BIO-SAFETY IN
OPERATION THEATRES
Dr.T.V.Rao MD
Key Recommendations of CDC
and HICPAC
• Ventilation and water system
performance
• Multidisciplinary risk assessment team
...
Regulate the Operating Room
Environment
• Ventilation = positive
pressure.
– Variable air systems
(positive pressure only)...
Can we Sterilize Operation theatre
• Sterilization means eradicating germs
completely, which is not 100%
possible in an op...
Follow the Standard protocols
• Standard cleaning,
disinfection with
appropriate chemical
agents, good theatre
practice an...
The following precautions have
greatly reduced the rates of infection
• 1.Every hospital must establish an infection
contr...
A good hand washing and Monitoring
reduces infections
• 3 A thorough washing with warm water and
good detergent can bring ...
Hand washing a boon to safety
• Thorough washing and
carbonizations, if done
every day after the
surgeries, will greatly
e...
Regulate the Operating Room
Environment

Minimize
personnel
traffic
during
operations
Surgical Attire
• Scrub suits

• Cap/hoods
• Shoe covers

• Masks
• Gloves
• Gowns
Surgeon and Skills
•

Technical skill set
– Excellent eye–
hand
coordination
– Extensive medical
knowledge
– Expertise in
...
Surgeon Skills
• Non-technical
skill set
– Situation
awareness
– Decision making
– Communication
and teamwork
– Leadership
Cleaning and Disinfecting
Environmental Surfaces

– Medical equipment surfaces
knobs, handles on
equipment such as x-ray
m...
Cleaning and Disinfecting
• Medical Equipment
• Manufacturer’s recommendation for
sterilization
– Recommended chemical ger...
Cleaning and Disinfecting
•

Housekeeping Surfaces
 Frequent hand contact “high touch surfaces
•

•

Doorknobs, bedrails,...
Cleaning
• A form of
decontamination by
removing organic
matter, salts, and
visible soils
– Physical action of
scrubbing w...
Cleaning Strategy
Minimize contamination of cleaning
solutions and tools
Change cleaning solutions frequently
– Replace so...
Cleaning Carpeting and Cloth
Furniture
Vacuum carpeting and cloth furniture on a
regular basis
Maintain vacuum to minimize...
Disinfection

“The process that eliminates many or all

pathogenic micro-organisms on inanimate
objects with the exception...
High-level Disinfection
Includes powerful sporocidal chemicals (glutaraldehyde,
peracteic acid and hydrogen peroxide)
Inac...
Intermediate-level Disinfection
Includes Chlorine-containing
compounds, alcohols (small surfaces),
some phenolic, and some...
Low-level Disinfection
Includes quaternary ammonium compounds,
some phenolic, and some iodophors
Inactivates vegetative ba...
Monitor employee
compliance to
hand hygiene
recommendations
Special Pathogen Concern
• Recent studies indicate that MRSA and VRE are most
likely transmitted either:
– Patient to pati...
Hand Hygiene
• Avoid artificial nails and keep natural nails < ¼ in
• For visibly soiled hands use soap and water
• Use al...
What is wrong with our Practices
• Disinfectants used
indiscrimately,
• Used unnecessarily
• Not used when needed.
• Conce...
Economical loss
• Money wasted on
unnecessary use.
• People concentrate on
Floors, Inanimate
objects,
If the resources are...
Disinfection x Sterilization
• Sterilization is absolute,
removes microbes and
spores too.
• To achieve Sterilization
is E...
Basic care of Operation Theatres.
• Reduction of Microbial
counts is important.
• Very rarely the Microbes
reach the opera...
Frequent cleaning of Walls and Roof of
Operation Theatre is not needed
• Frequent cleaning has little
effect.
• Do not dis...
Do not disturb the Roof
• Do not disturb
unnecessarily,
• Do not use ceiling fans
they cause aerosol
spread
• Clean only w...
How you care for Floors
• Use only
vacuum
cleaners
• Don't broom
• As it increases the
bacterial flora in
the environment
Cleaning the Floor
• A simple detergent
reduces flora by
80 %
• Addition of
disinfectant
reduces to 95 %
• In busy Hospita...
Aldehyde free sterilization of
Operation theatres
• Some of the emerging compounds developed
for use in the sterilization ...
Are Flowers Safe in the Hospital ?
Why flowers are Harmful
• They carry a prominent
bacteria which can
cause Hospital acquired
infections.
• Many Hospitals a...
Who/What is Important in prevention
of Infections
Remember we are More
important than many
Sterilization and Disinfection
policies.
• Create you own Infection control team which
suits your Hospital,
• Infection co...
Importance of Staff Education
• Specify the staff for
duties and
responsibilities.
• Education is a matter of
continuity
•...
Operation Theatre Safety
is
Responsibility
Of
Everyone
CDC Definition of Surgical Site
Infections
SSI level classification
Incisional SSI
- Superficial incisional = skin and
sub...
Frequent Washing of Hands saves
several Lives Universally
!

