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SURGICAL OPERATION THEATER

STANDARDS
creating better hospitals

Dr.T.V.Rao MD

7/9/16

Dr.T.V.Rao MD @Infection control

Need to Rethink on Safety and


Standards in our Operation
theaters
The Program file is created from various peer
reviewed, and world standard protocols in implantation
of Safe Operation theater standards for wider use in
the world, In India still we do not have any set
standards and practices, As good beginning is half
done, I wish all my professional friends go through the
article, your opinions and comments are highly
appreciated for future developments,
Can be reached at
Email doctortvrao@gmail.com
Mob +919961785124 India
7/9/16

Dr.T.V.Rao MD @Infection control

Hospitals Continues to be a
Great Risk to many who avail
the Services

7/9/16

Dr.T.V.Rao MD @Infection control

Why Standards
Infection Control a Priority in
Operation
Theaters

According to
Nosocomial
infection national
Surveillance
services (NINSS) in a
hospital, infections
acquired hospitals
are likely to
complicate illness,
causing anxiety,

7/9/16

Dr.T.V.Rao MD @Infection control

Public Confidence in Hospitals


Patients and the wider
public should have
complete confidence
in the cleanliness and
hygiene of their
healthcare
environment
So we Need Standards
7/9/16

Dr.T.V.Rao MD @Infection control

What is everybody's Role in


Safe Operation theaters
All healthcare
professionals have a
duty to set a standard
by which to practice.
With a focus on clinical
effectiveness and
evidence based care
theatre staff must be
able to demonstrate
the ability to audit care
and theatre practice.
7/9/16

Dr.T.V.Rao MD @Infection control

Plan a Operation Theater with


following objectives
To control the concentration of Pathogens
To prevent infiltration of non purified air into the
operating theatre
Air flow pattern that carries contaminated air
away from the operating table
Comfortable environment for the patient and
operating team
Convenient & uninterrupted personal movements
inside the OT
Safe Zone creation in OT [ for the safe location of
7/9/16
MD @Infection control
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sterile instrumentsDr.T.V.Rao
& Disposables

Document the Operation


Theater Functioning
The theatre register will record:
Procedures which were undertaken (both surgical and the type of
anaesthetic)
The names of surgeon and anaesthetist and a list of support staff
The name of the scrub and circulating practitioner
The time each patient entered and left theatre
The patients name, date of birth, sex, NHS number, scrub and
circulating practitioner, implanted materials and any untoward
incidents
Details of any implants
Details of untoward events
7/9/16

Dr.T.V.Rao MD @Infection control

However we have to Implement


Standard protocols as
associated with best practices
The care that is
delivered and
improvements in
practice must be
based on
evidence and
best practice
guidance.
7/9/16

Dr.T.V.Rao MD @Infection control

The safe surgery saves lives


approach
The Safe Surgery Saves Lives
programme aims to improve
surgical safety and reduce the
number of surgical deaths and
complications in four ways

Objective 1
1 by giving clinicians, hospital
administrators and public
health officials information on
the role and patterns of
surgical safety in public health
7/9/16

Dr.T.V.Rao MD @Infection control

10

Objective
2
by defining a

7/9/16

minimum set of
uniform measures
or surgical vital
statistics, for
national and
international
surveillance of
surgical care;

Dr.T.V.Rao MD @Infection control

11

Objective 3
by identifying a
simple set of
surgical safety
standards that
can be used in all
countries and
settings and are
compiled in a
surgical safety
7/9/16

Dr.T.V.Rao MD @Infection control

12

Objective 4

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by testing the
checklist and
surveillance
tools at pilot
sites in all WHO
regions and then
disseminating
the checklist to
hospitals

Dr.T.V.Rao MD @Infection control

13

Surgical Site Infections


Infections of the
Increases Morbidity
and
surgical wound
Mortality
are one of the
most common
HAI and are
important cause
of morbidity and
mortality for
patients
7/9/16

Dr.T.V.Rao MD @Infection control

14

Factors influencing the


Increased Rate of
Infection
There are several
factors that could affect
such infection, namely,
patient factors (i.e.
susceptibility to
infection). Surgical field
factors (i.e: the thermal
plume from the site),
room factors (i.e:
cleanness of the OR),
and HVAC factors ( i.e:
7/9/16

Dr.T.V.Rao MD @Infection control

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Consequences of
Infections in Surgical
The delay inPatients
recovery and

increased hospital stay also has


economic consequences. It is
estimated that each patient with
a surgical site infection requires
an additional stay for 6.5 days
and hospital cost are doubled. It
is a pre-requisite that Operating
7/9/16

