This document discusses formaldehyde fumigation of operating theatres and its potential health risks. It provides details on the procedures for formaldehyde fumigation, including calculating amounts needed based on room size. While formaldehyde is inexpensive and effective, it is also classified as a carcinogen and exposure can cause respiratory, skin and eye irritation. The document explores newer disinfectants like Bacillocid and Virkon that do not use formaldehyde. It emphasizes that infection control requires a multidisciplinary approach considering equipment maintenance, ventilation and sterilization practices, especially in resource-limited areas. Economic limitations in developing countries can compromise the adoption of safer chemical approaches.

1. FUMIGATION OF
OPERATION THEATRES
CAN WE STOP IT ???
Dr.T.V.Rao MD
DR.T.V.RAO MD 1

2. FUMIGATION
A BIOHAZARD PROCEDURE ?
DR.T.V.RAO MD 2

3. WHAT IS FORMALDEHYDE?
• Formaldehyde has the chemical elements carbon, hydrogen and
oxygen in its structure. Hydrocarbons are among the most
common of chemical compositions. The human body includes
hydrocarbons among its elements and compounds, and it
requires formaldehyde to metabolize biochemical substances.
• Formaldehyde is usually sold as an aqueous or watery solution
called formalin, which contains 37 to 50 percent formaldehyde
by weight. It is soluble in water, but not in most organic solvents,
except alcohol and ether. It is principally used to produce resins,
other industrial chemicals, and consumer items and as a
bactericide or fungicide.
DR.T.V.RAO MD 3

4. HOW CAN FORMALDEHYDE AFFECT OUR
HEALTH?
• Based on the best available evidence in OSHA’s record on formaldehyde,
OSHA determined that formaldehyde isgenotoxic, showing properties of both
a cancer initiator and promoter (early and late stage carcinogen). When
inhaled, formaldehyde is a carcinogen in rats. In humans, formaldehyde
exposure has been associated with cancers of the lung,nasopharynx and
oropharynx, and nasal passages
• When humans are exposed to excess levels of formaldehyde, adverse health
effects can result. Symptoms of excess exposure include respiratory
irritation; watery, itchy eyes; itchy, runny, or stuffy nose; dry or sore throat;
and headache.
• The EPA and OSHA recognize that contact with formaldehyde can cause
skin irritation and dermatitis.
DR.T.V.RAO MD 4

5. FUMIGATION
• Formaldehyde a Age old compound.
• Low temp heating produce vapor
• Vapor phase decontaminates the air/environment.
• Kills vegetative bacteria / Spore ?
• When Formaldehyde mixed with water and exposed to
elevated temperature
• Gaseous formaldehyde is generated
Time X Temp
DR.T.V.RAO MD 5

6. FUMIGATION
• To sterilize the operation theatre formaldehyde
gas (bactericidal & sporicidal,viricidal) is widely
employed as it is cheaper for sterilization of
huge areas like operation theatres.
Formaldehyde kills the microbes by alkylating the
amino acids and sulfhydryl group of proteins and
purine bases.
• In spite of the gas being hazardous continues
to be used in several developing countries
DR.T.V.RAO MD 6

7. FUMIGATION
• Fumigation usually involves the following phases:
First the area to be fumigated is usually covered to
create a sealed environment; next the fumigant is
released into the space to be fumigated; then, the
space is held for a set period while the fumigant
gas percolates through the space and acts on and
kills any infestation in the product, next the space
is ventilated so that the poisonous gases are
allowed to escape from the space, and render it
safe for humans to enter.
DR.T.V.RAO MD 7

8. PROCEDURE OF FUMIGATION
• Thoroughly clean windows, doors, floor, walls and
all washable equipment's with soap and water.
• Close windows and ventilators tightly. If any
openings found seal it with cellophane tape or
other material.
• Switch off all lights, A/C and other electrical &
electronic items
• Calculate the room size in cubic feet (L×B×H)
and calculate the required amount of
formaldehyde as given in
DR.T.V.RAO MD 8

9. PERSONAL CARE DURING FUMIGATION
• Adequate care must be
taken by wearing cap,
mask, foot cover,
spectacles
• Formaldehyde is irritant to
eye & nose; and it has
been recognized as a
potential carcinogen.
• So the fumigating
employee must be provided
with the personal protective
equipment's.
DR.T.V.RAO MD 9

10. CREATING THE FORMALDEHYDE GAS
• Electric Boiler Fumigation
Method: For Each 1000 cu.ft
of the volume of the operation
theatre 500ml of
formaldehyde (40% solution)
added in 1000ml of water in
an electric boiler. Switch on
the boiler, leave the room and
seal the door. After 45 minutes
(variable depending to volume
present in the boils apparatus)
switch off the boiler without
entering in to the room .
DR.T.V.RAO MD 10

