SterilizationSterilizationofof

Operation TheatresOperation Theatres updateupdate

Dr.T.V.Rao MD

History of HygieneHistory of Hygiene

BibleBible Book of LeviticusBook of Leviticus

Chapter 11 – 15Chapter 11 – 15

Code of Code of HygieneHygiene

Greek EraGreek Era Aristotle Greek Aristotle Greek

PhilosopherPhilosopher recommends recommends

Boiling water to Boiling water to armies. Advises the armies. Advises the Alexander.Alexander.

Recommends Recommends hygiene for healthy hygiene for healthy living living

HAND WASHING- HAND WASHING- SemmelweisSemmelweis

Practices, Practices, emphasizes the emphasizes the importance of importance of washing hands washing hands with chlorinated with chlorinated water in Obstetrics water in Obstetrics to reduce maternal to reduce maternal mortalitymortality

Beginning of Modern Beginning of Modern NursingNursing

The Very First The Very First Requirement in Requirement in

Hospitals that Hospitals that should do the sick should do the sick no harmno harm

Florence Florence

NightingaleNightingale

( Notes on Nursing ( Notes on Nursing 1860 )1860 )

Florence Nightingale Florence Nightingale creates fundamentals in creates fundamentals in

Nursing careNursing care

Beginning of Safe Beginning of Safe Operation Theatre Operation Theatre

PracticesPractices 1867 –Dr.Joseph Lister 1867 –Dr.Joseph Lister

first identifies airborne first identifies airborne bacteria and uses bacteria and uses Carbolic acid spray in Carbolic acid spray in surgical areassurgical areas

1880 – Johnson and 1880 – Johnson and Johnson introduce Johnson introduce antiseptic surgical antiseptic surgical dressings.dressings.

Historical Aspects Historical Aspects Changed Changed

the Historythe History Lister era 1868 Lister era 1868 changed the concept changed the concept of safe surgical of safe surgical procedures.procedures.

Carbolic Acid in Carbolic Acid in decontamination decontamination caused Reduction of caused Reduction of Hospital associated Hospital associated infectionsinfections

Mortality reducedMortality reduced Morbidity reducedMorbidity reduced..

Sterile Environment Sterile Environment reduces Surgical site reduces Surgical site

infections.infections. Surgical site infectionsSurgical site infections SSISSI are the second most are the second most

common cause of hospital acquired (Nosocomial) common cause of hospital acquired (Nosocomial) infections. These complications of surgical infections. These complications of surgical procedures cause considerable morbidity and, procedures cause considerable morbidity and, when these occur deep at the site of the when these occur deep at the site of the procedure, can lead to mortality as high as 77%. procedure, can lead to mortality as high as 77%. The source of SSIs may be endogenous (normal The source of SSIs may be endogenous (normal flora of the patient’s skin, mucous membranes, or flora of the patient’s skin, mucous membranes, or hollow viscera) or exogenous, which includes hollow viscera) or exogenous, which includes surgical personnel (especially members of the surgical personnel (especially members of the surgical team), the operating room environment surgical team), the operating room environment (including air), and tools, instruments, and (including air), and tools, instruments, and materials brought to the sterile field during an materials brought to the sterile field during an operation. By maintaining sterile environment in operation. By maintaining sterile environment in operation theatre we can control major part of operation theatre we can control major part of exogenous infections. exogenous infections.

What is wrong with our What is wrong with our PracticesPractices

Disinfectants used Disinfectants used indiscrimately,indiscrimately,

Used unnecessarilyUsed unnecessarily Not used when needed.Not used when needed. Concentration not Concentration not

adequateadequate Economic Economic

consideration,consideration, Business promotions.Business promotions. Laboratory testing X Laboratory testing X

Hospital conditions Hospital conditions may not correlate.may not correlate.

Economical lossEconomical loss

Money wasted on Money wasted on unnecessary use.unnecessary use.

People concentrate onPeople concentrate on

Floors, Inanimate Floors, Inanimate objects,objects,

If the resources are not If the resources are not spend with scientific spend with scientific understanding the understanding the limited resources are limited resources are lost in particular lost in particular developing countreis.developing countreis.

Basic PrinciplesBasic Principles

Cleaning more Cleaning more Important than Important than Disinfection and Disinfection and Sterilization ?Sterilization ?

