Ensuring a safe surgical environment
- 1. ENSURING A SAFE SURGICAL ENVIRONMENT: THEATRE CLEANING,HAND WASHING,CLEANING AND STERILIZATION OF INSTRUMENT BY SAMBO N.M RN,RM,RPON,BNSC,PGDE,PM,MSc N
- 2. OUTLINE • Introduction • Definitions • Safe surgical environment • Theatre cleaning • Hand washing • Sterilization of instruments
- 3. INTRODUCTION • Safe and sufficient surgical operations depends on a work environment larger than the individual operating room (OR) and on communications at the different levels of the hospital organization.
- 4. DEFINITION OF TERMS • Patient/resident safety in the OR: It refers to the safety (no harm) of both the patient and the working personnel • Sterilization :destroys or eliminates all forms of microbial life • Cleaning :reduces bioburden of contaminants present • Disinfection :eliminates many or all pathogenic microorganisms, except bacterial spores. • The operating room (OR): is a sterile, organized environment section in a hospital
- 5. SAFE SURGICAL ENVIRONMENT Ensuring surgical safety in the operating room begins before patient enters the operating room and include attention to all types of medical errors that may affect the patient or any of the team members. This errors include; • Wrong-patient surgery • Wrong-side surgery • Wrong-level surgery • Retained foreign objects • Medication errors • Teaching and untrained personnel Opportunities and challenges in improving surgical work flow(2008), The American college of obstetricians and gynaecologists (2010)
- 6. PREVENTION OF ERRORS IN THE OR • Universal protocol ; identification process, marking of op-site and performing of time out. • Stress management • Use of surgical safety checklist • Teaching • Patient’s involvement • Grant privileges for new procedures under supervision • Swab count before closing any cavity • Avoid distractions The American college of obstetricians and gynaecologists (2010)
- 7. CLEANING THE OPERATING ROOM(OR) To ensure a clean and safe surgical environment, cleaning an operating room or procedure room requires a team approach ORs should be cleaned: Before the first case of the day. Room turnover; In between cases. Terminal clean after the last case of the day . Cycle or Periodic deep cleaning
- 8. CLEANING PROCESS Use Dedicated equipment. Detergent and disinfectant solutions should be prepared as needed according to manufacturer’s instructions – and properly labeled. Follow Standard precautions. Be alert for sharps and sharp objects Follow protocol for hand hygiene Wet floor sign
- 9. HAND WASHING The most important tool for caring placed upon each patient who is hoping for answers, understanding, and healing remedies Hand hygiene is simple yet effective way to remove transient micro-organisms, acquired through everyday tasks in the clinical setting, from the surface of the hands. Good hand hygiene protects both patients and staff Alcohol-based formulations and soap & water. To maintain optimum hand hygiene; nothing is worn below the elbows (only a plain bands), and that the fingernails are clean and trimmed. Teachmesurgery, 2018 and https://www.cdc.gov, 2019
- 11. SURGICAL HAND WASHING • Surgical hand washing requires the removal and killing of transient micro-organisms and substantial reduction and suppuration of the resident flora from the nails, hands, and forearms of the surgical team for the duration of the operation, in case a surgical glove is punctured/torn. https://www.infectioncontroltoday.com/view/how-perform-surgical-hand-scrubs (2001)
- 15. STERILIZATION OF INSTRUMENTS • INTRODUTION The delivery of sterile products for use in patient care depends on the effectiveness of the sterilization process, the unit design, decontamination, disassembling and packaging of the device, loading the sterilizer, monitoring, sterilant quality and quantity, and the appropriateness of the cycle for the load contents, and other aspects of device reprocessing.
- 16. Spaulding's Classification of Disinfection Classification Definition Level of Processing Required • Critical Device that Cleaning followed by enters sterile tissues sterilization • Semi-critical Device in contact Cleaning + high-level disinfection with nonintact skin or +sterilization if preferred mucous membranes • Noncritical Device that touches Cleaning followed by low-level only intact skin and not disinfection. In some cases, cleaning mucous membranes or does alone is acceptable not directly touch the client/resident https://www.sciencedirect.com/topics/chemistry/sterilization-and-disinfection
- 17. CLEANING OF THE INSTRUMENTS • Friction (scrubbing the soiled area with a brush) is an old and dependable method. • Fluidics ( fluids under pressure) is used to remove soil and debris from internal channels after brushing and when the design does not allow passage of a brush through a channel. • https://www.cdc.gov/infectioncontrol/guidelines/disinfection/cleaning.html(2016)
- 18. METHODS OF STERILIZATIONS/DISINFECTION • Hypochloride 1% ,PH 6-8 • Glutaraldehyde (CIDEX ) 2% at 20ºC • Dry Heat Sterilization. 160 °C /170 °C /190°C • Steam autoclaving uses steam, pressure and time. At high temperature of 121°C (250°F) to 132°C (270°F) • Hydrogen peroxide gas 3%/ 1.5%/ 0.75% https://www.hopkinsmedicine.org/hse/forms/cidexopa/opahowtouse.pd f • 10 minutes • 20 minutes • 2h/1h/6-12min • 20-30 minutes • Aprox.10 /20 /60 min respectively www.cdc.gov/infectioncontrol/guidelines/disinfection/sterilization/sterhttpsilizing- practices.(2008)
- 19. Factors Affecting the Efficacy of Disinfection and Sterilization • Concentration and Potency of Disinfectants • Physical and Chemical Factors • Organic and Inorganic Matter • Innate Resistance of Microorganisms • Duration of Exposure • Biofilms
- 20. CONCLUTION • Members of the surgical team most work hard to coordinate their efforts to ensure the safety and care of their patients and themselves. • Nosocomial Infection rates are frequently reported • There are systems that we can put in place to ensure that the theatre environment is clean and safe to minimize this infection risk such as reducing the bioburden before disinfection and sterilization
- 21. REFERENCES • Laurence McKeen,( 2012) .The Effect of Sterilization on Plastics and Elastomers (Third Edition). • https://www.cdc.gov/infectioncontrol/guidelines/disinf ection/cleaning.html(2016) • https://www.infectioncontroltoday.com/view/how- perform-surgical-hand-scrubs, (2001) • Teachmesurgery, 2018 • https://www.cdc.gov, 2019 • Opportunities and challenges in improving surgical work flow(2008). • The American college of obstetricians and gynaecologists (2010)