The Program file is created from various peer reviewed, and world standard protocols in implantation of Safe Operation theater standards for wider use in the world, In India still we do not have any set standards and practices, As good beginning is half done, I wish all my professional friends go through the article, your opinions and comments are highly appreciated for future developments, Dr.T.V.Rao MD

1. SURGICAL OPERATION THEATER
STANDARDS
creating better hospitals
Dr.T.V.Rao MD
09-07-2016 Dr.T.V.Rao MD @Infection control 1

2. Need to Rethink on Safety and
Standards in our Operation
theaters
• The Program file is created from various peer reviewed,
and world standard protocols in implantation of Safe
Operation theater standards for wider use in the world, In
India still we do not have any set standards and practices,
As good beginning is half done, I wish all my professional
friends go through the article, your opinions and comments
are highly appreciated for future developments,
• Can be reached at
• Email doctortvrao@gmail.com
• Mob +919961785124 India
09-07-2016 Dr.T.V.Rao MD @Infection control 2

3. Hospitals Continues to be a
Great Risk to many who avail the
Services
09-07-2016 Dr.T.V.Rao MD @Infection control 3

4. Why Standards
Infection Control a Priority in
Operation Theaters
• According to Nosocomial
infection national
Surveillance services
(NINSS) in a hospital,
infections acquired
hospitals are likely to
complicate illness,
causing anxiety,
discomfort and can lead
to death09-07-2016 Dr.T.V.Rao MD @Infection control 4

5. Public Confidence in Hospitals
•Patients and the wider
public should have
complete confidence
in the cleanliness and
hygiene of their
healthcare
environment
•So we Need Standards
09-07-2016 Dr.T.V.Rao MD @Infection control 5

6. What is everybody's Role in Safe Operation
theaters
• All healthcare professionals
have a duty to set a
standard by which to
practice. With a focus on
clinical effectiveness and
evidence based care theatre
staff must be able to
demonstrate the ability to
audit care and theatre
practice.
09-07-2016 Dr.T.V.Rao MD @Infection control 6

7. Plan a Operation Theater with following
objectives
• To control the concentration of Pathogens
• To prevent infiltration of non purified air into the operating theatre
• Air flow pattern that carries contaminated air away from the
operating table
• Comfortable environment for the patient and operating team
• Convenient & uninterrupted personal movements inside the OT
• Safe Zone creation in OT [ for the safe location of sterile instruments
& Disposables
09-07-2016 Dr.T.V.Rao MD @Infection control 7

8. Document the Operation Theater
Functioning
• The theatre register will record:
• • Procedures which were undertaken (both surgical and the type of
anaesthetic)
• • The names of surgeon and anaesthetist and a list of support staff
• • The name of the scrub and circulating practitioner
• • The time each patient entered and left theatre
• • The patient’s name, date of birth, sex, NHS number, scrub and circulating
practitioner, implanted materials and any untoward incidents
• • Details of any implants
• • Details of untoward events
09-07-2016 Dr.T.V.Rao MD @Infection control 8

9. However we have to Implement
Standard protocols as associated
with best practices
•The care that is
delivered and
improvements in
practice must be
based on evidence
and best practice
guidance.
09-07-2016 Dr.T.V.Rao MD @Infection control 9

10. The safe surgery saves lives approach
• The Safe Surgery Saves Lives
programme aims to improve
surgical safety and reduce the
number of surgical deaths and
complications in four ways
• Objective 1
• 1 by giving clinicians, hospital
administrators and public health
officials information on the role
and patterns of surgical safety in
public health
09-07-2016 Dr.T.V.Rao MD @Infection control 10

11. Objective 2
•by defining a minimum
set of uniform
measures or ‘surgical
vital statistics’, for
national and
international
surveillance of surgical
care;
09-07-2016 Dr.T.V.Rao MD @Infection control 11

12. Objective 3
•by identifying a simple
set of surgical safety
standards that can be
used in all countries
and settings and are
compiled in a ‘surgical
safety check-list’ for
use in operating rooms
09-07-2016 Dr.T.V.Rao MD @Infection control 12

13. Objective 4
•by testing the
checklist and
surveillance tools at
pilot sites in all WHO
regions and then
disseminating the
checklist to hospitals
worldwide09-07-2016 Dr.T.V.Rao MD @Infection control 13

14. Surgical Site Infections –
Increases Morbidity and
Mortality•Infections of the
surgical wound are one
of the most common
HAI and are important
cause of morbidity and
mortality for patients
undergoing surgery
09-07-2016 Dr.T.V.Rao MD @Infection control 14

15. Factors influencing the Increased
Rate of Infection
• There are several factors that
could affect such infection,
namely, patient factors (i.e.
susceptibility to infection).
Surgical field factors (i.e: the
thermal plume from the site),
room factors (i.e: cleanness of
the OR), and HVAC factors ( i.e:
High air change rate(ACH) and
direction of air flow).
09-07-2016 Dr.T.V.Rao MD @Infection control 15

16. Consequences of Infections in
Surgical Patients
•The delay in recovery and increased hospital
stay also has economic consequences. It is
estimated that each patient with a surgical
site infection requires an additional stay for
6.5 days and hospital cost are doubled. It is a
pre-requisite that Operating Theaters achieve
Ultra- Clean status, especially for deep wound
surgery.09-07-2016 Dr.T.V.Rao MD @Infection control 16