HoweverHowever CleaningCleaning

Removes Removes contaminants,contaminants,

Dust, organic matter,Dust, organic matter,

Disinfection Disinfection

Reduces number of Reduces number of microbesmicrobes

DisinfectionDisinfection x x SterilizationSterilization

Sterilization is Sterilization is absolute, removes absolute, removes microbes and spores microbes and spores too.too.

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

An effective An effective Disinfection reduces Disinfection reduces the infections the infections drastically.drastically.

Basic care of Operation Basic care of Operation TheatresTheatres..

Reduction of Microbial Reduction of Microbial counts is important.counts is important.

Very rarely the Very rarely the Microbes reach the Microbes reach the operation siteoperation site,,

Paying great attention Paying great attention to Floors Using to Floors Using unnecessary, too many unnecessary, too many chemical not necessarychemical not necessary

Keep the floor Clean Keep the floor Clean and Dry - Bacteria are and Dry - Bacteria are reduced,reduced,

Most Important component Most Important component of Bacteria is water a dry of Bacteria is water a dry areas causes naturalareas causes natural death death except except sporesspores

Frequent cleaning of Walls and Frequent cleaning of Walls and Roof ofRoof of

Operation Theatre is not Operation Theatre is not neededneeded Frequent cleaning has Frequent cleaning has

little effect.little effect. Do not disturb these Do not disturb these

areas unnecessarily,areas unnecessarily, Floors get Floors get

contaminated quickly, contaminated quickly, depend ondepend on

Number of persons Number of persons present in the present in the

TheatreTheatre / / Movements Movements they make, has direct they make, has direct relation to increase of relation to increase of bacterial countsbacterial counts

Do not disturb the Roof Do not disturb the Roof

Do not disturb Do not disturb unnecessarily,unnecessarily,

Do not use ceiling Do not use ceiling fans they cause fans they cause aerosol spread aerosol spread

Clean only when Clean only when remodeling or remodeling or accumulated ,good accumulated ,good amount of dust.amount of dust.

Care of FloorsCare of Floors Do remember only 1 % of Do remember only 1 % of

the microbes present on the the microbes present on the floors are pathogenic.floors are pathogenic.

On many occasion S.aureus. On many occasion S.aureus. Isolated as a prominent Isolated as a prominent pathogenpathogen

Floor should be Floor should be decontaminated withdecontaminated with

Vacuum cleaner.Vacuum cleaner.

and Wet cleaning and Wet cleaning techniques techniques

Keep the mops dry when Keep the mops dry when not in use.not in use.

How you care for FloorsHow you care for Floors

Use only Use only vacuum vacuum cleanerscleaners

Don't broom Don't broom As it increases As it increases

the bacterial the bacterial flora in the flora in the environmentenvironment

Cleaning the FloorCleaning the Floor

A simple detergent A simple detergent reduces flora by 80 reduces flora by 80 %%

Addition of Addition of disinfectant disinfectant reduces to 95 %reduces to 95 %

In busy Hospitals In busy Hospitals counts raise in 2 counts raise in 2 hourshours

Environmental Cleaning Environmental Cleaning of Operation Theatresof Operation Theatres

Do not waste chemicals.Do not waste chemicals. Only remove the dust with cloth Only remove the dust with cloth

wetted with clean water,wetted with clean water, Don't use chemicals/Disinfectants as Don't use chemicals/Disinfectants as

a habit,a habit, Use only when contaminated with Use only when contaminated with

blood or body fluids.blood or body fluids.

Handling of Air in Handling of Air in Operation theatre.Operation theatre.

Negative Air Negative Air pressure vented to pressure vented to the operation the operation theatre.theatre.

Environmental Environmental cleaning should be cleaning should be twice dailytwice daily

Environmental cleaning of Hospital Environmental cleaning of Hospital

with Chlorinated compoundswith Chlorinated compounds.. Disinfectant PurposeDisinfectant Purpose Sodium hypochlorite Contaminated Sodium hypochlorite Contaminated

withwith Blood and bodyBlood and body fluidsfluids

Bleaching powder Toilets, bathroomsBleaching powder Toilets, bathrooms 9 grams/lit9 grams/lit

Environmental cleaning of Environmental cleaning of instruments and equipment in instruments and equipment in

OTOT

Disinfectant Disinfectant

Alcohol 70% Alcohol 70%

used in cleaning used in cleaning Metal surfaces and Metal surfaces and TrolleysTrolleys

However expensive However expensive for hospitals in for hospitals in developing countreisdeveloping countreis

FumigationFumigationa biohazard a biohazard procedureprocedure ? ?

