M icrobiological surveillance of ots

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M icrobiological surveillance of ots

  1. 1. Dr. SUMI NANDWANI Associate Professor, Microbiology, E.S.I.C.,PGIMSR, Basaidarapur, New Delhi
  2. 2. History of Hygiene Greek Era : Aristotle recommends Boiling water to armies. Advises the Alexander Semmelweis: Practices & emphasizes the importance of washing hands with chlorinated water in Obstetrics to reduce maternal mortality
  3. 3. Historical Aspects Changed the History <ul><li>1867 –Dr.Joseph Lister first identifies airborne bacteria and uses Carbolic acid spray in surgical areas </li></ul><ul><li>1880 – Johnson and Johnson introduce antiseptic surgical dressings. </li></ul><ul><li>Reduction of Hospital associated infections </li></ul><ul><li>Mortality reduced </li></ul><ul><li>Morbidity reduced </li></ul>
  4. 4. Role of Microbiological Surveillance in OTs <ul><li>Surgical site infections -a significant health risk to hospital patients. </li></ul><ul><li>Source of infection may be either endogenous or exogenous. </li></ul><ul><li>The O.T. environment plays a great role in the onset and spread of infection </li></ul><ul><li>Good infrastructures do not mean a safe environment </li></ul>
  5. 5. Factors affecting rate of post operative infection <ul><li>Effective sterilization and disinfections procedures </li></ul><ul><li>Good surgical technique </li></ul><ul><li>Theatre design </li></ul><ul><li>Bacterial contamination of theatre air </li></ul><ul><li>OT discipline - movement of staff </li></ul><ul><li>Appropriate use of prophylactic antibiotics </li></ul><ul><li>Flow of traffic from one zone to another </li></ul>
  6. 6. MONITORING EFFECTIVE STERILIZATION AND DISINFECTION <ul><li>METHODS OF STERILIZATION USED IN CSSD: </li></ul><ul><li>Moist Heat- Autoclave </li></ul><ul><li>Dry Heat – Hot Air Oven, Infra Red Sterilizer </li></ul><ul><li>Chemical- ETO,formaldehyde,Glutaraldehyde, Peracetic acid </li></ul><ul><li>Plasma sterilizer - H2O2 in plasma state used </li></ul>
  7. 7. INDICATORS FOR EFFECTIVE STERILIZATION : <ul><li>Physical - Graphs plotted based on temperature, pressure and humidity </li></ul><ul><li>Chemical - Chemical Indicators: can be found on medical packaging and autoclave tape ( BOWIE – DICK TEST), and these change color once the correct conditions have been met. </li></ul>
  8. 8. Biological indicators <ul><li>Contain spores of a heat-resistant bacterium, Bacillus stearothermophilus for autoclave and Bacillus subtilis for ETO in a strip kept in a 3M attest plastic vial. </li></ul><ul><li>Change of color of a pH -sensitive chemical. </li></ul>
  9. 9. IN USE TEST FOR DISINFECTANTS <ul><li>Growth in more than 5 drops = failure of Disinfection </li></ul><ul><li>A Chemical compound VIRKON gaining importance as non Aldehyde compound </li></ul>
  10. 10. What is wrong with our Practices <ul><li>Disinfectants used indiscrimately, </li></ul><ul><li>Used unnecessarily </li></ul><ul><li>Not used when needed. </li></ul><ul><li>Concentration not adequate </li></ul><ul><li>Economic consideration, </li></ul><ul><li>Business promotions. </li></ul><ul><li>Laboratory testing X Hospital conditions may not correlate. </li></ul>
  11. 11. Air Surveillance of Operation theatre <ul><li>Scope- To determine air bacterial count in OT and to detect pathogenic bacteria like staphylococcus aureus. </li></ul><ul><li>Factors influencing: </li></ul><ul><li>Number of persons present. </li></ul><ul><li>Body movements, </li></ul><ul><li>Disturbances of clothing. </li></ul><ul><li>Methods of Air surveillance : </li></ul><ul><li>Settle plate method. </li></ul><ul><li>Slit sampler method (from given volume) </li></ul><ul><li>Particle counter ( non viable count ) </li></ul>
  12. 12. Settle plate method <ul><li>A count of colonies yields a relative estimate of no. of organisms </li></ul><ul><li>INTERPRETATION : </li></ul><ul><li>Acceptable levels : </li></ul><ul><li>In OT- 10 cfu/ ft 3 / min </li></ul><ul><li>In specialized OT/ burns unit – 1 cfu/ ft 3 / min </li></ul><ul><li>Even a single colony of a pathogen like S. aureus should be taken as unsatisfactory. </li></ul>
  13. 13. Slit Sampler <ul><li>Very Effective / Highly sensitive </li></ul><ul><li>Fixed volume of air is sucked and bacterial counts are made </li></ul>
