The document discusses the principles and procedures of aseptic surgery and effective sterilization. It defines key terms like sepsis, asepsis, and sterilization. It describes the steps taken to ensure asepsis in surgery, including patient and surgeon preparation as well as sterilizing equipment. Various sterilization methods are covered, such as heat, radiation, and filtration. Strict adherence to aseptic protocols is important to decrease surgical infections and complications.

1. Asepsis Surgery & Effective
Sterilization
Dr Kaung Htike
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2. Principle of asepsis surgery
Wound infections have been a major problem since surgery began. Asepsis
surgery is the procedures used to keep the object or area sterile or completely
free from microorganisms.In surgical asepsis all practices are directed to the
elimination of both pathogenic and non pathogenic microorganisms.
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3. Definitions
• Sepsis – A state of being infected with pus producing microorganisms.
• Asepsis – A state of being free from microorganisms.
• Antisepsis – The prevention of sepsis by the inhibition or destruction
of causative microorganisms.
• Sterilization – Destruction or removal of all forms of microorganisms
including spores.
• Disinfection – Destruction or removal of some or all microorganisms
excluding spores.
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4. Principle
• Keep sterile equipment above your waist level or above table level.
(Waist level and table level are considered margins of safety and will
promote maximum visibility of the sterile field.)
• Do not speak, sneeze and cough over a sterile field. ( To prevent
droplet infection )
• Never across sterile field. ( When a non sterile object is held above a
sterile object, gravity causes microorganisms to fall into the sterile
field. )
• Keep the unsterile objects away from the sterile field.
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5. • Keep the sterile field dry. ( Microorganisms do not pass easily pass
through a dry surface. )
• The edge of the sterile field is considered unsterile.
• Each sterile supply should be clearly labeled as to its contents, time
and date of sterilization.
• Always check the sterility expiration date.
• Put on mask, Wash hands , put on gowns and gloves before handling
sterile supplies
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6. Procedures including in asepsis surgery
1. Preoperative patient preparation
2. Preparation of surgeon
3. Effective sterilization of surgical equipment
4. Operation theatre
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7. 1.Preoperative patient preparation
a. Short preoperative hospital stay reduces pathogenic bacteria on skin
and nasal carrier state.
b. Shaving the surgical area.
c. Patient’s skin preparation
d. Draping the patient
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8. 2.Preparation of surgeon
a. Surgical hand scrub
b. Gowning
c. Gloving
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9. a. Surgical hand scrub
Purpose :
Remove as many micro organisms from the hands as
possible before the sterile procedure.
Step of procedure
• Ensure fingernails are short, clean, healthy. Nail polish should be
removed.
• Apply personal protective equipment(PPE) includes cap ,
facemask and protective eyewear.
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10. • Turn on the water and adjust the flow.
• Wet hands and arms. Keep hands above elbows.
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11. • Apply antibacterial soap and wet scrub brush.
• Anatomic timed scrub: Starting with fingertips, scrub each anatomic
area (nail, fingers each side and web space ,palmar , dorsal surface and
forearm) for around 5 minutes.
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13. • Rinse hands thoroughly under warm running water, holding hands
upward. This is to allow water to drain towards the flexed elbows.
• Dry hands with a sterile towel
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14. b. Gowning
Purpose :
To apply entire necessary to safely carryout sterile procedures usually
in the operating room and delivery room.
Step of gowning procedure
• Grasp folded sterile gown at the neckline
• Allow gown to gently unfold, being careful that does not touch the
floor.
• The inside of the gown is towards the user.
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• Holding the arms at the shoulder level, grasp the sterile gown just below the
neckband near the shoulders and slide arms in the sleeves until the fingers are
at the end of the cuffs but not through the cuffs.
• Have someone tie the back of the gown.

