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Team Duties for Implant Surgery

Contents

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.

5

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 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.


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 ( ) ( ) ( )


Forceps Upper or Lower ( ) ( ) ( )

Mini Implants

Imtec Kit ( ) ( ) ( )

23

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 ______________________________________________

( ) ( ) ( )


Sinus Graft Retractors ( ) ( ) ( )

Aspirator tubing with

Fibre Optic Minnesota ( ) ( ) ( )

Retractor

Special Instruments:

25

Block Grafts

4 Needed Collected by Checked by Scrubbed Assistant Roving Assistant

Symphyseal or Ramus ( ) ( ) ( )

Retractors

Osteomed Screw Kit ( ) ( ) ( )

Osteomed Screwdriver ( ) ( ) ( )


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 ( ) ( ) (

)


Bioguide ( ) ( ) (

)

Collatape ( ) ( ) (

)

Interpore 200 ( ) ( ) ( )



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 ( ) ( ) ( )


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 ( ) ( ) ( )



(1557,1558, 560 )

Titanium Seating Instrument ( ) ( ) ( )

Interpore 200 ( ) ( ) ( )



Retractor

28


Aspirator Tip


)

Aspirator Tip

2 x Fibre Optic tubing ( ) ( ) ( )

Custom Blades

4 The Custom Blade ( ) ( ) ( )









(Offset)

Circular Seating Instrument ( ) ( ) ( )





(1557,1558, 560 )

Straight Round Burs ( ) ( ) ( )

Interpore 200 ( ) ( ) ( )


Retractor


Aspirator Tip


)

Aspirator Tip


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 ( ) ( ) ( )




(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 ( ) ( ) ( )




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 ( ) ( ) ( )


Retractor


Aspirator Tip


)

Aspirator Tip

30


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 ( ) ( ) ( )



Retractor


Aspirator Tip

Fibre Optic Narrows ( ) ( ) ( )

Aspirator Tip


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 ________________________________

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


___/______//_______/________//_______//_______//___________//_____________//___________

___/______//_______/________//_______//_______//___________//______/______//___________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

42

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//___________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

43

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

Patients Name________________________________Date_________/____________/_________

Oxygen Local


___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

___/______//_______/________//_______//_______//___________//______/______//____________

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

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