Role of operative infrastructurein prevention of infections

Dr Uday KumarSagar HospitalsSindhi HospitalChinmaya HospitalBangalore

17th Oct 2015RATS

Old Operation Theatre.

The Agnew Clinic, 1889, by Thomas Eakins, showing the observers watching the operation.

5.

Beginning of Safe Operation Theatre Practices

• 1867 – Dr. Joseph Lister first identifies airborne bacteria

-uses Carbolic acid spray in surgical areas.

• 1880 – Johnson and Johnson introduce antiseptic surgical dressings.

• All the materials used for an operation must be sterile.

• Basic items – linen, instrument set, basin

• Instrument sterilization :

1 night before

just before operation

• Once the instrument is removed from sterile wrapper :

use / discard

1. Linen colour : Dyed green(reduces glare from light & fatigue and eye strain).

2. Use sterile materials only

3. Sterile areas are setup just prior to use.

4. If in doubt : consider the material as unsterile.

5. Only the top surface of draped table is considered sterile.

Good Hand Washing Practices Save many Lives

1. Chlorhexidine 2 %2. Chlorhexidine 4 %3. Povidone with Iodine 7.5% - 10%

Areas of the harboring dirt and microorganisms

SCRUB AREA SINK

Incorrect Correct

Design

• scrub area sink should be wide

• should have depth of about 3 feet

--- prevents splashing of rebound water

• scrub sinks are fitted with doctors’ taps, rather

than ordinary taps, to facilitate its operation

with the help of arms

• peddle operated taps are ideal in scrub areas

as it permits hand free operations

Paper gown

Plastic gown

Linen gown

made up of cottonhaving a threadcount of 240 \ sqinch for the reusablestuff .

floors and walls should be-- smooth -- easily cleanable

-- should have minimum or no joints

Flooring should be- non porous-scratch proof- anti skid

walls should be covered withsmooth material like granite

ceilings should be painted withoil paints which give smooth finish

electrical fittings and water pipes in the OR must be concealed

OR complex should have only one entry and all the windows should be air tight

----Avoid contamination of wound.

---Contamination of surgical wound

is mostly from – skin / mucous membrane being incised.

• Other sources : nose, throat, hand, skin of operating team

members.

• Air contamination : omnipresent problem.

• All logical precaution & preparations should be done.

Stress must be laid on

1. Temperature

2. Humidity

3. Ventilation

Temperature : 24-270 C ---ortho 20 deg

Relative Humidity : 45% – 60% for adult

55% – 65% for infants

• 1 change / hr : contamination reduced by 60%

• 2 change / hr : contamination reduced by 86%

• 10 change / hr : contamination reduced by 99%

At least 10 to 20 airchanges per hour

Turbulent / mixing air distribution

Downward displacement piston system

Unidirectional airflow system lamellar flow ventilation

Zoning :To ensure aseptic conditions OT is divided into 4 zones :

1. Protective zone

2. Clean zone

3. Sterile zone

4. Disposal zone

Advantages of zoning

1. Minimizes hospital infection

2. Minimizes unproductive movement of staff, supplies &

patient.

3. Increases efficacy of operative team members.

4. Ensures smooth workflow.

5. Decreases hazards in operating room.

6. Ensures proper positioning of

equipment

STERILIZATION & DECONTAMINATION OF SURGICAL THEATRES

Why?1. Cleaning removes contaminants, dust, organic matter. 2. Disinfection reduces number of microbes.

Tuesday, December 8, 2015 25Operation Theater.

• Daily cleaning should be carried out after the operating sessions are over.

---All the walls must be wiped down to hand height everyday.

• Weekly cleaning of all the areas inside the operating theatre complex should be done thoroughly

Need for fumigation-common organisms

Staphylococcus aureus (16%)

• Coagulase negative staphylococcus aureus (26.7%)

• Acinobacter species (2.03%)

• Klebsiella (0.3%)

• E.coli----Pseudomonas --- Proteus

Procedure for fumigation:

• The windows are sealed

• formaldehyde generated either by

boiling a solution of formalin 40% or by

adding it to potassium permanganate

• The door is than closed and sealed.

• For a 10 x 10 x 10 ft room - 150 gm

potassium permanganate and 280 ml of

formalin are used

Fumigation Process.

Tuesday, December 8, 2015 29Operation Theater.

After fumigation

• Three swabs are taken from walls, all equipments, floor or O.T. table at intervals.

• 1st swab - 48 hrs after fumigation

• 2nd swab- 24 hrs after 1st swab

• 3rd swab - 12 hrs after 2nd swab

• All three consecutive swabs should come negative.

• Bacillocid is used for fumigation. It is combination of

chemically bound formaldehyde and glutaraldehyde.

• Ideally all O.T. rooms should be fumigated once a week

reduced infection rate in orthopaedicimplant surgeries with laminar flow systems and body exhaust suits—-Evans et al, Jbjs 2012

laminar flow systems and body exhaust suits

C arm ---potential source of infection—should be properly draped

High-Efficiency Particulate AirHEPA filters

-an air filter

- removes 99.97% of particles that have a size of 0.3 µm from the air

The Universal Precaution Rule:

Treat all human blood, bodily fluids and

other potentially infectious materials as if

they are infectious.

TAKE HOME MESSAGE

--The operation theatre should be clean

--Sterility should be maintained at all times

--Zoning in the OT is useful in reducing infection

--Fumigation is an essential component of OT protocol

--Hepa filters, laminar airflow and body suitshelp in reducing infection in orthopaedic surgeries