Bio safety in Operation Theaters in O T

8/12/2019 Bio safety in Operation Theaters in O T

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BIO-SAFETY IN

OPERATION THEATRESDr.T.V.Rao MD


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Key Recommendations of CDC

and HICPAC

Ventilation and water systemperformance

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


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Regulate the Operating Room

Environment

Ventilation = positivepressure.

Variable air systems(positive pressure only)

Air introduced at the

ceiling and exhaustednear the floor

Humidity


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Can we Sterilize Operation theatre

Sterilization means eradicating germs

completely, which is not 100%

possible in an operating theatre. Thesources of bacterial contamination

are from air and the environment,

infected body fluids, patients,

articles, or equipment.


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Follow the Standard protocols

Standard cleaning,

disinfection with

appropriate chemical

agents, good theatre

practice and

discipline can

provide amicrobiologically

safe environment.


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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.


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A good hand washing and Monitoring

reduces infections

3 A thorough washing with warm water andgood detergent can bring more of an overallimprovement than solely decontamination

sterilization with other chemicals,or fumigation.

4. Frequent monitoring and training ofmedical and paramedical staff must carry ahigh prioritydont merely observemechanical and chemical methods.


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Hand washing a boon to safety

Thorough washing and

carbonizations, if done

every day after the

surgeries, will greatlyenhance the safety

standards and reduce

the repeated

expenditure onfumigation.


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Regulate the Operating Room

Environment

Minimize

personneltraffic

duringoperations


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Surgical Attire Scrub suits

Cap/hoods

Shoe covers Masks

Gloves

Gowns


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Surgeon and Skills

Technical skill set

Excellent eye

handcoordination

Extensive medicalknowledge

Expertise inAnatomy


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Surgeon Skills Non-technical

skill set

Situationawareness

Decision making

Communicationand teamwork

Leadership


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Cleaning and Disinfecting

Environmental Surfaces

Medical equipment surfaces

knobs, handles onequipment such as x-ray

machines, instrument carts

Housekeeping surfacesfloors, walls, chairs, and

tabletops


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Medical Equipment

Manufacturers recommendation forsterilizationRecommended chemical germicidesWater-resistant properties

Required decontamination after

servicingNon-critical medical equipment (see

intermediate level disinfection)


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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


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Cleaning A form of

decontamination byremoving organicmatter, salts, and

visible soils

Physical action ofscrubbing withdetergents or surfactants

and rinsing with water

Necessary step prior tosterilization ordisinfection


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Cleaning Strategy

Minimize contamination of cleaningsolutions and tools

Change cleaning solutions frequently

Replace soiled cloths and mop heads witheach cleaning solution change

Launder cloths and mop heads after useand allow to dry before re-use or usedisposable cloths and mop heads

Use manufacturers recommendedconcentration


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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


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DisinfectionThe process that eliminates many or allpathogenic micro-organisms on inanimateobjects with the exception of bacterialspores

Spauldings*three levels ofdisinfection:

High-level

Intermediate-level Low-level*for treatment of devices and surfaces that do not

require sterility for safe use


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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 envelopedviruses

Utilize for items that come into contact with intact mucousmembranes and are heat sensitive semi-critical medical instruments (s/a flexible fiber optic endoscopes)

thermometers

vaginal speculums

sigmoid scopes


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Intermediate-level Disinfection

Includes Chlorine-containingcompounds, alcohols (small surfaces),some phenolic, and some iodophors

Inactivates a highly resistant organismsand exhibits some sporocidal activity

Utilize for non-critical medical

equipment s/a stethoscopes, bloodpressure cuffs, dialysis machines,equipment knobs and controls.


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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


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Monitor employee

compliance to

hand hygienerecommendations


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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 protocolsto control environmental contamination with

antibiotic-resistant, gram-positive coccid


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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


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What is wrong with our Practices

Disinfectants usedindiscrimately,

Used unnecessarily

Not used when needed.

Concentration notadequate

Economic consideration,

Business promotions. Laboratory testing XHospital conditions maynot correlate.

l l


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Economical loss

Money wasted on

unnecessary use.

People concentrate on

Floors, Inanimateobjects,

If the resources are notspend with scientificunderstanding the

limited resources arelost in particulardeveloping countries.


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Disinfection x Sterilization

Sterilization is absolute,removes microbes andspores too.

To achieve Sterilizationis Expensive, notsustainable, manytimes not needed.

An effectiveDisinfection reducesthe infectionsdrastically.


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Basic care of Operation Theatres.

Reduction of Microbialcounts is important.

Very rarely the Microbesreach the operation site,

Paying great attention toFloors Using unnecessary,too many chemical notnecessary

Keep the floor Clean andDry - Bacteria are reduced,

Most Important component ofBacteria is water a dry areascauses natural death exceptspores


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Frequent cleaning of Walls and Roof of

Operation Theatre is not needed

Frequent cleaning has littleeffect.

Do not disturb these areasunnecessarily,

Floors get contaminatedquickly, depend on

Number of personspresent in the

Theatre / Movementsthey make, has directrelation to increase ofbacterial counts


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Do not disturb the Roof

Do not disturb

unnecessarily,

Do not use ceiling fans

they cause aerosolspread

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

As it increases the

bacterial flora in

the environment


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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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Aldehyde free sterilization of

Operation theatres

Some of the emerging compounds developedfor use in the sterilization of operatingtheatres are more effective for environmental

decontamination, have a very goodcost/benefit ratio, good material compatibility,excellent cleaning properties and leavevirtually no residues. One particular product

available has the advantage of being aFormaldehyde-free disinfectant cleaner withlow use concentration


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Are Flowers Safe in the Hospital ?


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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/Orthopedicwards and critical care

areas.


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Who/What is Important in prevention

of Infections


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Remember we are More

important than many


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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 inHospital safety and Hygiene

Educate the staff on few useful option, many

theoretical ideas confuse. To many ChemicalsCostly, need not be

effective.


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Importance of Staff Education

Specify the staff for

duties and

responsibilities.

Education is a matter ofcontinuity

Train under the seniors

observation.

Train the staff with

scientific goals


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Operation Theatre Safetyis

ResponsibilityOf


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Everyone


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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

CDC Definition of Surgical SiteInfections


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Frequent Washing of Hands saves

several Lives Universally


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Created from Web sources


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Created from Web sources

Visit for Articles of Interest on Infectious

Diseases


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Programme Created by Dr.T.V.Rao MD

for Medical and Paramedical

Professionals in the Developing World

Email

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Bio safety in Operation Theaters in O T

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