Protect patients…protect healthcare personnel…
promote quality healthcare!
Created from Web sources
Visit for Articles of Interest on Infectious
Diseases
• Programme Created by Dr.T.V.Rao MD
for Medical and Paramedical
Professionals in the Developing World
• Email
• doctortvr...
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Bio safety in Operation Theaters

  1. 1. BIO-SAFETY IN OPERATION THEATRES Dr.T.V.Rao MD
  2. 2. Key Recommendations of CDC and HICPAC • Ventilation and water system performance • 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
  3. 3. Regulate the Operating Room Environment • Ventilation = positive pressure. – Variable air systems (positive pressure only) – Air introduced at the ceiling and exhausted near the floor • Humidity <68% • Temperature control
  4. 4. Can we Sterilize Operation theatre • Sterilization means eradicating germs completely, which is not 100% possible in an operating theatre. The sources of bacterial contamination are from air and the environment, infected body fluids, patients, articles, or equipment.
  5. 5. Follow the Standard protocols • Standard cleaning, disinfection with appropriate chemical agents, good theatre practice and discipline can provide a microbiologically safe environment.
  6. 6. 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.
  7. 7. A good hand washing and Monitoring reduces infections • 3 A thorough washing with warm water and good detergent can bring more of an overall improvement than solely decontamination sterilization with other chemicals, or fumigation. • 4. Frequent monitoring and training of medical and paramedical staff must carry a high priority – don’t merely observe mechanical and chemical methods.
  8. 8. Hand washing a boon to safety • Thorough washing and carbonizations, if done every day after the surgeries, will greatly enhance the safety standards and reduce the repeated expenditure on fumigation.
  9. 9. Regulate the Operating Room Environment Minimize personnel traffic during operations
  10. 10. Surgical Attire • Scrub suits • Cap/hoods • Shoe covers • Masks • Gloves • Gowns
  11. 11. Surgeon and Skills • Technical skill set – Excellent eye– hand coordination – Extensive medical knowledge – Expertise in Anatomy
  12. 12. Surgeon Skills • Non-technical skill set – Situation awareness – Decision making – Communication and teamwork – Leadership
  13. 13. Cleaning and Disinfecting Environmental Surfaces – Medical equipment surfaces knobs, handles on equipment such as x-ray machines, instrument carts – Housekeeping surfaces floors, walls, chairs, and tabletops
  14. 14. Cleaning and Disinfecting • Medical Equipment • Manufacturer’s recommendation for sterilization – Recommended chemical germicides – Water-resistant properties – Required decontamination after servicing – Non-critical medical equipment (see intermediate level disinfection)
  15. 15. 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
  16. 16. Cleaning • A form of decontamination by removing organic matter, salts, and visible soils – Physical action of scrubbing with detergents or surfactants and rinsing with water – Necessary step prior to sterilization or disinfection
  17. 17. Cleaning Strategy Minimize contamination of cleaning solutions and tools Change cleaning solutions frequently – Replace soiled cloths and mop heads with each cleaning solution change – Launder cloths and mop heads after use and allow to dry before re-use or use disposable cloths and mop heads Use manufacturers recommended concentration
  18. 18. 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
  19. 19. Disinfection “The process that eliminates many or all pathogenic micro-organisms on inanimate objects with the exception of bacterial spores” Spaulding’s* three levels of disinfection: • High-level • Intermediate-level • Low-level *for treatment of devices and surfaces that do not require sterility for safe use
  20. 20. 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 enveloped viruses Utilize for items that come into contact with intact mucous membranes and are heat sensitive – – – – semi-critical medical instruments (s/a flexible fiber optic endoscopes) thermometers vaginal speculums sigmoid scopes
