surgical operation theater standards

SURGICAL OPERATION THEATER

STANDARDScreating better hospitals

1Association of International Modular Operation Theatre

Need to Rethink on Safety and Standards in our Operation theaters

• The Program file is created from various peer reviewed, and world standard protocols in implantation of Safe

Operation theater standards for wider use in the world, In India still we do not have any set standards and practices, As good beginning is half done, I wish all my professional

friends go through the article, your opinions and comments are highly appreciated for future developments,

2

Hospitals Continues to be a Great Risk to many who avail the Services

3

Why Standards Infection Control a Priority in Operation Theaters

•According to Nosocomial infection national Surveillance services (NINSS) in a hospital, infections acquired hospitals are likely to complicate illness, causing anxiety, discomfort and can lead to death 4

Public Confidence in Hospitals

•Patients and the wider public should have complete confidence in the cleanliness and hygiene of their healthcare environment•So we Need Standards

5

What is everybody's Role in Safe Operation theaters

• All healthcare professionals have a duty to set a standard by which to practice. With a focus on clinical effectiveness and evidence based care theatre staff must be able to demonstrate the ability to audit care and theatre practice.

6

Plan a Operation Theater with following objectives

• To control the concentration of Pathogens

• To prevent infiltration of non purified air into the operating theatre

• Air flow pattern that carries contaminated air away from the operating table

• Comfortable environment for the patient and operating team

• Convenient & uninterrupted personal movements inside the OT

• Safe Zone creation in OT [ for the safe location of sterile instruments & Disposables

7

Document the Operation Theater Functioning

The theatre register will record:

• Procedures which were undertaken (both surgical and the type of anaesthetic)

• The names of surgeon and anaesthetist and a list of support staff

• The name of the scrub and circulating practitioner

• The time each patient entered and left theatre

• The patient’s name, date of birth, sex, NHS number, scrub and circulating practitioner, implanted materials and any untoward incidents

• Details of any implants

• Details of untoward events

8

Recording & Transmission of Surgical Procedures

New international standards also include:

• Recording of Surgical procedures performed on patient as records for medico legal purpose as well as HIPAA / NABH compliance

• Monitoring Pre-OP & Post-OP procedures performed by junior surgeons

• Live webcasting or IP transmission of surgical procedures to avoid chaos inside operation theatre

• To maintain privacy of personal information of patient during any CME activity

9

However we have to Implement Standard protocols as associated with best practices

•The care that is delivered and improvements in practice must be based on evidence and best practice guidance.

10

The safe surgery saves lives approach

• The Safe Surgery Saves Lives programme aims to improve surgical safety and reduce the number of surgical deaths and complications in four ways

• Objective 1• 1 by giving clinicians, hospital

administrators and public health officials information on the role and patterns of surgical safety in public health

11

Objective 2•by defining a minimum set of uniform measures or ‘surgical vital statistics’, for national and international surveillance of surgical care;

12

Objective 3•by identifying a simple set of surgical safety standards that can be used in all countries and settings and are compiled in a ‘surgical safety check-list’ for use in operating rooms

13

Objective 4•by testing the checklist and surveillance tools at pilot sites in all WHO regions and then disseminating the checklist to hospitals worldwide18-10-2016 14

Surgical Site Infections – Increases Morbidity and Mortality

•Infections of the surgical wound are one of the most common HAI and are important cause of morbidity and mortality for patients undergoing surgery

18-10-2016 15

Factors influencing the Increased Rate of Infection

• There are several factors that could affect such infection, namely, patient factors (i.e. susceptibility to infection). Surgical field factors (i.e: the thermal plume from the site), room factors (i.e: cleanness of the OR), and HVAC factors ( i.e: High air change rate(ACH) and direction of air flow).

