The reusable instruments have already been decontaminated.
We need to select an available method for sterilizing them for reuse in the next procedure.
STERILIZING AND DISINFECTING INSTRUMENTS:
Sterilization is the destruction of all living organisms.
- An item may only be STERILE or NON-STERILE.
- It CANNOT be NEARLY sterile.
- Disinfection, on the other hand is the REDUCTION of a population of pathogenic micro-organisms without achieving sterility.
- In these cases not all bacterial spores are destroyed.
Antiseptics are used in the skin to prevent infection. They are milder than disinfectants e.g. Iodine, Hydrogen peroxide and Chlorhexadine.
There are four methods of disinfecting and sterilizing instruments in Hospital practice:
1. Antiseptic solutions.
2. Boiling.
3. Hot air ovens.
4. Autoclave.
DISINFECTING SOLUTION
- Alcohol (Ethyl + Isopropyl) 70% was the solution most widely used.
- Recently of 0.5% chlorhexidine is widely used for emergency disinfection of surgical instruments
It requires only 2 minutes immersion.
- Where instruments are left for longer periods or stored continuously, addition of one tablet of sodium nitrite 1g will prevent rusting.
As the tablet dissolves over several days, another is added.
- The aldehydes (Formaldehyde & Gluteraldhyde) are powerful disinfectants and sterilizers.
A solution containing 2% glutaraldehyde will disinfect instruments if they are soaked for 10 minutes, and sterilize if left soaking for 10 hours.
The disadvantages are that the solution needs to be fresh, and it can cause staining if left on the skin.
- A detailed list is given at the end of this chapter (Table I.V)
BOILING:
This is still the most widely used method of disinfecting instruments in the World;
- it is simple, quick and reasonably effective, but
- will not destroy certain bacterial spores (tetanus, gas-gangrene)
- and certain viruses.
- Normally, instruments are cleaned, and then boiled for 5 minutes (100 degree C or 212 degree F).
- A boiling water `sterilizer' is badly named, because at a height of 3000 metres water boils at 90 degree C and is thus much less effective.
- This method is obviously not suitable for dressings or drapes.
Any questions be sent to drmmkapur@gmail.com
All earlier posts are stored in archives for your access and review
Friday, July 30, 2010
Friday, July 23, 2010
DECONTAMINATE BEFORE REUSE
HOW TO DECONTAMINATE USED SURGICAL INSTRUMENTS?
Washer Steriliser
The washer-sterilizer operates much the same as the steam
sterilizer.
The washer-sterilizer sends large amounts of soapy
water over the instruments.
Steam under pressure and air are then injected into the water, which activates the water significantly.
As the water is drained from the chamber, tissue
debris and scum are filtered off and steam fills the entire
chamber.
The temperature is then maintained at 270oF for 3
minutes.
Near the completion of the cycle, the steam is released
through the exhaust system.
Ultrasonic Cleaner
Following processing in the washer-sterilizer, all instruments
should be placed in the ultrasonic cleaner.
This process further removes particles and debris through a process called cavitation.
During cavitation, high frequency sound waves are generated
through a water bath in which the instruments are placed along
with a neutral to slightly alkaline detergent.
Cavitation explode inwardly (implosion), and this causes their release from the surface of the instrument.
Following cavitation, instruments are rinsed thoroughly and dried.
If the equipment mentioned is not available hand washing in running
Water is the alternative. Followed by detergent and hand brushing the
Instruments.
WHAT ARE THE DISPOSABLE MEDICAL WASTE?
The operation of a single surgical OT generates a large amount
of medical waste.
Among these are :
* gloves
* gowns
* backtable covers
* patient drapes
* needles and other sharps
* body fluids and secretions
* and other items that must be disposed of.
The types of regulated waste from health care facilities.
* These are radioactive waste, which is regulated by the
Nuclear Regulation Agency
* Hazardous chemical waste, which is regulated by environmental
protection agency
* The third type is potential infective waste, which, for
the purpose of this text will be referred to as regulated
medical waste these are all the items used in an operative procedure and
have been listed above.
Any questions be sent to drmmkapur@gmail.com
All earlier posts are stored in archives for your access and review
Washer Steriliser
The washer-sterilizer operates much the same as the steam
sterilizer.
The washer-sterilizer sends large amounts of soapy
water over the instruments.
Steam under pressure and air are then injected into the water, which activates the water significantly.
As the water is drained from the chamber, tissue
debris and scum are filtered off and steam fills the entire
chamber.
