High level disinfection

1. HIGH LEVEL DISINFECTION
CLEANING PROTOCOL
IMPORTANCE OF INVENTORY
CHECKING &
OT CHECKING

2. Sterilization
• Sterilization may be defined as the statistically complete destruction of all
microorganisms including the most resistant bacteria and spores.

4. Zones in an operation theater
• Outer – till the changing area
• Clean zone- from the door of changing room till the entrance of operation
theatre
• Sterile zone- operation theatre
• disposal zone- waste segregation and disposal area

5. Entrance into OT complex
• All outside belongings have to be kept in the changing area
• Wash your feet before entering the clean area to negate any contamination
• Carry bare minimum items when you enter the clean and sterile area
• Ensure that your OT dress and footwear is clean
• Wash your hands before start your work in the clean area

6. Autoclave
• An autoclave is a machine that uses steam under pressure to kill harmful bacteria,
viruses, fungi, and spores on items that are placed inside a pressure vessel
• Cycles :- wet, dry and vacuum

7. • Works like a pressure cooker
• The high temperature and pressure create saturated steam which penetrates
the objects and destabilises the structure of microorganisms including spores
• One of the methods of absolute sterilization.
 FLASH STERILIZATION/ LITTLE SISTER: rapid increase in
temperature upto 134 C /121 C with wet and moist mode, should be in
proximity to sterile area.

8. Cleaning protocol
• Before commencing and after finishing all cases:
10L Of water + 5L of Sodium Hypochlorite - 2% strength

9. In between the cases:-
• 1st mopping :- diluted soap solution – 200 ml soap sol. In 20L of plain water
• 2nd mopping :- plain water
• 3rd mopping:- 20L water+ 5L sod Hypo- 1%

10. Fumigation
• 4 L of water + 1 L of silvicide for minimum 30 minutes
• Fumigation has to be done after HLD and mopping the OT with 3 bucket
system. The screens of all the equipment should be covered but not tight ,
air entry should be there. The room must be airtight.
• Done every week and in case of every infected case
• We can use the OT 1-2 hour after fumigation in case of any emergency.

11. Soaking instruments after every case
• Wash the used instruments in running water for removing blood and tissue
• Soak the used instruments in :- 20L water+ 5L sod Hypo- 1% strength of
sodium hypochlorite for a minimum of 10-15 minutes.
• Instruments are then to be scrubbed and washed with soap solution
• Ensure that no blood stains or tissues are adhering to the instruments
• The instruments are then to be thoroughly dried before being sorted and
neatly packed

12. • All cleaning and instruments checking procedures have to be supervised by
the senior nursing officers
• Fumigation has to be recorded and reported to the next shift for the
continuity of care

13. Chemical sterilization

14. ETHYLENE OXIDE
• ETO is used in healthcare facilities to sterilize critical items (and sometimes
semicritical items) that are moisture or heat sensitive and cannot be sterilized by
steam sterilization.
• Based on a gas diffusion process,
• Sterility occurs when an EO gas molecule reacts with and destroys
the microbial DNA.
• All heat sensitive and delicate items are send for ETO sterilization
to CSSD after double packing

15. Process
• Basic goal is sterility

16. Procedure
• Wash the used item with soap and water

17. Dry it well, ensure there is no moisture

18. Seal it in double cover
Write the date, OT, full name of the Nursing officer and signature legibly. Ensure that there is no
damage to the item before sending and after receiving.

19. Check the sticker when your receive it from
CSSD
IT IS VALID FOR 6
MONTHS

20. TOXICITY
• The reaction with water or other material components to form toxic residual
compounds (ethylene oxide, ethylene glycol, and ethylene chlorhydrin).
• hazardous both to people and to the environment.
• Ethylene glycol is formed from ethylene oxide and water – CNS DEPRESSANT
• Rust will also form on the equipment.

