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1
Team Duties for Implant Surgery
Contents
Page 1 Team Duties
Page 2 Patient Carer Duties
Page 6 Patient Prep Kit
Page 7 Patient Prepping Procedure
Page 9 Aspirator Cleaning Procedure
Page 12 Roving Assistant Duties
Page 16 Surgical Assistant Duties Complete
Page 32 Sedation Consent Form
Page 34 Sedation Protocol
Page 42 Postoperative Care to help healing
Page 44 Fitness to leave Assessment
Page 46 Handcare
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The Team Day______________________Date____________________________
Patient’s Name ______________________________________________
Patient Arrival Time__________________________________________
Patient’s Dentist______________________________________________
Procedure to be performed_____________________________________
____________________________________________________________
The Treatment Team
Team Leader_________________________________________________
Operator____________________________________________________
Chairside Assistant___________________________________________
Surgical
Assistant_____________________________________________________
Roving Assistant______________________________________________
Patient Carer, and Clearer-upper________________________
Patient/ Escort Carer Prepper _________________________________
The Sedation Team
Sedationist___________________________________________________
Sedation Assistant____________________________________________________
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Patient Carer Duties 290606
Care for the Patient from the Time that they arrive at the Harpole Centre, particularly
during the Initial Sedation Period, and until the End of the Patient Prepping. The
Sedation Team is responsible for the care of the patient after this point.
Before the Patient arrives Find out
Patient’s Name________________________________________________________
Patient’s Dentist________________________________________________________
The Procedure to be performed _________________________________
Find out from the Patient’s Dentist and record the following information:-
1 The Likely State of Patient’s Feelings on Arrival
2 The Likely State of Patient’s Escort’s Feelings on Arrival
3 The Antibiotic Regimen to be used
What Antibiotic cover is to be used __________________________
4 Whether Ibuprofen is to be administered
Whether the Patient is Asthmatic Yes / No
Whether the Patient is Allergic to Aspirin Yes / No
Ibuprofen Dose 2 x 400 mgm pre-op 1 x 600 mgm post-op
1 x 600 mgm 4 x day x 2 days
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Set up 1. The Drugs required
2. A Toothbrush
3. Chlorhexidine Mouth Rinse
4. Chlorhexidine Gel
Change into your scrub suite in plenty of time the procedure.
Put on a cap and mask in plenty of time before the procedure.
Leave your mask around your neck until the patient is sedated.
(Wearing a mask before this may intimidate the patient.)
Be prepared to meet the patient when they arrive
1 hour before the procedure
1 Check with the Patient
1. Whether they are Allergic to Penicillin Yes / No
2. Whether they are Asthmatic Yes / No
3. Whether they are Allergic to Aspirin Yes / No
2 Have the patient
1. Brush their teeth and gums with Chlorhexidine Gel.
2. Rinse for 1 minute with Chlorhexidine Rinse
3. If they are not allergic to aspirin or are not asthmatic
Have the Patient take 2 x 600 mgm Ibuprofen
4. Have the Patient take their antibiotic if appropriate.
3 Have the patient go to the toilet just before the procedure
4 Check on the escort’s emotional state.
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Record the Actual of Patient’s Feelings on Arrival
Record the Actual of Patient’s Carer’s Feelings on Arrival
Be aware that the patient and the patient’s escort may be nervous although
they may not show it.
Put your mask on as soon as the patient is sedated before prepping the
patient.
Start prepping the patient as soon as they are sedated.
Let the Patient Draper know when you have finished prepping
9 Prepare the Aspirator Cleaning Solution after re-bagging the Prep Kit
10 Single Bag the Nailbrushes
11 Check that the Panoramic Radiograph Cassette has been loaded and positioned
on the Machine.
12 Clean the Aspirator Tubing at the end of the procedure.
During the Procedure.
1. Tidy up Treatment Room
2. Clear away any Wrapping Paper
3. Ensure that if there is any sterilizing to be done
the Autoclave is kept full.
4. Check Panoral Machine Ensure that the Panoral Cassette is loaded and installed on the Panoral
Machine.
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5. Press Reset Pad on Panoral Machine Control
6. Re-pack the Patient Prep Kit
Keep an Eye on the Patients Escort.
Yellow Bag Check
Check whether the Yellow Bag is Full
If so remove it from the Stand
Place a Black Tie around its neck
Place the Bag outside the Treatment Door
Prepare the Aspirator Cleaning Solution after re-bagging the Prep
Kit
After repacking the Prepping Kit mix the Aspirator Cleaning Liquid.
Near the End of the Procedure.
At the End of the Procedure Change Filter
Clean Aspirator Tubing and Tip. While the Aspirator Cleaner is aspirating the Cleaning Fluid sweep the Floor.
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Patient Prep Kit
Checked by (Print) ____________________________________Date____________
Re-checked by (Print) _________________________________Date____________ ( ) ( ) 4 x Gauze Squares
( ) ( ) Towel
( ) ( ) Large Metal Cup
( ) ( ) 3 Single Medium Gloves CUFF FOLDED BACK On the Right of the Pile
( ) ( ) Sensodyne Toothbrush
( ) ( ) Alice Forceps with Gauze attached (Roll the Gauze and bend double)
( ) ( ) Mouth Mirror
Double Bagging
First bag use the one from Largest Sterilizing Bag
Second bag use Largest Sterilizing Bags Available When opened up large bags provide a large sterile surface to work off.
Once wrapped all packs should be Clearly labeled using a Sandford
Super Sharpie Felt Tip Pen
1. The Date that Bag was sterilized.
2. The Name of the Pack
3. Write the Full Name of the Packer (Not just Initials)
4. The Name of the Checker
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Patient Prepping Procedure
The Prep Kit contains the Following
1. 3 Single Gloves 2. 4 x 10 cm Gauze 3. A 150cc Metal Bowl
4. Swabbing Forceps 5. Mirror, 6 a Towel 7 a Mop Cap
Prep thoroughly so that there is no need to go back
over areas not previously covered sufficiently
Preparing to Prep
1 Place a Mop Cap on the patient’s Head
2 Open Prepping Pack
3 Use the Bag as a Sterile Surface
4 Put on the Sterile gloves
Once the sterile gloves have been put on do not touch
anything non-sterile including the Patients Face.
