Operation theatre sterilization


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Operation theatre sterilization

  1. 1. Operation Theatre - STERILIZATION Presenter – Dr. Sukumar.T.K.
  2. 2.  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
  3. 3.  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
  4. 4. Surgical Site Infections
  5. 5.  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
  6. 6. 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
  7. 7.  Types of Ventilation  Mixing  Parallel Flow –(Laminar Airflow) a)Vertical Parallel Flow b)Horizontal Parallel Flow
  8. 8. OP – Box Ventillation
  9. 9. Ventilation Systems Mixing Vertical Parallel Flow Horizontal Parallel Flow
  10. 10.  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.
  11. 11.  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.
  12. 12.  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
  13. 13.  1% of microbes present on floor are pathogenic.  Simple detergent -  reduces flora by 80%  Addition of disinfectant –  95%  70% alcohol – Disinfectant. contd.
  14. 14. Fumigation
  15. 15.  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
  16. 16.  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
  17. 17.  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
  18. 18.  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)
  19. 19. 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)
  20. 20.  Formaldehyde free.  No residue.  Glutaral 100mg/g, benzyl-C12-18- alkyldimethylammonium chloride 60mg/g, didecyl- dimethylammonium chloride 60mg/g.  Wet wipe procedure. Bacillocid rasant™
  21. 21.  Virkon  Disinfects medical devices.  Disinfects laboratory equipment.  Decontaminate spillages with blood and body fluids.  Replace autoclaving and saving time. Newer non toxic compounds
  22. 22. Monitoring of hospital associated infections  Training of health care workers Investigations of outbreaks Any technical lapses Monitoring of staff health Infection Control Programmes
  23. 23. Education of universal precautions Advice on isolation of infectious patients Waste disposal Safe use of antibiotics Contd..
  24. 24. 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.
  25. 25.  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
  26. 26.  Factors influencing – i. Number of persons present ii. Body movements iii. Disturbances of clothing
  27. 27.  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??
  28. 28.  Detection of spores of Cl.tetani in ot – losing relevance  Routine testing for anaerobic spores not essential. Anaerobic spores
  29. 29. 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
  30. 30.  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
  31. 31.  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
  32. 32.  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
  33. 33.  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
  34. 34.  Dressing set/ tray  Suture removal set  Suturing set  Cut down tray  Tracheostomy set  Gloves(nowadays disposable) ITEMS COMMONLY HANDLED BY CSSD STORES
  35. 35.  HSG and CT set  Lumbar puncture set  Bone marrow/ liver/ kidney biopsy set  Burn pack  Intra costal drainage (ICD) procedure set
  36. 36.  Catheter set  Tapping/Aspiration set
  37. 37. 1. Receiving used items 2. Cleaning 3. Packing 4. Sterilizing 5. Storing (temporary) 6. Distributing to user departments Major Activities in CSSD
  39. 39.  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
  40. 40.  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
  41. 41.  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
  42. 42.  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.
  43. 43.  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.
  44. 44. 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
  45. 45.  High Temp – Steam Sterilization  Low Temp – Ethylene Oxide gas, Hydrogen peroxide gas plasma Sterilization
  46. 46.  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
  47. 47.  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
  48. 48.  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
  49. 49.  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
  50. 50.  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
  51. 51. Soap, Water and Common Sense – Yet the best antiseptic Importance of Hand Washing WILLIAM OSLER
  52. 52.  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
  53. 53.  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.
  54. 54. THANK YOU
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