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 ; tvraodoctor2000@yahoo.co.in