ot sterilization

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Sterilization of Operation Theatres :

Sterilization of Operation Theatres

Greek Era:

Greek Era Aristotle Greek Philosopher recommends Boiling water to armies. Advises the Alexander. Recommends hygiene for healthy living

HAND WASHING- Semmelweis:

HAND WASHING- Semmelweis Practices, emphasizes the importance of washing hands with chlorinated water in Obstetrics to reduce maternal mortality

Beginning of Safe Operation Theatre Practices:

Beginning of Safe Operation Theatre Practices 1867 –Dr.Joseph Lister first identifies airborne bacteria and uses Carbolic acid spray in surgical areas 1880 – Johnson and Johnson introduce antiseptic surgical dressings.

Sterile Environment reduces Surgical site infections.:

Surgical site infections SSI are the second most common cause of hospital acquired (Nosocomial) infections. These complications of surgical procedures cause considerable morbidity and, when these occur deep at the site of the procedure, can lead to mortality as high as 77%. Sterile Environment reduces Surgical site infections.

Basic Principles:

Basic Principles Cleaning is as Important as Disinfection and Sterilization ? However Cleaning Removes contaminants, Dust, organic matter, Disinfection Reduces number of microbes

PowerPoint Presentation:

Ideally should contain 4 zones A. OUTERZONE B RESTRICTED ZONE OR CLEAN ZONE C. ASEPTIC ZONE D. DISPOSAL ZONE

Basic care of Operation Theatres.:

Basic care of Operation Theatres. Reduction of Microbial counts is important. Using unnecessary, too many chemical not necessary Keep the floor Clean and Dry - Bacteria are reduced.

Frequent cleaning of Walls and Roof of Operation Theatre is not needed:

Frequent cleaning of Walls and Roof of Operation Theatre is not needed Frequent cleaning has little effect. Do not disturb these areas unnecessarily, Floors get contaminated quickly, depend on Number of persons present in the Theatre / Movements they make, has direct relation to increase of bacterial counts

Do not disturb the Roof :

Do not disturb the Roof Do not disturb unnecessarily, Do not use ceiling fans they cause aerosol spread Clean only when remodeling or accumulated ,good amount of dust.

How you care for Floors:

How you care for Floors Use only vacuum cleaners Don't broom As it increases the bacterial flora in the environment

Cleaning the Floor:

Cleaning the Floor A simple detergent reduces flora by 80 % Addition of disinfectant reduces to 95 % In busy Hospitals counts raise in 2 hours

Handling of Air in Operation theatre.:

Handling of Air in Operation theatre. Negative Air pressure vented to the operation theatre. Environmental cleaning should be twice daily

Environmental cleaning of Hospital with Chlorinated compounds.:

Disinfectant Purpose Sodium hypochlorite Contaminated with Blood and body fluids Bleaching powder Toilets, bathrooms 9 grams/lit Environmental cleaning of Hospital with Chlorinated compounds .

Environmental cleaning of instruments and equipment in OT :

Environmental cleaning of instruments and equipment in OT Disinfectant Alcohol 70% used in cleaning Metal surfaces and Trolleys However expensive for hospitals in developing countreis

Fumigation a biohazard procedure ?:

Fumigation a biohazard procedure ?

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 by alkylating the amino acids and sulfydral group of proteins and purine bases. In spite of the gas being hazardous continues to be used in several developing countries Fumigation

Fumigation:

Fumigation usually involves the following phases: First area usually covered to create a sealed environment; Second 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, Then space is ventilated so that the poisonous gases are allowed to escape from the space, and render it safe for humans to enter. Fumigation

Procedure of Fumigation:

Thoroughly clean windows, doors, floor, walls and all washable equipments 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 Procedure of Fumigation

Personal care during fumigation:

Adequate care must be taken by wearing cap, mask, foot cover, spectacle ., 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 equipments . Personal care during fumigation

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

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

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 vapor, immediately leave the room and seal it for at least 48 hours. Adding Potassium Permanganate to formaldehyde..

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 vapor

Several Chemicals are available but the Economic Limitation are great hurdle in exploring the Utility in Developing countries:

Several Chemicals are available but the Economic Limitation are great hurdle in exploring the Utility in Developing countries

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

Newer and Non Toxic compounds.:

A Chemical compound VIRKON gaining importance as non Aledyde compound. Virkon proved to be safe Virucidal Bactericidal, Fungicidal Mycobactericidal Newer and Non Toxic compounds.

