1. A R A V I N D E Y E C A R E S Y S T E M S Sr.Alikutty Varghese, OT In-charge

2. A R A V I N D E Y E C A R E S Y S T E M S Disinfection & Sterilization Disinfection : The Destruction of all the Pathogenic organisms capable of giving rise to infection Asepsis: It is a technique to prevent infection by eliminating micro- organisms. Sterilization : Defined as a process by which an article surface or medium is made free from all micro-organisms including spores.

3. A R A V I N D E Y E C A R E S Y S T E M S Parameters for Sterilization Nature of product associated Process associated Nature of product associated  Bio-burden – Degree of contamination  Bio- Resistance – Heat or moisture sensitivity and product stability  Bio Shielding – Nature f materials used for packing and their response towards sterilization  Density – Factors affecting penetrating

4. A R A V I N D E Y E C A R E S Y S T E M S Process associated  Temperature to achieve sterilization  Duration  Concentration of the agent  Capacity of sterilizer Parameters for Sterilization Contd….

5. A R A V I N D E Y E C A R E S Y S T E M S Methods of Sterilization Physical Agent Chemical Agent a.Dry Heat Sterilization b.Moist Heat Sterilization a.Gas sterilization b.Activated Glutaraldehyde c.Formaline sterilization d.Alcohol (70% Isopropanol) e.Povidine Iodine f.Dettol

6. A R A V I N D E Y E C A R E S Y S T E M S Physical Agent Dry Heat: A form of hot air is used to sterilize items that steam or ethylene oxide gas cannot penetrate. Advantages: 1.Hot air penetrates on certain substances that steam or gas cannot penetrate 2.Dry heat can be used in laboratories to sterilize glassware 3.Dry heat is protective method to sterilize delicate instruments 4.Instruments that cannot disassembled can be sterilized in hot air 5.Carbon steel does not become corroded or discoloured in dry heat

7. A R A V I N D E Y E C A R E S Y S T E M S Physical Agent (Cont..) Moist Heat : Pasteurization, boiling, steam under normal pressure, steam under pressure (Autoclave) Boiling : All pathogenic organism are killed within 15 min. of boiling at 100 0 C of temperature

8. A R A V I N D E Y E C A R E S Y S T E M S Sterilization Autoclave: Moist heat in the form of saturated steam under pressure is a dependable physical agent for the destruction of all form of microbial life including spores. The death of micro organisms by moist heat is caused by coagulation of the cell protein. Loading Unloading

9. A R A V I N D E Y E C A R E S Y S T E M S Sterilization Time for Autoclave PressureTemp.Time Linen & Instruments 15 pound121 0 C30 min. Rubber Items15 pound121 0 C10 min. Liquids15 pound121 0 C10 min.

10. A R A V I N D E Y E C A R E S Y S T E M S Autoclave Prevaccum High Speed Autoclave The pre vacuum high temperature autoclave requires the least time to sterilize a single load. Flash autoclave is an example for this. This is commonly used sterilize only instruments in between surgery. All the air is evacuated using a vacuum pump before admitting steam. This cause rapid rise of temperature (134 0 C). It permit instant steam penetration. The sterilization time is reduced to fifteen minutes. The cycle is timed automatically

11. A R A V I N D E Y E C A R E S Y S T E M S Autoclave Advantages of Steam Sterilization a.Steam sterilization is the easiest, safest and surest method of sterilization b.Steam sterilization is a fastest method c.Less expensive and easily supplied d.Steam sterilizer have automatic control e.Steam sterilization leaves no harmful residual

12. A R A V I N D E Y E C A R E S Y S T E M S Cleaning of Instruments Ultra sonic Instruments cleaning Manual cleaning

13. A R A V I N D E Y E C A R E S Y S T E M S Bin Packing Method All the items should be cleaned and dried properly All the detachable items are disassembled Oil and lubricants are wiped off well because steam or gas will not penetrate through it Rubber items should not be folded and kept separately from metal instruments to prevent damage Hinged instruments must be kept open with box locks unlocked permit steam contact on all surface Instrument must be kept open with box locks unlocked permit steam contact on all surface

