Bio safety in Operation Theaters

1. BIO-SAFETY IN
OPERATION THEATRES
Dr.T.V.Rao MD

2. Key Recommendations of CDC
and HICPAC
• Ventilation and water system
performance
• 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

3. Regulate the Operating Room
Environment
• Ventilation = positive
pressure.
– Variable air systems
(positive pressure only)
– Air introduced at the
ceiling and exhausted
near the floor
• Humidity <68%
• Temperature control

4. Can we Sterilize Operation theatre
• Sterilization means eradicating germs
completely, which is not 100%
possible in an operating theatre. The
sources of bacterial contamination
are from air and the environment,
infected body fluids, patients,
articles, or equipment.

5. Follow the Standard protocols
• Standard cleaning,
disinfection with
appropriate chemical
agents, good theatre
practice and
discipline can
provide a
microbiologically
safe environment.

6. 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.

7. A good hand washing and Monitoring
reduces infections
• 3 A thorough washing with warm water and
good detergent can bring more of an overall
improvement than solely decontamination
sterilization with other chemicals,
or fumigation.
• 4. Frequent monitoring and training of
medical and paramedical staff must carry a
high priority – don’t merely observe
mechanical and chemical methods.

8. Hand washing a boon to safety
• Thorough washing and
carbonizations, if done
every day after the
surgeries, will greatly
enhance the safety
standards and reduce
the repeated
expenditure on
fumigation.

9. Regulate the Operating Room
Environment
Minimize
personnel
traffic
during
operations

10. Surgical Attire
• Scrub suits
• Cap/hoods
• Shoe covers
• Masks
• Gloves
• Gowns

11. Surgeon and Skills
•
Technical skill set
– Excellent eye–
hand
coordination
– Extensive medical
knowledge
– Expertise in
Anatomy

12. Surgeon Skills
• Non-technical
skill set
– Situation
awareness
– Decision making
– Communication
and teamwork
– Leadership

13. Cleaning and Disinfecting
Environmental Surfaces
– Medical equipment surfaces
knobs, handles on
equipment such as x-ray
machines, instrument carts
– Housekeeping surfaces
floors, walls, chairs, and
tabletops

14. Cleaning and Disinfecting
• Medical Equipment
• Manufacturer’s recommendation for
sterilization
– Recommended chemical germicides
– Water-resistant properties
– Required decontamination after
servicing
– Non-critical medical equipment (see
intermediate level disinfection)

15. Cleaning and Disinfecting
•
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

16. Cleaning
• A form of
decontamination by
removing organic
matter, salts, and
visible soils
– Physical action of
scrubbing with
detergents or surfactants
and rinsing with water
– Necessary step prior to
sterilization or
disinfection

17. Cleaning Strategy
Minimize contamination of cleaning
solutions and tools
Change cleaning solutions frequently
– Replace soiled cloths and mop heads with
each cleaning solution change
– Launder cloths and mop heads after use
and allow to dry before re-use or use
disposable cloths and mop heads
Use manufacturers recommended
concentration

18. 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

19. Disinfection
“The process that eliminates many or all
pathogenic micro-organisms on inanimate
objects with the exception of bacterial
spores”
Spaulding’s* three levels of
disinfection:
• High-level
• Intermediate-level
• Low-level
*for
treatment of devices and surfaces that do not
require sterility for safe use

20. 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 enveloped
viruses
Utilize for items that come into contact with intact mucous
membranes and are heat sensitive
–
–
–
–
semi-critical medical instruments (s/a flexible fiber optic endoscopes)
thermometers
vaginal speculums
sigmoid scopes

21. Intermediate-level Disinfection
Includes Chlorine-containing
compounds, alcohols (small surfaces),
some phenolic, and some iodophors
Inactivates a highly resistant organisms
and exhibits some sporocidal activity
Utilize for non-critical medical
equipment s/a stethoscopes, blood
pressure cuffs, dialysis machines,
equipment knobs and controls.

22. 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

23. Monitor employee
compliance to
hand hygiene
recommendations

24. 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 protocols
to control environmental contamination with
antibiotic-resistant, gram-positive coccid

25. Hand Hygiene
• Avoid artificial nails and keep natural nails < ¼ 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

26. 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 may
not correlate.

27. Economical loss
• Money wasted on
unnecessary use.
• People concentrate on
Floors, Inanimate
objects,
If the resources are not
spend with scientific
understanding the
limited resources are
lost in particular
developing countries.

28. Disinfection x Sterilization
• Sterilization is absolute,
removes microbes and
spores too.
• To achieve Sterilization
is Expensive, not
sustainable, many
times not needed.
• An effective
Disinfection reduces
the infections
drastically.

29. Basic care of Operation Theatres.
• Reduction of Microbial
counts is important.
• Very rarely the Microbes
reach the operation site,
• Paying great attention to
Floors Using unnecessary,
too many chemical not
necessary
• Keep the floor Clean and
Dry - Bacteria are reduced,
• Most Important component of
Bacteria is water a dry areas
causes natural death except
spores

30. Frequent cleaning of Walls and Roof of
Operation Theatre is not needed
• 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, has direct
relation to increase of
bacterial counts

31. Do not disturb the Roof
• Do not disturb
unnecessarily,
• Do not use ceiling fans
they cause aerosol
spread
• Clean only when
remodeling or
accumulated ,good
amount of dust.

32. How you care for Floors
• Use only
vacuum
cleaners
• Don't broom
• As it increases the
bacterial flora in
the environment

33. Cleaning the Floor
• A simple detergent
reduces flora by
80 %
• Addition of
disinfectant
reduces to 95 %
• In busy Hospitals
counts raise in 2
hours

34. Aldehyde free sterilization of
Operation theatres
• Some of the emerging compounds developed
for use in the sterilization of operating
theatres are more effective for environmental
decontamination, have a very good
cost/benefit ratio, good material compatibility,
excellent cleaning properties and leave
virtually no residues. One particular product
available has the advantage of being a
Formaldehyde-free disinfectant cleaner with
low use concentration

35. Are Flowers Safe in the Hospital ?

36. 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/Orthopedic
wards and critical care
areas.

37. Who/What is Important in prevention
of Infections

38. Remember we are More
important than many

39. 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 in
Hospital safety and Hygiene
• Educate the staff on few useful option, many
theoretical ideas confuse.
• To many Chemicals – Costly, need not be
effective.

40. Importance of Staff Education
• Specify the staff for
duties and
responsibilities.
• Education is a matter of
continuity
• Train under the seniors
observation.
• Train the staff with
scientific goals

41. Operation Theatre Safety
is
Responsibility
Of

42. Everyone

43. CDC Definition of Surgical Site
Infections
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

44. Frequent Washing of Hands saves
several Lives Universally

45. !
Protect patients…protect healthcare personnel…
promote quality healthcare!

46. Created from Web sources
Visit for Articles of Interest on Infectious
Diseases

47. • Programme Created by Dr.T.V.Rao MD
for Medical and Paramedical
Professionals in the Developing World
• Email
• doctortvrao@gmail.com