4 Open Towel & place on Patients Chest just below the Adams Apple
5 Hold Prepping Cup out for assistant to fill with Betadine
6 Dip Sterile Gauze in Holders in Betadine
Initial Extra-oral Prepping 1. Ask the patient to open their mouth
2. Paint Betadine Clockwise round the patients lips
3. Continue applying Betadine in a Clockwise Direction increasingly
moving further and further away from the mouth
4. Ensure that the Nostrils and Folds of the Nose are covered
5. Extend the Betadine Coverage completely
1. Over the Nose up the Top of the Bridge
2. Just below the Lower Eyelid
3. Down the Neck to the Adams Apple
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Intra-oral Prepping
With a Toothbrush dipped in Betadine brush in the following Sequence
repeat dipping the Brush in Betadine as necessary
1. Paint Insides of Cheeks and Lips
Lower Jaw
1 The Buccal and Labial Surfaces of the Lower Gums and Teeth
2 The Lingual Surfaces of the Lower Teeth and Sublingual Region
3 All the Surfaces of the Tongue
Upper Jaw 1. The Buccal and Labial Surfaces of the Upper Gums and Teeth
2. The Palatal Surfaces of the Upper Teeth
3. The Palate
Extra-oral Re-prepping
6. Use New Gauze for Second Time Outside of the Mouth.
7. Ask the patient to open their mouth
8. Paint Betadine clockwise round the patients lips
9. Continue applying Betadine in a Clockwise Direction increasingly
moving further and further away from the mouth
10. Ensure that the Nostrils and Folds of the Nose are covered
11. Extend the Betadine Coverage completely
1. Over the Nose up the Top of the Bridge
2. Just below the Lower Eyelid
3. Down the Neck to the Adams Apple
Leave the Sterile Towel on the Patients Chest
Remove all Prepping Items and Re-Set up Prepping Pack
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Aspirator Tubing Cleaning
1. Mix up Aspirator Cleaner Liquid during the Procedure in the Clear
Plastic Jug.
2. Locate
1) A Narrow Aspirator Tubing Cleaning Brushes
2) A Medium Aspirator Tubing Cleaning Brushes
3) A Wide Aspirator Tubing Cleaning Brushes
4) A Container of Mediwipes
5) A Filter
6) A Plastic Basin
7) A Plastic Beaker
8) Mix the Aspirator Disinfection Solution
At the End of the Procedure in the Treatment Room
1) Pull off the Main Corrugated Aspirator Tubing
2) Clean the Grill
3) Aspirate some Cleaning Fluid
4) Reconnect Connector and Corrugated Tubing
Aspirator Tip and Gray Aspirator Tubing Cleaning
1) Before removing the Aspirator Tip and Grey Sterilizable Aspirator
Tubing from the main Central Aspirator Tubing
2) Clean the Rubber Grey Sterilizable Aspirator Tubing by wiping it down
with a Mediwipe
3) Clean the Central Suction Suction Tubing by wiping it down with a
Mediwipe
4) Aspirate ½ the Cleaning Liquid intermittently through the Aspirator Tip.
5) Remove the Gray Rubber Sterilizable Aspirator Tubing from the
Aspirator. Place in the Washing-up Basin
6) Brush the Central Suction Aspirator Tubing
7) Re-aspirate Cleaning Liquid
8) Repeat brushing the Aspirator Tubing with the Wide Cleaning
Brush
9) Re-aspirate Cleaning Liquid
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Filter Maintenance
1) Remove the Yellow Plastic Filter
2) Place the Filter in the Plastic Beaker
3) Connect a Clean Yellow Plastic Filter to the Screw Top
4) Fit into Filter Hole
Do not throw away the Used Filter
Clean Floor before Leaving the Treatment Room
Final Aspirator and Gray Aspirating Tubing
and Filter Cleaning
Take the Sterile Aspirator tubing and Plastic Beaker to the first sink in the
Lecture Theatre
Filer Cleaning
1) Fill the Plastic Beaker with Water to cover the Filter
2) Place the Plastic Beaker in the Ultrasonic for 15 minutes
3) Replace the Water
4) Ultrasonic for 15 minutes
5) Clean under a Running Tap
6) Place in Cold Sterilizing Solution
Aspirator Tip and Gray Tubing Cleaning 1) Remove the Aspirator Tip from the Gray Aspirator Tubing
2) Brush the Aspirator Tip using the Narrow Cleaning Brush ( If the Tip is
very narrow use an Aspirator Cleaning Wire)
3) Place the Aspirator Tip in the Ultrasonic Bath.
4) Place Rubber Tubing in Dishwasher.
5) Attach the Rubber Tubing to the Tap.
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6) Turn the Tap on.
7) Leave for 5 minutes.
8) Turn the Tap off.
9) Place Rubber Tubing in Dishwasher again.
10) Attach the Rubber Tubing to the Mobile Aspirator for 5 minutes to dry it.
12) Insert the Aspirator Tip Wire Cleaner in the Tip.
13) Re-attach the Aspirator Tip to the Rubber Tubing.
14) Wind up the Tubing and place an Elastic Band round the Tubing.
15) The Tubing and Aspirator Tip are ready to be packed in the Operator Side
Pack
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Roving Assistant Duties
The Roving Assistant is not scrubbed as is the Scrubbed Assistant
The role of the Roving Assistant
Be observant of any infringements of the Sterile Chain to ensure the
maximum level of sterility.
Change into your scrub suit in plenty of time before the procedure.
Put on a cap and mask in plenty of time before the procedure.
Put your mask on as soon as you start Unbagging Sterile Instruments.
Open the Scrubbed Assistant’s Gown Pack
Observe the Scrubbed Assistant scrubbing
Tie up the Assistant’s Gown
Ensure that the scrubbed Assistant takes the spare glove into the treatment
room
Clear away the Wrapping Paper
Start unbagging as soon as the Scrubbed Assistant is ready
Unwrap the Next Item before the Scrubbed Assistant is ready for it
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Before the Procedure
1. Know the procedure to be performed on the patient.
3 Help the Scrubbed Assistant gather together all the Items
required for the Surgery
3 Check the Items collected by the Scrubbed Assistant against the Scrubbed
Assistant List
When the items have been laid out in the treatment room check that they are in the following order:-
From the right of the long work surface
( ) 1 Mayo Table Cover
( ) 2 Empty Instrument Trays
( ) 3 Surgical Instrument Tray
( ) 4 The Assistant Side Bagged Items
( ) 5 Local Anaesthetic Needle.
( ) 6 Local Anaesthetic Carpules.
( ) 7 All other Items
Operator Side Work Surface
( ) Patient Drape
( ) Gray Aspirator Tubing and Aspirator Tip
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At the Beginning of the Procedure.