FumigatationFumigatation Formaldehyde a Age old compound.Formaldehyde a Age old compound. Low temp heating produce vaporLow temp heating produce vapor Vapor phase decontaminates the Vapor phase decontaminates the

air/environment.air/environment. Kills vegetative bacteria / Spore ?Kills vegetative bacteria / Spore ? When Formaldehyde mixed with water and When Formaldehyde mixed with water and

exposed to elevated temperature exposed to elevated temperature Gaseous formaldehyde is generated Gaseous formaldehyde is generated Time X TempTime X Temp

FumigationFumigation

To sterilize the operation theatre To sterilize the operation theatre formaldehyde gas (bactericidal & formaldehyde gas (bactericidal & sporicidal,viricidal) is widely employed as it sporicidal,viricidal) is widely employed as it is cheaper for sterilization of huge areas like is cheaper for sterilization of huge areas like operation theatres. Formaldehyde kills the operation theatres. Formaldehyde kills the microbes by alkylating the amino acids and microbes by alkylating the amino acids and sulfydral group of proteins and purine bases.sulfydral group of proteins and purine bases.

In spite of the gas being hazardous In spite of the gas being hazardous continues to be used in several continues to be used in several developing countreisdeveloping countreis

FumigationFumigation Fumigation usually involves the following Fumigation usually involves the following

phases: First the area to be fumigated is phases: First the area to be fumigated is usually covered to create a sealed usually covered to create a sealed environment; next the fumigant is released environment; next the fumigant is released into the space to be fumigated; then, the into the space to be fumigated; then, the space is held for a set period while the space is held for a set period while the fumigant gas percolates through the space fumigant gas percolates through the space and acts on and kills any infestation in the and acts on and kills any infestation in the product, next the space is ventilated so product, next the space is ventilated so that the poisonous gases are allowed to that the poisonous gases are allowed to escape from the space, and render it safe escape from the space, and render it safe for humans to enter. for humans to enter.

Procedure of FumigationProcedure of Fumigation Thoroughly clean windows, doors, floor, Thoroughly clean windows, doors, floor,

walls and all washable equipments with walls and all washable equipments with soap and water. soap and water.

Close windows and ventilators tightly. If Close windows and ventilators tightly. If any openings found seal it with cellophane any openings found seal it with cellophane tape or other material. tape or other material.

Switch off all lights, A/C and other Switch off all lights, A/C and other electrical & electronic items electrical & electronic items

Calculate the room size in cubic feet Calculate the room size in cubic feet (L×B×H) and calculate the required (L×B×H) and calculate the required amount of formaldehyde as given inamount of formaldehyde as given in

Personal care during Personal care during fumigationfumigation

Adequate care must be taken by Adequate care must be taken by wearing cap, mask, foot cover, wearing cap, mask, foot cover, spectacle ., spectacle .,

Formaldehyde is irritant to eye & Formaldehyde is irritant to eye & nose; and it has been recognized as a nose; and it has been recognized as a potential potential carcinogen. carcinogen.

So the fumigating employee must be So the fumigating employee must be provided with the personal protective provided with the personal protective equipmentsequipments. .

Creating the Formaldehyde Creating the Formaldehyde gasgas

Electric Boiler Fumigation Method:Electric Boiler Fumigation Method: For Each 1000 cu.ft of the volume of For Each 1000 cu.ft of the volume of the operation theatre 500ml of the operation theatre 500ml of formaldehyde (40% solution) added in formaldehyde (40% solution) added in 1000ml of water in an electric boiler. 1000ml of water in an electric boiler. Switch on the boiler, leave the room Switch on the boiler, leave the room and seal the door. After 45 minutes and seal the door. After 45 minutes (variable depending to volume present (variable depending to volume present in the boils apparatus) switch off the in the boils apparatus) switch off the boiler without entering in to the room . boiler without entering in to the room .

Methods on FumigationMethods on Fumigation In principle we have to In principle we have to

generate Formaldehyde generate Formaldehyde gas.gas.

Can be done byCan be done by

Most easier way to mix Most easier way to mix the needed quantity of the needed quantity of Formalin to water and Formalin to water and heating at lower heating at lower temperatures at 80temperatures at 8000c – c – 909000c c

Can done also with addition Can done also with addition of Formalin to potassium of Formalin to potassium permanganatepermanganate

Adding Potassium Adding Potassium PermanganatePermanganate to to formaldehyde..formaldehyde..

