OR cleaning & fumigation-Anesthesia

1. OR CLEANING &
FUMIGATION
Dr Nisar Ahmed Arain
Assistant Professor
Anesthesia/Critical care/ER

2. --Scrubbing with detergents and rinsing
with water
--Spot cleaning of walls and ceiling daily
--For open shelves –clean daily
-- For closed cabinets –clean weekly
--For furniture's, lights equipment’s
Clean end of the day with Lysol
--Lights and other equipment's –
steamed
weekly
- General Cleaning Of OR

3. General Cleaning contd.
--The Floors should be scrubbed with warm water and
detergent and dried. No disinfectant is necessary
-- The O.T. table and other nonclinical equipment’s
must be wiped to remove all visible dirt and left to
dry
-- Weakly cleaning of all the areas inside the operating
theatre complex should be done thoroughly with
warm water and detergent and dried
-- The storage shelves must be emptied and wiped
over, and allowed to dry and restacked

4. LEVELS OF DISINFECTION
--HIGH:
This kills all the organisms except
-spores, Prions e.g. Glutaraldehyde(Prions)-are misfolded proteins
with the ability to transmit their misfolded shape onto normal
variants of the same protein. They characterize several Fatal and
transmissible neurodegenerative diseases in Humans and other
animals
--INTERMEDIATE
Kills Mycobacteria, most viruses and bacteria
--LOW
Kills some viruses and bacteria

5. Formaldehyde fumigation
Commonly used to sterilize the OT
-Requirement (Foran area of 1000 cubic feet)
-500 ml of 40% formaldehyde in one
liter of water
-Stove or hot plate for heating formalin
-300 ml of 10% Ammonia

6. Procedure
--Close all the doors & windows of OR airtight and
switch off fans and A.C.
--Heat formalin solution till boiling
--Fumigate OR with it
--Leave the OT unentered over night
--Enter the OT next day morning with 300ml of
“ammonia”
--Keep the ammonia solution for 2 - 3 hrs to
neutralize formalin vapours
--Open the OT to start surgery
--Advised fumigation at weekly intervals

7. -Mode of Action
Formaldehyde inactivates microorganisms by alkylating
the aminoacid and sulfhydryl groups of proteins and
ring nitrogen atoms of purine bases.
-Disadvantages
-It acts as a potential carcinogen
-It is Toxic
-It is irritant

8. Duration
--In case of any construction in O.T.
→ 48 hrs
-- In case of inflected cases
→ 24hrs
-- For routine clean cases
→ 12 hrs
--Alternatively 250 ml of formalin and
3000 ml of tap water are put into a
machine (auto mist) and time is set
for 2 hrs. The mist is circulated for
2hrs inside the closed room.

9. Commercially available disinfectant
-Baccilocid rasant
--A newer and effective compound in environmental
decontamination with very good cost/benefit ratio
good material compatibility, excellent cleaning
properties. It is a Formaldehyde-free disinfectant
cleaner with low use concentration.
--Active ingredients
Glutaral 100 mg/g,Benzyl-C12-18-alkyldimethylammonium
chlorides 60 m g / g, didecyldimethylammonium chloride 60
mg/g.

10. Advantages
--Provides complete asepsis within
30 to 60 minutes.
Cleaning with detergent or
carbolic acid is not required
--Formalin fumigation not required
--Shutdown of O.T. for 24 hrs is not
required.

11. Aldekol
-A new method of fumigation
has been evolved using “Aldekol”
a mixture containing 6% formaldehyde
6%glutaraldehyde and 5%
benzalkonium120 chloride

12. -Disinfection by Radiation
-Ultraviolet radiation
--Daily U.V. Irradiation for 12 - 1 6 hrs
--To be switched off 2 hrs before

13. DECONTAMINATION OF EQUIPMENT
INSTRUMENTS, AND OTHER
REUSABLE ITEMS
--Immediately after use, all surgical instruments
reusable gloves, and other items that have been
in contact with blood or other body fluids should
be placed in a plastic bucket containing a solution
of 0.5% chlorine for 10 minutes. After 10 minutes
the items should be removed from the chlorine
solution and rinsed with water or cleaned
immediately

14. CLEANING OF EQUIPMENT
INSTRUMENTS AND OTHER
REUSABLE ITEMS
-The instruments and other items should
be washed vigorously with a brush
(a toothbrush is a good option) in
lukewarm water with detergent to
remove all blood, tissue.
-- Cleaning instruments with ultrasonic
cleaner is used for cleaning of micro
surgical instruments.

