7. Place sterile articles on a dry, sterile surface. Moisture will contaminate the articles.

8. Only the top portion of a draped instrument stand should be considered sterile. Sterile gloves must be used in this area. Any portion of the wrap hanging over the edge of the stand is considered unsterile.

9. If an instrument becomes contaminated, discard it immediately.

10. If a delay occurs in the procedure, the scrub assistant should cover all unwrapped packs with sterile drapes.

11. All sterile articles set out for a procedure must be cleaned and sterilized or disposed of after the procedure is completed. This pertains to articles that were not used.

12. Never reach behind another draped member of the surgical team.

13. Always keep your hands above your waist.

14. Always face the draped patient and the other members of the surgical team. If it becomes necessary to pass another draped member of the team, pass back to back.

15. Always pass an unsterile object in the operating room with your back toward the object. Unsterile objects include chairs, desks, cabinets, and similar items.

INSTRUMENT SETUP AND MATERIALS

It is critical that you establish and maintain a sterile field when preparing for a surgical procedure. A scrub assistant must have on sterile gloves when a sterile surgical tray is opened for a surgical procedure. The corners of the wraps are carefully unfolded and allowed to drape over the surface where the tray is positioned to provided a sterile field. The instruments and materials should be arranged in the sequence in which they are most commonly used during the procedure. This expedites the exchange of instruments between the scrub assistant and the dentist, and avoids searching the tray for an out-of-place instrument. Once instruments are used, they should be returned to their proper location whenever possible. Both the scrub and circulating assistants should know all the surgery instruments to be used by name, number, purpose, and sequence of use.

As part of the preparation, the scrub assistant must assemble several items on the tray setup, such as anesthetic syringes, scalpel and blade, irrigation syringe and tip (or bulb syringe if used), surgical suction tip, and handle with tubing. First, the circulating assistant fills the metal cup with sterile saline. After that the scrub assistant fills the irrigation syringe from the cup.

Figure 5-57 illustrates a tray setup for a complex or impacted surgical extraction. Please note that all the instruments shown in figure 5-57 may not be in the same setup that you may use at your command. The surgical tray setup should be kept covered with a sterile towel until the procedure begins.

POST-OPERATIVE PROCEDURES

Some of the more common post-operative procedures that the dentist may direct you to perform include control of bleeding, post-surgical instructions, and suture removal.

CONTROL OF BLEEDING

After an extraction, place a moistened pressure pack made of folded, sterile gauze squares over the socket (fig. 5-58). It is important that this pack stays in place to control bleeding and encourage blood clot formation. Instruct the patient to keep the pack in place for at least 30 minutes to an hour. Warn the patient that removing the compress too soon will disturb blood clot formation, and may increase the tendency of hemorrhage and delay healing. Give the patient extra gauze to place an additional pressure pack if hemorrhage has not stopped after the original pack is removed. Advise the patient to limit activity and avoid strenuous work or exercise for a few days after surgery to avoid hemorrhage at the surgical site.

POST-SURGICAL INSTRUCTIONS

Post-surgical instructions to patients are important guidelines that they should follow to prevent complications and unnecessary discomfort. In many instances, the dental assistant may be responsible for giving the post-surgical instructions to the patient. It is advisable to discuss these instructions with the patient after the surgery to prevent confusion. If a patient is sedated, verbal instructions must be given to the patient before the sedation and to the patient's escort.

In either case, the patient should be given a printed copy of the instructions to review after leaving the dental clinic. Patients tend to forget verbal instructions, especially when they are given right after