17. We Lack basic guidelines to
Structure the Operation Theaters
• In developing countries like
India, where there is no
uniform guidelines, many
OTs are built and maintained
according to the individual’s
knowledge level, availability of
funds, technical staff, and
equipment's
• However we need to start
with scientific beginning
09-07-2016 Dr.T.V.Rao MD @Infection control 17

18. INTERNATIONAL
FEDRATION OF
INFECTION CONTROL
(IFIC)
“ States it is now accepted that ULTRA-
09-07-2016 Dr.T.V.Rao MD @Infection control 18

19. Surveillance of the Operation theater
needs better understanding as it is not
absolute to true Saftey
• Good hospital hygiene is an
integral part of infection
control programme.
“Microbiological
surveillance” provides data
about the factors
contributing to infection. In
developed countries, though
standard protocols and
guidelines are available
09-07-2016 Dr.T.V.Rao MD @Infection control 19

20. Do not do the Settle plates with Blind
ideas,
Evaluate how good they suit to your
situations
•Settle plates to
estimate the CFU
can help in few
matters, but may
not serve the
absolute purpose
09-07-2016 Dr.T.V.Rao MD @Infection control 20

21. Doing settle plates Mandatory ?
The Results are Inconclusive ?
•Though settle plate method may be regarded as
a crude measure of airborne contamination, in
places without other facilities it can still
provide a simple and cost effective way of
enumerating the contamination rate of
horizontal surfaces at multiple points.
Although there is no need to routinely
perform surveillance cultures in operation
theatre09-07-2016 Dr.T.V.Rao MD @Infection control 21

22. Settle plates help us to know the
Environment we work and risk to patients
•However there are
evidences which
suggest that there is a
need to monitor the
air quality which may
help in reduction of
post-operative
complications due to
infection.09-07-2016 Dr.T.V.Rao MD @Infection control 22

23. *ASIAN HEALTHCARE WORKER
HANDOUT BY PACIFIC SOCEITY OF
INFECTION CONTROL
Type of
operating
Theatre.
Condition Criteria
cfu/m³
Conventional Empty
During operation
<35
< 180
ULTRA-CLEAN Empty
During
Operation
<1
<20(periphery)
<1009-07-2016 Dr.T.V.Rao MD @Infection control 23

24. *STANDARD DESIGNIING OF
OPERATING THEATERS.
Factor HTM 2025 ASHRAE
Pressur
e
Positive pressure with
respect Pressure
differential should be
around 9 up to 30 Pa.
Positive pressure by
to corridor and
adjacent area
supplying 15% excess
air
Air Filter Primary and
secondary filter
Primary filter – 25%
Secondary filter -90%
HEPA filter – 99.97%09-07-2016 Dr.T.V.Rao MD @Infection control 24

25. *STANDARD DESIGNIING FOR
OPERATING THEATER.
Factor HTM 2025 ASHRAE
Humidity 55% ± 5% 45% - 55%
Temperature Range for
working
Range for
working
09-07-2016 Dr.T.V.Rao MD @Infection control 25

26. *Standard Design Rules for
Operating Theatre
Factor HTM 2025 ASHRAE
Air Exchanges
Rates
Required 20 ACH
for the system
15 ACH for outdoor air
system
- 25 ACH for recirculation
air systems
Air Velocity Working zone area should be
between 0.1m/s to 0.3 m/s
Operating Area Minimum sterile The experimental procedure is
defined by
DIN 4799 (1990), OR floor area
09-07-2016 Dr.T.V.Rao MD @Infection control 26

27. *Standard Design Rules for Operating
Theatre
Factor HTM 2025 ASHRAE
Noise Level Maintain at 50
-55 dBA
Lighting At 500 lux for
working space
Operating Room Maintain positive pressure
with respect to corridor and Positive pressure09-07-2016 Dr.T.V.Rao MD @Infection control 27

28. *Standard Design Rules for
Operating Theatre
Factor HTM 2025 ASHRAE
Air Filter
Primary and Secondary
filter- 80-90 %
HEPA filter-95% or more
efficiency based on EU
Primary filter –
25%
Secondary
filter – 90%
Temperature
Temperature range for working
condition
condition is 19°C to 23°C is
Temperature
range for working09-07-2016 Dr.T.V.Rao MD @Infection control 28

29. References
• 1.CLINICAL GUIDELINE FOR THEATRE PRACTICE STANDARDS –
GENERIC
Royal Cornwall Hospital NHS
2WHO Guidelines for Safe Surgery 2009 Safe Surgery Saves Lives
09-07-2016 Dr.T.V.Rao MD @Infection control 29

30. *Source of Information on
following resources
•Source:
(I) HTM 2025
•(II) Memarzadeh, F and Manning A.P
•Comparison of Operating Room Ventilation
Systems in the Protection of the Surgical
Site ASHRAE Transactions 2002 V. 108, Pt.2.
09-07-2016 Dr.T.V.Rao MD @Infection control 30

31. •Program Created by Dr.T.V.Rao MD, Clinical
Microbiologist for benefit of many who deal the
matters with Surgical Operation Theaters and
patients, Please do share with many Professionals
and Patients on learning the basis of safety in
Operation Theaters
Email
doctortvrao@gmail.com
09-07-2016 Dr.T.V.Rao MD @Infection control 31