operation theatre sterilization
TRANSCRIPT
![Page 1: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/1.jpg)
Operation Theatre - STERILIZATION
Presenter – Dr. Sukumar.T.K.
![Page 2: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/2.jpg)
Freeing of an article from all living organisms including viable spores. Process that kills more than 106 organisms ,
including spores of a defined exceptionally high degree of resistance.
Sterilization
![Page 3: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/3.jpg)
1867 – Dr. Lister Joseph, identifies airborne bacteria. Uses carbolic acid spray in surgical areas.
1880 – Johnson and Johnson introduce antiseptic surgical dressings.
Use of Carbolic acid reduced Hospital associated infections.
Safe Operation Theatre Practices – The Beginning
![Page 4: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/4.jpg)
Surgical Site Infections
![Page 5: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/5.jpg)
![Page 6: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/6.jpg)
![Page 7: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/7.jpg)
![Page 8: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/8.jpg)
2nd most common cause of hospital acquired infections.
Mortality as high as – 77% . Sources –
Endogenous Exogenous
Maintaining sterile environment – control of major part of exogenous infections
Surgical Site Infection
![Page 9: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/9.jpg)
Operating Room Environment Ventilation
Dust, lint, skin squames, respiratory droplets. Microbial level Number of people moving in
room. Operating room should be maintained at
Positive Pressure.
Sources of Infectious Agents in OT
![Page 10: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/10.jpg)
Types of Ventilation Mixing Parallel Flow –(Laminar Airflow)
a)Vertical Parallel Flowb)Horizontal Parallel Flow
![Page 11: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/11.jpg)
OP – Box Ventillation
![Page 12: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/12.jpg)
Ventilation Systems
Mixing
Vertical Parallel Flow
Horizontal Parallel Flow
![Page 13: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/13.jpg)
All ventilation systems in hospital should have two filter beds in series (first = ≥30% ; second = ≥90%) – Ultra clean air.
Laminar airflow and use of UV is suggested to reduce SSI (velocity – 0.3-0.5µm/sec). Minimum of 12 cycles/hr
Recirculated air passed through HEPA Filter.
![Page 14: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/14.jpg)
Environmental Surfaces Routine cleaning has to be performed. Cleaned after contact with blood or potentially
infectious material. Wet vacuuming to be performed after last
operation of day or night.
![Page 15: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/15.jpg)
Frequent cleaning of walls and roof - not needed.
These areas should not be disturbed unnecessarily.
Floors get contaminated quickly – Depends on number of people present.
Ceiling fans should not be used. Clean roof – when remodelling or
accumulated good amount of dust.
Roof, Floors and Walls
![Page 16: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/16.jpg)
1% of microbes present on floor are pathogenic.
Simple detergent - reduces flora by 80%
Addition of disinfectant – 95%
70% alcohol – Disinfectant.
contd.
![Page 17: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/17.jpg)
![Page 18: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/18.jpg)
Fumigation
![Page 19: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/19.jpg)
Formaldehyde vapour – Produced on low temp heating.
Vapour phase decontaminates the air / environment.
Mechanism – alkylates amino acids and sulfydral group of proteins and purine bases.
Used widely to sterilize huge areas like operation theatres INSPITE OF BEING HAZARDOUS as it is cheap.
Fumigation
![Page 20: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/20.jpg)
Thoroughly clean windows, doors, floors and all washable equipment with soap and water.
Close windows and ventilators tightly. Switch off all lights, A/C and other electronic
items. Calculate room size and required amount of
formaldehyde.
Fumigation - Procedure
![Page 21: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/21.jpg)
Electric Boiler Fumigation For 1000 cu.ft of ot – 500ml of formalin added
in 1000ml water In electric boiler. Boiler switched on and kept on for 45 min. Switched off without entering room.
Creating Formaldehyde
![Page 22: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/22.jpg)
![Page 23: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/23.jpg)
Potassium permanganate method For 1000 cu.ft add 450gm KMno4 to 500mlof
formalin. Seal room and leave it for 48hrs.
Residual formaldehyde gas neutralised by using ammonia. (3Hrs)
![Page 24: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/24.jpg)
![Page 25: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/25.jpg)
Ecofriendly, non toxic non irritating environmental disinfectant.
Has bactericidal, virucidal, tuberculocidal, fungicidal and sporicidal action.
Complex formulation of stabilised 11% w/v hydrogen peroxide with 0.01% silver nitrate solution
Eco shield™ (Bio shield)
![Page 26: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/26.jpg)
Formaldehyde free. No residue. Glutaral 100mg/g, benzyl-C12-18-
alkyldimethylammonium chloride 60mg/g, didecyl-dimethylammonium chloride 60mg/g.
