Operation theatre   sterilization
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Operation theatre sterilization






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Operation theatre   sterilization Operation theatre sterilization Presentation Transcript

  • Operation Theatre - STERILIZATION Presenter – Dr. Sukumar.T.K.
  •  Freeing of an article from all living organisms including viable spores.  Process that kills more than 106 organisms , including spores of a defined exceptionally high degree of resistance. Sterilization
  •  1867 – Dr. Lister Joseph, identifies airborne bacteria. Uses carbolic acid spray in surgical areas.  1880 – Johnson and Johnson introduce antiseptic surgical dressings.  Use of Carbolic acid reduced Hospital associated infections. Safe Operation Theatre Practices – The Beginning
  • Surgical Site Infections
  •  2nd most common cause of hospital acquired infections.  Mortality as high as – 77% .  Sources –  Endogenous  Exogenous  Maintaining sterile environment – control of major part of exogenous infections Surgical Site Infection
  • Operating Room Environment  Ventilation  Dust, lint, skin squames, respiratory droplets.  Microbial level ∝ Number of people moving in room.  Operating room should be maintained at Positive Pressure. Sources of Infectious Agents in OT
  •  Types of Ventilation  Mixing  Parallel Flow –(Laminar Airflow) a)Vertical Parallel Flow b)Horizontal Parallel Flow
  • OP – Box Ventillation
  • Ventilation Systems Mixing Vertical Parallel Flow Horizontal Parallel Flow
  •  All ventilation systems in hospital should have two filter beds in series (first = ≥30% ; second = ≥90%) – Ultra clean air.  Laminar airflow and use of UV is suggested to reduce SSI (velocity – 0.3-0.5µm/sec). Minimum of 12 cycles/hr  Recirculated air passed through HEPA Filter.
  •  Environmental Surfaces  Routine cleaning has to be performed.  Cleaned after contact with blood or potentially infectious material.  Wet vacuuming to be performed after last operation of day or night.
  •  Frequent cleaning of walls and roof - not needed.  These areas should not be disturbed unnecessarily.  Floors get contaminated quickly – Depends on number of people present.  Ceiling fans should not be used.  Clean roof – when remodelling or accumulated good amount of dust. Roof, Floors and Walls
  •  1% of microbes present on floor are pathogenic.  Simple detergent -  reduces flora by 80%  Addition of disinfectant –  95%  70% alcohol – Disinfectant. contd.
  • Fumigation
  •  Formaldehyde vapour – Produced on low temp heating.  Vapour phase decontaminates the air / environment.  Mechanism – alkylates amino acids and sulfydral group of proteins and purine bases.  Used widely to sterilize huge areas like operation theatres INSPITE OF BEING HAZARDOUS as it is cheap. Fumigation
  •  Thoroughly clean windows, doors, floors and all washable equipment with soap and water.  Close windows and ventilators tightly.  Switch off all lights, A/C and other electronic items.  Calculate room size and required amount of formaldehyde. Fumigation - Procedure
  •  Electric Boiler Fumigation  For 1000 cu.ft of ot – 500ml of formalin added in 1000ml water In electric boiler.  Boiler switched on and kept on for 45 min.  Switched off without entering room. Creating Formaldehyde
  •  Potassium permanganate method  For 1000 cu.ft add 450gm KMno4 to 500mlof formalin.  Seal room and leave it for 48hrs.  Residual formaldehyde gas neutralised by using ammonia. (3Hrs)
  • Ecofriendly, non toxic non irritating environmental disinfectant. Has bactericidal, virucidal, tuberculocidal, fungicidal and sporicidal action. Complex formulation of stabilised 11% w/v hydrogen peroxide with 0.01% silver nitrate solution Eco shield™ (Bio shield)
  •  Formaldehyde free.  No residue.  Glutaral 100mg/g, benzyl-C12-18- alkyldimethylammonium chloride 60mg/g, didecyl- dimethylammonium chloride 60mg/g.  Wet wipe procedure. Bacillocid rasant™
  •  Virkon  Disinfects medical devices.  Disinfects laboratory equipment.  Decontaminate spillages with blood and body fluids.  Replace autoclaving and saving time. Newer non toxic compounds
  • Monitoring of hospital associated infections  Training of health care workers Investigations of outbreaks Any technical lapses Monitoring of staff health Infection Control Programmes
  • Education of universal precautions Advice on isolation of infectious patients Waste disposal Safe use of antibiotics Contd..
  • Role of Microbiology Department  Identifies pathogen  Monitoring of antibiotic therapy  Education on specimen collection  Information on common antibiogram patterns  Data on hospital infection  Surveillance of hospital environment  Counselling of hospital staff.
  •  Settle plate method  Position, duration.  Blood agar exposed for specified period and incubated  Slit sampler method  Very effective and highly sensitive.  Fixed volume of air is sucked and counts made Air surveillance
  •  Factors influencing – i. Number of persons present ii. Body movements iii. Disturbances of clothing
  •  Counts vary on number of personnel present on given area.  Nature of procedures  ONLY 1% ARE PATHOGENIC  Presence of Staphylococcus aureus makes difference Significant count??
