Bio safety in Operation Theaters in O T
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BIO-SAFETY IN
OPERATION THEATRESDr.T.V.Rao MD
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Key Recommendations of CDC
and HICPAC
Ventilation and water systemperformance
Multidisciplinary risk assessment team Use of dust control procedures during
construction, repair, renovation or
demolition Environmental surface cleaning and
disinfection strategies geared towards
antimicrobial resistant organisms
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Regulate the Operating Room
Environment
Ventilation = positivepressure.
Variable air systems(positive pressure only)
Air introduced at the
ceiling and exhaustednear the floor
Humidity
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Can we Sterilize Operation theatre
Sterilization means eradicating germs
completely, which is not 100%
possible in an operating theatre. Thesources of bacterial contamination
are from air and the environment,
infected body fluids, patients,
articles, or equipment.
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Follow the Standard protocols
Standard cleaning,
disinfection with
appropriate chemical
agents, good theatre
practice and
discipline can
provide amicrobiologically
safe environment.
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The following precautions have
greatly reduced the rates of infection
1.Every hospital must establish an infection
control committee to monitor the events in
the hospital on all matters related to the
control of infections.
2. The entry of unnecessary personnel should
be restricted into operation theatres as
everyone potentially contributes to infection.
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A good hand washing and Monitoring
reduces infections
3 A thorough washing with warm water andgood detergent can bring more of an overallimprovement than solely decontamination
sterilization with other chemicals,or fumigation.
4. Frequent monitoring and training ofmedical and paramedical staff must carry ahigh prioritydont merely observemechanical and chemical methods.
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Hand washing a boon to safety
Thorough washing and
carbonizations, if done
every day after the
surgeries, will greatlyenhance the safety
standards and reduce
the repeated
expenditure onfumigation.
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Regulate the Operating Room
Environment
Minimize
personneltraffic
duringoperations
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Surgical Attire Scrub suits
Cap/hoods
Shoe covers Masks
Gloves
Gowns
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Surgeon and Skills
Technical skill set
Excellent eye
handcoordination
Extensive medicalknowledge
Expertise inAnatomy
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Surgeon Skills Non-technical
skill set
Situationawareness
Decision making
Communicationand teamwork
Leadership
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Cleaning and Disinfecting
Environmental Surfaces
Medical equipment surfaces
knobs, handles onequipment such as x-ray
machines, instrument carts
Housekeeping surfacesfloors, walls, chairs, and
tabletops
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Cleaning and Disinfecting
Medical Equipment
Manufacturers recommendation forsterilizationRecommended chemical germicidesWater-resistant properties
Required decontamination after
servicingNon-critical medical equipment (see
intermediate level disinfection)
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Cleaning and Disinfecting
Housekeeping Surfaces
Frequent hand contact high touch surfaces
Doorknobs, bedrails, light switches, wall
areas around the toilet, edges of privacy
curtain
Clean/disinfect more frequently
Minimal hand contact
Hard surface floors and window sills
Clean on a regular basis, when soiled, and
when patient is discharged from facility
Walls, blinds and window curtains
Clean when visibly soiled
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Cleaning A form of
decontamination byremoving organicmatter, salts, and
visible soils
Physical action ofscrubbing withdetergents or surfactants
and rinsing with water
Necessary step prior tosterilization ordisinfection
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Cleaning Strategy
Minimize contamination of cleaningsolutions and tools
Change cleaning solutions frequently
Replace soiled cloths and mop heads witheach cleaning solution change
Launder cloths and mop heads after useand allow to dry before re-use or usedisposable cloths and mop heads
Use manufacturers recommendedconcentration
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Cleaning Carpeting and Cloth
Furniture
Vacuum carpeting and cloth furniture on a
regular basis
Maintain vacuum to minimize dust dispersal
by using HEPA filters
Maintain wet cleaning equipment in good
repair and allow to dry between uses
Note: Avoid use of carpeting and cloth
furnishings in areas where spills are likely
to occur
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DisinfectionThe process that eliminates many or allpathogenic micro-organisms on inanimateobjects with the exception of bacterialspores
Spauldings*three levels ofdisinfection:
High-level
Intermediate-level Low-level*for treatment of devices and surfaces that do not
require sterility for safe use
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High-level Disinfection
Includes powerful sporocidal chemicals (glutaraldehyde,peracteic acid and hydrogen peroxide)
Inactivates all vegetative bacteria, mycobacteria (TB), viruses,fungi, some bacterial spores, enveloped and non envelopedviruses
Utilize for items that come into contact with intact mucousmembranes and are heat sensitive semi-critical medical instruments (s/a flexible fiber optic endoscopes)
thermometers
vaginal speculums
sigmoid scopes
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Intermediate-level Disinfection
Includes Chlorine-containingcompounds, alcohols (small surfaces),some phenolic, and some iodophors
Inactivates a highly resistant organismsand exhibits some sporocidal activity
Utilize for non-critical medical
equipment s/a stethoscopes, bloodpressure cuffs, dialysis machines,equipment knobs and controls.