Potassium Permanganate MethodPotassium Permanganate Method:: For every 1000 cubic feet add 450gm of For every 1000 cubic feet add 450gm of Potassium permanganate (KMnO4) to Potassium permanganate (KMnO4) to 500 ml of formaldehyde (40% solution). 500 ml of formaldehyde (40% solution). Take about 5 to 8 bowels (heat resistant; Take about 5 to 8 bowels (heat resistant; place it in various locations) with equally place it in various locations) with equally divided parts of formaldehyde and add divided parts of formaldehyde and add equally divided KMnO4 to each bowel. equally divided KMnO4 to each bowel. This will cause auto boiling and generate This will cause auto boiling and generate fume. fume.

After the initiation of formaldehyde After the initiation of formaldehyde vapor, immediately leave the room and vapor, immediately leave the room and seal it for at least 48 hours. seal it for at least 48 hours.

Fumigation to be Fumigation to be neutralizedneutralized

Neutralize Residual Neutralize Residual formalin gas with formalin gas with Ammonia by exposing Ammonia by exposing 250 ml of Ammonia 250 ml of Ammonia per liter of per liter of Formaldehyde used.Formaldehyde used.

Place the ammonia Place the ammonia solution in the centre solution in the centre of the room and leave of the room and leave it for 3 hours to it for 3 hours to neutralize the formalin neutralize the formalin vaporvapor

An example is set asAn example is set as....

Operation Theatre Volume = L×B×H = Operation Theatre Volume = L×B×H = 20 × 15 × 10 = 20 × 15 × 10 = 3000 cubic feet3000 cubic feet

Formaldehyde required for fumigation = Formaldehyde required for fumigation = 500 ml for 1000 cubic feet500 ml for 1000 cubic feet

= So = So 1500 ml of formaldehyde1500 ml of formaldehyde requiredrequired

Ammonia required for neutralization = Ammonia required for neutralization = 150ml of 10% ammonia for 500 ml of 150ml of 10% ammonia for 500 ml of formaldehydeformaldehyde

= So = So 450 ml of 10% ammonia450 ml of 10% ammonia require require

Need for Newer Need for Newer Chemical Agents in Chemical Agents in

Hospital UseHospital Use 1. A need for Non 1. A need for Non

Aldehyde based Aldehyde based Chemicals is growing Chemicals is growing concernconcern

2 Need for quicker 2 Need for quicker sterilization methods sterilization methods with ever increasing with ever increasing work loads.work loads.

3. Need for non toxic 3. Need for non toxic safe agents.safe agents.

Several Chemicals are Several Chemicals are available but the Economic available but the Economic Limitation are great hurdle Limitation are great hurdle in exploring the Utility in in exploring the Utility in

Developing countriesDeveloping countries

Bacillocid® rasantBacillocid® rasant

Formaldehyde-free Formaldehyde-free disinfectant cleaner disinfectant cleaner with low use with low use concentrationconcentration

very good cost/benefit very good cost/benefit ratio ratio

good material good material compatibility compatibility

excellent cleaning excellent cleaning properties properties

virtually no residue virtually no residue

Bacillocid® rasantBacillocid® rasant

Active ingredients: Glutaral 100 mg/g, Active ingredients: Glutaral 100 mg/g, benzyl-C12-18-alkyldimethylammonium benzyl-C12-18-alkyldimethylammonium chlorides 60 mg/g, didecyl-chlorides 60 mg/g, didecyl-dimethylammonium chloride 60 mg/g. dimethylammonium chloride 60 mg/g.

Bacillocid® rasant is suitable for the Bacillocid® rasant is suitable for the disinfectant cleaning of washable surfaces disinfectant cleaning of washable surfaces using the wet-wipe-procedure. using the wet-wipe-procedure.

Especially suitable for economic short-Especially suitable for economic short-term disinfection in risk areas that are term disinfection in risk areas that are likely sources of infectionlikely sources of infection

Newer and Non Toxic Newer and Non Toxic compounds.compounds.

A Chemical compound VIRKON A Chemical compound VIRKON gaining importance as non Aledyde gaining importance as non Aledyde compound.compound.