  •  Detection of spores of Cl.tetani in ot – losing relevance  Routine testing for anaerobic spores not essential. Anaerobic spores
  • AIMS  To provide sterilized material from a central department  To alleviate the burden of work of the nursing personnel  To facilitate the wards to function smoothly Central Sterile Services Department
  •  Receipt and delivery of equipment from all areas of the hospital  Supply of sterile materials for dressings and procedures carried out in wards and departments  Supply of operation theatres with the necessary sterile instruments and linen FUNCTIONS
  •  To disassemble, clean and check for proper function of equipment, such as suction machines, feeding pumps, i.v infusion pumps etc.  To dry, wrap, bag and seal items in preparation for sterilization
  •  CSSD can broadly be classified into two parts:  Central Unit: Responsible for receiving dirty utilities, cleaning, processing, sterilization, storage and supply.  Peripheral Unit: Mainly responsible for DISTRIBUTION to various areas  TSSU (Theater Sterile Supply Unit) PLANNING OF A CSSD
  •  TSSU: In large hospitals, where number of OTs function, these have peripheral sterilization units known as Theater Sterile & Supply Units. (TSSU)  These work under high pressure and takes less time for sterilization.  Specially in hospitals, where the Central Unit does not function round the clock. PERIPHERAL UNIT
  •  Dressing set/ tray  Suture removal set  Suturing set  Cut down tray  Tracheostomy set  Gloves(nowadays disposable) ITEMS COMMONLY HANDLED BY CSSD STORES
  •  HSG and CT set  Lumbar puncture set  Bone marrow/ liver/ kidney biopsy set  Burn pack  Intra costal drainage (ICD) procedure set
  •  Catheter set  Tapping/Aspiration set
  • 1. Receiving used items 2. Cleaning 3. Packing 4. Sterilizing 5. Storing (temporary) 6. Distributing to user departments Major Activities in CSSD
  •  Should have access to outside through a window with a counter.  The items (especially for instruments in trays) are counted and received.  Instruments are inspected and blunt/unsuitable instruments are segregated/ discarded.  Necessary entries are made for records.  Items shifted to cleaning area. RECEIVING AREA
  •  Washing-Cleaning is the removal of visible soil (e.g., organic and inorganic material) from objects and surfaces  If used items are not decontaminated in user department then blood/ body fluid soiled items should be decontaminated with sodium hypochlorite before handling further.  Rinsing-Sorting-Soaking-Washing-Drying CLEANING AREA
  •  Rinsing-Detergents (preferably enzymatic) &brushes of various sizes and shapes are required in this area.  Instruments washed either manually or in machines.  For manual washing sinks with water supply and working counters are organized
  •  Tunnel washer - highly sophisticated machine that allow totally hand-off processing.  Instruments coming from operating room or other departments are placed into the tunnel washer without any further handling. The instruments are subjected to cycles washing, rinsing, ultrasonic cleaning and drying.
  •  Ultrasonic washer is a machine used for cleaning surgical instruments  It converts high frequency sound waves into mechanical vibration that produces small bubbles that burst on the internal surfaces of instruments and dislodge the waste particles.  After the instruments are washed, they are dried in oven dryer and shifted to packing area.
  • CATEGORY ITEMS PROCEDURE Critical Enter tissue, through which blood flows Sterilization Semi – Critical Touch mucous membrane, touch non intact skin High level disinfection Non – Critical Bandage, BP Cuffs Low level disinfection Procedures Used
  •  High Temp – Steam Sterilization  Low Temp – Ethylene Oxide gas, Hydrogen peroxide gas plasma Sterilization
  •  Liquid Immersion  ≥2.4% Glutaraldehyde for 10hrs  1.12% Glutaraldehyde and 1.93% phenol for 12 hrs  7.35%hydrogen peroxide and 0.23%peracetic acid for 3hrs  7.5% Hydrogen peroxide for 6hrs  1.0% Hydrogen peroxide and 0.08% peracetic acid for 8hrs.  ≥ 0.2% peracetic acid for 50 min at 50-56 degree Celsius
  •  Heat automated – Pasteurization for 50 min  Liquid immersion  2% glutaraldehyde for 20 – 45min  0,55% ortho – pthalaldehyde for 12 min  1.12% glutaraldehyde and 1.93% phenol for 20 min  7.35% hydrogen peroxide and 0.23% paracetic acid for 15 min  650 – 675 ppm chloride for 10 min High level Disinfection
  •  The shelf life of the sterile materials depend on the quality of packing materials used and the status of cleanliness of storing area.  Generally the items sterilized by steam autoclave can be used for one week and ETO packs can be used for 6 months. SHELF LIFE OF STERILIZED ITEMS
  •  Receipt register- to keep account of all the trays with instruments received in CSSD  Issue register to keep account of all the materials issued to users  Stock ledger of non consumable items- e.g. trays, instruments RECORDS
  •  Stock ledger of consumables- to keep account of the cotton and gauze received, and issued by the CSSD  Number of loads per machine per day  Duty rosters of staff  Log book of machine
  • Soap, Water and Common Sense – Yet the best antiseptic Importance of Hand Washing WILLIAM OSLER
  •  VENTILATION SYSTEMS IN OPERATING THEATRES, ASPECTS TO CONSIDER. A JOHNSON MEDICAL BULLET IN (REPUBLISHED 2002)  Operating theatre commissioning -Microbiological From HICSIG  Guidelines for prevention of hospital acquired infections. Yatin Mehta, Abhinav Gupta, etal.  Guideline for Prevention of Surgical Site Infection, 1999. Alicia J, Teresa C, etal Reference
  •  Recommendations for Infection Control for the Practice of Anaesthesiology. Developed by the ASA Committee Occupational Health Task Force on Infection Control.  Procedure-associated Module SSI – CDC  OT Sterilization. T V Rao  Text book of microbiology Mackie and McCartney-14th edition.