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Low-level Disinfection
Includes quaternary ammonium compounds,
some phenolic, and some iodophors
Inactivates vegetative bacteria, fungi, and
some lipid enveloped medium size viruses
Utilize for items that come in contact with
intact skin such as examining table top, baby
weigh scale, blood pressure cuff
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Monitor employee
compliance to
hand hygienerecommendations
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Special Pathogen Concern
Recent studies indicate that MRSA and VRE are most
likely transmitted either:
Patient to patient contact
Via health-care workers hands
Hand transfer from contaminated environmental
surfaces and patient care equipment
Note:Use standard cleaning and disinfection protocolsto control environmental contamination with
antibiotic-resistant, gram-positive coccid
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Hand Hygiene Avoid artificial nails and keep natural nails < in
For visibly soiled hands use soap and water
Use alcohol-based hand rubs
Before and after each patient
Before and after glove use
Improved hand hygiene adherence has:
Terminated outbreaks in health care facilities transmission of AR organisms
overall infection rates
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What is wrong with our Practices
Disinfectants usedindiscrimately,
Used unnecessarily
Not used when needed.
Concentration notadequate
Economic consideration,
Business promotions. Laboratory testing XHospital conditions maynot correlate.
l l
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Economical loss
Money wasted on
unnecessary use.
People concentrate on
Floors, Inanimateobjects,
If the resources are notspend with scientificunderstanding the
limited resources arelost in particulardeveloping countries.
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Disinfection x Sterilization
Sterilization is absolute,removes microbes andspores too.
To achieve Sterilizationis Expensive, notsustainable, manytimes not needed.
An effectiveDisinfection reducesthe infectionsdrastically.
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Basic care of Operation Theatres.
Reduction of Microbialcounts is important.
Very rarely the Microbesreach the operation site,
Paying great attention toFloors Using unnecessary,too many chemical notnecessary
Keep the floor Clean andDry - Bacteria are reduced,
Most Important component ofBacteria is water a dry areascauses natural death exceptspores
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Frequent cleaning of Walls and Roof of
Operation Theatre is not needed
Frequent cleaning has littleeffect.
Do not disturb these areasunnecessarily,
Floors get contaminatedquickly, depend on
Number of personspresent in the
Theatre / Movementsthey make, has directrelation to increase ofbacterial counts
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Do not disturb the Roof
Do not disturb
unnecessarily,
Do not use ceiling fans
they cause aerosolspread
Clean only when
remodeling or
accumulated ,good
amount of dust.
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How you care for Floors
Use only
vacuum
cleaners Don't broom
As it increases the
bacterial flora in
the environment
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Cleaning the Floor
A simple detergent
reduces flora by
80 %
Addition of
disinfectant
reduces to 95 % In busy Hospitals
counts raise in 2
hours
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Aldehyde free sterilization of
Operation theatres
Some of the emerging compounds developedfor use in the sterilization of operatingtheatres are more effective for environmental
decontamination, have a very goodcost/benefit ratio, good material compatibility,excellent cleaning properties and leavevirtually no residues. One particular product
available has the advantage of being aFormaldehyde-free disinfectant cleaner withlow use concentration
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Are Flowers Safe in the Hospital ?
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Why flowers are Harmful
They carry a prominent
bacteria which can
cause Hospital acquired
infections. Many Hospitals advise
not to bring flowers to
patients in
Burns/Orthopedicwards and critical care
areas.
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Who/What is Important in prevention
of Infections
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Remember we are More
important than many
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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 inHospital safety and Hygiene
Educate the staff on few useful option, many
theoretical ideas confuse. To many ChemicalsCostly, need not be
effective.
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Importance of Staff Education
Specify the staff for
duties and
responsibilities.
Education is a matter ofcontinuity
Train under the seniors
observation.
Train the staff with
scientific goals
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Operation Theatre Safetyis
ResponsibilityOf
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Everyone
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SSI level classification
Incisional SSI
- Superficial incisional = skin and
subcutaneous tissue- Deep incisional = involving deeper soft
tissue
Organ/Space SSI
- Involve any part of the anatomy (organs
and spaces), other than the incision,
opened or manipulated during operations
CDC Definition of Surgical SiteInfections
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Frequent Washing of Hands saves
several Lives Universally
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Created from Web sources
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Created from Web sources
Visit for Articles of Interest on Infectious
Diseases
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Programme Created by Dr.T.V.Rao MD
for Medical and Paramedical
Professionals in the Developing World
Email
doctortvrao@gmail.com
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