EMERGING TRENDS IN STERILIZATION OF OPERATION THEATERS AND CRITICAL CARE AREAS by Dr.T.V.Rao MD

1. EMERGING TRENDS IN STERILIZATION OF
OPERATION THEATERS AND CRITICAL CARE AREAS
Dr.T.V.Rao MD
It is very important to maintain good indoor air quality (IAQ) in Operation Rooms to ensure health
and safety for the patient and surgical team. A significant consideration in Operation Theatres is the
control of aerosols, anaesthesia gases and smoke. Aerosols are solid and liquid particles which many
humans are exposed in the operation theatres, and many ask us whether we do fumigation of
Operation Theaters, Critical care areas as ICU’s and MICU’s, even the short time the patients and
surgical caring staff spend in the operation theaters they face the environmental hazard for many
reasons. Let us think even the surgical professionals are at greater risk with hazardous matters in the
operation theaters, Age old traditional procedure of fumigation still patronised by many hospitals
and in many places the controversies regarding fumigation is not appreciated, Fumigation is the
process by which we can sterilize the enclosed area by injecting the chemical which will kill or
destroy microbes present in the air. This process may be used in order to rid a home or other
structure of insects such as termites or roaches, but it may also be used when products are being
processed for export or import in order to rid the goods of exotic pests and organisms.
WHY INFECTION CONTROL IN HEALTH CARE - The role of infection control is
primarily to prevent healthcare associated infections, necessitating a close working relationship with
the SS. Infection control co-ordinators and sterilizing service staff must jointly be involved in the
development of facility sterilization and disinfection policies and guidelines. Establishment of
committee structures and other means of formal and informal communication between infection
control and sterilizing services staff will ensure provision of appropriately processed equipment in
health care facilities.
ARE THE OPERATION THEATERS SAFE YES OR NO CERTAINLY NO - A significant consideration in
Operation Theatres is the control of aerosols, anaesthesia gases and smoke. In Operation Theatres,
however the main sources have an indoor origin are the patient, the surgical team and equipment.
The anaesthesia gases dispersed in Operation Theatres are also considered as pollutants. The
anaesthesia gases are dispersed in the environment through problems in the equipment and from
the exhalations of the patient, some gases used in the surgery. During surgery the highest
concentration of gases is on the floor. However, with the movements of people these gases can be
mixed with room air and inhaled by the surgical team.
The concentration of gases in the Operation Room is critical and needs to be controlled; otherwise
the productivity and quality of the work of the surgical team can decrease, and in the medium and
long term health problems may occur.
Fumigation is an age old process of sterilisation, of the environment, may be a sick room or
operation theatres. It is usually done with formalin fumes, which are very pungent and harmful. So
when a room is fumigated, it is tightly closed and sealed before fumigation. The room is opened
after fumigation (12 - 24 hours). The room can be used once all fumes are out. OSHA indicated that
formaldehyde should be handled in the workplace as potential carcinogen and set an employee
exposure standard for formaldehyde that limits an 8-hour time- weighted average exposure
concentration of 0.75ppm,
Fumigation is obsolete in many developed nations in view of toxic nature of Formalin. Too frequent
use and inhalation is hazardous. Several new safe chemicals are emerging but constrains of economy

2. limit the use and several hours of closure of operation theatres can be curtailed as with Fumigation
and increases the productivity of operation theaters
THINK ON BETTER OPERATION THEATERS
OPERATION ROOMS SHOULD BE -
®Big enough for free circulation
®Two openings 1Towards scrub area 2Towards sterile area
®Openings fitted with swing doors.
®Marble or polished stone flooring ®Glaze tiled walls ®No false ceiling
® Well ventilated ® Air circulation by positive pressure through High efficiency particulate air filter
(HEPA) system (0.3ú) ®
As per US Public Health services minimum requirement for OR air are 25 changes per hour, positive
pressure compared with corridors temperature between 18& 24º C humidity of 50 to 55%
® Operation table to be kept away from the entrance and head end should be close to the sterile
area
LOOKING AT BETTER ALTERNATIVES –As Aldehydes (Formaldehyde) are potentially
carcinogenic and it is therefore recommended that other agents such as hydrogen peroxide,
hydrogen peroxide with silver nitrate, peracitic acid and other chemical compounds of
Formaldehyde should be used in place of the currently prevalent practise of using Formaldehyde.
These agents are dispersed with the aid of a fogger-like device inside the theatre environment. The
contact time is about an hour and the theatre can be used immediately after this.
ULTRA VIOLET RADIATION - Daily U.V. Irradiation for 12 -16 hrs to be switched off 2
hrs before surgery
ULTRA CLEANING OF AIR In some critical situations the indoor air in Operation Room will be
ultra-cleaned, for example, for orthopaedic surgery, traumas, implants, burn patients, and other
situations where the patient is immune compromised. Otherwise, when the surgery is septic, there
should be also a higher control in the indoor environment, to protect the adjacent areas.
USE OF OZONE - Controlled Ozone is injected in the mainstream air in the return air duct. It
is present in the indoor space at the times at low concentration. When it encounters chemical
pollutants, it almost instantly oxidize them and keeps the indoor air free of chemical pollutants VOC
as interferes with metabolism of cell multiplication of fungi resulting in the reduction of fungi along
which is responsible for vide range of indoor related allergies
Ultra Clean Ventilation NEEDED AS Bacteria cause infection within operating theatres.
Main objective of the UCV is to combine the effect of both air dilution and room air displacement.
UCV provides a vertical air flow at uniform velocity in a single direction along parallel flow lines. The
air flow prevents less clean air from neighbouring rooms entering OR due to pressure difference. The
air is filtered at an efficiency of 99.99 % ensuring improvement in the bacterial count.
It also follows that sterilizing service should be aware of local and state wide infection control
policies that may affect the service they provide. They have a responsibility for achieving consistent
production and management standards in the reprocessing of reusable instruments and equipment

3. We need a better scientific understanding on Operation Theaters and critical care areas to reduce
chemical use and optimal human improvements for greater safety of our Patients
As yet there are yet no definitive standard operating procedures, peer reviewed articles to make the
matters mandatory and making the Theatre personal practice the matters with their convinces with
lesser understanding on mechanism of Infection Control in operation theaters
Ref 1 Solution on How to clean Operation Room Chemotronics
2 Sterilisation of Operating Theatres Published: 16th Dec 2013 in Arab Medical Hygiene
Magazine Dr.T.V.Rao MD
3 DISINFECTION & STERILIZATION INFECTION CONTROL GUIDELINES CHRISP Govt Au / Chrisp
Dr.T.V.Rao MD Professor of Microbiology Freelance writer
For comments and suggestions contact
Email doctortvrao@gmail.com
Mob - 7204113154 or 8281669524 (India)