Role of operative infrastructurein prevention of infections
Dr Uday KumarSagar HospitalsSindhi HospitalChinmaya HospitalBangalore
17th Oct 2015RATS
Old Operation Theatre.
The Agnew Clinic, 1889, by Thomas Eakins, showing the observers watching the operation.
5.
Beginning of Safe Operation Theatre Practices
• 1867 – Dr. Joseph Lister first identifies airborne bacteria
-uses Carbolic acid spray in surgical areas.
• 1880 – Johnson and Johnson introduce antiseptic surgical dressings.
• All the materials used for an operation must be sterile.
• Basic items – linen, instrument set, basin
• Instrument sterilization :
1 night before
just before operation
• Once the instrument is removed from sterile wrapper :
use / discard
1. Linen colour : Dyed green(reduces glare from light & fatigue and eye strain).
2. Use sterile materials only
3. Sterile areas are setup just prior to use.
4. If in doubt : consider the material as unsterile.
5. Only the top surface of draped table is considered sterile.
Good Hand Washing Practices Save many Lives
1. Chlorhexidine 2 %2. Chlorhexidine 4 %3. Povidone with Iodine 7.5% - 10%
Areas of the harboring dirt and microorganisms
• scrub area sink should be wide
• should have depth of about 3 feet
--- prevents splashing of rebound water
• scrub sinks are fitted with doctors’ taps, rather
than ordinary taps, to facilitate its operation
with the help of arms
• peddle operated taps are ideal in scrub areas
as it permits hand free operations
Paper gown
Plastic gown
Linen gown
made up of cottonhaving a threadcount of 240 \ sqinch for the reusablestuff .
floors and walls should be-- smooth -- easily cleanable
-- should have minimum or no joints
Flooring should be- non porous-scratch proof- anti skid
walls should be covered withsmooth material like granite
ceilings should be painted withoil paints which give smooth finish
electrical fittings and water pipes in the OR must be concealed
OR complex should have only one entry and all the windows should be air tight
----Avoid contamination of wound.
---Contamination of surgical wound
is mostly from – skin / mucous membrane being incised.
• Other sources : nose, throat, hand, skin of operating team
members.
• Air contamination : omnipresent problem.
• All logical precaution & preparations should be done.
Stress must be laid on
1. Temperature
2. Humidity
3. Ventilation
Temperature : 24-270 C ---ortho 20 deg
Relative Humidity : 45% – 60% for adult
55% – 65% for infants
• 1 change / hr : contamination reduced by 60%
• 2 change / hr : contamination reduced by 86%
• 10 change / hr : contamination reduced by 99%
At least 10 to 20 airchanges per hour
Zoning :To ensure aseptic conditions OT is divided into 4 zones :
1. Protective zone
2. Clean zone
3. Sterile zone
4. Disposal zone
Advantages of zoning
1. Minimizes hospital infection
2. Minimizes unproductive movement of staff, supplies &
patient.
3. Increases efficacy of operative team members.
4. Ensures smooth workflow.
5. Decreases hazards in operating room.
6. Ensures proper positioning of
equipment
STERILIZATION & DECONTAMINATION OF SURGICAL THEATRES
Why?1. Cleaning removes contaminants, dust, organic matter. 2. Disinfection reduces number of microbes.
Tuesday, December 8, 2015 25Operation Theater.
• Daily cleaning should be carried out after the operating sessions are over.
---All the walls must be wiped down to hand height everyday.
• Weekly cleaning of all the areas inside the operating theatre complex should be done thoroughly
Need for fumigation-common organisms
Staphylococcus aureus (16%)
• Coagulase negative staphylococcus aureus (26.7%)
• Acinobacter species (2.03%)
• Klebsiella (0.3%)
• E.coli----Pseudomonas --- Proteus
Procedure for fumigation:
• The windows are sealed
• formaldehyde generated either by
boiling a solution of formalin 40% or by
adding it to potassium permanganate
• The door is than closed and sealed.
• For a 10 x 10 x 10 ft room - 150 gm
potassium permanganate and 280 ml of
formalin are used
After fumigation
• Three swabs are taken from walls, all equipments, floor or O.T. table at intervals.
• 1st swab - 48 hrs after fumigation
• 2nd swab- 24 hrs after 1st swab
• 3rd swab - 12 hrs after 2nd swab
• All three consecutive swabs should come negative.
• Bacillocid is used for fumigation. It is combination of
chemically bound formaldehyde and glutaraldehyde.
• Ideally all O.T. rooms should be fumigated once a week
reduced infection rate in orthopaedicimplant surgeries with laminar flow systems and body exhaust suits—-Evans et al, Jbjs 2012
laminar flow systems and body exhaust suits
High-Efficiency Particulate AirHEPA filters
-an air filter
- removes 99.97% of particles that have a size of 0.3 µm from the air
The Universal Precaution Rule:
Treat all human blood, bodily fluids and
other potentially infectious materials as if
they are infectious.
TAKE HOME MESSAGE
--The operation theatre should be clean
--Sterility should be maintained at all times
--Zoning in the OT is useful in reducing infection
--Fumigation is an essential component of OT protocol
--Hepa filters, laminar airflow and body suitshelp in reducing infection in orthopaedic surgeries