Infection Control and Sterilization in Oral Surgery

Oral and maxillofacial surgery (OMFS) procedures entail a unique blend of inpatient and outpatient settings along with a combination of physiologically sterile and nonsterile patient structures. Adequate infection control and sterilization preoperatively and postoperatively can reduce cross contamination and ensure better patient outcomes. Depending on their use, surgical instruments are classified as critical, including those penetrating a sterile organ; semi-critical, defined as instruments contacting but not penetrating mucosal membranes; and noncritical classified as instruments touching intact skin. Proper identification of instruments is followed by adequate decontamination protocols including sterilization for complete elimination of surface microflora including bacterial spores, high-level disinfection eliminating surface organisms apart from bacterial spores, and low-level disinfection protocols. With the vast majority of surgical instruments classified as essential, development of efficient yet multitiered and redundant sterilization protocols is critical to desired surgical outcomes. Such protocols include several steps such as bedside decontamination, transportation to sterilization facilities, mechanical and chemical sterilization, packaging, and dedicated heat-based sterilization devices when applicable followed by several inspections. The efficacy of such protocols further relies on surgeon and staff infection-control measurements including proper hand hygiene and utilization of sterile protective equipment along with institutional efforts such as quality assurance of facilities and structures. When successfully performed, such procedures can significantly reduce adverse outcomes, while increasing both patient safety and surgeon satisfaction.