Fumigation of operation theatres

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Fumigation of operation theatres can we stop it ???:

Dr.T.V.Rao MD Fumigation of operation theatres can we stop it ??? Dr.T.V.Rao MD 1

Fumigation a biohazard procedure ?:

Fumigation a biohazard procedure ? Dr.T.V.Rao MD 2

What Is Formaldehyde?:

What Is Formaldehyde? Dr.T.V.Rao MD 3 Formaldehyde has the chemical elements carbon, hydrogen and oxygen in its structure. Hydrocarbons are among the most common of chemical compositions. The human body includes hydrocarbons among its elements and compounds, and it requires formaldehyde to metabolize biochemical substances . Formaldehyde is usually sold as an aqueous or watery solution called formalin , which contains 37 to 50 percent formaldehyde by weight. It is soluble in water, but not in most organic solvents, except alcohol and ether. It is principally used to produce resins, other industrial chemicals, and consumer items and as a bactericide or fungicide.

How Can Formaldehyde Affect Our Health?:

How Can Formaldehyde Affect Our Health? Dr.T.V.Rao MD 4 Based on the best available evidence in OSHA’s record on formaldehyde, OSHA determined that formaldehyde isgenotoxic , showing properties of both a cancer initiator and promoter (early and late stage carcinogen). When inhaled, formaldehyde is a carcinogen in rats. In humans, formaldehyde exposure has been associated with cancers of the lung,nasopharynx and oropharynx, and nasal passages When humans are exposed to excess levels of formaldehyde, adverse health effects can result. Symptoms of excess exposure include respiratory irritation; watery, itchy eyes; itchy, runny, or stuffy nose; dry or sore throat; and headache. The EPA and OSHA recognize that contact with formaldehyde can cause skin irritation and dermatitis.

Fumigation:

Fumigation Formaldehyde a Age old compound. Low temp heating produce vapor Vapor phase decontaminates the air/environment. Kills vegetative bacteria / Spore ? When Formaldehyde mixed with water and exposed to elevated temperature Gaseous formaldehyde is generated Time X Temp Dr.T.V.Rao MD 5

Fumigation:

Fumigation To sterilize the operation theatre formaldehyde gas (bactericidal & sporicidal,viricidal) is widely employed as it is cheaper for sterilization of huge areas like operation theatres. Formaldehyde kills the microbes by alkylating the amino acids and sulfhydryl group of proteins and purine bases. In spite of the gas being hazardous continues to be used in several developing countries Dr.T.V.Rao MD 6

Fumigation:

Fumigation Fumigation usually involves the following phases: First the area to be fumigated is usually covered to create a sealed environment; next the fumigant is released into the space to be fumigated; then, the space is held for a set period while the fumigant gas percolates through the space and acts on and kills any infestation in the product, next the space is ventilated so that the poisonous gases are allowed to escape from the space, and render it safe for humans to enter. Dr.T.V.Rao MD 7

Procedure of Fumigation:

Procedure of Fumigation Thoroughly clean windows, doors, floor, walls and all washable equipment's with soap and water. Close windows and ventilators tightly. If any openings found seal it with cellophane tape or other material. Switch off all lights, A/C and other electrical & electronic items Calculate the room size in cubic feet (L×B×H) and calculate the required amount of formaldehyde as given in Dr.T.V.Rao MD 8

Personal care during fumigation:

Adequate care must be taken by wearing cap, mask, foot cover, spectacles Formaldehyde is irritant to eye & nose; and it has been recognized as a potential carcinogen. So the fumigating employee must be provided with the personal protective equipment's . Personal care during fumigation Dr.T.V.Rao MD 9

Creating the Formaldehyde gas:

Electric Boiler Fumigation Method : For Each 1000 cu.ft of the volume of the operation theatre 500ml of formaldehyde (40% solution) added in 1000ml of water in an electric boiler. Switch on the boiler, leave the room and seal the door. After 45 minutes (variable depending to volume present in the boils apparatus) switch off the boiler without entering in to the room . Creating the Formaldehyde gas Dr.T.V.Rao MD 10

Methods on Fumigation:

Methods on Fumigation In principle we have to generate Formaldehyde gas. Can be done by Most easier way to mix the needed quantity of Formalin to water and heating at lower temperatures at 80 0 c – 90 0 c Can done also with addition of Formalin to potassium permanganate Dr.T.V.Rao MD 11