11. METHODS ON FUMIGATION
• In principle we have to
generate Formaldehyde gas.
• Can be done by Most easier
way to mix the needed
quantity of Formalin to water
and heating at lower
temperatures at 80 0c – 900c
Can done also with addition of
Formalin to potassium
permanganate
DR.T.V.RAO MD 11

12. ADDING POTASSIUM PERMANGANATE TO
FORMALDEHYDE..
• Potassium Permanganate Method: For every
1000 cubic feet add 450gm of Potassium
permanganate (KMnO4) to 500 ml of
formaldehyde (40% solution). Take about 5 to 8
bowels (heat resistant; place it in various
locations) with equally divided parts of
formaldehyde and add equally divided KMnO4 to
each bowel. This will cause auto boiling and
generate fume.
• After the initiation of formaldehyde vapour,
immediately leave the room and seal it for at
least 48 hours.
DR.T.V.RAO MD 12

13. FUMIGATION TO BE NEUTRALIZED
• Neutralize Residual
formalin gas with
Ammonia by exposing
250 ml of Ammonia per
liter of Formaldehyde
used.
• Place the ammonia
solution in the centre of
the room and leave it for 3
hours to neutralize the
formalin vapour
DR.T.V.RAO MD 13

14. AN EXAMPLE IS SET AS..
• Operation Theatre Volume = L×B×H = 20 × 15 × 10 =
3000 cubic feet
• Formaldehyde required for fumigation = 500 ml for
1000 cubic feet
• = So 1500 ml of formaldehyde required
• Ammonia required for neutralization = 150ml of 10%
ammonia for 500 ml of formaldehyde
• = So 450 ml of 10% ammonia required
DR.T.V.RAO MD 14

15. WHAT ARE THE SYMPTOMS OF
FORMALDEHYDE ALLERGY?
• Inhaling formaldehyde can
lead to symptoms such as
a burning sensation and
irritation in eyes, nose and
throat, coughing, wheezing,
tightness in throat, watery
eyes and runny nose. It can
also lead to breathlessness .
Pulmonary edema and
pneumonitis can be caused
if it injures the respiratory
tract.
DR.T.V.RAO MD 15

16. FORMALDEHYDE ALLERGY
• Formaldehyde allergy
symptoms include redness,
burning sensation, skin
rash, scaling, cracking,
white discoloration and
irritation of skin and might
cause hives as well. Eye
contact can cause pain,
inflammation, blurred vision
and excess tearing.
DR.T.V.RAO MD 16

17. WHAT IS THE FORMALDEHYDE ALLERGY TREATMENT?
First thing to do in case of any allergy is to
avoid contact with the substance causing
allergic reaction. With formaldehyde
present in so many things, it might be
difficult to do so. If your skin or eyes come
in direct contact with formaldehyde, you
must soon flush that part with a lot of cold
water. If you observe the formaldehyde
allergy symptoms after consuming food,
then you must drink a lot of water or milk
so as to dilute it and consult a physician
soon. In case of a skin reaction, topical
ointments used for eczema and contact
dermatitis might be prescribed by your
doctor for allergy relief
DR.T.V.RAO MD 17

18. FORMALDEHYDE AS CARCINOGEN
• Formaldehyde is listed by the
International Agency for Research on
Cancer as probably carcinogenic to
humans, on the basis of animal
evidence and at least limited human
data (IARC group 2A); listed by the
National Toxicology Program as
reasonably anticipated to be
carcinogenic; listed by ACGIH as an
A2 Industrial Substance Suspect of
Carcinogenic Potential for Man; and
OSHA, in its formaldehyde standard
(29 CFR 1910.1048), considers
formaldehyde potential carcinogen.
Formaldehyde (gas) is a chemical
known to the state of California to
cause cancer.
DR.T.V.RAO MD 18

19. NEED FOR NEWER CHEMICAL AGENTS IN
HOSPITAL USE
• 1. A need for Non
Aldehyde based
Chemicals is growing
concern
• 2 Need for quicker
sterilization methods with
ever increasing work
loads.
• 3. Need for non toxic safe
agents.
DR.T.V.RAO MD 19

20. THE WORLD IN SEARCH OF NEW SAFE
CHEMICAL AGENTS
DR.T.V.RAO MD 20

21. BACILLOCID® RASANT
• Formaldehyde-free
disinfectant cleaner
with low use
concentration very
good cost/benefit ratio
good material
compatibility excellent
cleaning properties
virtually no residue
DR.T.V.RAO MD 21

