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Dr.T.V.Rao MD

Key Recommendations of CDC and HICPAC

Ventilation and water system performance Multidisciplinary risk assessment team Use of dust control procedures during construction, repair, renovation or demolition Environmental surface cleaning and disinfection strategies geared towards antimicrobial resistant organisms

Regulate the Operating Room Environment

Ventilation = positive pressure. Variable air systems (positive pressure only) Air introduced at the ceiling and exhausted near the floor Humidity <68% Temperature control

Can we Sterilize Operation theatre

Sterilization means eradicating germs completely, which is not 100% possible in an operating theatre. The sources of bacterial contamination are from air and the environment, infected body fluids, patients, articles, or equipment.

Follow the Standard protocols

Standard cleaning, disinfection with appropriate chemical agents, good theatre practice and discipline can provide a microbiologically safe environment.

The following precautions have greatly reduced the rates of infection

1.Every hospital must establish an infection control committee to monitor the events in the hospital on all matters related to the control of infections. 2. The entry of unnecessary personnel should be restricted into operation theatres as everyone potentially contributes to infection.

A good hand washing and Monitoring reduces infections

3 A thorough washing with warm water and good detergent can bring more of an overall improvement than solely decontamination sterilization with other chemicals, or fumigation. 4. Frequent monitoring and training of medical and paramedical staff must carry a high priority dont merely observe mechanical and chemical methods.

Hand washing a boon to safety

Thorough washing and carbonizations, if done every day after the surgeries, will greatly enhance the safety standards and reduce the repeated expenditure on fumigation.

Regulate the Operating Room Environment

Minimize personnel traffic during operations

Surgical Attire
Scrub suits Cap/hoods Shoe covers



Surgeon and Skills

Technical skill set

Excellent eye hand coordination Extensive medical knowledge Expertise in Anatomy

Surgeon Skills
Non-technical skill set
Situation awareness Decision making Communication and teamwork Leadership

Cleaning and Disinfecting

Environmental Surfaces

Medical equipment surfaces knobs, handles on equipment such as x-ray machines, instrument carts Housekeeping surfaces floors, walls, chairs, and tabletops

Cleaning and Disinfecting

Medical Equipment Manufacturers recommendation for sterilization
Recommended chemical germicides Water-resistant properties Required decontamination after servicing Non-critical medical equipment (see intermediate level disinfection)

Cleaning and Disinfecting

Housekeeping Surfaces Frequent hand contact high touch surfaces
Doorknobs, bedrails, light switches, wall areas around the toilet, edges of privacy curtain Clean/disinfect more frequently

Minimal hand contact

Hard surface floors and window sills Clean on a regular basis, when soiled, and when patient is discharged from facility Walls, blinds and window curtains Clean when visibly soiled

A form of decontamination by removing organic matter, salts, and visible soils
Physical action of scrubbing with detergents or surfactants and rinsing with water Necessary step prior to sterilization or disinfection

Cleaning Strategy
Minimize contamination of cleaning solutions and tools Change cleaning solutions frequently
Replace soiled cloths and mop heads with each cleaning solution change Launder cloths and mop heads after use and allow to dry before re-use or use disposable cloths and mop heads

Use manufacturers recommended concentration

Cleaning Carpeting and Cloth Furniture

Vacuum carpeting and cloth furniture on a regular basis Maintain vacuum to minimize dust dispersal by using HEPA filters Maintain wet cleaning equipment in good repair and allow to dry between uses Note: Avoid use of carpeting and cloth furnishings in areas where spills are likely to occur

The process that eliminates many or all


pathogenic micro-organisms on inanimate objects with the exception of bacterial spores

Spauldings* three levels of disinfection:

High-level Intermediate-level Low-level

treatment of devices and surfaces that do not require sterility for safe use

High-level Disinfection
Includes powerful sporocidal chemicals (glutaraldehyde, peracteic acid and hydrogen peroxide) Inactivates all vegetative bacteria, mycobacteria (TB), viruses, fungi, some bacterial spores, enveloped and non enveloped viruses Utilize for items that come into contact with intact mucous membranes and are heat sensitive
semi-critical medical instruments (s/a flexible fiber optic endoscopes) thermometers vaginal speculums sigmoid scopes

Intermediate-level Disinfection
Includes Chlorine-containing compounds, alcohols (small surfaces), some phenolic, and some iodophors Inactivates a highly resistant organisms and exhibits some sporocidal activity Utilize for non-critical medical equipment s/a stethoscopes, blood pressure cuffs, dialysis machines, equipment knobs and controls.

