Sterilization and

Decontamination
of Surgical Theatres
and Critical areas

Vijay Pratap
Raghuvanshi
History of Hygiene
Bible
Book of Leviticus
Chapter 11 – 15
Code of Hygiene

Vijay Pratap
Raghuvanshi
Greek Era
 Aristotle recommends
Boiling water to armies.
Advises the Alexander

Vijay Pratap
Raghuvanshi
HAND WASHING
 Semmelweis
 Practices emphasizes
the importance of
washing hands with
chlorinated water
 In Obstetrics to reduce
maternal mortality

Vijay Pratap
Raghuvanshi
Starting of Modern Era 1860
Dr.Joseph Lister
Phenol in Surgery and
Decontamination
practices

Vijay Pratap
Raghuvanshi
Beginning of Modern Nursing

The Very First

requirement in
Hospitals that should
do the sick no harm

Florence
Nightingale
( Notes on Nursing
1860 )
Vijay Pratap
Raghuvanshi
Historical Aspects Changed
the History
 Listerera 1868
 Carbolic Acid in decontamination,

 Reduction of Hospital associated infections

 Mortality reduced

 Morbidity reduced.

Vijay Pratap
Raghuvanshi
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.

Vijay Pratap
Raghuvanshi
What is wrong with our
Practices
 Disinfectantsused indiscrimately,
 Used unnecessarily

 Not used when needed.

 Concentration not adequate

 Economic consideration,

 Business promotions.

 Laboratory testing X Hospital conditions.

Vijay Pratap
Raghuvanshi
Economical loss

 Money wasted on unnecessary use.

 People concentrate on

Floors, Inanimate objects,

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Raghuvanshi
Basic Principles
 Cleaning more Important
 Disinfection and Sterilization ?

 Cleaning

Removes contaminants, Dust, organic

matter, Disinfection Reduces number of
microbes

Vijay Pratap
Raghuvanshi
Disinfection x Sterilization
 Sterilization
is absolute, removes microbes
and spores too.
 To achieve Sterilization is Expensive, not
sustainable, many times not needed.

Vijay Pratap
Raghuvanshi
Basic care of Operation
Theatres.
 Reduction of Microbial counts is important.
 Very rarely the Microbes reach the operation site,
 Paying attention to Floors
 Using unnecessary, too many chemical not
necessary
 Keep Clean Dry - Bacteria are reduced,
 Most Important component of Bacteria is water, dry
areas causes natural death.

Vijay Pratap
Raghuvanshi
Walls and Roof of
Operation Theatre
 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,
On many people make unnecessary
movements than needed

Vijay Pratap
Raghuvanshi
Care of and Floors
 Do remember only 1 % are pathogenic.
 On many occasion S.aureus.

 Floor should be decontaminated with

Use Vacuum cleaner.

Wet cleaning techniques
Wet Mop / Keep the mops dry

Vijay Pratap
Raghuvanshi
Care of Roof
 Do not disturb unnecessarily,
 Do not use ceiling fans they cause aerosol
spread
 Clean only when remodeling or accumulated
,good amount of dust.

Vijay Pratap
Raghuvanshi
How you care for Floors
 Use only vacuum cleaners
 Don't broom

 Use a Mop keep it dry,

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Raghuvanshi
Roof, Artificial ceilings, Walls
 Donot disturb every day
 Routine disinfection not necessary

Vijay Pratap
Raghuvanshi
Caring for Floors
 Only 1 % are pathogenic
 The counts depend on the number of persons

 Only people needed for procedures should

enter the theatres.
 Unnecessary movements disturbs the
bacterial flora

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Raghuvanshi
Cleaning the Floor
A simple detergent reduces flora by 80 %
 Addition of disinfectant reduces to 95 %

 In busy Hospitals counts raise in 2 hours

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Raghuvanshi
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.

