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Decontamination
of Surgical Theatres
and Critical areas
Vijay Pratap
Raghuvanshi
History of Hygiene
Bible
Book of Leviticus
Chapter 11 – 15
Code of Hygiene
Vijay Pratap
Raghuvanshi
Greek Era
Aristotle recommends
Boiling water to armies.
Advises the Alexander
Vijay Pratap
Raghuvanshi
HAND WASHING
Semmelweis
Practices emphasizes
the importance of
washing hands with
chlorinated water
In Obstetrics to reduce
maternal mortality
Vijay Pratap
Raghuvanshi
Starting of Modern Era 1860
Dr.Joseph Lister
Phenol in Surgery and
Decontamination
practices
Vijay Pratap
Raghuvanshi
Beginning of Modern Nursing
Florence
Nightingale
( Notes on Nursing
1860 )
Vijay Pratap
Raghuvanshi
Historical Aspects Changed
the History
Listerera 1868
Carbolic Acid in decontamination,
Mortality reduced
Morbidity reduced.
Vijay Pratap
Raghuvanshi
Beginning of Safe Operation
Theatre Practices
Vijay Pratap
Raghuvanshi
What is wrong with our
Practices
Disinfectantsused indiscrimately,
Used unnecessarily
Economic consideration,
Business promotions.
Vijay Pratap
Raghuvanshi
Economical loss
Vijay Pratap
Raghuvanshi
Basic Principles
Cleaning more Important
Disinfection and Sterilization ?
Cleaning
Vijay Pratap
Raghuvanshi
Disinfection x Sterilization
Sterilization
is absolute, removes microbes
and spores too.
To achieve Sterilization is Expensive, not
sustainable, many times not needed.
Vijay Pratap
Raghuvanshi
Basic care of Operation
Theatres.
Reduction of Microbial counts is important.
Very rarely the Microbes reach the operation site,
Paying attention to Floors
Using unnecessary, too many chemical not
necessary
Keep Clean Dry - Bacteria are reduced,
Most Important component of Bacteria is water, dry
areas causes natural death.
Vijay Pratap
Raghuvanshi
Walls and Roof of
Operation Theatre
Frequent cleaning has little effect.
Do not disturb these areas unnecessarily,
Vijay Pratap
Raghuvanshi
Care of and Floors
Do remember only 1 % are pathogenic.
On many occasion S.aureus.
Vijay Pratap
Raghuvanshi
Care of Roof
Do not disturb unnecessarily,
Do not use ceiling fans they cause aerosol
spread
Clean only when remodeling or accumulated
,good amount of dust.
Vijay Pratap
Raghuvanshi
How you care for Floors
Use only vacuum cleaners
Don't broom
Vijay Pratap
Raghuvanshi
Roof, Artificial ceilings, Walls
Donot disturb every day
Routine disinfection not necessary
Vijay Pratap
Raghuvanshi
Caring for Floors
Only 1 % are pathogenic
The counts depend on the number of persons
Vijay Pratap
Raghuvanshi
Cleaning the Floor
A simple detergent reduces flora by 80 %
Addition of disinfectant reduces to 95 %
Vijay Pratap
Raghuvanshi
Environmental Cleaning of
Operation Theatres
Do not waste chemicals.
Only remove the dust with cloth wetted with
clean water,
Don't use chemicals/Disinfectants as a habit,
Vijay Pratap
Raghuvanshi
Handling of Air in Operation
theatre.
Negative Air pressure vented to the operation
theatre.
Environmental cleaning should be twice daily
Vijay Pratap
Raghuvanshi
Environmental cleaning of
Hospital.
Disinfectant Purpose
Vijay Pratap
Raghuvanshi
Environmental cleaning of OT
Contd
Disinfectant Purpose
Alcohol 70% Metal surfaces
trolleys
Vijay Pratap
Raghuvanshi
Fumigatation
Formaldehyde a Age old compound.