Open the Scrubbed Assistant’s Gown Pack
Assist the Scrubbed Assistant to Gown
Open the Mayo Table Pack
The Scrubbed Assistant fits the Mayo Table Cover on the Mayo Table
Unwrap and Pass Items to the Scrubbed Assistant who is setting up the Mayo Table.
Pass slowly to avoid breaking the chain of sterility.
Throw all Wrapping on the Floor
1 The 2 Empty Instrument Trays to be positioned at the Front of the
Mayo Table
2 The Surgical Instrument Tray
(Behind the Empty Trays to the Right)
3 Local Anaesthetic Needle.
4 Local Anaesthetic Carpules.
5 The Assistant Side Bagged Items Behind the Instrument Tray
6 Help connect the Sterile Aspirator Tubing.
7 Help connect the Physiodispenser Motor.
8 Help connect the Saline Tubing.
9 Place a Bin lined with a Yellow Bag close to the Scrubbed
Assistant
During the Procedure
1 Pick up all Debris from the Floor during and after the Procedure
2 Be prepared to pass any extra items as required.
3 Be observant of any infringements of the Sterile Chain.
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At the end of the procedure.
Remove all Instruments to the Instrument Cleaning Area
Help scrub instruments
Cleaning Handpieces
1. Do not leave Implant Handpieces immersed in Water
2. Take Implant Handpieces apart
3 Rinse all the parts Handpieces in the Warm Soapy Water
without immersing them.
(This removes the Saline from the internal parts of the handpiece
which could clog the handpiece)
1. Rinse all parts in Cold water
2. Reassemble the Handpiece
3. Spray Lubricant into the End of the Handpiece till Clean Oil
comes out of the Handpiece Head
Physiodispenser Motor Care
1. Do not immerse the Motor in Water
2. Wipe over the Motor to remove Blood etc
3. Place Plug in the End of the Motor
4. Double bag
Do NOT sterilize the Motor without the Plug in the End of the Motor
Clean up Procedure at the End of Surgeries
Collect the Lorna Clamp
Disconnect the Saline Tubing from the connection at the Physiodispenser
Disconnect the Motor
Help Remove all items from the Treatment Room
Tidy the Work Surfaces in the Treatment Room
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Surgical Assistant Duties Complete 270606
Patient’s Name
____________________________________________
Date _________________________________________________
Patients Dentist________________________________________
Scrubbed Assistants Name ______________________________________________
Procedure to be performed______________________________________________
_________________________________________________________________________________
Day of the Procedure____________________________Time of the Procedure________________
Change into your scrub suit in plenty of time before the procedure.
Put on a cap and mask in plenty of time before the procedure.
Have the Patient’s Dentist tick the Items required for the procedure on these
sheets as soon as possible.
Collect the necessary items for the procedure in a green tray.
Have the Roving Assistant check the items against the list
As soon as is possible lay out the items in the Treatment Room in their appropriate
place.
Have the Roving Assistant check the Layout
Scrub as soon as possible
Start laying out the Mayo Table with the assistance of the Roving Assistant as soon
as the Mayo Table is cleared
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Duties
1. To be in Charge the Delivery of the Surgical Instruments and
Supplies to the Operator.
2. To develop an understanding of the procedure to be performed on
the patient.
3. To check the Diagnostic Quality of the Radiographs
4. To become familiar with the Treatment Room Set –up
5. To gather together all the Instruments and Equipment for the
case.
6 . To have a Bowl of Sterile Saline or Local Anaesthetic ready to
wet a Gauze Square.
7 To ensure that all items necessary for the procedures are available
At the End of the Procedure
Help Clear the Treatment Room as fast as possible
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All Items are to be collected together and then transferred to the
Treatment Room before the Treatment is to commence
Left hand Column to be filled in by the Participants Dentist Needed Collected by Checked by Scrubbed Assistant Roving Assistant
To be placed in the Gowning Area
3 x Gown Packs ( ) ( ) ( )
3 x Sterile Glove Bags ( ) ( ) ( )
To be placed on the Assistant Side Pull-out Drawer
Prep Kit ( ) ( ) ( )
Videne Antiseptic Solution ( ) ( ) ( )
To be placed on the Operator Side Work Surface
Disposable Patient Drape ( ) ( ) ( )
Aspirator Tubing ( ) ( ) ( ) with Tip attached
To be placed on the Work Surface next to the Window First
Item at the Farthest End
Mayo Table Drape ( ) ( ) ( )
3 x Empty Small Instrument Tray ( ) ( ) ( )
with Instrument Rack
On Top of Each Other
1 bag of Surgical Instruments ( ) ( ) ( ) 1 x Assistants Side Bagged Items ( ) ( ) ( )
( Mouth Gag etc ) Saline Bag ( ) ( ) ( )
Green Saline Tubing ( ) ( ) ( )
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Needed Collected by Checked by 4 Scrubbed Assistant Roving Assistant
