Operation Theatre -
Presenter – Dr. Sukumar.T.K.
Freeing of an article from all living organisms
including viable spores.
Process that kills more than 106 organisms , including
spores of a defined exceptionally high degree of
1867 – Dr. Lister Joseph, identifies airborne bacteria.
Uses carbolic acid spray in surgical areas.
1880 – Johnson and Johnson introduce antiseptic
Use of Carbolic acid reduced Hospital associated
Safe Operation Theatre Practices –
2nd most common cause of hospital acquired
Mortality as high as – 77% .
Maintaining sterile environment – control of major
part of exogenous infections
Surgical Site Infection
Operating Room Environment
Dust, lint, skin squames, respiratory droplets.
Microbial level ∝ Number of people moving in room.
Operating room should be maintained at Positive
Sources of Infectious Agents in OT
Vertical Parallel Flow
Horizontal Parallel Flow
All ventilation systems in hospital should have two filter
beds in series (first = ≥30% ; second = ≥90%) – Ultra clean
Laminar airflow and use of UV is suggested to reduce
SSI (velocity – 0.3-0.5µm/sec). Minimum of 12 cycles/hr
Recirculated air passed through HEPA Filter.
Routine cleaning has to be performed.
Cleaned after contact with blood or potentially
Wet vacuuming to be performed after last operation of
day or night.
Frequent cleaning of walls and roof - not needed.
These areas should not be disturbed unnecessarily.
Floors get contaminated quickly – Depends on
number of people present.
Ceiling fans should not be used.
Clean roof – when remodelling or accumulated good
amount of dust.
Roof, Floors and Walls
1% of microbes present on floor are pathogenic.
Simple detergent -
reduces flora by 80%
Addition of disinfectant –
70% alcohol – Disinfectant.
Formaldehyde vapour – Produced on low temp
Vapour phase decontaminates the air / environment.
Mechanism – alkylates amino acids and sulfydral
group of proteins and purine bases.
Used widely to sterilize huge areas like operation
theatres INSPITE OF BEING HAZARDOUS as it is
Thoroughly clean windows, doors, floors and all
washable equipment with soap and water.
Close windows and ventilators tightly.
Switch off all lights, A/C and other electronic items.
Calculate room size and required amount of
Fumigation - Procedure
Electric Boiler Fumigation
For 1000 cu.ft of ot – 500ml of formalin added in 1000ml
water In electric boiler.
Boiler switched on and kept on for 45 min.
Switched off without entering room.
Potassium permanganate method
For 1000 cu.ft add 450gm KMno4 to 500mlof formalin.
Seal room and leave it for 48hrs.
Residual formaldehyde gas neutralised by using
Ecofriendly, non toxic non irritating environmental
Has bactericidal, virucidal, tuberculocidal, fungicidal
and sporicidal action.
Complex formulation of stabilised 11% w/v hydrogen
peroxide with 0.01% silver nitrate solution
Eco shield™ (Bio shield)
Disinfects medical devices.
Disinfects laboratory equipment.
Decontaminate spillages with blood and body fluids.
Replace autoclaving and saving time.
Newer non toxic compounds
Monitoring of hospital associated infections
Training of health care workers
Investigations of outbreaks
Any technical lapses
Monitoring of staff health
Infection Control Programmes
Education of universal precautions
Advice on isolation of infectious patients
Safe use of antibiotics
Role of Microbiology Department
Monitoring of antibiotic therapy
Education on specimen collection
Information on common antibiogram patterns
Data on hospital infection
Surveillance of hospital environment
Counselling of hospital staff.
Settle plate method
Blood agar exposed for specified period and incubated
Slit sampler method
Very effective and highly sensitive.
Fixed volume of air is sucked and counts made
Factors influencing –
i. Number of persons present
ii. Body movements
iii. Disturbances of clothing
Counts vary on number of personnel present on given
Nature of procedures
ONLY 1% ARE PATHOGENIC
Presence of Staphylococcus aureus makes difference
Detection of spores of Cl.tetani in ot – losing
Routine testing for anaerobic spores not essential.
To provide sterilized material from a central
To alleviate the burden of work of the nursing
To facilitate the wards to function smoothly
Central Sterile Services Department
Receipt and delivery of equipment from all areas of
Supply of sterile materials for dressings and
procedures carried out in wards and departments
Supply of operation theatres with the necessary
sterile instruments and linen
To disassemble, clean and check for proper function
of equipment, such as suction machines, feeding
pumps, i.v infusion pumps etc.