Virkon proved to be safeVirkon proved to be safe VirucidalVirucidal Bactericidal,Bactericidal, Fungicidal Fungicidal MycobactericidalMycobactericidal

VIKRON is Finding Place VIKRON is Finding Place inin

As a Chemical disinfectant.As a Chemical disinfectant. Disinfects Medical devices.Disinfects Medical devices. Disinfects Laboratory equipment.Disinfects Laboratory equipment. Decontaminate spillages with Blood Decontaminate spillages with Blood

and body fluids.and body fluids. Finding usefulness in replacing Finding usefulness in replacing

autoclaving and saving time.autoclaving and saving time.

Guidelines to be considered Guidelines to be considered constructing safe operation constructing safe operation

theatrestheatres Construction, carpentry, plumbing, electrical, Construction, carpentry, plumbing, electrical,

cleaning and other works should be completed cleaning and other works should be completed before the initiation of fumigation procedure. before the initiation of fumigation procedure.

If exhaust fan is used (instead of A/C) its exterior If exhaust fan is used (instead of A/C) its exterior level fins should be closed. level fins should be closed.

Rooms allotted for operation (as shown in the Rooms allotted for operation (as shown in the plan) should not be used for other purposes. plan) should not be used for other purposes.

The Construction must have The Construction must have Separate dressing room for medical officer and Separate dressing room for medical officer and

staff nurses staff nurses Patient waiting room Patient waiting room Operation room Operation room Veranda Veranda

Care of the self and Care of the self and surroundingssurroundings

Theatre dress (includes head cap, mask, apron, Theatre dress (includes head cap, mask, apron, chapel, should be made available for all persons chapel, should be made available for all persons who are entering into the operation theatre who are entering into the operation theatre (surgeons, anaesthetist, microbiologist team, (surgeons, anaesthetist, microbiologist team, nurses, theatre assistants& helper). nurses, theatre assistants& helper).

Surroundings should be clean and free from Surroundings should be clean and free from garbage, open drainage, bushes, shrubs, wastes, garbage, open drainage, bushes, shrubs, wastes, donot keep any material which are necessary for donot keep any material which are necessary for operation theatre procedures operation theatre procedures

Operation theatre should be cleaned and Operation theatre should be cleaned and fumigated as the prevailing conditions of working fumigated as the prevailing conditions of working and work load,and work load,

Depends on septic cases handled in the theatre Depends on septic cases handled in the theatre

Safety of Air conditioning Safety of Air conditioning andand

Water cooling systemsWater cooling systems Legionnaires Legionnaires

disease is disease is associated with Air associated with Air Conditioning Conditioning systemsystem

Chlorination / Chlorination / Heating of water Heating of water may prove better may prove better alternatives.alternatives.

Between procedures in Between procedures in the Operation Theatresthe Operation Theatres..

Clean operation tables, theatre equipment Clean operation tables, theatre equipment with disinfectant solution with detergent,with disinfectant solution with detergent,

In case of spillage of blood / body fluids In case of spillage of blood / body fluids decontaminate with bleaching decontaminate with bleaching powder/chlorine solution ( 10 % available powder/chlorine solution ( 10 % available chlorine ).chlorine ).

Always discard wastes in prescribed Always discard wastes in prescribed plastic bags – Don’t accumulate biohazard plastic bags – Don’t accumulate biohazard waste in the operation theatres.waste in the operation theatres.

Don’t discard discarded soiled gowns in Don’t discard discarded soiled gowns in the operation theatre.the operation theatre.

At the End of the DayAt the End of the Dayin Operation theatrein Operation theatre..

Clean all the table tops sinks, door handles Clean all the table tops sinks, door handles with detergent / low level of disinfectant.with detergent / low level of disinfectant.

Clean the floors with detergents mixed Clean the floors with detergents mixed with warm water,with warm water,

Finally mop with disinfectant like Phenol in Finally mop with disinfectant like Phenol in the concentration of 1 : 10the concentration of 1 : 10

Low concentration of Phenol serve as Low concentration of Phenol serve as perfume and not as disinfectant.perfume and not as disinfectant.

Infection control Infection control programmesprogrammes

1 Monitoring of Hospital associated 1 Monitoring of Hospital associated infections.infections.

2 Training of Health care workers.2 Training of Health care workers.3 Investigations of outbreaks.3 Investigations of outbreaks.4 Any technical lapses.4 Any technical lapses.5 Monitoring of staff health5 Monitoring of staff health6 Education on Universal Precautions 6 Education on Universal Precautions 7 Advise on isolation of Infectious patients.7 Advise on isolation of Infectious patients.8 Waste disposal8 Waste disposal9 Safe use of Antibiotics / Antibiotic policy.9 Safe use of Antibiotics / Antibiotic policy.

