surgical operation theater standards dr.t.v.rao md

01/05/2023 Dr.T.V.Rao MD @Infection control 1

SURGICAL OPERATION THEATER STANDARDS

creating better hospitals Dr.T.V.Rao MD


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,• Can be reached at • Email [email protected]• Mob +919961785124 India

mailto:[email protected]


Hospitals Continues to be a Great Risk to many who avail

the Services


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


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


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.


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


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


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.


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


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


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


Objective 4•by testing the checklist and surveillance tools at pilot sites in all WHO regions and then disseminating the checklist to hospitals worldwide


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


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).


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.


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


INTERNATIONAL FEDRATION OF

INFECTION CONTROL (IFIC)

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

in implant surgeries


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


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


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


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.


*ASIAN HEALTHCARE WORKER HANDOUT BY PACIFIC SOCEITY OF

INFECTION CONTROLType of

operating Theatre.

Condition Criteria cfu/m³

Conventional Empty During operation

<35 < 180

ULTRA-CLEAN Empty During

Operation

<1 <20(periphery) <10 (centre)


*STANDARD DESIGNIING OF OPERATING THEATERS.

Factor HTM 2025 ASHRAE

Pressure

Positive pressure with respect Pressure

differential should bearound 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


*STANDARD DESIGNIING FOR OPERATING THEATER.

Factor HTM 2025 ASHRAE

Humidity 55% ± 5% 45% - 55%

Temperature Range for working

condition is 60°C to 21°C

Range for working

conditionis 60°C to 26°C


*Standard Design Rules for Operating TheatreFactor 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 2.8 x 2.8 m

The experimental procedure is defined byDIN 4799 (1990), OR floor area should bebetween 25 to 60 m² and ceiling heightshould be at least 3m high



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.- The pressure differential shouldbe around 9 upto 30 pa.

Positive pressure by supplying 15% excess air



Air Filter Primary and Secondary filter- 80-90 %

HEPA filter-95% or more efficiency based on EU

Primary filter – 25%

Secondary filter – 90%

Temperature Temperature range for working condition

condition is 19°C to 23°C is 16°C to 26°CWinter 22 °C

Summer 20 °C

Temperature range for working

is 16°C to 26°C

Humidity 55 ± 5 % 40% ± 60%


References • 1.CLINICAL GUIDELINE FOR THEATRE PRACTICE STANDARDS –

GENERICRoyal Cornwall Hospital NHS 2WHO Guidelines for Safe Surgery 2009 Safe Surgery Saves Lives


*Source of Information on following resources •Source:

(I) HTM 2025•(II) Memarzadeh, F and Manning A.P

•Comparison of Operating Room Ventilation Systems in the Protection of the Surgical

Site ASHRAE Transactions 2002 V. 108, Pt.2.


• Program Created by Dr.T.V.Rao MD, Clinical Microbiologist for benefit of many who deal the

matters with Surgical Operation Theaters and patients, Please do share with many Professionals and Patients on learning the basis of safety in Operation Theaters

Email

[email protected]

surgical operation theater standards dr.t.v.rao md

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