The temperature is then maintained at 270oF for 3
minutes.
Near the completion of the cycle, the steam is released
through the exhaust system.
Ultrasonic Cleaner
Following processing in the washer-sterilizer, all instruments
should be placed in the ultrasonic cleaner.
This process further removes particles and debris through a process called cavitation.
During cavitation, high frequency sound waves are generated
through a water bath in which the instruments are placed along
with a neutral to slightly alkaline detergent.
Cavitation explode inwardly (implosion), and this causes their release from the surface of the instrument.
Following cavitation, instruments are rinsed thoroughly and dried.
If the equipment mentioned is not available hand washing in running
Water is the alternative. Followed by detergent and hand brushing the
Instruments.
WHAT ARE THE DISPOSABLE MEDICAL WASTE?
The operation of a single surgical OT generates a large amount
of medical waste.
Among these are :
* gloves
* gowns
* backtable covers
* patient drapes
* needles and other sharps
* body fluids and secretions
* and other items that must be disposed of.
The types of regulated waste from health care facilities.
* These are radioactive waste, which is regulated by the
Nuclear Regulation Agency
* Hazardous chemical waste, which is regulated by environmental
protection agency
* The third type is potential infective waste, which, for
the purpose of this text will be referred to as regulated
medical waste these are all the items used in an operative procedure and
have been listed above.
Any questions be sent to drmmkapur@gmail.com
All earlier posts are stored in archives for your access and review
Thursday, July 15, 2010
CLOSING ACT
WHAT IS THE END OF DAY CLEANING THEATER ROUTINE?
Clean OT thoroughly after each day's list, and completely every week.
Decontamination of Furniture and Fixed Equipment
* The room itself and its furniture and fixed equipment can be cleaned and disinfected.
* All equipment and furniture used during a surgical procedure are thoroughly cleaned
* Floors should be cleaned using a wet-vacuum system. This can be a centralized built in system or a portable wet-vacuum. If neither is available, the following procedure may be used:
1) Two buckets are filled with disinfectant/detergent
2) Mop heads must be sterilized or a disposable mop head (used once only) used in the operating room suite.
3) Solutions and mop heads are changed for each suite and the buckets cleaned before new solution is mixed.
* The pads of the operating table are removed to expose the undersurface of the table. All surfaces of the table and pads are cleaned with particular attention to hinges, pivotal points, and castors.
* Doors and walls are spot cleaned with disinfectant
End of Day Cleanup
* Surgical lights and slide tracks
* All ceiling-mounted equipment
* All furniture including castors or wheels
* All shelves, counters, work tables and autoclave cabinet tops
* All floor surfaces in the department the surfaces are carbonized.
* Scrub sinks
* Soap dispensers
Weekly Cleanup
* Ventilation and air conditioning/heating duct grills must be vacuumed to prevent the release of bacteria-laden dust into the surgical environment
* Utility rooms, including those used to store house keeping supplies, sewer hoppers, and linens, must be cleaned
* OT Fumigation is utilized after occurrence of infection.
Cleaning Instruments:
Use an old scrub brush. Open hinged instruments fully,
scrub them, and take special care to clean their jaws and serrations
Any questions be sent to drmmkapur@gmail.com
All earlier posts are saved in archives for tour access and review..
Clean OT thoroughly after each day's list, and completely every week.
Decontamination of Furniture and Fixed Equipment
* The room itself and its furniture and fixed equipment can be cleaned and disinfected.
* All equipment and furniture used during a surgical procedure are thoroughly cleaned
* Floors should be cleaned using a wet-vacuum system. This can be a centralized built in system or a portable wet-vacuum. If neither is available, the following procedure may be used:
1) Two buckets are filled with disinfectant/detergent
2) Mop heads must be sterilized or a disposable mop head (used once only) used in the operating room suite.
3) Solutions and mop heads are changed for each suite and the buckets cleaned before new solution is mixed.
* The pads of the operating table are removed to expose the undersurface of the table. All surfaces of the table and pads are cleaned with particular attention to hinges, pivotal points, and castors.
* Doors and walls are spot cleaned with disinfectant
End of Day Cleanup
* Surgical lights and slide tracks
* All ceiling-mounted equipment
* All furniture including castors or wheels
* All shelves, counters, work tables and autoclave cabinet tops
* All floor surfaces in the department the surfaces are carbonized.