  14. 14. <ul><li>  Note: doors must be kept closed and the theatre empty until sampling is complete. </li></ul><ul><li>  Sampling volume needs to be greater than 0.25 m 3 (250 L) . Usually 300 l/ min. Preset for 1 min </li></ul><ul><li>Acceptable counts : </li></ul><ul><li>( Ayliffe et al) </li></ul><ul><li>< 35 colony-forming units (cfu) / m 3 of air for a conventional theatre </li></ul><ul><li>During operation < 180 CFU/m 3 of air using ultra clean laminar flow. </li></ul><ul><li>Less than one CFU of Clostridium perfringens or Staphylococcus aureus in 30 m 3 . </li></ul>
  15. 15. Basic care of Operation Theatres . <ul><li>Reduction of Microbial counts is important. </li></ul><ul><li>Paying great attention to Floors Using too many chemicals not necessary </li></ul><ul><li>Keep the floor Clean and Dry - with Vacuum cleaner and Wet cleaning techniques </li></ul><ul><li>Keep the mops dry when not in use, </li></ul><ul><li>Frequent cleaning of Walls and Roof is not needed </li></ul><ul><li>Number of persons present and Movements they make, has direct relation to increase of bacterial counts </li></ul><ul><li>Prompt disposal of Theatre waste out of the theatre is of top priority </li></ul>
  16. 16. Handling of Air in Operation theatre. <ul><li>Critical parameters for air quality include ( WHO Guidelines) </li></ul><ul><li>(1) Maintenance / validation of efficacy of filters </li></ul><ul><li>(2) Pressure gradient across the filter bed and in the operation theatre </li></ul><ul><li>(3) Air changes per hour (minimum 15 air changes per hour) </li></ul><ul><li>(4) Temperature and humidity should be maintained between 20-22°C and 30-60%, </li></ul><ul><li>Air pressure vented to the operation theatre. </li></ul><ul><li>Direction of air flow should be from clean to less clean </li></ul><ul><li>areas. </li></ul><ul><li>Environmental cleaning should be twice daily </li></ul><ul><li>Proper design and ventilation of operating theatres(HVAC) systems </li></ul><ul><li>HEPA filters indicated in operating rooms designated for orthopaedic implant procedures </li></ul>
  17. 17. Good Hand Washing Practices Save many Lives <ul><li>Alcohol with Chlorhexidine. </li></ul><ul><li>2.Alchool without Chlorhexidine. </li></ul><ul><li>3 Chlorhexidine 2 % </li></ul><ul><li>4 Chlorhexidine 4 % </li></ul><ul><li>5 Povidone with Iodine 7.5 % </li></ul><ul><li>6 Triclosan 1 % </li></ul><ul><li>Or Anything NEW </li></ul>BEST HAND WASH IS
  18. 18. Fumigation a biohazard procedure ? To sterilize the operation theatre formaldehyde gas (bactericidal & sporicidal,viricidal) is widely employed as it is cheaper. In spite of the gas being hazardous continues to be used in several developing countries Newer Chemical Agents in Hospital Use available but the Economic Limitation
  19. 19. <ul><li>Bacteriological surveillance testing at regular intervals is not warranted </li></ul><ul><li>But warranted when : </li></ul><ul><li>modification of operation theaters are done </li></ul><ul><li>In any unforeseen increase of incidence of infection from any particular operation theatre. </li></ul><ul><li>Routine and regular testing for Anerobic spores is not essential except when there was suspected case of Tetanus or Gas Gangrene attributed </li></ul><ul><li>Culturing unnecessary surface areas causes confusion and meaningful interpretation is lost. </li></ul>
  20. 20. Use your Wisdom
  21. 22. Everyone
  22. 23. References <ul><li>Surveillance, Sterilization and Disinfection of Operation Theatres in the Developing World by Dr.T.V.Rao MD – Dr.Chithra.VN MD July 17, 2010 By 4u Articles </li></ul><ul><li>Principles, And Practices of Disinfection, Preservation and Sterilization by A.D.Russel, W.B.Hugo & G.A.J Ayliffe. </li></ul><ul><li>www.cdc.gov/cdc.htm </li></ul><ul><li>www.his.org.uk </li></ul><ul><li>www.ific.narod.ru </li></ul><ul><li>WHO : Prevention of Hospital aquired infections. A practical guide. 2 nd ed. 2002. </li></ul><ul><li>Geeta Mehta. Microbiological surveillance of operation theatre.     http://www.orthoteers.org/content/content.aspx?article=372 </li></ul><ul><li>Colquhoun J, Partridge L. Computational Fluid Dynamics Applications in Hospital Ventilation Design. The Australian Hospital Engineer 2003; 26(1):35-40. </li></ul>

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