Removal of a Tooth or Root
Surface Anaesthetic for Upper ( ) ( ) ( )
Syrijet for Upper and Lower ( ) ( ) ( )
Scalpel Handle ( ) ( ) ( )
No 15 Scalpel Blade ( ) ( ) ( )
Periotome ( ) ( ) ( )
Coloured Subluxators ( ) ( ) ( )
Mallet ( ) ( ) ( )
For Screw Implants
Green Ring Implant Handpiece ( ) ( ) ( )
Internal Irrigation Tubing ( ) ( ) ( )
Red Ring Handpiece ( ) ( ) ( )
Ridge Mapper ( ) ( ) ( )
To be placed at the Side of the Foot of the Chair
Implant Motor ( ) ( ) ( )
Implant Unit ( ) ( ) ( )
Items to be kept Wrapped ready but not Opened
Tatum Implant Screw Kit ( ) ( ) ( )
Tatum Implant Tapered Screw Kit ( ) ( ) ( )
Straight Bone Expansion Kit ( ) ( ) ( )
Tapered Bone Expansion Kit ( ) ( ) ( )
For Lower Anterior and all Upper and Lower Posterior Cases
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Offset Bone Expansion Kit ( ) ( ) ( )
Offset Scalpel Handles ( ) ( ) ( )
For Lower Anterior and all Upper and Lower Posterior Cases
Offset Scalpel Handles ( ) ( ) ( )
Vicryl 3.0 Sutures ( ) ( ) ( )
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For D Shaped Fin Implants
Left long table:
Tatum Implant D Fin Kit ( ) ( ) ( )
Long Amalgam Plugger ( ) ( ) ( )
Osteogen ( ) ( ) ( )
Vicryl 3.0 Sutures ( ) ( ) ( )
Forceps Upper or Lower ( ) ( ) ( )
Mini Implants
Imtec Kit ( ) ( ) ( )
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Ailing Implant Treatment Kit
Surgical Tray ( ) ( ) ( )
Bur Kit ( ) ( ) ( )
High Speed Handpiece Bagged ( ) ( ) ( )
Three in one Syringe ( ) ( ) ( )
Extra Tin Foil to cover
the Dental Unit and Tubings ( ) ( ) ( )
Micro-etcher ( ) ( ) ( )
Composite Etchant ( ) ( ) ( )
Tetracycline Tablets Crushed ( ) ( ) ( )
Mixed with Distilled Water ( ) ( ) ( )
Betadyne ( ) ( ) ( )
Chlorhexidine ( ) ( ) ( )
4 x Porcelain /Glass Crucibles ( ) ( ) ( )
Surgical Mallet ( ) ( ) ( )
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For Soft Tissue Grafts Needed Collected by Checked by
Scrubbed Assistant Roving
Assistant
Glass Slab ( ) ( ) ( )
Gillette Disposable Razor ( ) ( ) ( )
in Gluteraldehyde
Orban Knife ( ) ( ) ( )
Sterile Scalers ( ) ( ) ( )
Needed Setup Positioned in
For Sinus Grafts Treatment Room
Sinus Elevator Kit (Box) ( ) ( ) ( ) Straight Handpiece ( ) ( ) ( )
Set of Long Round Burs ( ) ( ) ( )
2 x 2cc Syringe for Bone ( ) ( ) ( )
Aspirator tubing with
Fibre Optic Narrow Aspirator Tip ( ) ( ) ( )
Collatape 1 per Sinus ( ) ( ) ( )
Irradiated Bone ( ) ( ) ( )
Antibiotic to be mixed with Graft ______________________________________________
( ) ( ) ( )
Vicryl 3.0 Sutures ( ) ( ) ( )
Sinus Graft Retractors ( ) ( ) ( )
Aspirator tubing with
Fibre Optic Minnesota ( ) ( ) ( )
Retractor
Special Instruments:
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Block Grafts
4 Needed Collected by Checked by Scrubbed Assistant Roving Assistant
Symphyseal or Ramus ( ) ( ) ( )
Retractors
Osteomed Screw Kit ( ) ( ) ( )
Osteomed Screwdriver ( ) ( ) ( )
Red Ring Handpiece ( ) ( ) ( )
Straight Handpiece ( ) ( ) ( )
Straight Round Burs ( ) ( ) ( )
Round Friction Grip Burs ( ) ( ) ( )
(1/4,1/2,1)
Fissure Bur FG Set ( ) ( ) ( )
(1557,1558, 560 )
Diamond Wheels
(straight and contra-angle ) ( ) ( ) ( )
3 Sizes of Acrylic Trimming Burs ( ) ( ) ( )
High Speed Airotor Handpiece ( ) ( ) ( )
Osteotomes ( ) ( ) ( )
Large Metal Bowl ( ) ( ) (
)
Irradiated Bone ( ) ( ) ( )
Bioguide ( ) ( ) (
)
Collatape ( ) ( ) (
)
Interpore 200 ( ) ( ) ( )
Vicryl 3.0 Sutures ( ) ( ) ( )
Fibre Optic Minnesota ( ) ( ) ( )
Retractor
Fibre Optic Standard ( ) ( ) ( )
Aspirator Tip
26
Fibre Optic Narrow ( ) ( ) (
)
Aspirator Tip
Fibre Optic tubing ( ) ( ) ( )
27
Tunnel Grafts 4 Needed Collected by Checked by Scrubbed Assistant Roving Assistant
Straight Handpiece –
Narrow Long Nozzle ( ) ( ) ( )
Straight Long Round Burrs ( ) ( ) ( )
Irradiated Bone ( ) ( ) ( )
Interpore 200 ( ) ( ) ( )
Biomend ( ) ( ) ( )
TCP
Tri-Calcium Phosphate ( ) ( ) ( )
Antibiotics- injectable to mix
with the graft material ( ) ( ) ( )
2cc Disposable Syringes ( ) ( ) ( )
Ramus Blades The Ramus Blades ( ) ( ) ( )
Ramus Blade Try-in ( ) ( ) ( )
Ramus Blade Bending Jig x 2 ( ) ( ) ( )
Titanium Tipped Pliers ( ) ( ) ( )
Ramus Blade Inserting Instrument ( ) ( ) ( )
Seating Instruments Straight ( ) ( ) ( )
Seating Instruments Bayonet ( ) ( ) ( )
(Offset)
Straight Round Burs ( ) ( ) ( ) Straight Handpiece ( ) ( ) ( )
Highspeed Airotor Handpiece ( ) ( ) ( )
Red Ring Handpiece ( ) ( ) ( )
Fissure Bur FG Set ( ) ( ) ( )
(1557,1558, 560 )
Titanium Seating Instrument ( ) ( ) ( )
Interpore 200 ( ) ( ) ( )
Vicryl 3.0 Sutures ( ) ( ) ( )
Fibre Optic Minnesota ( ) ( ) ( )
Retractor
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Fibre Optic Standard ( ) ( ) ( )
Aspirator Tip
Fibre Optic Narrow ( ) ( ) (
)
Aspirator Tip
2 x Fibre Optic tubing ( ) ( ) ( )
Custom Blades
4 The Custom Blade ( ) ( ) ( )
Vicryl 3.0 Sutures ( ) ( ) ( )
Highspeed Airotor Handpiece ( ) ( ) ( )
Ramus Blade Inserting Instrument ( ) ( ) ( )