Role of Microbiology Role of Microbiology Departments.Departments.

Identifies the pathogensIdentifies the pathogens Monitoring of Antibiotic Monitoring of Antibiotic

therapy,therapy, Education on specimen Education on specimen

collection and collection and transportation,transportation,

Information on common Information on common Antibiogram patternsAntibiogram patterns

Data on Hospital Data on Hospital InfectionInfection

Surveillance of the Surveillance of the Hospital environmentHospital environment

Counseling of the Counseling of the Infected Hospital Staff.Infected Hospital Staff.

Settle plates for bacterial Settle plates for bacterial counts are used by counts are used by

MicrobiologistsMicrobiologists

Recent advances in Air Recent advances in Air SamplingSampling

There is a sea change in analysis of bacterial There is a sea change in analysis of bacterial counts recent past with advances in medical counts recent past with advances in medical technologies as in Joint replacement technologies as in Joint replacement surgeries dealing with critical patients, Slit surgeries dealing with critical patients, Slit sampler and Air centrifuge equipment for sampler and Air centrifuge equipment for bacterial counts are replacing settle plates.bacterial counts are replacing settle plates.

The safe levels of colony counts can The safe levels of colony counts can calculated as per the standards created with calculated as per the standards created with peer reviewed studies by microbiologists peer reviewed studies by microbiologists and manufacturers.and manufacturers.

Slit SamplerSlit Sampler

Very Effective / Very Effective / Highly sensitiveHighly sensitive

Fixed volume of Fixed volume of air is sucked air is sucked and bacterial and bacterial counts are counts are mademade

Surveillance of Operation Surveillance of Operation theatretheatre

Examination of AirExamination of Air Estimations are done Estimations are done

for detection of for detection of bacteria carrying bacteria carrying particles in Air.particles in Air.

Factors influence Factors influence

Number of persons Number of persons present.present.

Body movements,Body movements,

Disturbances Disturbances of clothing.of clothing.

Methods of Air Methods of Air surveillancesurveillance

11 Settle plate method.Settle plate method.22 Slit sampler method Slit sampler method

(from given volume)(from given volume)33 Counts vary from one Counts vary from one

to manyto many Settle plates methodSettle plates method Record position – Time - Record position – Time -

DurationDuration Plates with media as Plates with media as

Blood agar exposed for Blood agar exposed for specified period and specified period and incubated in the incubated in the

incubator for 24 hours incubator for 24 hours at 37º c at 37º c

How many bacteria are How many bacteria are pathogenicpathogenic

Counts vary On number of personal Counts vary On number of personal present in the given area.present in the given area.

Behavior of the persons.Behavior of the persons. Depend on nature of procedures, type of Depend on nature of procedures, type of

operations.operations. Varying rangesVarying ranges But remember only 1 % are pathogenic But remember only 1 % are pathogenic Presence of S. aureus makes differencePresence of S. aureus makes difference

Surveillance for Anaerobic Surveillance for Anaerobic sporesspores

The age old tradition of detection of The age old tradition of detection of anaerobic spores of Cl.tetani and other gas anaerobic spores of Cl.tetani and other gas gangrence producing spores in the gangrence producing spores in the operation theatre and closing the theatres is operation theatre and closing the theatres is losing relavance with changing understaning losing relavance with changing understaning and newer conceptsand newer concepts

Routine and regular testing for Anerobic Routine and regular testing for Anerobic spores is not essential except when there spores is not essential except when there was suspected case of Tetanus or Gas was suspected case of Tetanus or Gas Gangrene attributed to operting in a Gangrene attributed to operting in a particular operation theatreparticular operation theatre

Anaerobic spores are Anaerobic spores are isolated from Robertson isolated from Robertson

Cooked mediumCooked medium

Ideal to Survey for Ideal to Survey for AnaerobesAnaerobes

It is ideal to survey the It is ideal to survey the operation theatres for operation theatres for anaerobes when anaerobes when operating in newly operating in newly constructed or after constructed or after remodelling and remodelling and structural alterations structural alterations are doneare done

In these circustances In these circustances survelaance will survelaance will increase safety of the increase safety of the theatres.theatres.