Vijay Pratap
Raghuvanshi
Handling of Air in Operation
theatre.
 Negative Air pressure vented to the operation
theatre.
 Environmental cleaning should be twice daily

Vijay Pratap
Raghuvanshi
Environmental cleaning of
Hospital.
 Disinfectant Purpose

Sodium hypochlorite Contaminated with

Blood and body
fluids
Bleaching powder Toilets, bathrooms
9 grams/lit

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Raghuvanshi
Environmental cleaning of OT
Contd
 Disinfectant Purpose
Alcohol 70% Metal surfaces
trolleys

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Raghuvanshi
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

Vijay Pratap
Raghuvanshi
Methods on Fumigation
 In principle we have to generate Formaldehyde gas.
 Can be done by

Most easier way to mix the needed quantity of

Formalin to water and heating at lower temperatures
at 80 – 90
Addition of Formalin to potassium permanganate

Vijay Pratap
Raghuvanshi
Procedure of Fumigation
 Seal the room with adhesive tape.
 Sealing the edges around the doors is important,
 Measure the volume of your operation theatre
 For each 1000 cu ft use 500 ml of formaldehyde.
 Mix with water @ 1000 ml for 500 ml of
Formaldehyde needed.
 Seal the Room for 24 hours,
 Open the Door / Avoid the formalin gas with mask
 Neutralize Residual formalin gas with Ammonia by
exposing 250 ml of Ammonia per liter of
Formaldehyde used.

Vijay Pratap
Raghuvanshi
Safety of Air conditioning and
Water cooling system
 Legionnaires disease is associated with Air
Condition system
 Chlorination / Heating of water may prove
better alternatives.

Vijay Pratap
Raghuvanshi
Between procedures in the
Operation Theatres.
 Clean operation tables, theatre equipment with
disinfectant solution with detergent,
 In case of spillage of blood / body fluids
decontaminate with bleaching powder/chlorine
solution ( 1 % available chlorine ).
 Always discard wastes in prescribed plastic bags –
Don’t accumulate biohazard waste in the operation
theatres.
 Don’t discard discarded soiled gowns in the
operation theatre.

Vijay Pratap
Raghuvanshi
At the End of the Day
in Operation theatre.
 Clean all the table tops sinks, door handles with
detergent / low level of disinfectant.
 Clean the floors with detergents mixed with warm
water,
 Finally mop with disinfectant like Phenol in the
concentration of 1 : 10
 Low concentration of Phenol serve as perfume and
not as disinfectant.

Vijay Pratap
Raghuvanshi
Infection control programmes
1 Monitoring of Hospital associated infections.
2 Training of Health care workers.
3 Investigations of outbreaks.
4 Any technical lapses.
5 Monitoring of staff health
6 Education on Universal Precautions
7 Advise on isolation of Infectious patients.
8 Waste disposal
9 Safe use of Antibiotics / Antibiotic policy.

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Raghuvanshi
Role of Microbiology
Department
 Identifies the pathogens
 Monitoring of Antibiotic therapy,
 Education on specimen collection and
transportation,
 Information on common Antibiogram patterns
 Data on Hospital Infection
 Surveillance of the Hospital environment
 Counseling of the Infected Hospital Staff.

Vijay Pratap
Raghuvanshi
Surveillance of Operation theatre
Examination of Air
 Estimations are done for detection of bacteria
carrying particles in Air.
 Factors influence

Number of persons present.

Body movements,
Disturbances of clothing.

Vijay Pratap
Raghuvanshi
Methods of Air surveillance
1 Settle plate method.
2 Slit sampler method (from given volume)
3 Counts vary from one to many
Settle plates method
Record position – Time - Duration
Plates with media as Blood agar exposed for
specified period and incubated in the
incubator for 24 hours at 37º c

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Raghuvanshi
Slit Sampler
 Very Effective / Highly sensitive
 Fixed volume of air is sucked and bacterial
counts are made

Vijay Pratap
Raghuvanshi
How many bacteria are
pathogenic
 Counts vary On number of personal present in the
given area.
 Behavior of the persons.
 Depend on nature of procedures, type of operations.
 Varying ranges
 But remember only 1 % are pathogenic
 Presence of S. aureus makes difference

Vijay Pratap
Raghuvanshi
Do we need surveillance
regularly
 Bacteriological surveillance testing at
regular internals is not warranted,
 But warranted when modification of
operation theaters are done,
 In any unforeseen increase of
incidence of infection form any
particular operation theatre.

Vijay Pratap
Raghuvanshi