENE) AND ARE WEARING STERILE SURGICAL PPE, YOU MUST NOT TOUCH ANYTHING OUTSIDE OF THE ASEPTIC AREA.
The next video demonstrates the aseptic set up of dental instruments and consumables for dental surgery:
