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Operation Theatre


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The file contains simple methods to improve the safety in our hospitals and operation theaters and save many helpless patients

Published in: Health & Medicine, Technology
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Operation Theatre

  1. 1. Sterilization and Decontamination of Surgical Theatres and Critical areas in DEVELOPING WORLD Dr.T.V.Rao MD Jubilee Mission Medical College and Research Institute, Trichur, Kerala, India
  2. 2. History of Hygiene <ul><li>Bible </li></ul><ul><li>Book of Leviticus </li></ul><ul><li>Chapter 11 – 15 </li></ul><ul><li>Code of Hygiene </li></ul>
  3. 3. Greek Era <ul><li>Aristotle recommends </li></ul><ul><li>Boiling water to armies. Advises the Alexander </li></ul>
  4. 4. HAND WASHING <ul><li>Semmelweis </li></ul><ul><li>Practices emphasizes the importance of washing hands with chlorinated water </li></ul><ul><li>In Obstetrics to reduce maternal mortality </li></ul>
  5. 5. Starting of Modern Era 1860 Dr.Joseph Lister <ul><li>Phenol in Surgery and Decontamination practices </li></ul>
  6. 6. Beginning of Modern Nursing <ul><li>The Very First Requirement in </li></ul><ul><li>Hospitals that should do the sick no harm </li></ul><ul><li>Florence </li></ul><ul><li>Nightingale </li></ul><ul><li>( Notes on Nursing 1860 ) </li></ul>
  7. 7. Historical Aspects Changed the History <ul><li>Lister era 1868 </li></ul><ul><li>Carbolic Acid in decontamination, </li></ul><ul><li>Reduction of Hospital associated infections </li></ul><ul><li>Mortality reduced </li></ul><ul><li>Morbidity reduced. </li></ul>
  8. 8. Beginning of Safe Operation Theatre Practices <ul><li>1867 –Dr.Joseph Lister first identifies airborne bacteria and uses Carbolic acid spray in surgical areas </li></ul><ul><li>1880 – Johnson and Johnson introduce antiseptic surgical dressings. </li></ul>
  9. 9. What is wrong with our Practices <ul><li>Disinfectants used indiscrimately, </li></ul><ul><li>Used unnecessarily </li></ul><ul><li>Not used when needed. </li></ul><ul><li>Concentration not adequate </li></ul><ul><li>Economic consideration, </li></ul><ul><li>Business promotions. </li></ul><ul><li>Laboratory testing X Hospital conditions. </li></ul>
  10. 10. Economical loss <ul><li>Money wasted on unnecessary use. </li></ul><ul><li>People concentrate on </li></ul><ul><li>Floors, Inanimate objects, </li></ul>
  11. 11. Basic Principles <ul><li>Cleaning more Important </li></ul><ul><li>Disinfection and Sterilization ? </li></ul><ul><li>Cleaning </li></ul><ul><li>Removes contaminants, </li></ul><ul><li>Dust, organic matter, </li></ul><ul><li>Disinfection </li></ul><ul><li>Reduces number of microbes </li></ul>
  12. 12. Disinfection x Sterilization <ul><li>Sterilization is absolute, removes microbes and spores too. </li></ul><ul><li>To achieve Sterilization is Expensive, not sustainable, many times not needed. </li></ul>
  13. 13. Basic care of Operation Theatres. <ul><li>Reduction of Microbial counts is important. </li></ul><ul><li>Very rarely the Microbes reach the operation site, </li></ul><ul><li>Paying attention to Floors </li></ul><ul><li>Using unnecessary, too many chemical not necessary </li></ul><ul><li>Keep Clean Dry - Bacteria are reduced, </li></ul><ul><li>Most Important component of Bacteria is water, dry areas causes natural death. </li></ul>
  14. 14. Walls and Roof of Operation Theatre <ul><li>Frequent cleaning has little effect. </li></ul><ul><li>Do not disturb these areas unnecessarily, </li></ul><ul><li>Floors get contaminated quickly, depend on </li></ul><ul><li>Number of persons present in the </li></ul><ul><li>Theatre / Movements they make, </li></ul><ul><li>On many people make unnecessary movements than needed </li></ul>
  15. 15. Care of and Floors <ul><li>Do remember only 1 % are pathogenic. </li></ul><ul><li>On many occasion S.aureus. </li></ul><ul><li>Floor should be decontaminated with </li></ul><ul><li>Use Vacuum cleaner. </li></ul><ul><li>Wet cleaning techniques </li></ul><ul><li>Wet Mop / Keep the mops dry </li></ul>
  16. 16. Care of Roof <ul><li>Do not disturb unnecessarily, </li></ul><ul><li>Do not use ceiling fans they cause aerosol spread </li></ul><ul><li>Clean only when remodeling or accumulated ,good amount of dust. </li></ul>
  17. 17. How you care for Floors <ul><li>Use only vacuum cleaners </li></ul><ul><li>Don't broom </li></ul><ul><li>Use a Mop keep it dry, </li></ul>
  18. 18. Roof, Artificial ceilings, Walls <ul><li>Do not disturb every day </li></ul><ul><li>Routine disinfection not necessary </li></ul>
  19. 19. Caring for Floors <ul><li>Only 1 % are pathogenic </li></ul><ul><li>The counts depend on the number of persons, </li></ul><ul><li>Only people needed for procedures should enter the theatres. </li></ul><ul><li>Unnecessary movements disturbs the bacterial flora </li></ul>
  20. 20. Cleaning the Floor <ul><li>A simple detergent reduces flora by 80 % </li></ul><ul><li>Addition of disinfectant reduces to 95 % </li></ul><ul><li>In busy Hospitals counts raise in 2 hours </li></ul>
  21. 21. Environmental Cleaning of Operation Theatres <ul><li>Do not waste chemicals. </li></ul><ul><li>Only remove the dust with cloth wetted with clean water, </li></ul><ul><li>Don't use chemicals/Disinfectants as a habit, </li></ul><ul><li>Use only when contaminated with blood or body fluids. </li></ul>
  22. 22. Handling of Air in Operation theatre. <ul><li>Negative Air pressure vented to the operation theatre. </li></ul><ul><li>Environmental cleaning should be twice daily </li></ul>
  23. 23. Environmental cleaning of Hospital. <ul><li>Disinfectant Purpose </li></ul><ul><li>Sodium hypochlorite Contaminated with </li></ul><ul><li>Blood and body </li></ul><ul><li>fluids </li></ul><ul><li>Bleaching powder Toilets, bathrooms </li></ul><ul><li>9 grams/lit </li></ul>
  24. 24. Environmental cleaning of OT Contd <ul><li>Disinfectant Purpose </li></ul><ul><li>Alcohol 70% Metal surfaces </li></ul><ul><li>trolleys </li></ul>
  25. 25. Fumigatation <ul><li>Formaldehyde a Age old compound. </li></ul><ul><li>Low temp heating produce vapor </li></ul><ul><li>Vapor phase decontaminates the air/environment. </li></ul><ul><li>Kills vegetative bacteria / Spore ? </li></ul><ul><li>When Formaldehyde mixed with water and exposed to elevated temperature </li></ul><ul><li>Gaseous formaldehyde is generated </li></ul><ul><li>Time X Temp </li></ul>
  26. 26. Methods on Fumigation <ul><li>In principle we have to generate Formaldehyde gas. </li></ul><ul><li>Can be done by </li></ul><ul><li>Most easier way to mix the needed quantity of Formalin to water and heating at lower temperatures at 80 – 90 </li></ul><ul><li>Addition of Formalin to potassium permanganate </li></ul>
  27. 27. Procedure of Fumigation <ul><li>Seal the room with adhesive tape. </li></ul><ul><li>Sealing the edges around the doors is important, </li></ul><ul><li>Measure the volume of your operation theatre </li></ul><ul><li>For each 1000 cu ft use 500 ml of formaldehyde. </li></ul><ul><li>Mix with water @ 1000 ml for 500 ml of Formaldehyde needed. </li></ul><ul><li>Seal the Room for 24 hours, </li></ul><ul><li>Open the Door / Avoid the formalin gas with mask </li></ul>
  28. 28. Fumigation ( cont ) <ul><li>Neutralize Residual formalin gas with Ammonia by exposing 250 ml of Ammonia per liter of Formaldehyde used. </li></ul>
  29. 29. Safety of Air conditioning and Water cooling system <ul><li>Legionnaires disease is associated with Air Condition system </li></ul><ul><li>Chlorination / Heating of water may prove better alternatives. </li></ul>
  30. 30. Between procedures in the Operation Theatres. <ul><li>Clean operation tables, theatre equipment with disinfectant solution with detergent, </li></ul><ul><li>In case of spillage of blood / body fluids decontaminate with bleaching powder/chlorine solution ( 1 % available chlorine ). </li></ul><ul><li>Always discard wastes in prescribed plastic bags – Don’t accumulate biohazard waste in the operation theatres. </li></ul><ul><li>Don’t discard discarded soiled gowns in the operation theatre. </li></ul>
  31. 31. At the End of the Day in Operation theatre. <ul><li>Clean all the table tops sinks, door handles with detergent / low level of disinfectant. </li></ul><ul><li>Clean the floors with detergents mixed with warm water, </li></ul><ul><li>Finally mop with disinfectant like Phenol in the concentration of 1 : 10 </li></ul><ul><li>Low concentration of Phenol serve as perfume and not as disinfectant. </li></ul>
  32. 32. Infection control programmes <ul><li>1 Monitoring of Hospital associated infections. </li></ul><ul><li>2 Training of Health care workers. </li></ul><ul><li>3 Investigations of outbreaks. </li></ul><ul><li>4 Any technical lapses. </li></ul><ul><li>5 Monitoring of staff health </li></ul><ul><li>6 Education on Universal Precautions </li></ul><ul><li>7 Advise on isolation of Infectious patients. </li></ul><ul><li>8 Waste disposal </li></ul><ul><li>9 Safe use of Antibiotics / Antibiotic policy. </li></ul>