Seating Instruments Straight ( ) ( ) ( )
Seating Instruments Bayonet ( ) ( ) ( )
Ramus Blade Inserting Instrument ( ) ( ) ( )
Seating Instruments Straight ( ) ( ) ( )
Seating Instruments Bayonet ( ) ( ) ( )
(Offset)
Circular Seating Instrument ( ) ( ) ( )
Straight Handpiece ( ) ( ) ( )
Highspeed Airotor Handpiece ( ) ( ) ( )
Red Ring Handpiece ( ) ( ) ( )
Fissure Bur FG Set ( ) ( ) ( )
(1557,1558, 560 )
Straight Round Burs ( ) ( ) ( )
Interpore 200 ( ) ( ) ( )
Fibre Optic Minnesota ( ) ( ) ( )
Retractor
Fibre Optic Standard ( ) ( ) ( )
Aspirator Tip
Fibre Optic Narrow ( ) ( ) (
)
Aspirator Tip
Fibre Optic tubing ( ) ( ) ( )
29
Ramus Frames Needed Collected by Checked by
4 Scrubbed Assistant
Roving Assistant
The Ramus Frame ( ) ( ) ( )
Ramus Frame Retractors ( ) ( ) ( )
Anterior Try Ins ( ) ( ) ( )
Posterior Try Ins ( ) ( ) ( )
Bending Pliers for Posterior Try-Ins ( ) ( ) ( )
Ramus Blade Inserting Instrument ( ) ( ) ( )
Seating Instruments Straight ( ) ( ) ( )
Seating Instruments Bayonet ( ) ( ) ( )
(Offset)
“D” Shaped Circular Seating Instrumen ( ) ( ) ( )
Anterior Foot Bending Instruments ( ) ( ) ( )
Curved Pointed Instrument ( ) ( ) ( )
for elevating tissue anteriorly in the
posterior site
Vicryl 3.0 Sutures 1 Box ( ) ( ) ( )
Straight Handpiece ( ) ( ) ( )
Red Ring Handpiece ( ) ( ) ( )
Highspeed Airotor Handpiece ( ) ( ) ( )
1557,1558 and 560 FG ( ) ( ) ( )
Surgical Length Burs
Straight Handpiece Round Burs ( ) ( ) ( )
Interpore 200 ( ) ( ) ( )
Irradiated Bone (14 grams) ( ) ( ) ( )
Antibiotic to mix with Irradiated Bone ( ) ( ) ( )
4 x 2 cc Syringes ( ) ( ) ( )
Fibre Optic Minnesota ( ) ( ) ( )
Retractor
Fibre Optic Standard ( ) ( ) ( )
Aspirator Tip
Fibre Optic Narrow ( ) ( ) (
)
Aspirator Tip
30
Fibre Optic tubing ( ) ( ) ( )
31
Lab Set-up
For Ramus Frame Construction
Alligator Pliers ( ) ( ) ( )
Mole Grip Pliers ( ) ( ) ( )
Modified Slip Joint Pliers ( ) ( ) ( )
Black Handled Pliers ( ) ( ) ( )
Microwave ( ) ( ) ( )
Chrome Lathe ( ) ( ) ( )
Strong Wire Cutters ( ) ( ) ( )
Ramus Frame Polishing Items
Lab Motor ( ) ( ) ( )
Polishing Lathe ( ) ( ) ( )
Multilayer Calico Mop
order no 35000830 Ivoclar Vivadent ( ) ( ) ( )
Small Black Polishing Wheel 2.5 inches ( ) ( ) ( )
With wooden centre Hawley Russell
T.C. Lab Bur ( ) ( ) ( )
(Bredent Cat. No. D194KT50) Ivoclar Vivadent)
Mandrels ( ) ( ) ( )
Blue Wheel (Renfert No92)SRE726 ( ) ( ) ( )
Skillbond Direct
Green Barrel Polishing Rubbers ( ) ( ) ( )
CJS137A Chaperlin & Jacobs
Tiger Brilliant Polish ( ) ( ) ( )
Dentaurum (Haley Russel Baker)
Micro-etcher ( ) ( ) ( )
Aluminium Oxide 90 micron Tan ( ) ( ) ( )
32
Passivating Items
Decontamination Instructions ( ) ( ) ( )
Ultrasonic Bath ( ) ( ) ( )
Container for Ramus Frame ( ) ( ) ( )
(must fit into the Ultrasonic Bath )
Acetone ( ) ( ) ( )
Nitric Acid ( ) ( ) ( )
Plastic Funnel ( ) ( ) ( )
Distilled Water ( ) ( ) ( )
Autoclave Bags ( ) ( ) ( )
Vacuum Autoclave ( ) ( ) ( )
For Denture Modification
Former for Denture Modification ( ) ( ) ( )
Polishing Lathe ( ) ( ) ( )
Acrylic Polishing Soap ( ) ( ) ( )
Model Trimmer ( ) ( ) ( )
Lab Motor and Handpiece ( ) ( ) ( )
Chrome Lathe ( ) ( ) ( )
Acrylic Trimming Burs ( ) ( ) ( )
Pink Acrylic Cold Cure ( ) ( ) ( )
in Plastic Dispensing Bottle
Acrylic Cold Cure Monomer ( ) ( ) ( )
Acrylic Monomer Dispensing ( ) ( ) ( )
Bottle with Needle Pippette
Acrylic Mixing Bowl ( ) ( ) ( )
33
Sectional Osteotomy Needed Collected by Checked by
Scrubbed Assistant Roving
Assistant
Metal Plate ( ) ( ) ( )
Osteomed Screws ( ) ( ) ( )
Three Pronged Pliers ( ) ( ) ( )
Curved Beaked Pliers ( ) ( ) ( )
Wire Cutters ( ) ( ) ( )
Microtomes ( ) ( ) ( )
Vicryl 3.0 Sutures ( ) ( ) ( )
Fibre Optic Minnesota ( ) ( ) ( )
Retractor
Fibre Optic Standard ( ) ( ) ( )
Aspirator Tip
Fibre Optic Narrows ( ) ( ) ( )
Aspirator Tip
Fibre Optic tubing ( ) ( ) ( )
Nerve Repositioning
Molts CM2 No 2 SE Curette (Hu-Friedy) ( ) ( ) ( )
Molts CM4 No 4 SE Curette (Hu-Friedy) ( ) ( ) ( )
34
Sedation Protocol doc
Patient’s Name _______________________________________________
Date ________________________________________________________
Patient’s Dentist______________________________________________
Procedure to be
performed_______________________________________
_
____________________________________________________________
____________________________________________________________
Obtain the Patient’s Folder before preparing for the Procedure
For Medico-legal Reason
All this form must be filled out accurately and fully put in the back of the Harpole
Centre Patient’s Folder
Ensure that all Names and Signatures are obtained as soon as possible
The Sheets must be given to Stuart Orton-Jones after being completed
With a Cheque from the Patient’s Dentist
Sedation Tutor Acceptance of Responsibility
I, Sedation Tutor’s Name in BLOCK CAPITALS __________________________________
take full responsibility for the wellbeing of this patient during the patient’s Sedation and immediately Post-operatively.
