Operation Theatre Sterilization and Disinfection

OPERATION THEATRE STERLIZATION

AND DISINFECTION

I. FUMIGATION
1. Seal close all the outlets like doors/windows.

2. Put off the fans, A/C, any electrical/electronic device.

3. Formaldehyde gas is generated by adding 150grams of KMno4 (Potassium

permanganate) to 300ml of formalin (40%) for every 1000cubic feet of space.

4. PROCEDURE

a. Take three one litre capacity heat resistant vessels. Divide the calculated
quantity of formalin and KMno4 approximately into three equal parts and dispense
formalin into each vessel. Place the vessels at equal distance in the centre of the
operation theatre. Add KMno4 into each vessel now and immediately leave the
room.

b. Other method of producing formaldehyde gas is to place the calculated quantity

of formalin (no KMno4 is needed) in a single large vessel in the centre and heating
done electrically for 45mins, then put off the heater from the switch situated outside
the OT room.

c. The OT room should be kept closed for 36 to 48hrs.

d. NEUTRALIZATION OF TOXIC FORMALDEHYDE GAS. 250ml of 10% liquid
Ammonia per litre of formalin used, is placed in a container in the centre of the
room for 3hrs. This will neutralize the toxic formaldehyde gas produced. Operation
theatre room should be well ventilated before the entry of any personnel.

e. Fumigation ideally should be performed every week; desirably on Saturday

evening so that it can be re-opened on Monday morning (after 36hrs). Switch over
to monthly fumigation procedure can be done in favorable circumstances under
supervision.

f. Fumigating employee must be provided with personal protective equipments like

(cap, masks, foot cover, protective goggles, etc).

Note: Bacillocid Rasant spray or VIRKON disinfectant are excellent alternatives

for fumigation, which should be considered if feasible as fumigation has certain
major health concerns.

g. Walls should be disinfected only once in 6 months and roof /ceiling is to be

disinfected only once a year unless obvious fungal growth/dampness is noticed. In
such case, report immediately to the concerned authorities.
II. Cleaning and Mopping in Operation
Theatre.

Large bacterial load (about 85-95%) can be reduced just by following

regular/proper cleaning and mopping procedures.

Before starting in the morning (everyday)

1. Clean using vacuum cleaner (using broom increases bacterial counts in air
which is highly undesirable).

2. After 10min of cleaning, Mopping should be done using plain water with 10grams
of bleaching powder per litre.

3. Let the floor dry after the first Mop, Second round of Mopping is done using 2-
5% phenol (carbolic acid 20ml-50ml per litre of water) or a good quality disinfectant
like Lysol can be used as per the manufacturers instructions.

4. Lower concentration of phenol acts as a perfume rather than a disinfectant.

5. Clean the Operation Theatre table, instruments coming in intimate contact with
patient and door handles with 70% Alcohol solution.

6. Dont enter OT till the floor is completely dry.

7. After mopping, mops must be kept dry by exposure to sunlight. Continuous use
of mops without intermittent drying leads to contamination more than disinfection.
Between two procedures in the same session.

1. Clean the Operation Theatre table and instruments coming in intimate contact
with patient with 70% Alcohol solution.

2. Discard waste immediately into respective plastic bags.

After concluding in the evening (everyday)

1. Wait for at least 30min after all the OT Personnel are out of the room.

2. Mopping is to be done using 2% phenol solution.

3. Bathrooms and toilets should be disinfected with bleaching powder (10 grams
per litre).
III. MICROBIOLOGICAL MONITORING OF
OPERATION THEATRE

Swabbing and culture for bacterial and fungal organisms should be requested for
once in every three months and/or whenever an outbreak is suspected, whenever
there is some renovation work done in the OT complex.

Interpretation of Microbiological monitoring

culture reports:
Most important parameters are:
Bacterial/fungal spore counts in air.
Surface bacterial / fungal counts on the OT table and its vicinity.
Routine screening for Clostridium tetani has lost its relevance and should be done
only when suspected tetanus case is operated or whenever there is some
renovation work done in the OT complex.

1. Results of pre fumigation microbiological monitoring indicates the prevalent

bacterial load to which the patient could be exposed.

2. Results of post fumigation microbiological monitoring indicates the effectiveness

of the fumigation procedure.
Air Samples
Average colony count per plate/30min
Interpretation
Action to be taken.

Less than 10 bacterial colonies- Acceptable >

No special action. Maintain regular fumigation and Mopping.

More than 10 bacterial colonies- Unacceptable >

Repeat fumigation with microbiological monitoring.

Isolation of any number of colonies of Staphylococcus aureus and Pseudomonas

species.- Unacceptable >
Repeat fumigation with microbiological monitoring. > Follow the precautions given
under heading IV

More than 2 Fungal colonies- Unacceptable >

Repeat fumigation & thorough cleaning of all the objects intimate with the patient
using 70% Alcohol. See for any obvious fungal growth on walls and ceiling.
Surface Samples
Colony count per square feet.
Interpretation
Action to be taken

Area (A) I.e. OT table and area adjacent to it.

Less than 5 colonies- Acceptable >
No special action. Maintain regular fumigation and Mopping

5-9 Colonies- Undesirable >

Follow the precautions given under heading IV. Maintain regular fumigation and
Mopping.

10 colonies- Unacceptable >

Repeat fumigation with microbiological monitoring.

Area (B) I.e. area away from the OT table.

<19colonies>
No special action. Maintain regular fumigation and Mopping

20colonies- Unacceptable >

Repeat fumigation with microbiological monitoring.
IV. Precautions taken to keep low bacterial counts
in operation theatre

1. Allow only those who are absolutely needed to be in the operation theatre

2. Maintain in and out movements as minimum as possible

3. Prompt disposal of OT waste outside the OT complex.

4. Use of 10% sodium hypochlorite solution to clean blood and body fluid spillages.

5. Frequent and proper hand washing saves many lives.

6. Check for hand washing solution which should ideally have a combination of
phenolic compound and a surfactant ( alcohol with chlorhexidine, chlorlheximide
2% or 4%, povidone iodine 7.5% or triclosan 1% etc).
7. Request for inspection/cleaning of A/C ducts should be made every 3rd month.
8. More than 2 consecutive Monitoring reports indicating the growth of
Staphylococcus aureus specially Methicillin resistant(MRSA) and Multidrug
resistant strains of Pseudomonads, should alert the screening for carriers amongst
the regular OT Personnel.
Reference:

1. www.delhi.gov.in

2. www.authorstream.com

3. www.solutionexchange-unnet.in

4. www.ssmwdworld.com

5. Ananthanarayan and Panikers text book of microbiology,8th edition

6. Konemans color atlas and textbook of microbiology, 6th edition

7. Bailey and Scotts textbook of microbiology, 12th edition

8. Jawetz, Mel nick and Adelbergs medical microbiology, 23rd edition

9. Mackie and McCartneys textbook of practical microbiology, 14th edition