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Sterilization and Decontamination

of Surgical Theatresand Critical areas

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History of Hygiene

Bible

Book of Leviticus

Chapter 11 – 15

Code of Hygiene

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Greek Era

Aristotle recommends

Boiling water to armies. Advises the Alexander

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HAND WASHING

Semmelweis Practices emphasizes

the importance of washing hands with chlorinated water

In Obstetrics to reduce maternal mortality

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Starting of Modern Era 1860Dr.Joseph Lister

Phenol in Surgery and Decontamination practices

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Beginning of Modern Nursing

The Very First requirement in

Hospitals that should do the sick no harm

Florence Nightingale

( Notes on Nursing 1860 )

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Historical Aspects Changed the History

Lister era 1868 Carbolic Acid in decontamination, Reduction of Hospital associated infections Mortality reduced Morbidity reduced.

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Beginning of Safe Operation Theatre Practices

1867 –Dr.Joseph Lister first identifies airborne bacteria and uses Carbolic acid spray in surgical areas

1880 – Johnson and Johnson introduce antiseptic surgical dressings.

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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.

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Economical loss

Money wasted on unnecessary use. People concentrate on

Floors, Inanimate objects,

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Basic Principles

Cleaning more Important Disinfection and Sterilization ? Cleaning

Removes contaminants, Dust, organic matter, Disinfection Reduces number of microbes

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Disinfection x Sterilization

Sterilization is absolute, removes microbes and spores too.

To achieve Sterilization is Expensive, not sustainable, many times not needed.

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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.

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Walls and Roof ofOperation Theatre

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,

On many people make unnecessary movements than needed

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Care of and Floors

Do remember only 1 % are pathogenic. On many occasion S.aureus. Floor should be decontaminated with

Use Vacuum cleaner.

Wet cleaning techniques

Wet Mop / Keep the mops dry

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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.

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How you care for Floors

Use only vacuum cleaners Don't broom Use a Mop keep it dry,

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Roof, Artificial ceilings, Walls

Do not disturb every day Routine disinfection not necessary

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Caring for Floors

Only 1 % are pathogenic The counts depend on the number of persons Only people needed for procedures should

enter the theatres. Unnecessary movements disturbs the

bacterial flora

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Cleaning the Floor

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

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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, Use only when contaminated with blood or

body fluids.

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Handling of Air in Operation theatre.

Negative Air pressure vented to the operation theatre.

Environmental cleaning should be twice daily

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Environmental cleaning of Hospital.

Disinfectant Purpose Sodium hypochlorite Contaminated with Blood and body fluidsBleaching powder Toilets, bathrooms 9 grams/lit

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Environmental cleaning of OT Contd

Disinfectant Purpose

Alcohol 70% Metal surfaces

trolleys

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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

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Methods on Fumigation

In principle we have to generate Formaldehyde gas. Can be done by

Most easier way to mix the needed quantity of Formalin to water and heating at lower temperatures at 80 – 90

Addition of Formalin to potassium permanganate

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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.

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Safety of Air conditioning andWater cooling system

Legionnaires disease is associated with Air Condition system

Chlorination / Heating of water may prove better alternatives.

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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.

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At the End of the Dayin 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.

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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 health6 Education on Universal Precautions 7 Advise on isolation of Infectious patients.8 Waste disposal9 Safe use of Antibiotics / Antibiotic policy.

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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.

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Surveillance of Operation theatreExamination of Air

Estimations are done for detection of bacteria carrying particles in Air.

Factors influence

Number of persons present.

Body movements,

Disturbances of clothing.

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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

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Slit Sampler

Very Effective / Highly sensitive Fixed volume of air is sucked and bacterial

counts are made

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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

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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.