This document discusses trends in operation theater surveillance and safety. It emphasizes the importance of proper maintenance of facilities like air conditioning and ventilation systems, as well as strict adherence to disinfection and sterilization protocols. Close monitoring of airborne pathogens through regular microbiological surveillance is recommended, using techniques suited to environmental sampling. Adherence to infection control guidelines by all staff, along with training programs, can greatly reduce surgical site infection rates. Routine testing for anaerobic spores may no longer be necessary with improved sterilization practices.

1. TRENDS IN OPERATION THEATER SURVEILLANCE AND SAFETY
Dr.T.V.Rao MD
In spite of brief stay of 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 because of a
multifactor causation of infection. It is usually necessary to study the epidemiology of infection as a
multidisciplinary approach. In resource poor circumstances as in most developing countries, work in
isolation and few facilities to make any epidemiological surveys Many believe that routine
Microbiological monitoring is most essential but in reality it is not practicable. But every hospital
should 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.
Operation theatres should be built with implementation of good civil Engineering standards.
OPERATION THEATRE - DISCIPLINE
1. Only people absolutely needed for an assigned work should be present.
2. People present in theatre should make minimal movements and curtail unnecessary movements
in and out of theatres, which will greatly reduce bacterial count.
3. Air borne contamination is usually affected by type of surgery, quality of air which in fact depends
on rate of air exchange.
All the persons including the least cadre of employers are partners in infection control and should
be aware to comply with infection control regulations
4 Prompt disposal of Theatre waste out of the theatre is of top priority. Any spillage of Body fluids
including Blood on the floors is highly hazardous and prompts the rapid multiplication of Nosocomial
pathogens in particular Pseudomonas spp
SURVEILLANCE OF OPERATION THEATRE
Role of Microbiological Surveillance
The environments in the operation theatre are dynamic and subject to continuous change. Good
infrastructures do not mean a safe environment as human make a greater difference in making the
environment unsafe.
Microbiologists should be aware of organisms, sites and populations as surveillance cultures should
be chosen carefully to allow meaningful interpretation of results.
Microbiologists should be familiar with the clinical techniques as those normally used for culturing
clinical specimens may not yield correct result when applied to environmental specimens.
Sites and cultured reports should not be chosen as etiological sources in the present infections.
Culturing unnecessary surface areas causes confusion and meaningful interpretation is lost.
AIR IS THE IMPORTANT SOURCE OF INFECTION
Bacterial counts in operation theatres are influenced by the number of individuals present,
ventilation and air flow, the results should be interpreted taking the above facts into consideration.
Surveillance for Air borne Pathogens:

2. In resource poor Hospitals settle plates with blood agar are used and can detect pathogens,
commensals and saprophytic bacteria. Multiple plates are kept and results are based on overall
assessment rather than on a single plate study in the room. Microbiologists will clarify the
acceptable counts at the different physical locations in multispecialty hospitals.
There is a sea change in analysis of bacterial counts in recent past with advances in medical
technologies like Joint replacement surgeries dealing with critical patients. Slit sampler and Air
centrifuge equipment for bacterial counts are replacing settle plates, the safe level of colony counts
can be calculated as per the standards created with peer reviewed studies by the manufacturers.
How frequently we can do the Surveillance for Air borne Microbes.
Yet there is no definite answer to this question
Doing too frequent surveys are expensive and will not correlate the existing infection rate in the
Hospital.
But can indicate the circumstance we operate which can have bearing effect if the safety standards
fall
Surveillance for Clostridia spores
The age old tradition of detection of anaerobic spores of C.tetani, and Gas gangrene producing
organisms are losing ground with onset of more awareness on theatre sterilization. Routine testing
for the Anaerobes is not essential except when there were suspected cases of Tetanus or Gas
gangrene attributed to operating in a particular Operation theatre.
But it is ideal to survey the Operation theatres for anaerobes when newly constructed or any
remodelling or structural alterations are done. In such situations which will have trust worthy safety
of the theatre.
THE FOLLOWING PRECAUTIONS HAVE GREATLY REDUCED THE RATES OF INFECTION
1. Every Hospital must constitute Infection control committee to monitor the events in the Hospital,
on all matters related to control of Infections.
2. The entry of unnecessary personnel to be restricted into operation theatres as everyone
contributes to Infection.
3. A thorough washing with warm water and good detergent and carbonisation can bring overall
improvement than mere fumigation.
4. Frequent monitoring and training of medical and paramedical staff must carry high priority than
mere mechanical and chemical methods.
5. Thorough washing and carbonisation if done every day after the surgeries will greatly enhance
the safety standards and economize the repeated expenditure on fumigation.
TRAINING OF PARAMEDICAL STAFF/ RESIDENTS
1. The short solution to control infection lies with trained staff.
2. The principal and control of infection to all new comers and junior staff should be a goal of any
good Institution.

3. 3. Formulate guidelines update as per the changing situation in control the infection.
4. Institute should formulate ideas on infection control to the need of circumstances, as there are
no fixed guidelines or formulae to control to suit all occasional.
5. Simple repeated hygienic hand wash is most cost effective method to reduce several infections in
Hospitals, in particular operation theatres
Note
The knowledge on Maintenance, Sterilization and control of Infections in Operation theatres a
rapidly evolving Science
Wish to know more about Operation theatre Maintenance for control of Infection Read through
Principles, And Practice of Disinfection, Preservation and Sterilization by A.D.Russel, W.B.Hugo &
G.A.J Ayliffe.
All Institutes wish to develop to improve hygiene and sterilization standards, and start critical
surgeries doing Cardiothoracic, Organ replacement and prosthetic surgeries should subscribe to the
internationally accredited Journal "The Operating Theatre journal" published from U K.
Dr.T.V.Rao MD works as Freelancing Clinical Microbiologist at Kolar and Bangalore India and
contributes articles of Medical interest for open source knowledge for Medical Professional
Dr Chitra Valsan works as Professor of Microbiology at Jubilee Mission Medical College, Thrissur
India