Wet wipe procedure.
Bacillocid rasant™
![Page 27: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/27.jpg)
Virkon Disinfects medical devices. Disinfects laboratory equipment. Decontaminate spillages with blood and
body fluids. Replace autoclaving and saving time.
Newer non toxic compounds
![Page 28: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/28.jpg)
Monitoring of hospital associated infections Training of health care workersInvestigations of outbreaksAny technical lapsesMonitoring of staff health
Infection Control Programmes
![Page 29: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/29.jpg)
Education of universal precautionsAdvice on isolation of infectious patientsWaste disposalSafe use of antibiotics
Contd..
![Page 30: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/30.jpg)
![Page 31: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/31.jpg)
Role of Microbiology Department
Identifies pathogen Monitoring of antibiotic therapy Education on specimen collection Information on common antibiogram
patterns Data on hospital infection Surveillance of hospital environment Counselling of hospital staff.
![Page 32: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/32.jpg)
Settle plate method Position, duration. Blood agar exposed for specified period and
incubated
Slit sampler method Very effective and highly sensitive. Fixed volume of air is sucked and counts made
Air surveillance
![Page 33: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/33.jpg)
Factors influencing – i. Number of persons presentii. Body movementsiii. Disturbances of clothing
![Page 34: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/34.jpg)
Counts vary on number of personnel present on given area.
Nature of procedures ONLY 1% ARE PATHOGENIC Presence of Staphylococcus aureus makes
difference
Significant count??
![Page 35: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/35.jpg)
Detection of spores of Cl.tetani in ot – losing relevance
Routine testing for anaerobic spores not essential.
Anaerobic spores
![Page 36: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/36.jpg)
![Page 37: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/37.jpg)
AIMS To provide sterilized material from a central
department
To alleviate the burden of work of the nursing personnel
To facilitate the wards to function smoothly
Central Sterile Services Department
![Page 38: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/38.jpg)
Receipt and delivery of equipment from all areas of the hospital
Supply of sterile materials for dressings and procedures carried out in wards and departments
Supply of operation theatres with the necessary sterile instruments and linen
FUNCTIONS
![Page 39: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/39.jpg)
To disassemble, clean and check for proper function of equipment, such as suction machines, feeding pumps, i.v infusion pumps etc.
To dry, wrap, bag and seal items in preparation for sterilization
![Page 40: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/40.jpg)
CSSD can broadly be classified into two parts:
Central Unit: Responsible for receiving dirty utilities, cleaning, processing, sterilization, storage and supply.
Peripheral Unit: Mainly responsible for DISTRIBUTION to various areas
TSSU (Theater Sterile Supply Unit)
PLANNING OF A CSSD
![Page 41: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/41.jpg)
TSSU: In large hospitals, where number of OTs function, these have peripheral sterilization units known as Theater Sterile & Supply Units. (TSSU) These work under high pressure and takes less
time for sterilization. Specially in hospitals, where the Central Unit
does not function round the clock.
PERIPHERAL UNIT
![Page 42: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/42.jpg)
Dressing set/ tray Suture removal set Suturing set Cut down tray Tracheostomy set Gloves(nowadays disposable)
ITEMS COMMONLY HANDLED BY CSSD STORES
![Page 43: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/43.jpg)
HSG and CT set Lumbar puncture set Bone marrow/ liver/ kidney biopsy set Burn pack Intra costal drainage (ICD) procedure set
![Page 44: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/44.jpg)
Catheter set Tapping/Aspiration set
![Page 45: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/45.jpg)
1. Receiving used items2. Cleaning3. Packing4. Sterilizing5. Storing (temporary)6. Distributing to user departments
Major Activities in CSSD
![Page 46: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/46.jpg)
RECEIVE
DIRTY ITEMS
CLEANING &DRYING
PACKAGING &LABELLING
GLOVERS, DRIP SET
RUBBER GOODS
SYRINGES ,LINENSGAUZE,COTTON
INSTRUMENTS
ETOGAMMA
RADIATION HEAT
DRY/ MOIST CHEMICAL
STERILIZATION
STERILE STORAGE DISTRIBUTION
![Page 47: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/47.jpg)
Should have access to outside through a window with a counter.
The items (especially for instruments in trays) are counted and received.
Instruments are inspected and blunt/unsuitable instruments are segregated/ discarded.
Necessary entries are made for records. Items shifted to cleaning area.