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

Ultra Violet Radiation:

Daily UV irradiation for 12-16 hours To be switched off 2 hours before surgery Ultra Violet Radiation

Care of the self and surroundings:

Theatre dress (includes head cap, mask, apron, chapel, should be made available for all persons who are entering into the operation theatre (surgeons, anaesthetist, microbiologist team, nurses, theatre assistants& helper). Surroundings should be clean and free from garbage, open drainage, bushes, shrubs, wastes, donot keep any material which are necessary for operation theatre procedures Operation theatre should be cleaned and fumigated as the prevailing conditions of working and work load, Depends on septic cases handled in the theatre Care of the self and surroundings

Safety of Air conditioning and Water cooling systems:

Safety of Air conditioning and Water cooling systems Legionnaires disease is associated with Air Conditioning system Chlorination / Heating of water may prove better alternatives.

Between procedures in the Operation Theatres.:

Clean operation tables, theatre equipment with disinfectant solution with detergent, In case of spillage of blood / body fluids decontaminate with bleaching powder/chlorine solution ( 10 % available chlorine ). Always discard wastes in prescribed plastic bags – Don’t accumulate biohazard waste in the operation theatres. Don’t discard discarded soiled gowns in the operation theatre. Between procedures in the Operation Theatres .

At the End of the Day in Operation theatre.:

Clean all the table tops sinks, door handles with detergent / low level of disinfectant. Clean the floors with detergents mixed with warm water, Finally mop with disinfectant like Phenol in the concentration of 1 : 10 Low concentration of Phenol serve as perfume and not as disinfectant. At the End of the Day in Operation theatre .

Microbiological monitoring:

Swabbing and culture for bacteria Frequency Areas swabbed Table Over head lamp Wall Floor Instrument trolley AC Microscope Microbiological monitoring

Media for culture:

Blood agar, Chocolate agar Robertson cooked meat media Media for culture

Settle plates for bacterial counts are used by Microbiologists:

Settle plates for bacterial counts are used by Microbiologists

Recent advances in Air Sampling:

There is a sea change in analysis of bacterial counts recent past Slit sampler and Air centrifuge equipment for bacterial counts are replacing settle plates. Recent advances in Air Sampling

Slit Sampler:

Slit Sampler Very Effective / Highly sensitive Fixed volume of air is sucked and bacterial counts are made

Surveillance of Operation theatre Examination of Air:

Surveillance of Operation theatre Examination of Air Estimations are done for detection of bacteria carrying particles in Air. Factors influence Number of persons present. Body movements, Disturbances of clothing.

Methods of Air surveillance :

Methods of Air surveillance Settle plate method. Slit sampler method (from given volume) Counts vary from one to many Settle plates method Record position – Time - Duration Plates with media as Blood agar exposed for specified period and incubated in the incubator for 24 hours at 37º c

PowerPoint Presentation:

Air Samples Average colony count per plate/30min Interpretation Action to be taken. Less than 10 bacterial colonies Acceptable No special action. Maintain regular fumigation and Mopping. More than 10 bacterial colonies Unacceptable Repeat fumigation with microbiological monitoring. Isolation of any number of colonies of Staphylococcus aureus and Pseudomonas species. Unacceptable Repeat fumigation with microbiological monitoring. Follow the precautions given under heading IV More than 2 Fungal colonies Unacceptable Repeat fumigation & thorough cleaning of all the objects intimate with the patient using 70% Alcohol. See for any obvious fungal growth on walls and ceiling. Surface Samples Colony count per square feet. Interpretation Action to be taken Area (A) I.e. OT table and area adjacent to it. Less than 5 colonies Acceptable No special action. Maintain regular fumigation and Mopping 5-9 Colonies Undesirable Follow the precautions given under heading IV. Maintain regular fumigation and Mopping. ≥10 colonies Unacceptable Repeat fumigation with microbiological monitoring. Area (B) I.e. area away from the OT table. <19colonies Acceptable No special action. Maintain regular fumigation and Mopping ≥20colonies Unacceptable Repeat fumigation with microbiological monitoring.

Anaerobic spores are isolated from Robertson Cooked medium:

Anaerobic spores are isolated from Robertson Cooked medium

Ideal to Survey for Anaerobes:

Ideal to Survey for Anaerobes When OT in newly constructed or after remodelling and structural alterations are done In these circustances survailance will increase safety of the theatres.

Good Hand Washing Practices Save many Lives:

Good Hand Washing Practices Save many Lives

Choice of Soap:

Choice of Soap Simple soap routinely used. Medicated Soap warranted in specific circumstances Soap advertisement claims are they real? To frequent use of medicated soaps are injurious to skin and cause allergic dermatitis

Operation Theatre Saftey is Responsibility Of:

Operation Theatre Saftey is Responsibility Of

Everyone:

Everyone

Our Future Vision for Developing world should be:

Our Future Vision for Developing world should be Thank You All

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