Operationalising surgical aseptic technique

Dental assistant positioning an intraoral X-ray tube head at the chair

What triggers a surgical procedure is related to how invasive and complex a procedure is, which may or may not involve the use of a blade.

Kylie Robb, Director of Niche Dental

Aseptic technique is a key element of Standard Precautions.

Aseptic technique aims to prevent pathogenic organisms, in sufficient quantity to cause infection, from being introduced into susceptible body sites by the hands of the team or the surfaces of equipment.

What triggers the escalation of standard aseptic technique to surgical aseptic technique (the requirement for sterile gloves, for example) is often misunderstood.

This poses risks to organisations from a patient safety and quality perspective, due to the higher risk of infection for patients, and regulatory risks where the management of infection risk for surgical procedures does not align to best practice.

What triggers a surgical procedure in a dental setting?

What triggers a surgical procedure is related to how invasive and complex a procedure is, and therefore the patient’s risk of infection, which may or may not involve the use of a blade or raising a flap.

The Australian Commission on Safety and Quality in Health Care (the Commission) publishes an implementation guide for Action 3.11 Aseptic Technique of the National Safety and Quality Health Service (NSQHS) Standards. The guide outlines a framework to support classification of invasive clinical procedures into either ‘simple’ or ‘complex’, and therefore which require surgical aseptic technique and which require standard aseptic technique.

Risk based frameworks support practitioner decision making

A list of resources is included at the end of this article.

Simple procedures are generally:

  • Technically simple,
  • use simple equipment with minimal key parts,
  • involve small key sites; and
  • are of a short duration (usually less than 20 minutes).

These criteria are likely to include simple or straightforward extractions.

Complex procedures are generally:

  • Technically difficult,
  • require specialised equipment with many key parts,
  • involve large or many key sites; and
  • require extended periods of time to complete.

These criteria are likely to include more complex or technical extractions, implant placements and other surgical dental procedures.

Practitioners need knowledge and confidence in how they are managing risk for the procedures they provide. This is part of scope of practice.

From the practitioner’s decision to a practice system

The framework classifies. The practitioner decides. Having systems to support the work practitioners do in a practice can help the team to be efficient, proactive and more effective in providing surgical procedures.

When operationalising surgical aseptic technique, consider these four principles:

  1. What are the surgical procedures we provide where surgical aseptic technique applies?
  2. How do we define and assess the competencies required of the team performing surgical aseptic technique, and how can we train to close any gaps?
  3. What resources do we need to provide the surgical procedures we want to do, and how do we ensure these items are available, safe and fit for their intended purpose?
  4. How do we monitor the systems that support surgical aseptic technique to make sure they are working?

These are big questions that are not always easy to answer. To give you confidence on how to proceed, let us drill down into each of these principles.

1. Identify the procedures you do that require surgical aseptic technique

Sometimes practitioners are surprised when they learn how many surgical procedures they are actually providing. It is likely you already have data on the procedures you do that require surgical aseptic technique. Run a report through your practice management software and count how many item numbers with the word ‘surgical’ in the descriptor were provided over the past six months. This could include 322, 324 and 688, among others. This information helps with resource planning, training opportunities for the team, and prioritising efforts on streamlining systems to improve efficiency.

2. Competence and training

If the practice performs surgical procedures, there needs to be a written protocol describing how surgical aseptic technique is applied. The written procedure uses the concepts of key parts, key sites, a critical aseptic field, sterile gloves and non-touch technique, and is anchored to the National Health and Medical Research Council (NHMRC) 2019 definition and the Australian Dental Association (ADA) Guidelines for Infection Prevention and Control.

Training then has two parts and is role-specific:

  • Theory: why aseptic technique is required, the terminology and the practice’s procedure. The operator, the dental assistant setting up and assisting, and whoever manages sterile stock each learn the part of the procedure they perform or are responsible for. Completion is recorded in the team training register.
  • Assessed practical: a team member who is competent in surgical aseptic technique observes each person doing their part, either during a real case or in a simulation at a team meeting, using the practice’s competency checklist. Both people sign and date the checklist, it is filed in the training folder, and the training register is updated with the role assessed and the date the next assessment is due.

Assessment happens at induction or role change, again on a defined interval the practice sets, and whenever the procedure, equipment or products change or a breach occurs.

3. Resources

If you provide surgical procedures, you need the resources to support surgical aseptic technique.

Typical sterile resources include:

  • Sterile gloves for both the practitioner and the assistant.
  • Gowns, drapes and gauze purchased sterile and listed on the Australian Register of Therapeutic Goods (ARTG).
  • Sterile irrigation solution, stored and handled so that sterility is maintained.
  • ARTG listed surgical hand preparation and sterile hand towels.
  • Surgical handpieces and motors reprocessed in a B Class steriliser.
  • Sterile stock stored in a dedicated clean drawer or cupboard.

4. Monitor

You need to monitor the effectiveness of your systems for surgical aseptic technique. This could include observation of a real case using the practice’s own competency checklist, to confirm procedures are provided as per the written protocol. It includes recording and reviewing breaches or near misses as quality improvement opportunities, checks on sterile stock storage and expiry dates, and reviews of training registers and induction checklists to ensure the people supporting these procedures are trained and competent.

5. Accountability

The biggest shift in infection prevention over the years is the framing of accountability as governance rather than prescription on how to do a specific task. The practice, or organisation, must have a system for preventing infection more broadly, beyond aseptic technique. In essence, the owner of the organisation is responsible for the written procedures existing, for providing the resources and the systems that train, assess and monitor the workforce, and for nominating a person who runs that system day to day. Each practitioner is responsible for providing safe and quality healthcare, which includes applying surgical aseptic technique with their own patients.

What now

It is hard to write with confidence, especially protocols and procedures that are supposed to align to the moving target that is best practice.

Because this is one of my most frequent recommendations, I am putting the finishing touches on a Surgical Aseptic Technique Kit for practices. It includes the documentation you need to have, and it is likely to add value to your working lives by streamlining operations and defining roles and responsibilities for this work.

In the meantime, here is a surgical aseptic technique shopping list you can use today to check whether you have the resources needed to provide these procedures. Register interest in the kit and you will hear when it is ready.

Download the shopping list

The Surgical Aseptic Technique Kit is nearly ready. Register your interest and you will hear the moment it is.

Register interest

References and resources

For more information contact Niche Dental: hello@niche.dental

Kylie Robb, September 2026.