15. -HIGH LEVEL DISINFACTANTS
---Chlorine solutions
These are fast acting, very effective against
HBV, HCV and HIV/ AIDS, these are inexpensive
and readily available .
---Formaldehyde
(8%), which is inexpensive and readily available
is an effective high-level disinfectant (HLD)
but, the vapours are very irritating and it is
classified as a potential carcinogen. Do not
dilute with chlorinated water as a dangerous
gas (bis- chloromethyl-ether) can be
produced.

16. Glutaraldehyde
-It is suitable for instruments that cannot
be autoclaved like sharp cutting
instruments, plastic & rubber items, and
endoscopes. It is effective against
vegetative pathogens in 15 minutes and
resistant pathogenic spores in 3 hrs

17. Hydrogen Peroxide
--(H2O2), which must be diluted
t o a 6% solution, is less expensive.
The 3%H2O2 solutions used as
antiseptics, however, it should not
be used as a disinfectant.
The major disadvantage of
hydrogen peroxide is that i t is
highly corrosive

18. Steam Sterilization (Autoclaving)
-Steam sterilization (frequently referred to
as autoclaving) depends on the use of
steam above 100 0C. Temperatures ranging
from 121-134 0C at pressures of 1 5 - 3 0
psi are generally recommended.
-Steam readily penetrates all wrapped
materials with the destruction of all
viruses and bacteria, including the most
resistant spores.
-Minimum holding times for the
sterilization of medical equipment are 15
minutes at 121 0C.

19. -CHEMICAL STERILIZATION (Gas)
-Ethylene Oxide (E. T. O.)
--Widely used for re -sterilizing ‘packaged
heat sensitive devices’ like sharp knives
and blades.
--It is non-corrosive and safe for most plastic
and polyethylene materials.
--it is the preferred method for sterilizing
heat labile tubings, vitrectomy cutters,
cryoprobes, light pipes, laser probes
diathermy leads, cannulated instruments
like endoscopes etc.

20. Sterilization methods of choice
for articles DURING SURGERY
-1-Linen (Gowns, Caps, Masks, Drapes)- Autoclaving
-2-Glassware (Syringes) - Dry heat sterilization or use
disposables from reputed firms
-3-Metal instruments- Autoclaving
-4-Plastic instruments/Components-Ethylene oxide
sterilization, formalin chamber
-5-Sharp edges instruments - ETO/Hot air oven
/Chemical disinfection.
-6- Sutures - Can be autoclaved
-7-Diathermy, Cautery electrodes- Autoclaving.
-8-Diathermy, Cautery electrodes- Autoclaving.
-9- Endoilluminators/ probes- Ethylene oxide
sterilization.

21. -
-SURVEILLANCE OF OPERATION THEATRE
MONITORING
--Swabs collected from various locations in
the OT include
-1. Operation table at the head end
-2. Over head lamp
-3. Four Walls
-4. Floor below the head end of the table
-5. Instrument trolley
-6. AC duct
-7. Microscope handles
--The swabs obtained are cultured for aerobic
(Chocolate agar) and anaerobic (Robertson’s
Cooked Meat Medium) growth

22. CHOCOLATE AGAR
--Solid culture medium
--Useful for the isolation of many
organisms including
H.influenzae
N.meningitidis
N.gonorrhoeae and
Moraxella species

23. ROBERSON,S COOKED MEAT MEDIUM
--Most widely used fluid medium for the
culture of anaerobes
--It consists of fat free minced cooked
meat in broth
--Permits the growth of even strict
anaerobes
--Meat turned red – sacchrolysis
--Meat turned black - proteolysis

25. ANAEROBIC CULTURE METHODS
---Mc Intosh Fildes anaerobic jar
---Gaspak
---RCM
---Pre reduced anaerobic system
---Anaerobic glove box

26. -Mc INTOSH FILDES ANAEROBIC JAR

27. ANAEROBIC BACTERIA
--Clostridium perfringens
--Clostridium septicum
--Clostridium novyi
--Clostridium botulinum
--CLOSTRIDIUM TETANI

28. -CLOSTRIDIUM TETANI

29. CULTURE
Swarming growth –detected on the opposite
half of the plate after 1 - 2 days of incubation