21. High level disinfection
• High-level disinfection traditionally is defined as complete
elimination of all microorganisms in or on an instrument,
except for small numbers of bacterial spores.
• Eg : glutaraldehyde (cidex)

23. Chemical sterilization (Contd)
• We use 2% glutaraldehyde solution which comes in with activator
• Effective against fungi, bacteria, virus, spores, including pseudomonas,
tubercle bacillus, HIV, HBV Antigens
• Soaking time – minimum of 30 minutes , average -45 minutes

24. WHAT ALL CAN BE SOAKED IN CIDEX
• monopolar points
• Endoscopic things, camera and lens should be covered with the available
sheaths
• Fibreoptic cables
• Heat and pressure sensitive items
• All cidex soaked items have to washed with saline and dried before using on
the patient.

25. • Basically used when the equipment cannot withstand high temperature of
sterilization via a mechanical method.
• Reduces wear and tear
• Less change of physical damage
• Please note that for complete sterilization the item should be cleaned and
immersed completely into the cidex solution and kept undisturbed for 45min
and above

26. SURFACE CLEANING
• 250ml of silvicide (hydrogen peroxide base) in 5L of plain water (5%).
• Not useful towards spores
• Should not be kept near combustible substances like ether
• Electronic devices should be switched off before application
• Exposure time is 5 minutes

27. WEEKLY THOUROUGH CLEANING
• The entire OT has to be cleaned thoroughly
• All portable items like ot table and other furnitures , cusa machine etc. has to
be pushed out of the ots and cleaned with 5% silvicide(surface cleaning)
• The floor, wall and ceiling have to be cleaned with high dusting
• Vacuuming to be done every week in the ideal setting
• After the satisfactory cleaning is done, the entire OT has to be fumigated

28. • Screens( monitors, tv screens, microscope screens, ventilaler screen) to be cleaned
with instaact solution (undiluted)( for IOMRI)
• Care has to be taken that the sockets and key boards don’t get soaked
• Areas that are prone for dust collection like corers and veranda should be cleaned
diligently
• Weekly culture samples to be taken – both air sampling and swab culture, records to
be maintained
• Autoclave biological indicator also to be send every week and the records are to be
maintained.

29. Importance of Documentation
• “ not documented i equal to not done”
• Documentation should be
1. Timely
2. Accurate
3. Complete
4. Concise
5. Legible

30. What is
missing ?

31. • Eg : the following things have to be mentioned while writing due slips for
implants used:-
• Date & OT
• Patients name, age, sex, unit, UHID/N.no
• Name of the surgery
• Name of the surgeon: consultant and resident
• Name of the scrub nurse

32. Few documents in operation theatre
• Related to patients or specimen:
 surgical safety checklist
Pre operative checklist
Recovery register
Daily report book
Specimen book
Frozen book
Post op monitoring chart

33. • Related to OT and material management:-
 daily inventory checking book
Cssd book
Eto book
Fumigation book
Bme register
Implants register
HIV/PPE book
Microbiology culture sample sending and reporting book

34. Inventory checking
• Inventory checking basically means to have an account of the stock in hand
• Daily checking helps us to know any missing items and helps to locate them
early
• Helps us to know our functioning capacity and intimate other HCP

35. • Types of inventory that we follow:
1. Daily or essential use items : patient trolley, IV stand, head rings , plaster
cutting scissors, trimmers, blankets etc
2. High cost items: 4K endoscope, Colorado monopolar point,
microvascular sets, doppler machines, cusa, aneurysm clips, ICG etc
3. Sterile things: sterile packs and ETO items

36. When there is no periodic inventory
• Loss/breakage/misuse of supply
• Lack of accountability
• Harm to the patient
• Delay in repair and replacement

37. OT CHECKING
• Check complete equipment, cleaning and the required items in the ot
• The cables must be neatly folded
• All extra items must be removed from the ot. Eg: syringes, urobags
• Plasters or labels stuck on the walls must be removed
• Look out for blood stains especially on ot table, ventilators, suction bottles
• Remove any extra equipment from the ot.
• Ensure clean scrub stations

38. Importance of OT checking
• Helps us to ensure patient safety
• Makes OT presentable
• Helps in decluttering
• Prevents over stocking
• Allows equal distribution of available resources
• Allows in identification of missing items and prompt rectification.

39. • The whole class can be summarized on the basic principles of nursing:
“Make the best possible use of time and
energy while providing the best possible
quality of care”

40. THANK YOU