* Scrub sinks
* Soap dispensers
Weekly Cleanup
* Ventilation and air conditioning/heating duct grills must be vacuumed to prevent the release of bacteria-laden dust into the surgical environment
* Utility rooms, including those used to store house keeping supplies, sewer hoppers, and linens, must be cleaned
* OT Fumigation is utilized after occurrence of infection.
Cleaning Instruments:
Use an old scrub brush. Open hinged instruments fully,
scrub them, and take special care to clean their jaws and serrations
Any questions be sent to drmmkapur@gmail.com
All earlier posts are saved in archives for tour access and review..
Thursday, July 8, 2010
ACT ONE SCENE ONE
THE MAIN EVENT
HOW DO YOU PREPARE THE OPERATION SITE?
Shaving:
The operation area should be clean and free of infection before the operation, and the ward nurse to check this in the ward before sending the patient to the O.T. (Figs 2.12A – E)
- Shave the area on the morning of the operation, or as part of operation.
Preparation:
Prepare the skin as soon as the patient is anaesthetized.
- Start with a soap solution, and follow this with spirit.
- If there is a low sensitivity to iodine in the community, use alcoholic iodine.
- Take a sterile swab on a holder start in the middle of the operation site, and work outwards.
- Discard both swab and holder, and repeat the process with a second swab (some surgeons use a third).
- The last is spirit which will evaporate to leave the skin dry.
- Be sure to prepare a wide enough area of skin.
- In an abdominal operation this should extend from the patient's nipple line to below his groin.
Draping
The skin has been prepared:
-Place the first towel across the lower part of the operation site. fig 2.13a
-Place another towel at right angle on the nearer edge of the operation site. fig 2.13b
-Apply a towel clip at the point of crossing of the two towels. fig 2.14
-Place another towel at the far edge of the operation site.
-The final towel goes across the top end of the site.
All the corners should have towel clips to prevent them from slipping they can go through the skin if the operation is under G.A.
-In an abdominal operation an abdominal sheet covers the abdomen on top of the towels. This sheet has an opening in its middle to provide access to the operation site [double toweling]
-If any area close to the operation site becomes contaminated at any time during the operation, place another sterile towel over the contaminated site.
SWABS
Ten cm. gauze squares folded and held in sponge forceps are used for swabbing
PACKS Large squares of gauze or linen are used as packs. These packs are placed in cavities so as to keep organs and vital structures out of reach of sharp instruments being used at the operation site.
All these swabs and packs are counted and placed on the sterile trolley
Any questions be sent to drmmkapur@gmail.com
All earlier posts are saved in archives for your access and review.
HOW DO YOU PREPARE THE OPERATION SITE?
Shaving:
The operation area should be clean and free of infection before the operation, and the ward nurse to check this in the ward before sending the patient to the O.T. (Figs 2.12A – E)
- Shave the area on the morning of the operation, or as part of operation.
Preparation:
Prepare the skin as soon as the patient is anaesthetized.
- Start with a soap solution, and follow this with spirit.
- If there is a low sensitivity to iodine in the community, use alcoholic iodine.
- Take a sterile swab on a holder start in the middle of the operation site, and work outwards.
- Discard both swab and holder, and repeat the process with a second swab (some surgeons use a third).
- The last is spirit which will evaporate to leave the skin dry.
- Be sure to prepare a wide enough area of skin.
- In an abdominal operation this should extend from the patient's nipple line to below his groin.
Draping
The skin has been prepared:
-Place the first towel across the lower part of the operation site. fig 2.13a
-Place another towel at right angle on the nearer edge of the operation site. fig 2.13b
-Apply a towel clip at the point of crossing of the two towels. fig 2.14
-Place another towel at the far edge of the operation site.
-The final towel goes across the top end of the site.
All the corners should have towel clips to prevent them from slipping they can go through the skin if the operation is under G.A.
-In an abdominal operation an abdominal sheet covers the abdomen on top of the towels. This sheet has an opening in its middle to provide access to the operation site [double toweling]
-If any area close to the operation site becomes contaminated at any time during the operation, place another sterile towel over the contaminated site.
SWABS
Ten cm. gauze squares folded and held in sponge forceps are used for swabbing
PACKS Large squares of gauze or linen are used as packs. These packs are placed in cavities so as to keep organs and vital structures out of reach of sharp instruments being used at the operation site.
All these swabs and packs are counted and placed on the sterile trolley
Any questions be sent to drmmkapur@gmail.com
All earlier posts are saved in archives for your access and review.