14. A R A V I N D E Y E C A R E S Y S T E M S Instrument must be placed in a perforated tray to allow steam penetration Sharp and delicate instruments placed on top of the tray Loose packing and space between items are very important for easy circulation and penetration of steam Indicator (autoclave tape) should be placed in the bottom, middle and top of the bin to check whether the autoclave is functioning correctly. If the indicator colour remains the same the sterilization cycle is inadequate Name of the item, date of sterilization, date of expiry should be mentioned on each package. Close the bin and keep the holes open so that the steam can enter and penetrate easily. Bin Packing Method Cont…

15. A R A V I N D E Y E C A R E S Y S T E M S Bin Packing Cont… Control : Positive assurance that sterilization condition is achieved by either steam under pressure, gas sterilization or hot air oven can be obtained only through a biological test. One spore strip can be placed at the bottom of the bin and sterilize in a routine cycle. Once the cycle is completed the spore strip is taken out and sent to the laboratory.

16. A R A V I N D E Y E C A R E S Y S T E M S Linen Packing Gowns are folded in such a way the inside part faces outside so the surgeons and the nurses wear the gown without touching the outside portion. While folding the eye towels the holes of the towel must be visible. Avoid packing items too lightly to enable steam penetration in each and every layer of the liners

17. A R A V I N D E Y E C A R E S Y S T E M S Chemical Agent Definition : They destroy micro-organisms by protein coagulation and breaking the cell membrane A. Ethylene Oxide Gas sterilization AdvantageDisadvantage It damages very little materialsIt is slow and costly method It can sterilize materials that cannot be sterilized by other methods It is flammable and toxic in nature Effective against all organismsIt requires special equipment Achieve good penetration

18. A R A V I N D E Y E C A R E S Y S T E M S Activated Glutaraldehyde AdvantageDisadvantage It is not corrosive and non staining It is very costly It is not absorbed by rubber articles or plastic It has to be discarded after 15 days of activation It can be reused throughout effective activation period Glutaraldehyde is effective in room temperature

19. A R A V I N D E Y E C A R E S Y S T E M S Operation Room Cleaning Purpose : To destroy microorganisms as quickly as possible To protect operating room personnel from getting in contact with known or unknown infectious materials To prevent cross contamination

20. A R A V I N D E Y E C A R E S Y S T E M S Operation Room Cleaning Procedure : The floor is swept first Equipment such as electro surgical units should be checked up and cleaned well Ceiling and wall mounted fixtures are cleaned Cabinets and doors are cleaned, especially around the handles or push plate Walls of the scrub sink need special attention Transportation carts and wheels need special attention

21. A R A V I N D E Y E C A R E S Y S T E M S Operation Room Cleaning Procedure : (contd…) Waste buckets are cleaned well and disinfected Furniture’s are thoroughly scrubbed and cleaned with chemical disinfectant Floor is always mopped up at last. Clean mop is used to mop the floor Keep two buckets for mopping floor, one with plain water and the other with chemical disinfectant (e.g..Dettol 1:4 dilution in water) First dip the mop cloth in dettol, wrung out and again dip in dettol water, and mop up the floor in same manner

22. A R A V I N D E Y E C A R E S Y S T E M S Operation Room Cleaning Weekly / Monthly Cleaning : Remove all the furniture & equipment from Operating room suit Cleaning and replacement of air conditioner filter AC filter, clean and the dust away from OT was the filter, dip in antiseptic solution, dry it and replace Regular cleaning of all sterilizers must be done as recommended by the manufacturers. Floors through out the operating room suit should be machine – Scrubbed periodically to remove the accumulated deposits Washing the walls and floors in the operating room, suit once a week is very important Clean and arrange all the equipment and furniture in proper place after washing operating room Mop the floor as mentioned before

23. A R A V I N D E Y E C A R E S Y S T E M S Operation Room Fumigation How: Equal quantity of distil water is added in the OT care machine as required according to the size of the operating room The solution is poured into the machine and the fan placed above the machine is operated electrically, and that leads to the evaporation of formalin Advantages : Significant reduction of bacteria in the environment Effective decontamination of exposed surface Decreased housekeeping costs

24. A R A V I N D E Y E C A R E S Y S T E M S Conclusion  A Good surgery can be spoiled by infection  Infection prolongs hospital stay for the patients.  Increase the cost, both for the patient and the Institution

25. A R A V I N D E Y E C A R E S Y S T E M S