surgical safety

1. ENSURING A SAFE SURGICAL
ENVIRONMENT: THEATRE
CLEANING,HAND
WASHING,CLEANING AND
STERILIZATION OF INSTRUMENT
BY SAMBO N.M
RN,RM,RPON,BNSC,PGDE,PM,MSc N

2. OUTLINE
• Introduction
• Definitions
• Safe surgical environment
• Theatre cleaning
• Hand washing
• Sterilization of instruments

3. INTRODUCTION
• Safe and sufficient surgical operations
depends on a work environment larger than
the individual operating room (OR) and on
communications at the different levels of the
hospital organization.

4. DEFINITION OF TERMS
• Patient/resident safety in
the OR: It refers to the
safety (no harm) of both
the patient and the
working personnel
• Sterilization :destroys or
eliminates all forms of
microbial life
• Cleaning :reduces
bioburden of contaminants
present
• Disinfection :eliminates
many or all pathogenic
microorganisms, except
bacterial spores.
• The operating room
(OR): is a sterile,
organized environment
section in a hospital

5. SAFE SURGICAL ENVIRONMENT
Ensuring surgical safety in the operating room begins before
patient enters the operating room and include attention
to all types of medical errors that may affect the patient
or any of the team members.
This errors include;
• Wrong-patient surgery
• Wrong-side surgery
• Wrong-level surgery
• Retained foreign objects
• Medication errors
• Teaching and untrained personnel
Opportunities and challenges in improving surgical work flow(2008), The American college of obstetricians and
gynaecologists (2010)

6. PREVENTION OF ERRORS IN THE OR
• Universal protocol ; identification process,
marking of op-site and performing of time out.
• Stress management
• Use of surgical safety checklist
• Teaching
• Patient’s involvement
• Grant privileges for new procedures under
supervision
• Swab count before closing any cavity
• Avoid distractions
The American college of obstetricians and gynaecologists (2010)

7. CLEANING THE OPERATING ROOM(OR)
To ensure a clean and safe surgical
environment, cleaning an operating room or
procedure room requires a team approach
ORs should be cleaned:
Before the first case of the day.
Room turnover; In between cases.
Terminal clean after the last case of the day .
Cycle or Periodic deep cleaning

8. CLEANING PROCESS
Use Dedicated equipment.
Detergent and disinfectant solutions should be
prepared as needed according to
manufacturer’s instructions – and properly
labeled.
Follow Standard precautions.
Be alert for sharps and sharp objects
Follow protocol for hand hygiene
Wet floor sign

9. HAND WASHING
 The most important tool for caring placed upon each
patient who is hoping for answers, understanding, and
healing remedies
 Hand hygiene is simple yet effective way to remove
transient micro-organisms, acquired through everyday
tasks in the clinical setting, from the surface of the hands.
 Good hand hygiene protects both patients and staff
 Alcohol-based formulations and soap & water.
 To maintain optimum hand hygiene; nothing is worn
below the elbows (only a plain bands), and that
the fingernails are clean and trimmed.
Teachmesurgery, 2018 and https://www.cdc.gov, 2019

11. SURGICAL HAND WASHING
• Surgical hand washing requires the removal and
killing of transient micro-organisms and
substantial reduction and suppuration of the
resident flora from the nails, hands, and
forearms of the surgical team for the duration of
the operation, in case a surgical glove is
punctured/torn.
https://www.infectioncontroltoday.com/view/how-perform-surgical-hand-scrubs (2001)

15. STERILIZATION OF INSTRUMENTS
• INTRODUTION
The delivery of sterile products for use in patient
care depends on the effectiveness of the
sterilization process, the unit design,
decontamination, disassembling and packaging of
the device, loading the sterilizer, monitoring,
sterilant quality and quantity, and the
appropriateness of the cycle for the load contents,
and other aspects of device reprocessing.

16. Spaulding's Classification of
Disinfection
Classification Definition Level of Processing Required
• Critical Device that Cleaning followed by
enters sterile tissues sterilization
• Semi-critical Device in contact Cleaning + high-level disinfection
with nonintact skin or +sterilization if preferred
mucous membranes
• Noncritical Device that touches Cleaning followed by low-level
only intact skin and not disinfection. In some cases, cleaning
mucous membranes or does alone is acceptable
not directly touch the
client/resident
https://www.sciencedirect.com/topics/chemistry/sterilization-and-disinfection

17. CLEANING OF THE INSTRUMENTS
• Friction (scrubbing the soiled area with a
brush) is an old and dependable method.
• Fluidics ( fluids under pressure) is used to
remove soil and debris from internal
channels after brushing and when the
design does not allow passage of a brush
through a channel.
• https://www.cdc.gov/infectioncontrol/guidelines/disinfection/cleaning.html(2016)

18. METHODS OF
STERILIZATIONS/DISINFECTION
• Hypochloride 1% ,PH 6-8
• Glutaraldehyde (CIDEX ) 2% at 20ºC
• Dry Heat Sterilization. 160 °C /170 °C
/190°C
• Steam autoclaving uses steam, pressure
and time. At high temperature of 121°C
(250°F) to 132°C (270°F)
• Hydrogen peroxide gas
3%/ 1.5%/ 0.75%
https://www.hopkinsmedicine.org/hse/forms/cidexopa/opahowtouse.pd
f
• 10 minutes
• 20 minutes
• 2h/1h/6-12min
• 20-30 minutes
• Aprox.10 /20 /60 min respectively
www.cdc.gov/infectioncontrol/guidelines/disinfection/sterilization/sterhttpsilizing-
practices.(2008)

19. Factors Affecting the Efficacy of
Disinfection and Sterilization
• Concentration and Potency of Disinfectants
• Physical and Chemical Factors
• Organic and Inorganic Matter
• Innate Resistance of Microorganisms
• Duration of Exposure
• Biofilms

20. CONCLUTION
• Members of the surgical team most work hard to
coordinate their efforts to ensure the safety and
care of their patients and themselves.
• Nosocomial Infection rates are frequently
reported
• There are systems that we can put in place to
ensure that the theatre environment is clean and
safe to minimize this infection risk such as
reducing the bioburden before disinfection and
sterilization

21. REFERENCES
• Laurence McKeen,( 2012) .The Effect of Sterilization on
Plastics and Elastomers (Third Edition).
• https://www.cdc.gov/infectioncontrol/guidelines/disinf
ection/cleaning.html(2016)
• https://www.infectioncontroltoday.com/view/how-
perform-surgical-hand-scrubs, (2001)
• Teachmesurgery, 2018
• https://www.cdc.gov, 2019
• Opportunities and challenges in improving surgical
work flow(2008).
• The American college of obstetricians and
gynaecologists (2010)