Dr.T.V.Rao MD @Infection control

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We Lack basic
guidelines to Structure
Operation Theaters
the
In developing
countries like India,
where there is no
uniform guidelines,
many OTs are built

and maintained
according to the
individuals knowledge
level, availability of
funds, technical staff,
and equipment's
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Dr.T.V.Rao MD @Infection control

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INTERNATIONAL
FEDRATION OF
INFECTION CONTROL
(IFIC)
States it is now accepted
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Dr.T.V.Rao MD @Infection control

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Surveillance of the Operation


theater needs better
understanding as it is not
Good absolute
to true Saftey
hospital hygiene
is an integral part of
infection control
programme.
Microbiological
surveillance
provides data about
the factors
contributing to
infection. In developed
countries, though

7/9/16

Dr.T.V.Rao MD @Infection control

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Do not do the Settle plates with


Blind ideas,
Evaluate how good they suit to
your situations
Settle plates to
estimate the CFU
can help in few
matters, but may
not serve the
absolute purpose

7/9/16

Dr.T.V.Rao MD @Infection control

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Doing settle plates


Mandatory ?
The Results
Though settle plate method may
are Inconclusive
? of
be regarded
as a crude measure
airborne contamination, in places
without other facilities it can still
provide a simple and cost effective
way of enumerating the
contamination rate of horizontal
surfaces at multiple points.

Although there is no need to

7/9/16

Dr.T.V.Rao MD @Infection control

21

Settle plates help us to know


the Environment we work and
risk to patients

However there are


evidences which
suggest that there
is a need to
monitor the air
quality which may
help in reduction
of post-operative
complications due
7/9/16

Dr.T.V.Rao MD @Infection control

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*ASIAN HEALTHCARE WORKER


HANDOUT BY PACIFIC SOCEITY OF
INFECTION CONTROL
Type of
Criteria
operating
cfu/m
Theatre.

Conditi
on

Conventio
nal
ULTRA7/9/16

Empty

During
operation

Empty
During

Dr.T.V.Rao MD @Infection control

<35

<
180
<1
<20(periphery)

23

*STANDARD DESIGNIING OF
OPERATING THEATERS.
Factor HTM 2025 ASHRAE

Pressur
e

Positive
pressure with
respect
Pressure
differential
should be
around 9 up to
30 Pa.

Positive
pressure by
to corridor and
adjacent area
supplying 15%
excess air

Air

Primary

Primary filter
24
25%

7/9/16

Dr.T.V.Rao MD @Infection control

*STANDARD DESIGNIING FOR


OPERATING THEATER .
Factor HTM 2025 ASHRAE

Humidit 55%
y
5%

45% 55%

Temperat Range for


working
ure

Range for
working
condition

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condition
Dr.T.V.Rao MD @Infection control

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*Standard Design Rules


for Operating Theatre
HTM
ASHRAE
Factor
2025

Air Exchanges
Rates

Required 20
ACH for the
system

Air Velocity

Working zone area


should be
between 0.1m/s to 0.3
m/s

7/9/16

Dr.T.V.Rao MD @Infection control

15 ACH for outdoor


air system
- 25 ACH for
recirculation air
systems

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The experimental procedure

*Standard Design Rules


for Operating Theatre
HTM
ASHRAE
Factor
2025

Noise
Level

Maintain at
50 -55 dBA

Lighting

At 500 lux for


working space

Operating

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Maintain positive
pressure
with
respect
Dr.T.V.Rao MD
@Infection
control
to corridor and

Positive

27

*Standard Design Rules


for Operating Theatre
HTM
ASHRAE
Factor
2025

Air
Filter
7/9/16

Primary and
Secondary filter- 8090 %
HEPA filter-95% or
more efficiency
based on EU

Dr.T.V.Rao MD @Infection control

Temperature range for

Primary filter
25%
Secondary
filter
90%
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References
1.CLINICAL GUIDELINE FOR THEATRE PRACTICE
STANDARDS GENERIC
Royal Cornwall Hospital NHS
2WHO Guidelines for Safe Surgery 2009 Safe Surgery
Saves Lives

7/9/16

Dr.T.V.Rao MD @Infection control

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*Source of Information
on following resources

Source:

(I) HTM 2025


(II) Memarzadeh, F and Manning A.P
Comparison of Operating Room
Ventilation Systems in the Protection
of the Surgical Site ASHRAE
Transactions 2002 V. 108, Pt.2.
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Dr.T.V.Rao MD @Infection control

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Program Created by Dr.T.V.Rao MD, Clinical


Microbiologist for benefit of many who deal the
matters with Surgical Operation Theaters and
patients, Please do share with many
Professionals and Patients on learning the
basis of safety in Operation Theaters
Email

doctortvrao@gmail.com
7/9/16

Dr.T.V.Rao MD @Infection control

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