Date_________/____________/_________
Sedation Tutor Signature ________________________________
35
36
Sedationist’s Consent for Sedation
Procedure to be performed__________________________________________________________
______________________________________________________________________________________________
Concerning the treatment to be performed
1 I have been informed and I understand the purpose and the nature of the surgical
procedure to be performed.
2 My dentist has carefully examined my mouth and alternatives to this treatment
have been explained.
3 To my knowledge I have given an accurate report of my physical and mental
history. I have also reported any prior allergic or unusual reactions to drugs,
foods, insect bites, anaesthetics, pollen, dust, blood or body diseases, gum or skin
reactions, abnormal bleeding or any other conditions related to my health.
Concerning the treatment to be performed
1 I agree to the type of sedation, which has been explained to me, depending on the
decision of the sedationist.
2 The alternatives to sedation such as local anaesthetic alone or a general
anaesthetic have been explained to me and I have chosen sedation.
Pre-sedation Instructions
1 I understand that I should have a light non-fatty meal 4 hours before sedation
and must not drink anything from 2 hours before.
2 I give my full consent to my dentist to arrange for a fully qualified dental
sedationist to administer my sedation
3 The effects of sedation have been fully explained to me.
4 I understand that I will be sufficiently awake to converse with the sedationist
throughout the procedure
5 I have been informed that after sedation my judgement will be impaired for some
hours and I may not remember the procedure.
6 I understand that I must not drive a car, use machinery, cook or make any
important decisions for at least 24 hours.
7 I understand that I must not be left in charge of children.
37
8 I have been told that I may have a feeling of wellbeing and being able to cope
with normal situations when in fact I may not be fit to do so.
9 My dentist has explained to me that additional procedures may become necessary
during the sedation. I consent that the dentist who is performing the procedure
should proceed with these treatments should they become necessary.
10 I have been given instructions to follow both before and after the operation.
11 I agree to the photographing and videoing of the treatment to be performed on
me.
12 I agree to go directly home after the procedure, accompanied by a responsible
adult who will remain with me over night to look after me. I agree to rest quietly
there for at least 12 hours.
Please wear Loose Clothing for the Appointment
I have been given the opportunity to ask questions about sedation.
I am satisfied with all the information and explanations and alternatives that have
been given to me
I have read and understood this consent form and have been given a copy to take home
Initial _________
Patients Name_________________________________________________________
Patient's Signature .................................................................Date................................
Sedationist’s Name (In Block Capitals)………..................................................................
Sedationist’s Signature .................................................................Date................................
Stuart Orton-Jones 33 High Street, Harpole, Northampton, NN7 4DH, UK.
Telephone: - 01604 832399 Fax: - 01604 832867 Mobile: - 07885 349300
email [email protected]
38
Sedation Set-up Use a Plastic Tray for I.V. Set-up
Draw up the necessary Drugs well before the Surgery is due to start each syringe
Cover the I.V. Set up from the sight of the patient
At the End of the Procedure the Sedation Pupil takes the Panoral X-ray but does not develop it. Delegate the developing of the
Panoral to anyone who is available.
The Sedation Pupil must look after the patient.
Pre-sedation Check
Emergency Oxygen Checked ( )
Emergency Drug Sheet Filled out ( )
Patient been to the Toilet ( )
Sedationist’s Patient Assessment Find out from the patient’s dentist the likely state of patient’s feelings concerning
having the procedure done
Likely State of Patient’s Feelings____________________________________
_______________________________________________________________
Actual Patient’s Feelings on Arrival ________________________________
_______________________________________________________________
Time of Last Meal _______________________________________
Extent of Last Meal______________________________________________________
39
Medical History Patient’s Name_______________________________________
Circle in Red relevant items. Add appropriate notes on lines below the Checklist.
Draw black or blue line through all items not relevant
Date___/___/___ General Health ? _____________________________________________________
Any Recent Changes in General Health Any Weight Loss
Seen a Doctor Recently Yes /No Been to Hospital Recently Yes /No Ever been Hospitalized Yes
/No
Ever had Surgery Yes /No Medication Pills Tablets Drugs Bisphosphonates
Taking Contraceptive Pill Yes /No
Awareness of effect of Antibiotics on Effectiveness of Contraceptive Pill Yes /No
Any Serious Illnesses Shortness of Breath Ever had Swollen Ankles
Ever had Swollen Joints
Heart Trouble Blood Pressure Anaemia Rheumatic Fever Stomach Problems
Ever had Jaundice Kidney Problems Thyroid Problems Liver Disease Hepatitis Chest Problems
Chest Pain on Exertion Persistent Cough Tuberculosis Bronchitis Asthma
Diabetes Epilepsy Bleeding Problems Radiation Treatment to Head or Neck
Treatment of Growths or Tumours Nervous Problems Headaches Migraine Pregnancy
Sinus Problems Smoking__________________________________________________
Alcohol Problems Aspirin Allergy Chlorhexidine Allergy Iodine Allergy
Penicillin Allergy Other Allergies_________________________________________
Occupation __________________________________
Drugs Currently taken______________________________________________________
_____________________________________________________________________
_____________________________________________________________________
40
Sedation Record
Patients Name___________________________________________________Date________/___________/_________
Sedation Tutor in BLOCK Capitals __________________________________________Signature_________________
Sedation Pupil Signature in BLOCK Capitals ___________________________________Signature_______________
( ) Emergency Drugs checked
Preoperative Patient Preparation
Ibuprofen___________________________Corsodyl Rinsing and Toothbrushing ( )
Antibiotics Administered__________________________________________________
Other Information_______________________________________________________
Initial Starting Information
Blood Pressure Preoperatively________/_________ Postoperatively________/_________
Start Time ___________________________Start Oxygen Level _____________________
Starting Pulse _________________________
Venipunctures Site
Right Anticubital Fossa ( ) Right Hand ( ) Right Foot ( )
Left Anticubital Fossa ( ) Left Hand ( ) Left Foot ( )
Other Information________________________________________________________________
41
Patients Name________________________________Date_________/____________/__________
Induction Dose
Robinul (200 microgm)____________ug Dexamethazone( 8mgm 2ml) ____________mgm
Total Drugs given
Robinul (200 microgm)________ug Dexamethazone( 8mgm 2ml) ___________mgm Midazolam mgm
____________
Anexate _________________microgm Local Anaesthetic____________________________________________
Venepuncture performed by
in BLOCK Capitals
___________________________________Signature_____________
Oxygen Local
Time Blood Pressure Level Pulse Midazolam Anaesthetic Other
cc / Total
___/______//_______/________//_______//_______//___________//______/______//______________
Ask Patient Prepper to proceed Prepping
Oxygen Local
Time Blood Pressure Level Pulse Midazolam Anaesthetic Other
___/______//_______/________//_______//_______//___________//_____________//___________
___/______//_______/________//_______//_______//___________//______/______//___________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
42
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//___________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
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___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
Patients Name________________________________Date_________/____________/_________
Oxygen Local
Time Blood Pressure Level Pulse Midazolam Anaesthetic Other
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
___/______//_______/________//_______//_______//___________//______/______//____________
44
Record of Clinical Treatment
Patient’s Name_______________________________________________________Date__________________________
Operator’s Name in BLOCK Capitals __________________________________________________________________
Participant’s Dentist Name in BLOCK Capitals ___________________________________________________________
Operator’s Write-up of Procedure
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Operator’s Signature__________________________________________________________________________
45
Postoperative Care to help healing. postop.wpd
For the next Few Days after Surgery.