  21. 21. Intermediate-level Disinfection Includes Chlorine-containing compounds, alcohols (small surfaces), some phenolic, and some iodophors Inactivates a highly resistant organisms and exhibits some sporocidal activity Utilize for non-critical medical equipment s/a stethoscopes, blood pressure cuffs, dialysis machines, equipment knobs and controls.
  22. 22. 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
  23. 23. Monitor employee compliance to hand hygiene recommendations
  24. 24. 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 protocols to control environmental contamination with antibiotic-resistant, gram-positive coccid
  25. 25. Hand Hygiene • Avoid artificial nails and keep natural nails < ¼ 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
  26. 26. 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 may not correlate.
  27. 27. Economical loss • Money wasted on unnecessary use. • People concentrate on Floors, Inanimate objects, If the resources are not spend with scientific understanding the limited resources are lost in particular developing countries.
  28. 28. Disinfection x Sterilization • Sterilization is absolute, removes microbes and spores too. • To achieve Sterilization is Expensive, not sustainable, many times not needed. • An effective Disinfection reduces the infections drastically.
  29. 29. Basic care of Operation Theatres. • Reduction of Microbial counts is important. • Very rarely the Microbes reach the operation site, • Paying great attention to Floors Using unnecessary, too many chemical not necessary • Keep the floor Clean and Dry - Bacteria are reduced, • Most Important component of Bacteria is water a dry areas causes natural death except spores
  30. 30. Frequent cleaning of Walls and Roof of Operation Theatre is not needed • 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, has direct relation to increase of bacterial counts
  31. 31. Do not disturb the Roof • Do not disturb unnecessarily, • Do not use ceiling fans they cause aerosol spread • Clean only when remodeling or accumulated ,good amount of dust.
  32. 32. How you care for Floors • Use only vacuum cleaners • Don't broom • As it increases the bacterial flora in the environment
  33. 33. Cleaning the Floor • A simple detergent reduces flora by 80 % • Addition of disinfectant reduces to 95 % • In busy Hospitals counts raise in 2 hours
  34. 34. Aldehyde free sterilization of Operation theatres • Some of the emerging compounds developed for use in the sterilization of operating theatres are more effective for environmental decontamination, have a very good cost/benefit ratio, good material compatibility, excellent cleaning properties and leave virtually no residues. One particular product available has the advantage of being a Formaldehyde-free disinfectant cleaner with low use concentration
  35. 35. Are Flowers Safe in the Hospital ?
  36. 36. 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/Orthopedic wards and critical care areas.
  37. 37. Who/What is Important in prevention of Infections
  38. 38. Remember we are More important than many
  39. 39. 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, need not be effective.
  40. 40. Importance of Staff Education • Specify the staff for duties and responsibilities. • Education is a matter of continuity • Train under the seniors observation. • Train the staff with scientific goals
  41. 41. Operation Theatre Safety is Responsibility Of
  42. 42. Everyone
  43. 43. CDC Definition of Surgical Site Infections 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
  44. 44. Frequent Washing of Hands saves several Lives Universally
  45. 45. ! Protect patients…protect healthcare personnel… promote quality healthcare!
  46. 46. Created from Web sources Visit for Articles of Interest on Infectious Diseases
  47. 47. • 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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