Operation Theatre Protocol
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
Infection Control
- 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
Sterilisation
- 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
- The machine must be periodically tested
- Two type of sterilizer is commonly used in dental surgeries, Type N & Type B
- Type N sterilizers also known as bowl & instrument sterilizers
- Type B sterilizers also known as vacuum bench top sterilizers
- Majority of surgical instruments are sterilized by type N sterilizer
- Autoclaving: 121°C, pressure 15 lbs, time 15 minute
- Metal instruments: 4 minute at 134°C
- Wrapped metal instruments: 9 minute at 134°C
- Textile articles: 12–16 minute at 134°C
- Note the chamber pressure gauge till zero
- After drying, valve is turned off
Waste Management
- Spent X-ray fixer is hazardous and should not be drained
- Undeveloped X-ray films must be disposed in proper containers
- Lead foil and aprons contain toxins
- Blood-soaked gauze disposed in yellow biomedical bags
- Sharp waste collected in puncture resistant containers
- Nonchlorinated plastic preferred
- Nonhazardous waste recycled where possible
Medical Emergency Management
- Ensuring that oxygenated blood is being delivered to critical organs
- In severe emergency give CPR to the patient
- Oxygen pressure should not exceed 35 liters per minute
- Epinephrine is the drug of choice
- Nitroglycerin is indicated for acute angina
- Injectable Antihistamine is indicated
- Salbutamol is used for bronchospasm
- Aspirin is life-saving drug
- Oral carbohydrate source should be provided
- Glucagon for hypoglycemia
- Atropine for hypotension
- Hydrocortisone for anaphylaxis
- Morphine for severe pain
- Benzodiazepine for seizures