1. Alcohol. Avoid alcohol for 2 weeks as this can affect the healing of the tissues.
2. Smoking. Avoid smoking for 3 days before treatment and 2 weeks after.
Smoking slows down the healing process.
3. Avoid Very Hot Food and Drinks and spicy and acidic foods.
4 Avoid Hard Crusty Foods.
5. A surgical dressing may be placed around the incision after surgery. This should
remain in place for one to two weeks.
6. Avoid Vigorously Brushing this area Clean gently.
7. Do not use play with the area with your tongue,
8. If you have had a sinus graft procedure, or upper posterior implants placed,
s
a) Please avoid blowing your nose for approximately 2 weeks after surgery.
This will help prevent infection.
b) Please try and sneeze through your mouth and not through your nose.
c) Please avoid swimming for 2 weeks after surgery
First and Second Week.
1. Rinse with Chlorhexidine ( Corsodyl ) twice a day.
2. Take antibiotics and pain relieving pills as prescribed.
Finish the course of antibiotics.
If you have a reaction to the medication, please telephone.
4. Avoid brushing the area.
5. Maintain a soft, high protein diet.
46
6. Avoid excessive physical exertion (i.e. sports, heavy lifting etc.).
Third Week Lightly brush the area.
Fourth Week. Resume normal cleaning.
It is very important that you maintain your oral hygiene and home care at a high
standard and that you attend for regular check-up appointments.
I have been given the opportunity to ask questions about my treatment and
understand the post-operative instructions.
If anything concerns you at any time contact your dentist immediately.
If you are not able to contact your Dentist,
contact Stuart Orton-Jones.
I have read this, have understood it and have a copy to take home.
Patient's Name in BLOCK Capitals
___________________________________________Signature_____________
Patient's Escort Name in BLOCK Capitals
___________________________________________Signature________________
To be signed by the Dentist who gives the Post-operative instructions to the Escort
Dentist giving Instructions Name in BLOCK Capitals
________________________________________Signature______________________
Stuart Orton-Jones 33 High Street Harpole Northampton England. Telephone:-
01604 832399 Fax:- 01604 832867 (Mobile) 07885 349300
47
Fitness to leave Assessment
Tick Brackets if the Patient passes Each Test
Patient’s
Name__________________________Date_______ 1. Vital Signs Stable
Blood Pressure ______/______
Pulse ___________/minute
Patient alertness
Ask the Patient Today’s date ( )
Date of birth, ( )
Their Home Address ( )
2. Check protecting reflexes
Swallowing , give patient a sip of water ( )
Breathing Deeply and Cough ( )
3. Balance Test
Walking in a straight line ( )
Let patient turn around ( )
Lift one leg up for a few seconds ( )
4. No Post-operative Nausea and Vomiting ( )
5. Pain Controlled ( )
6. Bleeding Control Verified ( )
7. Canulla Removed
8. Denture/Temporary Bridge adjusted and fitted ( )
Fit to discharge Yes/No
Date ________________________ Time of Discharge_______________am / pm_
Discharged by
48
Print Name______________________________Signiture______________________
49
Hand Care 1 Social Handwashing
2 Handwashing for Clean or Universal Technique
3 Surgical Handwashing
Hand Sanitizers
Good hand washing is for everybody’s safety
Bacteria or Germs live on our skin and can be passed from one person to another by
physical contact.
Everyone involved in a procedure must wash their hands before and after every patient
or spray their hands with hand disinfectant
Fingernails should be kept short and clean
Jewellery and Watches should be removed so that the fingers may be cleaned
Millions of bacteria hide under bracelets and watches
Any cuts, sores or abrasions should be covered with a new waterproof plaster or Band-
Aid
Some facts about hand washing
Deadly bacteria such as MRSA, E-Coli and Salmonella are spread as a result of the
absence of hand washing or inadequate hand washing
We have between 2 and 10 million bacteria between our fingertips and elbows
Damp hands spread 1000 time as many bacteria/germs as dry hands
The number of Bacteria or Germs doubles after going to the toilet
Bacteria can stay alive on hands for up to three hours
When should you wash your hands?
Before Eating
After going to the toilet
After blowing one’s nose, coughing or sneezing
After handling household and clinical waste
After decontamination of instruments and impressions
At the end of the day before leaving the practice
50
Whenever you notice your hands are not clean
Hand washing for General Dentistry At the beginning of the treatment
1 Clean their fingernails
2 Wash their hands using the correct technique as described on later
3 Dry Hands with a Paper Towel
4 Wipe hands with a hand sanitizer with moisturizer
5 Put on a pair of non-sterile Examination gloves
At the end of a patient’s treatment 1 Gloves should be removed as soon as possible
2 Turn the glove inside out
3 Discarded the gloves into a Clinical Waste Bin
Before the Next Procedure
1 Wipe hands with a hand sanitizer with moisturizer
2 The Disinfectant should be allowed to dry
3 A new pair of Gloves should be put on
Wash hands before patient’s treatment if they are soiled
When gloves have been previously worn, it is not necessary to hand wash again unless
contact has been made with infected material or blood
51
Routine Handwashing Technique Appropriate for Non-aseptic Surgical Procedures and before Surgical
Handwashing
1. Clean the Fingernails
2. Wet your hands with water
3. Apply two squirts of disinfectant soap
4. Rub hands palm to palm
5. Rub the Right palm over the back of the Left hand with fingers interlaced
6. Rub the Left palm over the back of the Right hand with fingers interlaced
7. Rub Palm to palm with fingers interlaced
8. Rub the Backs of fingers to opposing palms with fingers interlocked
9. Rotational rubbing of Left thumb clasped in Right hand
10. Rotational rubbing of Right thumb clasped in Left hand
11. Rotational rubbing backwards and forwards with clasped fingers of right hand in
left palm and vice versa
12. Rinse well with warm water
13. Consider applying hand cream
52
Surgical Hand Washing
Principles 1 Handwash from the Hands down to the elbows
2 Do not scrub with an abrasive scrubbing brush. Vigorous scrubbing may cause
abrasions of the skin and bring bacteria to the surface of the skin.
