What is wrong with our Practices

1. 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.

2. Economical loss • Money wasted on unnecessary use. • People concentrate on Floors, Inanimate objects,

3. Basic Principles • Cleaning more Important • Disinfection and Sterilization ? • Cleaning Removes contaminants, Dust, organic matter, Disinfection Reduces number of microbes

4. Disinfection x Sterilization • Sterilization is absolute, removes microbes and spores too. • To achieve Sterilization is Expensive, not sustainable, many times not needed.

5. 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.

6. Walls and Roof ofOperation 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

7. 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

8. 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.

9. How you care for Floors • Use only vacuum cleaners • Don't broom • Use a Mop keep it dry,

10. Roof, Artificial ceilings, Walls • Do not disturb every day • Routine disinfection not necessary

11. 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

12. Cleaning the Floor • A simple detergent reduces flora by 80 % • Addition of disinfectant reduces to 95 % • In busy Hospitals counts raise in 2 hours

13. 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.

14. Handling of Air in Operation theatre. • Negative Air pressure vented to the operation theatre. • Environmental cleaning should be twice daily

15. Environmental cleaning of Hospital. • Disinfectant Purpose Sodium hypochlorite Contaminated with Blood and body fluids Bleaching powder Toilets, bathrooms 9 grams/lit

16. Environmental cleaning of OT Contd • Disinfectant Purpose Alcohol 70% Metal surfaces trolleys

17. Safety of Air conditioning andWater cooling system • Legionnaires disease is associated with Air Condition system • Chlorination / Heating of water may prove better alternatives.

18. 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.

19. At the End of the Dayin 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.

20. 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.

21. 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.

22. Surveillance of Operation theatreExamination of Air • Estimations are done for detection of bacteria carrying particles in Air. • Factors influence Number of persons present. Body movements, Disturbances of clothing.

23. 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. Do we need surveillance regularly