Adding Potassium Permanganate to formaldehyde..:

Adding Potassium Permanganate to formaldehyde .. Potassium Permanganate Method : For every 1000 cubic feet add 450gm of Potassium permanganate (KMnO4) to 500 ml of formaldehyde (40% solution). Take about 5 to 8 bowels (heat resistant; place it in various locations) with equally divided parts of formaldehyde and add equally divided KMnO4 to each bowel. This will cause auto boiling and generate fume. After the initiation of formaldehyde vapour, immediately leave the room and seal it for at least 48 hours. Dr.T.V.Rao MD 12

Fumigation to be neutralized:

Fumigation to be neutralized Neutralize Residual formalin gas with Ammonia by exposing 250 ml of Ammonia per liter of Formaldehyde used. Place the ammonia solution in the centre of the room and leave it for 3 hours to neutralize the formalin vapour Dr.T.V.Rao MD 13

An example is set as..:

An example is set as .. Operation Theatre Volume = L×B×H = 20 × 15 × 10 = 3000 cubic feet Formaldehyde required for fumigation = 500 ml for 1000 cubic feet = So 1500 ml of formaldehyde required Ammonia required for neutralization = 150ml of 10% ammonia for 500 ml of formaldehyde = So 450 ml of 10% ammonia required Dr.T.V.Rao MD 14

What are the Symptoms of Formaldehyde Allergy?:

Inhaling formaldehyde can lead to symptoms such as a burning sensation and irritation in eyes, nose and throat, coughing, wheezing, tightness in throat, watery eyes and runny nose. It can also lead to breathlessness . Pulmonary edema and pneumonitis can be caused if it injures the respiratory tract. What are the Symptoms of Formaldehyde Allergy? Dr.T.V.Rao MD 15

Formaldehyde allergy:

Formaldehyde allergy symptoms include redness, burning sensation, skin rash , scaling, cracking, white discoloration and irritation of skin and might cause hives as well. Eye contact can cause pain, inflammation, blurred vision and excess tearing. Formaldehyde allergy Dr.T.V.Rao MD 16

What is the Formaldehyde Allergy Treatment? :

First thing to do in case of any allergy is to avoid contact with the substance causing allergic reaction. With formaldehyde present in so many things, it might be difficult to do so. If your skin or eyes come in direct contact with formaldehyde, you must soon flush that part with a lot of cold water. If you observe the formaldehyde allergy symptoms after consuming food, then you must drink a lot of water or milk so as to dilute it and consult a physician soon. In case of a skin reaction, topical ointments used for eczema and contact dermatitis might be prescribed by your doctor for allergy relief What is the Formaldehyde Allergy Treatment? Dr.T.V.Rao MD 17

Formaldehyde as carcinogen:

Formaldehyde is listed by the International Agency for Research on Cancer as probably carcinogenic to humans, on the basis of animal evidence and at least limited human data (IARC group 2A); listed by the National Toxicology Program as reasonably anticipated to be carcinogenic; listed by ACGIH as an A2 Industrial Substance Suspect of Carcinogenic Potential for Man; and OSHA, in its formaldehyde standard (29 CFR 1910.1048), considers formaldehyde potential carcinogen. Formaldehyde (gas) is a chemical known to the state of California to cause cancer. Formaldehyde as carcinogen Dr.T.V.Rao MD 18

Need for Newer Chemical Agents in Hospital Use:

Need for Newer Chemical Agents in Hospital Use 1. A need for Non Aldehyde based Chemicals is growing concern 2 Need for quicker sterilization methods with ever increasing work loads. 3. Need for non toxic safe agents. Dr.T.V.Rao MD 19

The world in search of new safe chemical agents :

Dr.T.V.Rao MD 20 The world in search of new safe chemical agents

Bacillocid® rasant:

Bacillocid® rasant Formaldehyde-free disinfectant cleaner with low use concentration very good cost/benefit ratio good material compatibility excellent cleaning properties virtually no residue Dr.T.V.Rao MD 21

COMMERCIALLY AVAILABLE Disinfectant:

Bacillocid special ® Is a surface and environmental disinfectant® Has a very good cleansing property along with bactericidal , virucidal , sporicidal and fungicidal activity ® Composition ® Each 100 g contains : • 1.6 Dihydroxy 11.2G ® ( Chemically bound formaldehyde ) • Glutaraldehyde 5.0• Benzalkonium chloride 5.0 • Alkyl urea derivatives 3.0g COMMERCIALLY AVAILABLE Disinfectant Dr.T.V.Rao MD 22