22. COMMERCIALLY AVAILABLE
DISINFECTANT
• Bacillocid special® Is a surface
and environmental disinfectant®
Has a very good cleansing
property along with bactericidal,
virucidal , sporicidal and
fungicidal activity
• ®Composition
• ® Each 100 g contains: • 1.6
Dihydroxy 11.2G ® ( Chemically
bound formaldehyde) •
Glutaraldehyde 5.0• Benzalkonium
chloride 5.0 • Alkyl urea
derivatives 3.0g
DR.T.V.RAO MD 22

23. BACILLOCID® RASANT
• Active ingredients: Glutaral 100 mg/g, benzyl-C12-
18-alkyldimethylammonium chlorides 60 mg/g,
didecyl-dimethylammonium chloride 60 mg/g.
• Bacillocid® rasant is suitable for the disinfectant
cleaning of washable surfaces using the wet-wipe-
procedure.
• Especially suitable for economic short-term
disinfection in risk areas that are likely sources of
infection
DR.T.V.RAO MD 23

24. BACILLOCID
® ADVANTAGES
• Provides complete asepsis
within 30 to 60 mts.
• ® Cleaning with detergent
or carbolic acid
• not required
• ® Formalin fumigation not
required
• ® Shutdown of O.T. for 24
hrs not required
DR.T.V.RAO MD 24

25. NEWER AND NON TOXIC COMPOUNDS.
• A Chemical compound
VIRKON gaining
importance as non
Aldehyde compound.
• Virkon proved to be safe
Virucidal
Bactericidal,
Fungicidal
Mycobactericidal
DR.T.V.RAO MD 25

26. VIRKON A MULTIPURPOSE DISINFECTANT
• Virkon is a multi-purpose disinfectant. It contains oxone
(potassium peroxymonosulphate), sodium
dodecylbenzenesulfonate, sulphamic acid; and inorganic
buffers. It is typically used for cleaning up hazardous spills,
disinfecting surfaces and soaking equipment. The solution is
used in many areas, including hospitals, laboratories, nursing
homes, funeral homes, medical, dental and veterinary facilities,
and anywhere else where control of pathogens is required.
• Virkon has a wide spectrum of activity against viruses, some
fungi, and bacteria. However, it is less effective against spores
and fungi than some alternative disinfectants.
DR.T.V.RAO MD 26

27. VIKRON IS FINDING PLACE IN
• As a Chemical disinfectant.
• Disinfects Medical devices.
• Disinfects Laboratory
equipment.
• Decontaminate spillages
with Blood and body fluids.
• Finding usefulness in
replacing autoclaving and
saving time.
DR.T.V.RAO MD 27

28. VIRKON® S HAS A UNIQUE
FORMULATION
• Virkon® S has a unique
formulation; no other disinfectant
has the same powerful
composition. In terms of efficacy
Virkon® S has been proven highly
effective against 65 strains of virus
in over 19 viral families, 400 strains
of bacteria and over 100 strains of
fungi. This list of proven efficacy
includes the major OIE List A
diseases of concern; Avian
Influenza (H5N1), Newcastle
Disease, Classical Swine Fever
(Hog Cholera) and Foot and
Mouth Disease.
DR.T.V.RAO MD 28

29. ULTRAVIOLET GERMICIDAL IRRADIATION
(UVGI)
• Do not use
UVGI in the
operating
theatre to
prevent Surgical
site infections.
DR.T.V.RAO MD 29

30. INFECTION CONTROL IS MULTIDISCIPLINARY
APPROACH
• Despite the limited time spent by patients in the operation
theatre (in majority of circumstances), the environment of
operation theatre plays a great role in the onset and spread of
infection due to multifactor causation of infection.
• Hence, it becomes essential to study the epidemiology of
infection as a multidisciplinary approach. In resource poor
circumstances as in most developing countries, it is believed
that though routine Microbiological monitoring is most essential,
in reality it is not practicable. But it is the responsibility of every
hospital to pay good attention in proper maintenance of air
conditioning plants, ventilator systems, and to have greater
control on mechanisms and personnel involved in disinfection
and sterilization of materials used in the theatres in operative
procedures.
DR.T.V.RAO MD 30

31. ECONOMIC CONSIDERATIONS COMPROMISES SAFE
CHEMICAL APPROACHES
• Several Chemicals
are available but
the Economic
Limitation are great
hurdle in exploring
the Utility in
Developing
countries
DR.T.V.RAO MD 31

32. WHO/WHAT IS IMPORTANT IN PREVENTION
OF INFECTIONS

33. REMEMBER WE ARE MORE IMPORTANT
THAN MANY CHEMICALS

34. FOR ARTICLES OF INTEREST ON
ANTIBIOTICS FOLLOW ME ON
DR.T.V.RAO MD 34

35. • Created by Dr.T.V.Rao MD for ‘e’ learning
resources for Microbiologists and Health
care Workers in Developing World
• Email
• doctortvrao@gmail.com
DR.T.V.RAO MD 35