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Surgical operation theater standards

  1. SURGICAL OPERATION THEATER STANDARDS creating better hospitals 1 Association of International Modular Operation Theatre
  2. 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, 2
  3. Hospitals Continues to be a Great Risk to many who avail the Services 3
  4. 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, discomfort and can lead to death 4
  5. 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 5
  6. 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. 6
  7. 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 sterile instruments & Disposables 7
  8. 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 patient’s 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 8
  9. Recording & Transmission of Surgical Procedures New international standards also include: • Recording of Surgical procedures performed on patient as records for medico legal purpose as well as HIPAA / NABH compliance • Monitoring Pre-OP & Post-OP procedures performed by junior surgeons • Live webcasting or IP transmission of surgical procedures to avoid chaos inside operation theatre • To maintain privacy of personal information of patient during any CME activity 9
  10. 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. 10
  11. 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 11
  12. Objective 2 •by defining a minimum set of uniform measures or ‘surgical vital statistics’, for national and international surveillance of surgical care; 12
  13. 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 check-list’ for use in operating rooms 13
  14. Objective 4 •by testing the checklist and surveillance tools at pilot sites in all WHO regions and then disseminating the checklist to hospitals worldwide18-10-2016 14
  15. Surgical Site Infections – Increases Morbidity and Mortality •Infections of the surgical wound are one of the most common HAI and are important cause of morbidity and mortality for patients undergoing surgery 18-10-2016 15
  16. 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: High air change rate(ACH) and direction of air flow). 16
  17. Consequences of Infections in Surgical Patients •The delay in 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 Theaters achieve Ultra- Clean status, especially for deep wound surgery. 17
  18. We Lack basic guidelines to Structure the Operation Theaters • In developing countries like India, where there is no uniform guidelines, many OTs are built and maintained according to the individual’s knowledge level, availability of funds, technical staff, and equipment's • However we need to start with scientific beginning 18
  19. INTERNATIONAL FEDRATION OF INFECTION CONTROL (IFIC) “ States it is now accepted that ULTRA- CLEAN air reduces the risk of infection in implant surgeries 19
  20. Surveillance of the Operation theater needs better understanding as it is not absolute to true Saftey • Good hospital hygiene is an integral part of infection control programme. “Microbiological surveillance” provides data about the factors contributing to infection. In developed countries, though standard protocols and guidelines are available 20
  21. 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 18-10-2016 21
  22. Doing settle plates Mandatory ? The Results are Inconclusive ? •Though settle plate method may be regarded as a crude measure of 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 routinely perform surveillance cultures in operation theatre 22
  23. 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 to infection. 23
  24. *ASIAN HEALTHCARE WORKER HANDOUT BY PACIFIC SOCEITY OF INFECTION CONTROL Type of operating Theatre. Condition Criteria cfu/m³ Conventional Empty During operation <35 < 180 ULTRA-CLEAN Empty During Operation <1 <20(periphery) <10 (centre) 24
  25. *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 Filter Primary and secondary filter Primary filter – 25% Secondary filter -90% HEPA filter – 99.97%18-10-2016 Dr.T.V.Rao MD @Infection control 25
  26. *STANDARD DESIGNIING FOR OPERATING THEATER. Factor HTM 2025 ASHRAE Humidity 55% ± 5% 45% - 55% Temperature Range for working Range for working 26
  27. *Standard Design Rules for Operating Theatre Factor HTM 2025 ASHRAE Air Exchanges Rates Required 20 ACH for the system 15 ACH for outdoor air system - 25 ACH for recirculation air systems Air Velocity Working zone area should be between 0.1m/s to 0.3 m/s Operating Area Minimum sterile The experimental procedure is defined by DIN 4799 (1990), OR floor area 27
  28. *Standard Design Rules for Operating Theatre Factor HTM 2025 ASHRAE Noise Level Maintain at 50 -55 dBA Lighting At 500 lux for working space Operating Room Maintain positive pressure with respect to corridor and Positive pressure28
  29. *Standard Design Rules for Operating Theatre Factor HTM 2025 ASHRAE Air Filter Primary and Secondary filter- 80-90 % HEPA filter-95% or more efficiency based on EU Primary filter – 25% Secondary filter – 90% Temperature Temperature range for working condition condition is 19°C to 23°C is Temperature range for working29
  30. References 1. CLINICAL GUIDELINE FOR THEATRE PRACTICE STANDARDS – GENERIC. Royal Cornwall Hospital NHS 2. WHO Guidelines for Safe Surgery 2009 Safe Surgery Saves Lives 30