1. STERILIZATION AND DISINFECTION OF
OPERATION THEATRES
(GENERAL ASPECTS AND PROTOCOLS)
HEAD
PROF. Dr. NAEEM AKHTAR
Prepared by
Dr. USMAN QURESHI
Dr. KIRAN AHMAD
Dr. RABIA ANJUM
Dr. MOBEEN KAUSAR
2. PURPOSE AND INTENT
1. To provide evidence based guidelines for
thorough, consistent and safe cleaning and
disinfection practices in the Operation Theatres.
2. To provide a clean environment and minimize
exposure risks to Operation theatre personnel
and patients.
3. To foster an environment of teamwork and
collaboration.
4. PROBLEMS IN OUR PRACTICES
• Indiscriminate/unnecessary use of disinfectants.
• High traffic flow and increased activity in theatres.
• Poor communication.
• Bad operative techniques.
• Malfunctioning or improper use of equipment.
• Cognitive errors due to stress or inattention
• Resource and organizational problems
5. ZONES OF OPERATION THEATRE
ZONE 1 PROTECTIVE: reception, waiting, trolley bay, Changing
rooms for all staff, Transfer bay for patient, material and record
rooms for administrative staff
ZONE 2 CLEAN AREA : preoperative, recovery, plaster room, staff
lounges, stores, pantry, maintenance workshop, close circuit T.V.
control area, emergency exit
ZONE 3 STERILE AREA: operating room, scrub room, anesthesia room,
setup room.
ZONE 4 DISPOSAL AREA: dirty utility, disposal corridor
6. ITEMS
Critical:
Require high level of disinfection or sterilization
Semi critical:
Require high level of disinfection or sterilization
Non critical:
Require low level of disinfection
7. STANDARD PRECAUTIONS
These precautions are applied to prevent transmission
of diseases that can be acquired by contact with blood,
body fluids, non-intact skin (including rashes), and
mucous membranes.
a. Hand hygiene.
b. Personal protective equipment.
c. Needle stick or sharp injury prevention.
d. Cleaning and disinfection.
e. Respiratory hygiene (cough etiquette).
f. Waste disposal.
g. Safe injection practices.
8. STERILIZATON AND DIINFECTION OF
OPERATION THEATRES
A.Washing & Cleaning
B. Disinfection of surfaces and equipment
C. Disinfection of environment
9. HIGH: Kills all the organisms except Spores, Prions E.g..
Glutaraldehyde
INTERMEDIATE: Kills Mycobacteria, most viruses and
bacteria
LOW: Kills some viruses and bacteria
LEVELS OF DISINFECTION
10. Clean environment for each patient is a shared
responsibility.
• Use Appropriate Personal Protective Equipment (PPE)
• Use approved cleaning products as per
manufactures instructions.
• Ensure availability of Safety Data Sheets
• Use Reusable/single use low-lint cleaning materials
• Change mop heads after each use and do not
reintroduce into the bucket.
• Keep minimum storage of equipment in theatre
GENERAL PRINCIPLES
11. GENERAL PRINCIPLES
• Minimize the theatre traffic and keep OTdoors closed.
• Visually inspect the OTs for cleanliness before the
Commencement of list.
• Simple detergent reduces flora to >80%, addition
of disinfectant results in 95% reduction.
12. PRELIMINARY CLEANING
• Damp dust horizontal surfaces prior to first case.
• Clean and disinfect portable patient-care equipment
which is not stored within the operating room,
• Inspect ORTheatre lights for cleanliness before
the first case of the day.
13. INTRAOPERATIVE CLEANING
• If a team member is aware of contamination occurring
during a procedure it is his/her responsibility to
ensure the contaminated surface/item is cleaned.
• Equipment leaving the OR Theatre is cleaned and
disinfected.
• Chemical spills occurring intra-operatively are to be
managed as per site/regional policy/procedure and
according to the SDS
14. BETWEEN PROCEDURES CLEANING
• Remove all trash, linen, and recycling from the room
including soiled anesthesia equipment and supplies.
• All surfaces that have been in direct or indirect
contact with the patient or body fluids are
considered to be contaminated.
• Ensure OR Theatres are cleaned/disinfected as required
after each patient.
• Wipe touched objects and areas after each procedure.
• Clean and disinfect from least contaminated to most
contaminated and top to bottom.
15. BETWEEN PROCEDURES CLEANING
Remove all used linen and surgical drapes, waste for reprocessing or
disposal.
Clean and disinfect:
• High-touch surfaces outside of the surgical field
• Any visible blood or body fluids outside of the surgical field.
• All surfaces (high- and low-touch) and the floor inside the surgical
field, including:
Tops of surgical lights
Reflective portion of surgical lights
Suction canisters
Tourniquet cuffs and leads, patient monitors.
Anesthesia trolley, anesthesia machines
Operating table from top to bottom and floor area under
the bed
16. TERMINAL CLEANING
• Additional PPEmay be required.
• Occurs at the end of the day or at minimum once
every 24 hours during a regular work week.
• All floors should be cleaned using a wet vacuum or
single-use mop and a Disinfectant.
• Cleaning and disinfecting of all exposed surfaces.
• Fixed and mobile equipment
• Horizontal & Vertical surfaces
• Hand washing sinks and scrubs
• Base boards and area under operating table
17. • Visual inspection
• Short-term evaluation of the impact of infection-control
measures or changes in infection control protocols.
• Swabs collected from various locations in the OT
include
Operation table at the head end
Over head lamp
Four Walls
Floor below the head end of the table
Instrument trolley
AC duct
Microscope handles.
SURVEILLANCE OF OPERATION THEATRES
18. Unit /Area Level of restriction
Post anesthesia care unit Unrestricted or semi-restricted
Endoscopy suite Unrestricted
Pain clinic/procedure room Unrestricted
Locker room/administrative office/waiting room Unrestricted
Sterile processing area Semi-restricted
Equipment and sterile supply storage Semi-restricted
Sterile processing decontamination area Semi-restricted
Operating room /invasive procedure room Restricted
Preoperative/postoperative patient-care area Unrestricted
LEVELS OF TRAFFIC RESTRICTION
