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The file contains simple methods to improve the safety in our hospitals and operation theaters and save many helpless patients
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Sterilization and Decontamination
of Surgical Theatresand Critical areas inDEVELOPING WORLD
Dr.T.V.Rao MDJubilee Mission Medical College
and Research Institute,Trichur, Kerala, India
History of Hygiene
Bible Book of Leviticus Chapter 11 – 15Code of Hygiene
Greek Era
Aristotle recommends
Boiling water to armies. Advises the Alexander
HAND WASHING
Semmelweis Practices
emphasizes the importance of washing hands with chlorinated water
In Obstetrics to reduce maternal mortality
Starting of Modern Era 1860Dr.Joseph Lister
Phenol in Surgery and Decontamination practices
Beginning of Modern Nursing
The Very First Requirement in
Hospitals that should do the sick no harm
Florence Nightingale
( Notes on Nursing 1860 )
Historical Aspects Changed the History Lister era 1868 Carbolic Acid in decontamination, Reduction of Hospital associated
infections Mortality reduced Morbidity reduced.
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.
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.
Economical loss
Money wasted on unnecessary use. People concentrate on Floors, Inanimate objects,
Basic Principles
Cleaning more Important Disinfection and Sterilization ? Cleaning Removes contaminants, Dust, organic matter,Disinfection Reduces number of microbes
Disinfection x Sterilization
Sterilization is absolute, removes microbes and spores too.
To achieve Sterilization is Expensive, not sustainable, many times not needed.
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.
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
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
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.
How you care for Floors
Use only vacuum cleaners Don't broom Use a Mop keep it dry,
Roof, Artificial ceilings, Walls Do not disturb every day Routine disinfection not necessary
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
Cleaning the Floor
A simple detergent reduces flora by 80 %
Addition of disinfectant reduces to 95 %
In busy Hospitals counts raise in 2 hours
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.
Handling of Air in Operation theatre. Negative Air pressure vented to the
operation theatre. Environmental cleaning should be
twice daily
Environmental cleaning of Hospital. Disinfectant Purpose Sodium hypochlorite Contaminated
with Blood and body fluidsBleaching powder Toilets, bathrooms 9 grams/lit
Environmental cleaning of OT Contd Disinfectant Purpose Alcohol 70% Metal surfaces trolleys
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
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
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
Fumigation ( cont )
Neutralize Residual formalin gas with Ammonia by exposing 250 ml of Ammonia per liter of Formaldehyde used.
Safety of Air conditioning andWater cooling system Legionnaires disease is associated
with Air Condition 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 ( 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.
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.
Infection control programmes1 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.
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.
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.
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
Slit Sampler
Very Effective / Highly sensitive Fixed volume of air is sucked and
bacterial counts are made
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
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.
Factors which influence Saftey
inHospital Environment
Importance of Hand Washing Soap Water and
Common SenseYet the best Antiseptic William Osler
Good Hand Washing Practices Save many Lives
Choice of Soap
Simple routinely used. Medicated Soap Soap advertisement claims are they
real?
Which hand wash solution is best ?
1 Alcohol with Chlorhexidine.2.Alchool without Chlorhexidine.3 Chlorhexidine 2 %4 Chlorhexidine 4 %5 Povidone with Iodine 7.5 %6 Triclosan 1 %
Confused with promotions of commercial interests.
Best hand wash solution is
Which suits the circumstances, Availability of resources/economical Safe to your skin. Sense of responsibility more
important
Are Flowers Safe in the Hospital ?
Why flowers are Harmful
They carry a prominent bacteria which can cause Hospital acquired infections.
Many Hospitals in UK advise not to bring flowers to patients in Burns/Orthopedic wards and critical care areas.
Sterilization and Disinfection policies. Create you own Infection control team which
suits your Hospital, Infection control team decides the policies. Educate the staff on Methods and policies in
Hospital safety and Hygiene Educate the staff on few useful option, many
theoretical ideas confuse. To many Chemicals – Costly, least successful
Importance of Staff Education Speicify the staff for duties and
responsibilities. Education is a matter of continuity Train under the seniors observation. Train the staff with scientific goals
Operation Theatre Saftey is
Responsibility Of
?
Cheerful / Dedicated staff Make a Great success.
Our Future Vision - Create Clean,techinically advanced Operation theatres which can change the safety of our cherished patient.
Thank You All
Praying the Best from of Divinity
Clean Hands - the safe hands for everything we do in Hospitals.
Created for the Public Domain for the Safety of our Patients / and attitude change in beloved staff who make all the difference
Dr.T.V.Rao MD e mail ; [email protected]