1. Sterilization of Operation Theatres update
Dr.T.V.Rao MD
Dr.T.V.Rao MD

2. History of Hygiene Code of Hygiene Bible Book of Leviticus
Chapter 11 – 15
Code of Hygiene
Dr.T.V.Rao MD

3. Greek Era Aristotle Greek Philosopher recommends
Boiling water to armies. Advises the Alexander.
Recommends hygiene for healthy living
Dr.T.V.Rao MD

4. HAND WASHING- Semmelweis
Practices, emphasizes the importance of washing hands with chlorinated water in Obstetrics to reduce maternal mortality
Dr.T.V.Rao MD

5. Beginning of Modern Nursing
The Very First Requirement in
Hospitals that should do the sick no harm
Florence
Nightingale
( Notes on Nursing 1860 )
Dr.T.V.Rao MD

6. Florence Nightingale creates fundamentals in Nursing care
Dr.T.V.Rao MD

7. Beginning of Safe Operation Theatre Practices
1867 –Dr.Joseph Lister first identifies airborne bacteria and uses Carbolic acid spray in surgical areas
1880 – Johnson and Johnson introduce antiseptic surgical dressings.
Dr.T.V.Rao MD

8. Historical Aspects Changed the History
Lister era 1868 changed the concept of safe surgical procedures.
Carbolic Acid in decontamination caused Reduction of Hospital associated infections
Mortality reduced
Morbidity reduced.
Dr.T.V.Rao MD

9. Sterile Environment reduces Surgical site infections.
Surgical site infections SSI are the second most common cause of hospital acquired (Nosocomial) infections. These complications of surgical procedures cause considerable morbidity and, when these occur deep at the site of the procedure, can lead to mortality as high as 77%. The source of SSIs may be endogenous (normal flora of the patient’s skin, mucous membranes, or hollow viscera) or exogenous, which includes surgical personnel (especially members of the surgical team), the operating room environment (including air), and tools, instruments, and materials brought to the sterile field during an operation. By maintaining sterile environment in operation theatre we can control major part of exogenous infections.
Dr.T.V.Rao MD

10. 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.
Dr.T.V.Rao MD

11. 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 countreis.
Dr.T.V.Rao MD

12. Basic Principles
Cleaning more Important than Disinfection and Sterilization ?
However
Cleaning
Removes contaminants,
Dust, organic matter,
Disinfection
Reduces number of microbes
Dr.T.V.Rao MD

13. 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.
Dr.T.V.Rao MD

14. 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
Dr.T.V.Rao MD

15. 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
Dr.T.V.Rao MD

16. 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.
Dr.T.V.Rao MD

17. Care of Floors
Do remember only 1 % of the microbes present on the floors are pathogenic.
On many occasion S.aureus. Isolated as a prominent pathogen
Floor should be decontaminated with
Vacuum cleaner.
and Wet cleaning techniques
Keep the mops dry when not in use.
Dr.T.V.Rao MD

18. How you care for Floors Use only vacuum cleaners Don't broom
As it increases the bacterial flora in the environment
Dr.T.V.Rao MD

19. Cleaning the Floor A simple detergent reduces flora by 80 %
Addition of disinfectant reduces to 95 %
In busy Hospitals counts raise in 2 hours
Dr.T.V.Rao MD

20. Environmental Cleaning of Operation Theatres
Do not waste chemicals.
Only remove the dust with cloth wetted with clean water,
Don't use chemicals/Disinfectants as a habit,
Use only when contaminated with blood or body fluids.
Dr.T.V.Rao MD

21. Handling of Air in Operation theatre.
Negative Air pressure vented to the operation theatre.
Environmental cleaning should be twice daily
Dr.T.V.Rao MD

22. Environmental cleaning of Hospital with Chlorinated compounds.
Disinfectant Purpose
Sodium hypochlorite Contaminated with
Blood and body
fluids
Bleaching powder Toilets, bathrooms
9 grams/lit
Dr.T.V.Rao MD

23. Environmental cleaning of instruments and equipment in OT
Disinfectant
Alcohol 70%
used in cleaning Metal surfaces and Trolleys
However expensive for hospitals in developing countreis
Dr.T.V.Rao MD

24. Fumigation a biohazard procedure ?
Dr.T.V.Rao MD

25. Fumigatation Formaldehyde a Age old compound.
Low temp heating produce vapor
Vapor phase decontaminates the air/environment.
Kills vegetative bacteria / Spore ?
When Formaldehyde mixed with water and exposed to elevated temperature
Gaseous formaldehyde is generated
Time X Temp
Dr.T.V.Rao MD

26. Fumigation
To sterilize the operation theatre formaldehyde gas (bactericidal & sporicidal,viricidal) is widely employed as it is cheaper for sterilization of huge areas like operation theatres. Formaldehyde kills the microbes by alkylating the amino acids and sulfydral group of proteins and purine bases.
In spite of the gas being hazardous continues to be used in several developing countreis
Dr.T.V.Rao MD

27. Interesting, right?
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