Operation Theatre Protocol

Cleanliness of hospital environment
Ensure infection control for the patient who undergo surgical procedure
Critical instruments are sterile by autoclave, semi-critical instruments are sterile by using Glutaraldehyde solution & more than 2 % strength alkaline solution; Non-Critical instruments are cleaned by washing with detergent
Allow the patient to become dry before draping
Sterile area should be separated from other by draping
Team members should not talk except when essential
The doors from the corridors into operating room should be kept close
For hand scrubbing the area should be wide enough
Operator should gloved properly
Temperature of the operation theatre should be in between 24-270C
Relative humidity should be 45 – 600C
The room should be well ventilated

Patient Preparation

Hospitalization 2 – 3 days prior to surgery
Intake patient’s medical history
Outside clothing should be discarded & the patient should be provided with clean hospital clothing
Patient should not be shifted in operating room with full bladder
The oral cavity should be thoroughly inspected, loose teeth should be extracted as the may come in the way of intubation
Application of preoperative skin antiseptic
Scrubbing of the operative site, starts at the centre and goes to periphery
Then the area should be painted with 5% povidine iodine solution & remain on skin for atleast 2 minute
Adhering drape is applied
For isolation of mouth clear plastic drape with an adhesive side can be used

Appreciation of basic microbiology & modes of disease transmission
Implementation of work practices which prevent transmission of infection
Conscientious hygiene, including handwashing & regular cleaning of work areas
Adoption of nationally recommended procedures for sterilization & disinfection
Single-used or sterilisable equipment used routinely where this is practical
Appropriate use of antibiotics
Vaccination against infections which are potential risk in health care setting
Ongoing quality management & improvement
Risk minimization technique
Precaution require the assumption that all blood & body substances are potential sources for infection
Standard precaution include good hygiene practice

Steam sterilization is the preferred method of sterilization of re-usable dental instruments
Instrument surface must be in direct contact with dry saturated steam at the required temperature, for the requisite time, in the absence of air
The machine must be periodically tasted to ensure that the parameters established at installation are still valid
Two type of sterilizer is commonly used in dental surgeries, these are Type N & Type B
Type N sterilizers also known as bowl & instrument, unwrapped instruments & utensile sterilizers, or natural displacement sterilizers
Type B sterilizers also known as vacuum bench top sterilizers
Majority of surgical instruments are sterilized by type N sterilizer
In general for autoclaving temperature should be 121⁰C, pressure 15 lbs, time 15 minute
Metal instruments should kept 4 minute at 134⁰C in autoclave
Wraped metal instruments should kept 9 minute at 134⁰C in autoclave
Textile articles should kept 12 – 16 minute at 134⁰C in autoclave
Note the chamber pressure guage till it comes to zero
After drying is completed valve is turned off the autoclave

Spent X-ray fixer used in dental clinics to develop X-rays is a hazardous material that should not be simply rinse down the drain
Undeveloped X-ray films contain a high level of silver & must be treated as hazardous waste & needs to disposing in a recommended container for for recycling
The lead foil inside X-ray packet & lead aprons contain leachable toxin which can contaminate soil & ground water. This should only be handed over to CWC.
Blood-soaked/dripping gauze should be enclosed in a yellow biomedical waste bag covered with a double bag, a CWC should be contacted for disposal
All sharp waste (needle, scalpels, glass carpules, burs, files, blades etc.) should collect in a red or yellow puncture resistance container with a lead that cannot be removed, with biohazards symbol & once full, the CWC should be contacted for disposal
Nonchlorinated plastic container should be preferred to minimize environmental impacts & placed in a solid waste stream for management of chemicals, disinfectants & sterilizing agents
Nonhazardous wastes should be collected in a PVC plastic container & recycle them wher the service exists.

Ensuring that oxygenated blood is being delivered to critical organs, this is consistent with basic cardiopulmonary resuscitation
In severe emergency give CPR to the patient
Oxygen pressure should not be exceed 35 liters per minute which provide some additional time to induced emergency drug to the patient
Epinephrine is the drug of choice for the emergency treatment of anaphylaxis & asthama. This is also indicate for cardiac arrest
Nitroglycerin is indicated for acute angina or myocardial infraction.
Injectable Antihistamine is indicated for the management of allergic reactions. Whereas mild non-0life threatening allergic reaction may be managed by oral administration
Salbutamol is a selective beta-2 agonist is the firstchoice for management of bronchospasm
Aspirin is one of the more newly recognized life-saving drugs as it acts on acute myocardial infraction
Oral carbohydrate source should be provided to the patient
Glucagon allows intramascular management of hypoglycemia in an unconscious patients
Atropine an anti-muscarinic, anti-cholinergic drug is indicated for management of hypotension, which is accompanied by bradycardia
Administration of a corticosteroid such as hydrocortisone may be indicated for prevention of recurrent anaphylaxis
Morphine is indicated for the management of severe pain which occurs with myocardial infraction
Injectable Benzodiazepine is indicated for management of seizures which are prolonged or recurrent