Low temp heating produce vapor
Vapor phase decontaminates the air/environment.
Kills vegetative bacteria / Spore ?
When Formaldehyde mixed with water and exposed
to elevated temperature
Gaseous formaldehyde is generated
Time X Temp
Vijay Pratap
Raghuvanshi
Methods on Fumigation
In principle we have to generate Formaldehyde gas.
Can be done by
Vijay Pratap
Raghuvanshi
Procedure of Fumigation
Seal the room with adhesive tape.
Sealing the edges around the doors is important,
Measure the volume of your operation theatre
For each 1000 cu ft use 500 ml of formaldehyde.
Mix with water @ 1000 ml for 500 ml of
Formaldehyde needed.
Seal the Room for 24 hours,
Open the Door / Avoid the formalin gas with mask
Neutralize Residual formalin gas with Ammonia by
exposing 250 ml of Ammonia per liter of
Formaldehyde used.
Vijay Pratap
Raghuvanshi
Safety of Air conditioning and
Water cooling system
Legionnaires disease is associated with Air
Condition system
Chlorination / Heating of water may prove
better alternatives.
Vijay Pratap
Raghuvanshi
Between procedures in the
Operation Theatres.
Clean operation tables, theatre equipment with
disinfectant solution with detergent,
In case of spillage of blood / body fluids
decontaminate with bleaching powder/chlorine
solution ( 1 % available chlorine ).
Always discard wastes in prescribed plastic bags –
Don’t accumulate biohazard waste in the operation
theatres.
Don’t discard discarded soiled gowns in the
operation theatre.
Vijay Pratap
Raghuvanshi
At the End of the Day
in Operation theatre.
Clean all the table tops sinks, door handles with
detergent / low level of disinfectant.
Clean the floors with detergents mixed with warm
water,
Finally mop with disinfectant like Phenol in the
concentration of 1 : 10
Low concentration of Phenol serve as perfume and
not as disinfectant.
Vijay Pratap
Raghuvanshi
Infection control programmes
1 Monitoring of Hospital associated infections.
2 Training of Health care workers.
3 Investigations of outbreaks.
4 Any technical lapses.
5 Monitoring of staff health
6 Education on Universal Precautions
7 Advise on isolation of Infectious patients.
8 Waste disposal
9 Safe use of Antibiotics / Antibiotic policy.
Vijay Pratap
Raghuvanshi
Role of Microbiology
Department
Identifies the pathogens
Monitoring of Antibiotic therapy,
Education on specimen collection and
transportation,
Information on common Antibiogram patterns
Data on Hospital Infection
Surveillance of the Hospital environment
Counseling of the Infected Hospital Staff.
Vijay Pratap
Raghuvanshi
Surveillance of Operation theatre
Examination of Air
Estimations are done for detection of bacteria
carrying particles in Air.
Factors influence
Vijay Pratap
Raghuvanshi
Methods of Air surveillance
1 Settle plate method.
2 Slit sampler method (from given volume)
3 Counts vary from one to many
Settle plates method
Record position – Time - Duration
Plates with media as Blood agar exposed for
specified period and incubated in the
incubator for 24 hours at 37º c
Vijay Pratap
Raghuvanshi
Slit Sampler
Very Effective / Highly sensitive
Fixed volume of air is sucked and bacterial
counts are made
Vijay Pratap
Raghuvanshi
How many bacteria are
pathogenic
Counts vary On number of personal present in the
given area.
Behavior of the persons.
Depend on nature of procedures, type of operations.
Varying ranges
But remember only 1 % are pathogenic
Presence of S. aureus makes difference
Vijay Pratap
Raghuvanshi
Do we need surveillance
regularly
Bacteriological surveillance testing at
regular internals is not warranted,
But warranted when modification of
operation theaters are done,
In any unforeseen increase of
incidence of infection form any
particular operation theatre.
Vijay Pratap
Raghuvanshi