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17. c. Gloving
Purpose :
Prevent transfer of micro organisms from hands to sterile objects
or open wounds.
• Position the glove over the cuff of the gown.
• Adjust gloves for comfort and fit, taking care to keep gloved hands
above waist level at all times
• Wash hands before and after removing gloves to prevent
contamination of hands.
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18. 18
C
B
D

19. 19
E F
G

20. 3.Effective sterilization of surgical equipment
Methods of sterilization
a. Physical methods
1. Heat
2. Radiation
3. Filtration
b. Chemical methods
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21. 1. Heat
Dry Heat
• Hot air oven
• 160 °C × 1 hour
• 170 °C × half hour
• Uses;
• Dry Glassware, e.g. test tubes,
• Surgical instruments, e.g. forceps, scissors.
• Powders, Fat, oil
• Flaming
• Direct exposure of heat for a few seconds.
• Uses;
• For scaplels , mouth of test tubes.
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Hot air oven
Flaming

22. Moist heat
• Pasteurization
• Holding method 63°C × 30 min
• Flash method 72 °C × 20 seconds
• Boiling
• 100 °C × 5 to 20 min
• Best method of achieving disinfection but not sporicidal
• Autoclaving
Principle of an autoclave
• Water boiled in a closed vessel with increase pressure results in a rise of
boiling temperature.
• Steaming under pressure
• 15 lb per square inch at 121 °C × 15-30 min
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23. Uses;
• Surgical instruments
• Syringes (all glass and glass metal)
• Rubber and silicones articles
• Laboratory glassware
Tests for efficiency of an autoclave
Chemical indicators
• Bowies – dick tape test
• A pellet of sulphur
• Browne’s sterilizer control tubes
Biological indicator
• Bacillus stearothermophilus spore strips
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Autoclave

24. 2. Radiation
Ultra violet light
Natural- sunlight
Artificial- mercury vapour lamp
Ionizing radiation
Gamma rays
X- rays
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Gamma rays
Artificial- mercury
vapour lamp
Ultra violet light

25. 3. Filtration
Filtration for liquids
Uses; Liquids that cannot tolerate heat such as toxin, antibiotic solution,
serum.
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26. Chemical Method
Ethylene oxide gas
Uses; For sterilization of heat sensitive materials such as surgical
instruments and plastics.( Disposable plastic syrings)
Formaldehyde and glutaraldehyde
Uses; to sterilize respiratory therapy equipment.
Hydrogen peroxide
Uses; as an antiseptic to clean wounds.
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27. Clinical applications
Disinfection of the skin
Surgeon’s hand
• Soap and water
• 70% ethanol or methylated spirit
Patients skin for operation
• Soap solution – solution 1
• 70% alcohol or methylated spirit – solution 2
• Weak iodine solution – solution 3
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28. 4.Operation theatre
Ideal theatre should have:
• Pressure release dampers
• Minimum fixtures , shelves
• Doors should be closed properly
• Windows should be sealed properly
• Flooring should have no gaps
• Painted surface should be finish
• Walls preferably rounded
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30. REQUIREMENTS
• AIR DELIVERY SYSTEM
• AIR FILTERATION SYSTEM
• TEMPERATURE CONTROL
• HUMIDITY CONTROL
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31. Sterilize the operation theatre
Fumigation
• Low temperature heating produce vapor
• Vapor phase decontaminates the air/environment.
• Kills vegetative bacteria.
• Gaseous formaldehyde is generated - Time X Temp
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32. Common breaks In aseptic technique
Operating team
• Exposed hair
• Active respiratory infection
• Dermatitis
• Loose-fitting mask
• Soiled scrub suit
Scrub procedure
• Rings and bracelets left on
• Long or dirty fingernails
• Improper scrub sequence, duration or technique
• Gowning or gloving with wet hands
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33. Touch contamination break
• Sterile team member having front to back contact with another
sterile member
• Any contact with non-sterile surface, usually during draping
• Hands held below table level
• Torn glove
Technique breaks
• Drapes soaked by blood or solutions
• Unnecessary conversation
• Non-sterile person leaning over sterile field
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34. Conclusion
STRICTLY FOLLOWING THE PROTOCOLS OF ASEPSIS SURGERY & EFFECTIVE
STERILISATION WILL RESULTS IN HIGH SUCCESS RATE & DECREASE IN
SURGICAL INFECTIONS & POSTOPERATIVE COMPLICATIONS.
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35. REFFERENCES
• Cotemporary Oral & Maxillofacial Surgery Seventh Edition
• Microbiology Volume One–Department of Microbiology DSMA
• Laskin-Textbook of Oral & Maxillofacial Surgery
• Surgical asepsis: principles and protocols - STEPHEN BAINES
• THEATRE DESIGN AND VENTILATION - DR.LOKESHSHAROFF
• SURGICAL ASEPSIS - K.THILAGAVATHI
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