Complete nose coverage to prevent airborne contamination via nostrils is unnecessary

Abstract

Besides an atraumatic procedure, aseptic techniques during surgery have been suggested to have a positive impact on the predictability of osseointegration. To avoid an infection of the surgical field, coverage of the face of the patient (drapes) and nose (surgical mask, drape and plastic film) were advocated in order to reduce airborne infections and to prevent a contact contamination of instruments and gloves. Such a coverage, however, increases the feeling of claustrophobia when local anaesthesia is used and can lead to hypoxemia. The aim of the present study was to investigate whether the expired air via the nostrils could contribute to the contamination of the oral surgical field. Test blood agar plates were installed for 30 min under the nose of volunteers lying on a surgical table; once with full coverage of their nostrils, as indicated above, and once without. Simultaneously, control plates were installed on a table besides the patient to measure the basic contamination from the environment. All plates were incubated both aerobically and anaerobically. The number of colony forming units (c.f.u.) recorded on test plates after aerobic and anaerobic incubation were surprisingly low, with a mean score of 2.7 and 5.0 c.f.u. for the uncovered situation, and 2.5 and 3.3 c.f.u. for the covered situation, respectively. The control plates were infected by a nearly comparable number of bacteria (means ranging from 2.2 to 3.2). These findings indicate that covering nostrils by a mask and sterile adhesive plastic film is not essential in avoiding airborne microbial contamination. However, the use of a meshed nose guard to prevent contact with the highly contaminated nasal skin is highly recommended.

Impact of local and systemic factors on the incidence of oral implant failures, up to abutment connection

“…Many people perform surgery in this field without a proper surgical background. Often, sterility measures do not even involve covering of the nose, the most infected site in this area (van Steenberghe et al 1997). In the present study, a series of 120 patient files (516 implants) were analysed for the use of antibiotics in the peri‐operative period.…”

Impact of local and systemic factors on the incidence of late oral implant loss

“…A minimal bone height of 7 mm was the requirement for implant placement. Surgery in the department is performed under strict aseptic conditions (van Steenberghe et al 1997). A thorough sterility policy allows limiting the use of antibiotics to well‐defined indications such as endocarditis prophylaxis, a remaining infection at the site of surgery, coughing or sneezing by the patient during surgery.…”

“…Finally, a special note was made for patients with claustrophobia. These patients were treated with reduced coverage of the face, often without a nose cap and as such with a serious breach of asepsia (van Steenberghe et al 1997).…”

Infectious risks for oral implants: a review of the literature

“…Furthermore, the salivary microbial load can be reduced by 95% via a preoperative rinse with chlorhexidine (Altonen et al 1976; Veksler et al 1991). Disinfection of the peri‐oral skin with a chlorhexidine‐alcohol solution can only partially reduce the microbial load on this surface (van Steenberghe et al 1997). To deal with the skin and mucosae of the nares, a perforated cap should be installed over the patient's nose (van Steenberghe et al 1997).…”