  33. 33. Role of Microbiology Department <ul><li>Identifies the pathogens </li></ul><ul><li>Monitoring of Antibiotic therapy, </li></ul><ul><li>Education on specimen collection and transportation, </li></ul><ul><li>Information on common Antibiogram patterns </li></ul><ul><li>Data on Hospital Infection </li></ul><ul><li>Surveillance of the Hospital environment </li></ul><ul><li>Counseling of the Infected Hospital Staff. </li></ul>
  34. 34. Surveillance of Operation theatre Examination of Air <ul><li>Estimations are done for detection of bacteria carrying particles in Air. </li></ul><ul><li>Factors influence </li></ul><ul><li>Number of persons present. </li></ul><ul><li>Body movements, </li></ul><ul><li>Disturbances of clothing. </li></ul>
  35. 35. Methods of Air surveillance <ul><li>Settle plate method. </li></ul><ul><li>Slit sampler method (from given volume) </li></ul><ul><li>Counts vary from one to many </li></ul><ul><li>Settle plates method </li></ul><ul><li>Record position – Time - Duration </li></ul><ul><li>Plates with media as Blood agar exposed for specified period and incubated in the </li></ul><ul><li>incubator for 24 hours at 37 º c </li></ul>
  36. 36. Slit Sampler <ul><li>Very Effective / Highly sensitive </li></ul><ul><li>Fixed volume of air is sucked and bacterial counts are made </li></ul>
  37. 37. How many bacteria are pathogenic <ul><li>Counts vary On number of personal present in the given area. </li></ul><ul><li>Behavior of the persons. </li></ul><ul><li>Depend on nature of procedures, type of operations. </li></ul><ul><li>Varying ranges </li></ul><ul><li>But remember only 1 % are pathogenic </li></ul><ul><li>Presence of S. aureus makes difference </li></ul>
  38. 38. Do we need surveillance regularly <ul><li>Bacteriological surveillance testing at regular internals is not warranted, </li></ul><ul><li>But warranted when modification of operation theaters are done, </li></ul><ul><li>In any unforeseen increase of incidence of infection form any particular operation theatre. </li></ul>
  39. 39. Factors which influence Saftey in Hospital Environment
  40. 40. Importance of Hand Washing <ul><li>Soap </li></ul><ul><li>Water </li></ul><ul><li>and </li></ul><ul><li>Common </li></ul><ul><li>Sense </li></ul><ul><li>Yet the best Antiseptic </li></ul><ul><li>William Osler </li></ul>
  41. 41. Good Hand Washing Practices Save many Lives
  42. 42. Choice of Soap <ul><li>Simple routinely used. </li></ul><ul><li>Medicated Soap </li></ul><ul><li>Soap advertisement claims are they real? </li></ul>
  43. 43. Which hand wash solution is best ? <ul><li>1 Alcohol with Chlorhexidine. </li></ul><ul><li>2.Alchool without Chlorhexidine. </li></ul><ul><li>3 Chlorhexidine 2 % </li></ul><ul><li>4 Chlorhexidine 4 % </li></ul><ul><li>5 Povidone with Iodine 7.5 % </li></ul><ul><li>6 Triclosan 1 % </li></ul>
  44. 44. Confused with promotions of commercial interests.
  45. 45. Best hand wash solution is <ul><li>Which suits the circumstances, </li></ul><ul><li>Availability of resources/economical </li></ul><ul><li>Safe to your skin. </li></ul><ul><li>Sense of responsibility more important </li></ul>
  46. 46. Are Flowers Safe in the Hospital ?
  47. 47. Why flowers are Harmful <ul><li>They carry a prominent bacteria which can cause Hospital acquired infections. </li></ul><ul><li>Many Hospitals in UK advise not to bring flowers to patients in Burns/Orthopedic wards and critical care areas. </li></ul>
  48. 48. Sterilization and Disinfection policies. <ul><li>Create you own Infection control team which suits your Hospital, </li></ul><ul><li>Infection control team decides the policies. </li></ul><ul><li>Educate the staff on Methods and policies in Hospital safety and Hygiene </li></ul><ul><li>Educate the staff on few useful option, many theoretical ideas confuse. </li></ul><ul><li>To many Chemicals – Costly, least successful </li></ul>
  49. 49. Importance of Staff Education <ul><li>Speicify the staff for duties and responsibilities. </li></ul><ul><li>Education is a matter of continuity </li></ul><ul><li>Train under the seniors observation. </li></ul><ul><li>Train the staff with scientific goals </li></ul>
  50. 50. Operation Theatre Saftey is Responsibility Of ?
  51. 51. Cheerful / Dedicated staff Make a Great success.
  52. 52. Our Future Vision - Create Clean,techinically advanced Operation theatres which can change the safety of our cherished patient. <ul><li>Thank You All </li></ul>
  53. 53. Praying the Best from of Divinity
  54. 54. Clean Hands - the safe hands for everything we do in Hospitals.
  55. 55. <ul><li>Created for the Public Domain for the Safety of our Patients / and attitude change in beloved staff who make all the difference </li></ul><ul><li>Dr.T.V.Rao MD </li></ul><ul><li>e mail ; </li></ul>