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Environmental Control of Operating Theater

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حنان المساوى

on 19 November 2014

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Transcript of Environmental Control of Operating Theater

Environmental Control of Operating Theater
Prof. Dr/ Gehan Fahmy
operation room Construction Role in Minimizing SSI
Infection Control Consultant ASUSH and Prof of Microbiology

Post-operative wound infections (or surgical site infections, SSIs) delay recovery, increase length of stay & are associated with increased morbidity & mortality
They increase healthcare costs by delaying discharge & increasing the need for investigation, treatment & nursing care
Prevention or reduction of SSIs is thus an essential part of quality patient care.
Low rates of SSIs are associated with education, awareness of the causes of infection & the implementation of infection control practices
Prevention is aided by surveillance of SSIs with regular reporting of the results back to individual surgeons
Source and Route of Infection
Early’ SSIs usually occur in the operating theatre within 5 days (deep)
They usually arise from the patient's own flora
Commonly from a member of the operating team, equipment or operating theater
Often the source is not easily identified
Source & route of infection
Commonly direct spread from incised skin & organs
Air is important in development of intera operative infection especially implantation of prostheses
Sometimes intra operative contamination of instruments, gloves & clothing
Rarely contamination of apparatus
Sources of SSI
Patients own flora
Staff, Environment ,Devices
Colonisation usually precedes infection
Often from other patients via staff hands
Risk factors for SSI related to perioperative patient care
Inappropriate antibiotic prophylaxis.
Inadequate skin preparation or care.
Inadequate staffing levels & theatre design.
Staff with skin infections in the theatre.
Excessive movement of staff.
Inadequate operating theatre ventilation.
Simultaneous operations in the same room.
Preventative measures
Theatre clothing

Normal clothing may become saturated with S. aureus & other potential pathogens; staff should therefore change into clean theatre clothing
To avoid contamination of theatre clothing, it should not be worn outside the theatre suite
The operating team should wear sterile gowns & gloves
Preventative measures
Staff, theatre design & planning
Humans shed potential organisms of SSI (especially S. aureus & beta-hemolytic streptococci) into the air
Excessive numbers & movement of staff increases this shedding & should be avoided
Staff with boils or septic lesions of the skin or eczema colonized with S.aureus should not be allowed in the theatre.
The Isolation of Operating Rooms Using Transfer Areas and Airlocks
Staff, theatre design & planning
Humans shed potentia
The isolation of operating rooms from the rest of the hospital facilities is to prevent the introduction of pathogens into the operating room via persons or materials.
The transfer room should serve as an active airlock between the operating rooms and the remainder of the hospital. This requires that the transfer room is designed and constructed to ensure that doors to and from adjacent rooms cannot be opened simultaneously. The transfer room should be divided into an inner and outer zone and may be connected directly to the recovery room
The patient transfer area may be used to move equipment, materials for anesthesia and other essential items into the operating room. Transport packaging must, however, be removed from these items immediately prior to entering the patient transfer room.
A practical transfer area for operating room personnel consists of:
Changing/washing room,
Dressing room in which to don operating attire prior to entering the operating room .
An undressing room to be used for the removal of operating attire after exiting the operating room.
It should be noted that whilst separation of rooms 1 and 3 is not mandatory (2-room-transfer), steps need to be taken to ensure that the operating room can only be accessed via room 2 and exited via room 3.
Room 1 should be equipped with hand washing facilities complete with liquid soap, brushes, disposable towels and utensils for nail cleaning.
Before entering room 2, operating room personnel should ensure that their hands are disinfected with an alcoholic disinfectant (alcoholic hand rub).

Final surgical hand disinfection with an alcoholic disinfectant should be performed in room 2 immediately before entering the operating room.

The usual scrub room within the surgical unit can therefore be reduced to a facility for hand washing fitted with furnishings for surgical hand disinfection.
AWMF online - Recommendations Hospital Hygiene 
Installations for Ventilation and Air-Conditioning
Ventilation and air-conditioning installations (VACI) in hospitals are primarily designed to create and maintain adequate workplace conditions.
The conditioning of air in operation areas also serves to prevent infection by reducing airborne contamination of the operation site. In this way, an essential prerequisite for the prevention of wound infection is fulfilled.
Preventative measures
Operating theatre ventilation
Ideally, operating theatre air should be circulated & filtered to reduce the airborne bacteria generated by staff.
Air conditioning systems should ensure a minimum of 20 to 24 air changes per hour of filtered air
With good design the level of airborne contamination should be <100 cfu/m3.
Preventative measures
Ultra Clean Air
Ultra Clean Air (<10 cfu/m3) reduces the risk of infection
To achieve this, laminar flow systems (airflow 0.5m/s) which deliver about 300 air changes per hour, or special ventilation combined with bacteria impermeable clothing, must be used
Regular maintenance & checking of the ventilation filters & airflows (duct cleaning is essential )
The following recommendations are made:
Low turbulence, large-surface air outlets – the so-called “laminar flow systems” – are superior to other air-conditioning systems and impart a high level of hygienic safety as far as airborne organisms are concerned. Systems of this type should be preferred in both new and renovated buildings.
Cleanroom Certification:
A room in which the concentration of airborne particles is controlled and which is constructed and used in a manner to minimize the introduction ,generation and retention of particles inside the room and in which other relevant parameters ,e.g.
Temperature ,humidity ,and pressure are controlled as necessary.
Cleanroom environmental parameters and practices Led to the formation of a technical committee of the International Standards Organization ISO-14644.
Cleanroom Certification (ASO-14644)
What Dose “Cleanroom”
A room in which the concentration of
airborne particles is controlled
To reduce possibility of particles ending in the medical product and latter in the patient
WHAT Particle size
0.5 Micron &larger
Major Sources of Contamination
Outside air:
One cubic foot of untreated air contains
Over 1.2 million particles 0.5 micron and
HEPA Filters:
High efficiency particulate air filters Starts at 99.97% efficiency on 0.3 micron & larger Particles
Duct cleaning
Minimize Generation of Particles in Room from Internal Sources
Construction Material
Minimize horizontal surfaces
Use non-shading materials, flush lights and windows , cove joints at ceilings , wall and wall-floor joints , epoxy floor , etc
Personnel generates skin flakes, hair, clothing particles
Clean Room Equipment
Standing person sheds 100.000 particles /min using clean garments and walking carefully
Air Distribution
Airflow Rates
Unidirectional airflow
Mixed airflow
Ceiling supply filters and low wall returns
Air changes of room volume per hour
Velocity of air
Minimize movement and retention of particles
Room Pressurization
Positive for cleanrooms
Mobile Theaters as a solution for expanding current OT facilities
Knowing the least precautions are taken while constructing OT Mobile solutions can be considered especially for serving sporadic living population very poor to travel to large urban areas to get medical treatment
Set up of proper light and ventilation through HEPS filters
Ultra clean operation theater with laminar filtered air flow through HEPA filtration and under positive pressure
Pre-filtration through cloth material to be replaced frequently and send for washing is vital for protecting the HEPA filter from short period clogging
Ultra clean operation theater with laminar filtered air flow through HEPA filtration and under positive pressure
Pre-filtration through cloth material to be replaced frequently and send for washing is vital for protecting the HEPA filter from short period clogging
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