RECEIVING AREA
![Page 48: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/48.jpg)
Washing-Cleaning is the removal of visible soil (e.g., organic and inorganic material) from objects and surfaces
If used items are not decontaminated in user department then blood/ body fluid soiled items should be decontaminated with sodium hypochlorite before handling further.
Rinsing-Sorting-Soaking-Washing-Drying
CLEANING AREA
![Page 49: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/49.jpg)
Rinsing-Detergents (preferably enzymatic) &brushes of various sizes and shapes are required in this area.
Instruments washed either manually or in machines.
For manual washing sinks with water supply and working counters are organized
![Page 50: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/50.jpg)
Tunnel washer - highly sophisticated machine that allow totally hand-off processing.
Instruments coming from operating room or other departments are placed into the tunnel washer without any further handling. The instruments are subjected to cycles washing, rinsing, ultrasonic cleaning and drying.
![Page 51: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/51.jpg)
Ultrasonic washer is a machine used for cleaning surgical instruments
It converts high frequency sound waves into mechanical vibration that produces small bubbles that burst on the internal surfaces of instruments and dislodge the waste particles.
After the instruments are washed, they are dried in oven dryer and shifted to packing area.
![Page 52: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/52.jpg)
CATEGORY ITEMS PROCEDURE
Critical Enter tissue, through which
blood flows
Sterilization
Semi – Critical Touch mucous membrane, touch
non intact skin
High level disinfection
Non – Critical Bandage, BP Cuffs Low level disinfection
Procedures Used
![Page 53: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/53.jpg)
High Temp – Steam Sterilization Low Temp – Ethylene Oxide gas, Hydrogen
peroxide gas plasma
Sterilization
![Page 54: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/54.jpg)
Liquid Immersion ≥2.4% Glutaraldehyde for 10hrs 1.12% Glutaraldehyde and 1.93% phenol for 12 hrs 7.35%hydrogen peroxide and 0.23%peracetic acid
for 3hrs 7.5% Hydrogen peroxide for 6hrs 1.0% Hydrogen peroxide and 0.08% peracetic acid
for 8hrs. ≥ 0.2% peracetic acid for 50 min at 50-56 degree
Celsius
![Page 55: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/55.jpg)
Heat automated – Pasteurization for 50 min Liquid immersion
2% glutaraldehyde for 20 – 45min 0,55% ortho – pthalaldehyde for 12 min 1.12% glutaraldehyde and 1.93% phenol for 20
min 7.35% hydrogen peroxide and 0.23% paracetic
acid for 15 min 650 – 675 ppm chloride for 10 min
High level Disinfection
![Page 56: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/56.jpg)
![Page 57: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/57.jpg)
The shelf life of the sterile materials depend on the quality of packing materials used and the status of cleanliness of storing area.
Generally the items sterilized by steam autoclave can be used for one week and ETO packs can be used for 6 months.
SHELF LIFE OF STERILIZED ITEMS
![Page 58: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/58.jpg)
Receipt register- to keep account of all the trays with instruments received in CSSD
Issue register to keep account of all the materials issued to users
Stock ledger of non consumable items- e.g. trays, instruments
RECORDS
![Page 59: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/59.jpg)
Stock ledger of consumables- to keep account of the cotton and gauze received, and issued by the CSSD
Number of loads per machine per day Duty rosters of staff Log book of machine
![Page 60: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/60.jpg)
Soap, Water and Common Sense – Yet the best
antiseptic
Importance of Hand Washing
WILLIAM OSLER
![Page 61: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/61.jpg)
VENTILATION SYSTEMS IN OPERATING THEATRES, ASPECTS TO CONSIDER. A JOHNSON MEDICAL BULLET IN (REPUBLISHED 2002)
Operating theatre commissioning -Microbiological From HICSIG
Guidelines for prevention of hospital acquired infections. Yatin Mehta, Abhinav Gupta, etal.
Guideline for Prevention of Surgical Site Infection, 1999. Alicia J, Teresa C, etal
Reference
![Page 62: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/62.jpg)
Recommendations for Infection Control for the Practice of Anaesthesiology. Developed by the ASA Committee Occupational Health Task Force on Infection Control.
Procedure-associated Module SSI – CDC OT Sterilization. T V Rao Text book of microbiology Mackie and
McCartney-14th edition.
![Page 63: Operation theatre sterilization](https://reader034.vdocument.in/reader034/viewer/2022050702/554b1599b4c9056f098b4cbd/html5/thumbnails/63.jpg)
THANK YOU