Bacillocid® rasant:

Bacillocid® rasant Active ingredients: Glutaral 100 mg/g, benzyl-C12-18-alkyldimethylammonium chlorides 60 mg/g, didecyl-dimethylammonium chloride 60 mg/g. Bacillocid® rasant is suitable for the disinfectant cleaning of washable surfaces using the wet-wipe-procedure. Especially suitable for economic short-term disinfection in risk areas that are likely sources of infection Dr.T.V.Rao MD 23

Bacillocid ® Advantages:

Provides complete asepsis within 30 to 60 mts. ® Cleaning with detergent or carbolic acid not required ® Formalin fumigation not required ® Shutdown of O.T. for 24 hrs not required Bacillocid ® Advantages Dr.T.V.Rao MD 24

Newer and Non Toxic compounds.:

A Chemical compound VIRKON gaining importance as non Aldehyde compound. Virkon proved to be safe Virucidal Bactericidal, Fungicidal Mycobactericidal Newer and Non Toxic compounds. Dr.T.V.Rao MD 25

Virkon a multipurpose disinfectant :

Virkon a multipurpose disinfectant Dr.T.V.Rao MD 26 Virkon is a multi-purpose disinfectant. It contains oxone (potassium peroxymonosulphate), sodium dodecylbenzenesulfonate, sulphamic acid; and inorganic buffers. It is typically used for cleaning up hazardous spills, disinfecting surfaces and soaking equipment. The solution is used in many areas, including hospitals, laboratories, nursing homes, funeral homes, medical, dental and veterinary facilities, and anywhere else where control of pathogens is required . Virkon has a wide spectrum of activity against viruses, some fungi, and bacteria . However, it is less effective against spores and fungi than some alternative disinfectants .

VIKRON is Finding Place in:

As a Chemical disinfectant. Disinfects Medical devices. Disinfects Laboratory equipment. Decontaminate spillages with Blood and body fluids. Finding usefulness in replacing autoclaving and saving time. VIKRON is Finding Place in Dr.T.V.Rao MD 27

Virkon® S has a unique formulation:

Virkon ® S has a unique formulation; no other disinfectant has the same powerful composition.  In terms of efficacy Virkon® S has been proven highly effective against 65 strains of virus in over 19 viral families, 400 strains of bacteria and over 100 strains of fungi.  This list of proven efficacy includes the major OIE List A diseases of concern; Avian Influenza (H5N1), Newcastle Disease, Classical Swine Fever (Hog Cholera) and Foot and Mouth Disease. Virkon® S has a unique formulation Dr.T.V.Rao MD 28

Ultraviolet Germicidal Irradiation (UVGI):

Do not use UVGI in the operating theatre to prevent Surgical site infections. Ultraviolet Germicidal Irradiation (UVGI) Dr.T.V.Rao MD 29

Infection control is multidisciplinary approach :

Infection control is multidisciplinary approach Despite the limited time spent by patients in the operation theatre (in majority of circumstances), the environment of operation theatre plays a great role in the onset and spread of infection due to multifactor causation of infection. Hence, it becomes essential to study the epidemiology of infection as a multidisciplinary approach. In resource poor circumstances as in most developing countries, it is believed that though routine Microbiological monitoring is most essential, in reality it is not practicable. But it is the responsibility of every hospital to pay good attention in proper maintenance of air conditioning plants, ventilator systems, and to have greater control on mechanisms and personnel involved in disinfection and sterilization of materials used in the theatres in operative procedures. Dr.T.V.Rao MD 30

Economic considerations compromises safe chemical approaches:

Several Chemicals are available but the Economic Limitation are great hurdle in exploring the Utility in Developing countries Economic considerations compromises safe chemical approaches Dr.T.V.Rao MD 31

Who/What is Important in prevention of Infections:

Who/What is Important in prevention of Infections

Remember we are More important than many chemicals:

Remember we are More important than many chemicals

For Articles of Interest on Antibiotics follow me on:

Dr.T.V.Rao MD 34 For Articles of Interest on Antibiotics follow me on

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Created by Dr.T.V.Rao MD for ‘e’ learning resources for Microbiologists and Health care Workers in Developing World Email doctortvrao@gmail.com Dr.T.V.Rao MD 35