16

Consequences of Infections in Surgical Patients

•The delay in recovery and increased hospital stay also has economic consequences. It is estimated that each patient with a surgical site infection requires an additional stay for 6.5 days and hospital cost are doubled. It is a pre-requisite that Operating Theaters achieve Ultra- Clean status, especially for deep wound surgery. 17

We Lack basic guidelines to Structure the Operation Theaters

• In developing countries like India, where there is no uniform guidelines, many OTs are built and maintained according to the individual’s knowledge level, availability of funds, technical staff, and equipment's

• However we need to start with scientific beginning

18

INTERNATIONAL FEDRATION OF INFECTION CONTROL (IFIC)

“ States it is now accepted that ULTRA-CLEAN air reduces the risk of infection

in implant surgeries19

Surveillance of the Operation theater needs better understanding as it is not absolute to

true Saftey• Good hospital hygiene is an

integral part of infection control programme. “Microbiological surveillance” provides data about the factors contributing to infection. In developed countries, though standard protocols and guidelines are available

20

Do not do the Settle plates with Blind ideas,Evaluate how good they suit to your situations

•Settle plates to estimate the CFU can help in few matters, but may not serve the absolute purpose

18-10-2016 21

Doing settle plates Mandatory ? The Results are Inconclusive ?

•Though settle plate method may be regarded as a crude measure of airborne contamination, in places without other facilities it can still provide a simple and cost effective way of enumerating the contamination rate of horizontal surfaces at multiple points. Although there is no need to routinely perform surveillance cultures in operation theatre 22

Settle plates help us to know the Environment we work and risk to patients

•However there are evidences which suggest that there is a need to monitor the air quality which may help in reduction of post-operative complications due to infection. 23

*ASIAN HEALTHCARE WORKER HANDOUT BY PACIFIC SOCEITY OF INFECTION CONTROL

Type of operating Theatre.

Condition Criteria cfu/m³

Conventional Empty

During operation<35

< 180

ULTRA-CLEAN Empty During Operation

<1<20(periphery)

<10

(centre) 24

*STANDARD DESIGNIING OF OPERATING THEATERS.

Factor HTM 2025 ASHRAE

Pressur

e

Positive pressure with respect Pressure

differential should be

around 9 up to 30 Pa.

Positive pressure byto corridor and adjacent area

supplying 15% excess air

Air Filter Primary and secondary filter

80-90%

Primary filter – 25%Secondary filter -90%HEPA filter – 99.97%

efficiency

18-10-2016 Dr.T.V.Rao MD @Infection control 25

*STANDARD DESIGNIING FOR OPERATING THEATER.

Factor HTM 2025 ASHRAE

Humidity 55% ± 5% 45% - 55%

Temperature Range for working

condition is

Range for working

condition26

*Standard Design Rules for Operating Theatre

Factor HTM 2025 ASHRAE

Air Exchanges Rates

Required 20 ACH for the system

15 ACH for outdoor air system

- 25 ACH for recirculation air systems

Air Velocity Working zone area should bebetween 0.1m/s to 0.3 m/s

Operating Area Minimum sterile area required is

The experimental procedure is defined byDIN 4799 (1990), OR floor area should be

27

*Standard Design Rules for Operating Theatre

Factor HTM 2025 ASHRAE

Noise Level Maintain at 50 -55 dBA

Lighting At 500 lux for working space

Operating Room Pressure

Maintain positive pressure with respect to corridor and adjacent areas.

Positive pressure by supplying 15%

28

*Standard Design Rules for Operating Theatre

Factor HTM 2025 ASHRAE

Air FilterPrimary and Secondary

filter- 80-90 % HEPA filter-95% or more efficiency based on EU

Primary filter –25%

Secondary filter – 90%

TemperatureTemperature range for working

conditioncondition is 19°C to 23°C is

16°C to 26°C

Temperature range for working

is 16°C to 26°C

29

References 1. CLINICAL GUIDELINE FOR THEATRE PRACTICE STANDARDS –GENERIC. Royal Cornwall Hospital NHS

2. WHO Guidelines for Safe Surgery 2009 Safe Surgery Saves Lives

30