Do we need surveillance Do we need surveillance regularlyregularly

Bacteriological surveillance testing at Bacteriological surveillance testing at regular internals is not warranted,regular internals is not warranted,

But warranted when modification of But warranted when modification of operation theaters are done,operation theaters are done,

In any unforeseen increase of In any unforeseen increase of incidence of infection form any incidence of infection form any particular operation theatre.particular operation theatre.

Factors which Factors which influence Safteyinfluence Saftey

ininHospital Hospital

EnvironmentEnvironment

Importance of Hand Importance of Hand WashingWashing

SoapSoap

WaterWater

and and Common Common

SenseSense

Yet the best Yet the best AntisepticAntiseptic

William OslerWilliam Osler

Good Hand Washing Practices Good Hand Washing Practices Save many LivesSave many Lives

Choice of SoapChoice of Soap Simple soap routinely Simple soap routinely

used.used. Medicated Soap Medicated Soap

warranted in specific warranted in specific circumstancescircumstances

Soap advertisement Soap advertisement claims are they real?claims are they real?

To frequent use of To frequent use of medicated soaps medicated soaps are injurious to skin are injurious to skin and cause allergic and cause allergic dermatitisdermatitis

Which hand wash Which hand wash solution is best ?solution is best ?

1 Alcohol with 1 Alcohol with Chlorhexidine.Chlorhexidine.

2.Alchool without 2.Alchool without Chlorhexidine.Chlorhexidine.

3 Chlorhexidine 2 %3 Chlorhexidine 2 %4 Chlorhexidine 4 %4 Chlorhexidine 4 %5 Povidone with 5 Povidone with

Iodine 7.5 %Iodine 7.5 %6 Triclosan 1 %6 Triclosan 1 % Or Anything Or Anything

NEWNEW

BEST HAND WASH ISBEST HAND WASH IS Which suits the Which suits the

Circumstances.Circumstances. Availability of Availability of

Resources.Resources. Economical.Economical. Safe to you.Safe to you. Some chemical Some chemical

containing containing compounds can compounds can cause sensitization cause sensitization and Allergic and Allergic reactions.reactions.

Confused with Confused with promotions of promotions of

commercial interests ?commercial interests ?..

Use your WisdomUse your Wisdom

Are Flowers Safe in the Are Flowers Safe in the Hospital ?Hospital ?

Why flowers are HarmfulWhy flowers are Harmful

They carry a They carry a prominent bacteria prominent bacteria which can cause which can cause Hospital acquired Hospital acquired infections.infections.

Many Hospitals Many Hospitals advise not to bring advise not to bring flowers to patients in flowers to patients in Burns/Orthopedic Burns/Orthopedic wards and critical wards and critical care areas.care areas.

Who/What is Important Who/What is Important in prevention of in prevention of

InfectionsInfections

Remember we are More Remember we are More important than manyimportant than many

Sterilization and Sterilization and Disinfection policies.Disinfection policies.

Create you own Infection control team Create you own Infection control team which suits your Hospital,which suits your Hospital,

Infection control team decides the Infection control team decides the policies.policies.

Educate the staff on Methods and Educate the staff on Methods and policies in Hospital safety and Hygiene policies in Hospital safety and Hygiene

Educate the staff on few useful option, Educate the staff on few useful option, many theoretical ideas confuse.many theoretical ideas confuse.

To many Chemicals – Costly, need To many Chemicals – Costly, need not be effectivenot be effective..

Importance of Staff Importance of Staff EducationEducation

Speicify the staff for Speicify the staff for duties and duties and responsibilities.responsibilities.

Education is a Education is a matter of continuitymatter of continuity

Train under the Train under the seniors observation.seniors observation.

Train the staff with Train the staff with scientific goalsscientific goals

Operation Theatre Saftey Operation Theatre Saftey isis

ResponsibilityResponsibility OfOf

EveryoneEveryone

Frequent Washing of Hands Frequent Washing of Hands saves several Lives saves several Lives

UniversallyUniversally

Our Future Vision for Our Future Vision for Developing world should beDeveloping world should be

Thank You AllThank You All

Created for Created for Dr.T.V.Rao MD’s ‘e’ learning ‘e’ learning ProgrammeProgramme

Email.Email.

doctortvrao@gmail.comdoctortvrao@gmail.com