Use a Synthetic Sponge. This will clean the skin without causing these problems
3 Keep the hands above the elbows at all time so that the water runs from the hands
down to the elbow carrying bacteria with it
4 At the end of Handwashing before the hand have been dried keep the hands
above the elbows to prevent water running down to the hands.
5 Shake the hands and arms to shake off surplus water before Hand drying
6 Do not allow water to run from the Elbows down to the Hands
This allow microorganisms to travel back towards the hands
The Items required 1 The Handwashing Sink
The water spout must be high enough to allow the hands to be rinsed while
keeping the elbows below the hands
2 The Tap controls must be operated using Elbow Tap Controls
3 Warm not hot water
4 Antibacterial Soap Chlorhexidine Soap such as Hibiscrub
5 A Synthetic Sponge kept in a Disinfectant Liquid
6 Fingernail Cleaners
7 Caps or Green Mop Caps
8 Mouth masks
9 A Sterile Towel for hand and arm drying
(Usually included in the Sterile Gown Pack)
10 Surgical Instruction Sheets to be followed during surgical Handwashing
53
Surgical Handwashing
Stage 1 1 Before surgical Handwashing, put a Cap for Short Hair
or a Mop Cap for Long Hair
2 Take off Watches and Rings
3 Put on Spectacles if worn and Eye protection
4 Put on a Mask
5 Tuck the Front of the Scrub Suit Top into the Front and
Back of the Trousers
When hand drying this lessens the Possibility of the Sterile Towel
touching the non-sterile Front of the Scrub Suit top at Waist Level
6 Turn the Taps on to the correct temperature
7 Identify a Synthetic Sponge
8 Identify the Fingernail Cleaner
54
Stage 2
Initial Handwashing
using the Routine Handwashing Technique
1. Clean Fingernails
2. Wet your hands with water
3. Apply two squirts of disinfectant soap
4. Rub hands palm to palm
5. Rub the Right palm over the back of the Left hand with fingers
interlaced
6. Rub the Left palm over the back of the Right hand with fingers
interlaced
7. Rub Palm to palm with fingers interlaced
8. Rub the Backs of fingers to opposing palms with fingers interlocked
9. Rotational rubbing of Left thumb clasped in Right hand
10. Rotational rubbing of Right thumb clasped in Left hand
11. Rotational rubbing backwards and forwards with clasped fingers
of right hand in left palm and vice versa
12. Rinse well with warm water
55
Stage 3 Final Surgical Handwash
Using a Disinfectant Soap such as Hibiscrub in a Pump Dispenser
1 Check that all fingernails are clean
Clean as necessary
2 Wash the hands and arms in Warm water
3 Dispense Disinfectant Soap onto hands and arms by pressing on the pump bottle of
disinfectant with an arm.
4 Spread the Soap from the hands down to the
From now on keep hands above the elbows allowing all liquid to flow from the
hands and arms
5 Sponge the Tips of the Fingers of One Hand
6 With the Fingers together sponge the Backs of each Finger of One Hand 10
Times.
7 With the Fingers together sponge the Backs of the Hand down to the Wrist of One
Hand 10 Times.
8 Turn the Hand over
9 With the Fingers together sponge the Inside of each Finger, on the Palm Side, of
One Hand 10 Times.
10 Sponge the Palm of the Hand 10 Times
11 Sponge the Sides of the Hand, both sides, 10 Times
12 Sponge up and down between each Finger 10 Times
13 Sponge the Thumb up and down 10 Times dividing the Thumb into 4 Surfaces
14 Sponge down the Forearm down to the Elbow
56
15 Do not sponge from the Elbow back up towards the Hand
Stage 4 Repeat for the Other Hand
1 Dispense more Disinfectant Soap onto hands and arms using an elbow
on the pump bottle
2 Soap from the hands down to the elbows
3 Sponge the Tips of the Fingers of the other Hand
4 With the Fingers together sponge the Backs of each Finger of One
Hand 10 Times.
5 With the Fingers together sponge the Backs of the Hand down to the
Wrist of One Hand 10 Times.
6 Turn the Hand over
7 With the Fingers together sponge the Inside of each Finger, on the
Palm Side, of One Hand 10 Times.
8 Sponge the Palm of the Hand 10 Times
9 Sponge the Sides of the Hand, both sides, 10 Times
10 Sponge up and down between each Finger 10 Times
11 Sponge the Thumb up and down 10 Times dividing the Thumb into 4
Surfaces
12 Sponge down the Forearm down to the Elbow without going back up
the arm
13 Discard the Sponge to the Sink
14 Keeping the Hands Upwards rinse the Hands and Arms thoroughly
Ensure that the Water runs from the fingers down from the Hands and Arms, to
the Elbows.
The water should flow from the clean area of the hands to the unclean area of the
57
elbows
58
Stage 5 The Final Stage
1 Keeping the Hands together and pointing upward shake excess Water into
the Sink
2 Turn the Taps off with the elbows
Check that You have put a Cap and Mask on
If not put a Cap and Mask on and Start Handwashing again
3 Keeping the Hands raised and together. Walk to the Gowning Area
59
Repeat Surgical Handwashing Technique To be used if the Full Handwashing Technique has already been
performed and another patient is to be treated
This reduced technique may be used of there has been no significant
contamination of the hands since the previous procedure 1 Clean Fingernails
2 Wet hands with water
3 Apply two squirts of disinfectant soap
4 Rub hands palm to palm
5 Rub the Right palm over the back of the Left hand with fingers interlaced
6 Rub the Left palm over the back of the Right hand with fingers interlaced
7 Rub Palm to palm with fingers interlaced
8 Rub the Backs of fingers to opposing palms with fingers interlocked
9 Rotational rubbing of Left thumb clasped in Right hand
10 Rotational rubbing of Right thumb clasped in Left hand
11 Rotational rubbing backwards and forwards with clasped fingers of right hand in
left palm and vice versa
12 Rinse well with warm water