Thursday, July 1, 2010
A DAY AT THE THEATRE
PREPAREEVERY OT DAY
HOW TO PREPARE THE OT?
- All equipment, particularly the operating theatre table and
all storage ledges within the OT rooms should be cleaned with damp
duster.
Floors are cleaned before sterile trolleys are prepared.
- Sterile nail brushes, scrub solution gown packs and all items
required in the OT should be checked and replaced if required
- The required number of bottles or flasks of sterile saline or
water for hand-lotion bowls are placed in position.
- Fresh replacements of bandages, strapping, splints and lotions,
etc., should be available before the operation list commences.
- Finally equipment required for the first operation is checked by
the senior operating theatre nurse or the scrub nurse also selects
sterile packs, may prepare instruments and special apparatus for
sterilization.
- Special attention is given to the operation table and
accessories to ensure that these are present and in working
order, lights are inspected for illumination and focus.
- All electro medical apparatus such as the diathermy and suction
machines or pipeline suction set are switched on and tested.
HOW TO PREPARE AN INSTRUMENT TROLLEY?
- Instrument trolley should be prepared immediately before an
operation.
- It is a bad practice to prepare all trolleys’ required for a
list in the morning, for even if they are covered carefully, it
is impossible to guarantee sterility when required later.
- All metal surfaces of trolleys and tables which are to be used
for setting out sterile instruments and apparatus should first
be covered with a sterile water-proof material before the
application of sterile drapes.
- If the instrument trays have been placed on the trolleys
aseptically, the instruments are laid out by a nurse wearing
sterile gown and gloves.
- It is a bad practice for an" unscrubbed"person to complete
this arrangement using Cheatle forceps, because of the great
risk of contamination occurring when ungloved hands are moved
to and fro over the sterile trolley.
THERE IS NO PLACE IN A MODERN OPERATING ROOM FOR USE OF UN-STERILE
FORCEPS STORED HALF SUBMERGED IN A CONTAINER OF DISINFECTANT.
- Prepared sterile packs containing all the necessary equipment
relevant to a listed operation, and incorporating trolley
drapes which fall into position as the pack is opened, will
shorten the time taken for preparation and cut down bacterial
contamination in the O.T.
Any questions be sent to drmmkapur@gmail.com
All posts are stored in archives for you’re access and review
HOW TO PREPARE THE OT?
- All equipment, particularly the operating theatre table and
all storage ledges within the OT rooms should be cleaned with damp
duster.
Floors are cleaned before sterile trolleys are prepared.
- Sterile nail brushes, scrub solution gown packs and all items
required in the OT should be checked and replaced if required
- The required number of bottles or flasks of sterile saline or
water for hand-lotion bowls are placed in position.
- Fresh replacements of bandages, strapping, splints and lotions,
etc., should be available before the operation list commences.
- Finally equipment required for the first operation is checked by
the senior operating theatre nurse or the scrub nurse also selects
sterile packs, may prepare instruments and special apparatus for
sterilization.
- Special attention is given to the operation table and
accessories to ensure that these are present and in working
order, lights are inspected for illumination and focus.
- All electro medical apparatus such as the diathermy and suction
machines or pipeline suction set are switched on and tested.
HOW TO PREPARE AN INSTRUMENT TROLLEY?
- Instrument trolley should be prepared immediately before an
operation.
- It is a bad practice to prepare all trolleys’ required for a
list in the morning, for even if they are covered carefully, it
is impossible to guarantee sterility when required later.
- All metal surfaces of trolleys and tables which are to be used
for setting out sterile instruments and apparatus should first
be covered with a sterile water-proof material before the
application of sterile drapes.
- If the instrument trays have been placed on the trolleys
aseptically, the instruments are laid out by a nurse wearing
sterile gown and gloves.
- It is a bad practice for an" unscrubbed"person to complete
this arrangement using Cheatle forceps, because of the great
risk of contamination occurring when ungloved hands are moved
to and fro over the sterile trolley.
THERE IS NO PLACE IN A MODERN OPERATING ROOM FOR USE OF UN-STERILE
FORCEPS STORED HALF SUBMERGED IN A CONTAINER OF DISINFECTANT.
- Prepared sterile packs containing all the necessary equipment
relevant to a listed operation, and incorporating trolley
drapes which fall into position as the pack is opened, will
shorten the time taken for preparation and cut down bacterial
contamination in the O.T.
Any questions be sent to drmmkapur@gmail.com
All posts are stored in archives for you’re access and review
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