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PPT on the sterilization and decontamination in Opeartion theater
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Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Sterilization and Decontamination
of Surgical Theatresand Critical areas
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
History of Hygiene
Bible
Book of Leviticus
Chapter 11 – 15
Code of Hygiene
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Greek Era
Aristotle recommends
Boiling water to armies. Advises the Alexander
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
HAND WASHING
Semmelweis Practices emphasizes
the importance of washing hands with chlorinated water
In Obstetrics to reduce maternal mortality
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Starting of Modern Era 1860Dr.Joseph Lister
Phenol in Surgery and Decontamination practices
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Beginning of Modern Nursing
The Very First requirement in
Hospitals that should do the sick no harm
Florence Nightingale
( Notes on Nursing 1860 )
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Historical Aspects Changed the History
Lister era 1868 Carbolic Acid in decontamination, Reduction of Hospital associated infections Mortality reduced Morbidity reduced.
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
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.
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
What is wrong with our Practices
Disinfectants used indiscrimately, Used unnecessarily Not used when needed. Concentration not adequate Economic consideration, Business promotions. Laboratory testing X Hospital conditions.
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Economical loss
Money wasted on unnecessary use. People concentrate on
Floors, Inanimate objects,
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Basic Principles
Cleaning more Important Disinfection and Sterilization ? Cleaning
Removes contaminants, Dust, organic matter, Disinfection Reduces number of microbes
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Disinfection x Sterilization
Sterilization is absolute, removes microbes and spores too.
To achieve Sterilization is Expensive, not sustainable, many times not needed.
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Basic care of Operation Theatres. Reduction of Microbial counts is important. Very rarely the Microbes reach the operation site, Paying attention to Floors Using unnecessary, too many chemical not
necessary Keep Clean Dry - Bacteria are reduced, Most Important component of Bacteria is water, dry
areas causes natural death.
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Walls and Roof ofOperation Theatre
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,
On many people make unnecessary movements than needed
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Care of and Floors
Do remember only 1 % are pathogenic. On many occasion S.aureus. Floor should be decontaminated with
Use Vacuum cleaner.
Wet cleaning techniques
Wet Mop / Keep the mops dry
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Care of Roof
Do not disturb unnecessarily, Do not use ceiling fans they cause aerosol
spread Clean only when remodeling or
accumulated ,good amount of dust.
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
How you care for Floors
Use only vacuum cleaners Don't broom Use a Mop keep it dry,
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Roof, Artificial ceilings, Walls
Do not disturb every day Routine disinfection not necessary
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Caring for Floors
Only 1 % are pathogenic The counts depend on the number of persons Only people needed for procedures should
enter the theatres. Unnecessary movements disturbs the
bacterial flora
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Cleaning the Floor
A simple detergent reduces flora by 80 % Addition of disinfectant reduces to 95 % In busy Hospitals counts raise in 2 hours
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Environmental Cleaning of Operation Theatres
Do not waste chemicals. Only remove the dust with cloth wetted with
clean water, Don't use chemicals/Disinfectants as a habit, Use only when contaminated with blood or
body fluids.
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Handling of Air in Operation theatre.
Negative Air pressure vented to the operation theatre.
Environmental cleaning should be twice daily
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Environmental cleaning of Hospital.
Disinfectant Purpose Sodium hypochlorite Contaminated with Blood and body fluidsBleaching powder Toilets, bathrooms 9 grams/lit
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Environmental cleaning of OT Contd
Disinfectant Purpose
Alcohol 70% Metal surfaces
trolleys
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Fumigatation 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
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
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 – 90
Addition of Formalin to potassium permanganate
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Procedure of Fumigation
Seal the room with adhesive tape. Sealing the edges around the doors is important, Measure the volume of your operation theatre For each 1000 cu ft use 500 ml of formaldehyde. Mix with water @ 1000 ml for 500 ml of
Formaldehyde needed. Seal the Room for 24 hours, Open the Door / Avoid the formalin gas with mask Neutralize Residual formalin gas with Ammonia by
exposing 250 ml of Ammonia per liter of Formaldehyde used.
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Safety of Air conditioning andWater cooling system
Legionnaires disease is associated with Air Condition system
Chlorination / Heating of water may prove better alternatives.
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
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 ( 1 % 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.
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
At the End of the Dayin 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.
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Infection control programmes
1 Monitoring of Hospital associated infections.2 Training of Health care workers.3 Investigations of outbreaks.4 Any technical lapses.5 Monitoring of staff health6 Education on Universal Precautions 7 Advise on isolation of Infectious patients.8 Waste disposal9 Safe use of Antibiotics / Antibiotic policy.
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Role of Microbiology Department
Identifies the pathogens Monitoring of Antibiotic therapy, Education on specimen collection and
transportation, Information on common Antibiogram patterns Data on Hospital Infection Surveillance of the Hospital environment Counseling of the Infected Hospital Staff.
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Surveillance of Operation theatreExamination of Air
Estimations are done for detection of bacteria carrying particles in Air.
Factors influence
Number of persons present.
Body movements,
Disturbances of clothing.
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Methods of Air surveillance
1 Settle plate method.2 Slit sampler method (from given volume)3 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
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Slit Sampler
Very Effective / Highly sensitive Fixed volume of air is sucked and bacterial
counts are made
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
How many bacteria are pathogenic
Counts vary On number of personal present in the given area.
Behavior of the persons. Depend on nature of procedures, type of operations. Varying ranges But remember only 1 % are pathogenic Presence of S. aureus makes difference
Vijay Pratap Vijay Pratap RaghuvanshiRaghuvanshi
Do we need surveillance regularly
Bacteriological surveillance testing at regular internals is not warranted,
But warranted when modification of operation theaters are done,
In any unforeseen increase of incidence of infection form any particular operation theatre.