To dry, wrap, bag and seal items in preparation for
CSSD can broadly be classified into two parts:
Central Unit: Responsible for receiving dirty utilities,
cleaning, processing, sterilization, storage and supply.
Peripheral Unit: Mainly responsible for DISTRIBUTION
to various areas
TSSU (Theater Sterile Supply Unit)
PLANNING OF A CSSD
TSSU: In large hospitals, where number of OTs
function, these have peripheral sterilization units
known as Theater Sterile & Supply Units. (TSSU)
These work under high pressure and takes less time for
Specially in hospitals, where the Central Unit does not
function round the clock.
Dressing set/ tray
Suture removal set
Cut down tray
ITEMS COMMONLY HANDLED BY
HSG and CT set
Lumbar puncture set
Bone marrow/ liver/ kidney biopsy set
Intra costal drainage (ICD) procedure set
1. Receiving used items
5. Storing (temporary)
6. Distributing to user departments
Major Activities in CSSD
Should have access to outside through a window with
The items (especially for instruments in trays) are
counted and received.
Instruments are inspected and blunt/unsuitable
instruments are segregated/ discarded.
Necessary entries are made for records.
Items shifted to cleaning area.
Washing-Cleaning is the removal of visible soil (e.g.,
organic and inorganic material) from objects and
If used items are not decontaminated in user
department then blood/ body fluid soiled items
should be decontaminated with sodium hypochlorite
before handling further.
Rinsing-Detergents (preferably enzymatic) &brushes
of various sizes and shapes are required in this area.
Instruments washed either manually or in machines.
For manual washing sinks with water supply and
working counters are organized
Tunnel washer - highly sophisticated machine that
allow totally hand-off processing.
Instruments coming from operating room or other
departments are placed into the tunnel washer
without any further handling. The instruments are
subjected to cycles washing, rinsing, ultrasonic
cleaning and drying.
Ultrasonic washer is a machine used for cleaning
It converts high frequency sound waves into
mechanical vibration that produces small bubbles
that burst on the internal surfaces of instruments and
dislodge the waste particles.
After the instruments are washed, they are dried in
oven dryer and shifted to packing area.
CATEGORY ITEMS PROCEDURE
Critical Enter tissue, through
which blood flows
Semi – Critical Touch mucous
membrane, touch non
High level disinfection
Non – Critical Bandage, BP Cuffs Low level disinfection
High Temp – Steam Sterilization
Low Temp – Ethylene Oxide gas, Hydrogen peroxide
≥2.4% Glutaraldehyde for 10hrs
1.12% Glutaraldehyde and 1.93% phenol for 12 hrs
7.35%hydrogen peroxide and 0.23%peracetic acid for
7.5% Hydrogen peroxide for 6hrs
1.0% Hydrogen peroxide and 0.08% peracetic acid for
≥ 0.2% peracetic acid for 50 min at 50-56 degree Celsius
Heat automated – Pasteurization for 50 min
2% glutaraldehyde for 20 – 45min
0,55% ortho – pthalaldehyde for 12 min
1.12% glutaraldehyde and 1.93% phenol for 20 min
7.35% hydrogen peroxide and 0.23% paracetic acid for 15
650 – 675 ppm chloride for 10 min
High level Disinfection
The shelf life of the sterile materials depend on the
quality of packing materials used and the status of
cleanliness of storing area.
Generally the items sterilized by steam autoclave can
be used for one week and ETO packs can be used for
SHELF LIFE OF STERILIZED ITEMS
Receipt register- to keep account of all the trays with
instruments received in CSSD
Issue register to keep account of all the materials
issued to users
Stock ledger of non consumable items- e.g. trays,
Stock ledger of consumables- to keep account of the
cotton and gauze received, and issued by the CSSD
Number of loads per machine per day
Duty rosters of staff
Log book of machine
Soap, Water and Common
Sense – Yet the best antiseptic
Importance of Hand Washing
VENTILATION SYSTEMS IN OPERATING THEATRES, ASPECTS TO
CONSIDER. A JOHNSON MEDICAL BULLET IN (REPUBLISHED
Operating theatre commissioning -Microbiological From HICSIG
Guidelines for prevention of hospital acquired infections. Yatin
Mehta, Abhinav Gupta, etal.
Guideline for Prevention of Surgical Site Infection, 1999. Alicia J,
Teresa C, etal
Recommendations for Infection Control for the
Practice of Anaesthesiology. Developed by the ASA
Committee Occupational Health Task Force on
Procedure-associated Module SSI – CDC
OT Sterilization. T V Rao
Text book of microbiology Mackie and McCartney-14th