Low-level Disinfection
Includes quaternary ammonium compounds, some phenolic, and some iodophors Inactivates vegetative bacteria, fungi, and some lipid enveloped medium size viruses Utilize for items that come in contact with intact skin such as examining table top, baby weigh scale, blood pressure cuff

Monitor employee compliance to hand hygiene recommendations

Special Pathogen Concern

Recent studies indicate that MRSA and VRE are most likely transmitted either: Patient to patient contact Via health-care workers hands Hand transfer from contaminated environmental surfaces and patient care equipment Note: Use standard cleaning and disinfection protocols to control environmental contamination with antibiotic-resistant, gram-positive coccid

Hand Hygiene
Avoid artificial nails and keep natural nails < in For visibly soiled hands use soap and water Use alcohol-based hand rubs
Before and after each patient Before and after glove use

Improved hand hygiene adherence has:

Terminated outbreaks in health care facilities transmission of AR organisms overall infection rates

What is wrong with our Practices

Disinfectants used indiscrimately, Used unnecessarily Not used when needed. Concentration not adequate Economic consideration, Business promotions. Laboratory testing X Hospital conditions may not correlate.

Economical loss
Money wasted on unnecessary use. People concentrate on Floors, Inanimate objects, If the resources are not spend with scientific understanding the limited resources are lost in particular developing countries.

Disinfection x Sterilization
Sterilization is absolute, removes microbes and spores too. To achieve Sterilization is Expensive, not sustainable, many times not needed. An effective Disinfection reduces the infections drastically.

Basic care of Operation Theatres.

Reduction of Microbial counts is important. Very rarely the Microbes reach the operation site, Paying great attention to Floors Using unnecessary, too many chemical not necessary Keep the floor Clean and Dry - Bacteria are reduced,
Most Important component of Bacteria is water a dry areas causes natural death except spores

Frequent cleaning of Walls and Roof of Operation Theatre is not needed

Frequent cleaning has little effect. Do not disturb these areas unnecessarily, Floors get contaminated quickly, depend on Number of persons present in the Theatre / Movements they make, has direct relation to increase of bacterial counts

Do not disturb the Roof

Do not disturb unnecessarily, Do not use ceiling fans they cause aerosol spread Clean only when remodeling or accumulated ,good amount of dust.

How you care for Floors

Use only vacuum cleaners
Don't broom As it increases the bacterial flora in the environment

Cleaning the Floor

A simple detergent reduces flora by 80 % Addition of disinfectant reduces to 95 % In busy Hospitals counts raise in 2 hours

Aldehyde free sterilization of Operation theatres

Some of the emerging compounds developed for use in the sterilization of operating theatres are more effective for environmental decontamination, have a very good cost/benefit ratio, good material compatibility, excellent cleaning properties and leave virtually no residues. One particular product available has the advantage of being a Formaldehyde-free disinfectant cleaner with low use concentration

Are Flowers Safe in the Hospital ?

Why flowers are Harmful

They carry a prominent bacteria which can cause Hospital acquired infections. Many Hospitals advise not to bring flowers to patients in Burns/Orthopedic wards and critical care areas.

Who/What is Important in prevention of Infections

Remember we are More important than many

Sterilization and Disinfection policies.

Create you own Infection control team which suits your Hospital, Infection control team decides the policies. Educate the staff on Methods and policies in Hospital safety and Hygiene Educate the staff on few useful option, many theoretical ideas confuse. To many Chemicals Costly, need not be effective.

Importance of Staff Education

Specify the staff for duties and responsibilities. Education is a matter of continuity Train under the seniors observation. Train the staff with scientific goals

Operation Theatre Safety is Responsibility Of


CDC Definition of Surgical Site Infections

SSI level classification Incisional SSI - Superficial incisional = skin and subcutaneous tissue - Deep incisional = involving deeper soft tissue Organ/Space SSI - Involve any part of the anatomy (organs and spaces), other than the incision, opened or manipulated during operations

Frequent Washing of Hands saves several Lives Universally

Protect patientsprotect healthcare personnel promote quality healthcare!

Created from Web sources Visit for Articles of Interest on Infectious Diseases

Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Professionals in the Developing World Email