Surgery Online

Surgery and Surgical Procedure

The theatre

The siting of the theatre, by contrast to its design, is not of major importance from a bacteriological point of view, although obviously it should not be adjacent to an incinerator or refuse. Clean and dirty areas should be separated and well demarcated with trafficking of personnel kept to a minimum through the sterile area. The dirty corridor should have an independent exit for contaminated materials.
The scrub room
Design of the scrub room should incorporate:
•  two doors leading to the corridor and into the theatre;
•  sinks with taps that can be manipulated with the elbows and soap holders that can be manipulated by foot pedals or the elbows. Good drainage and suitable panels incorpo­rated in the sink to prevent splashing of clothes;
•  anti-slip floors;
•  easily cleaned shelves for gownpacks and gloves;
•  adequate facilities for separate disposal of linen and paper;
•  brushes for cleaning finger nails.
The operating room
The operating room should have a double-door entrance from the anaesthetic room and a double-door exit into the clean corridor. There will also be two small door entrances from the clean store room where sutures, dressings and needles are kept (this is a subsidiary of the main store in the theatre area) and an opening from the scrub room. There is also a single exit door to the dirty corridor for removal of drapes, instruments and waste products at the end of the
procedure. All the doors should be well sealed in order to comply with the air ventilation system.
The operating table should be adjustable with all working parts sealed. The cushions should be easy to clean and in good repair. The lights should be adjustable, sealed and easily cleaned with facilities for attachment of light handles so that the surgeon and scrub team can adjust them. The plaster work and floor should be well sealed and any defects must be repaired as a matter of urgency as disturbance of plaster or the soaking through of leaking water will cause an increase in the bacterial content in the theatre environment.

•  Fixed surfaces in the operating theatre should be avoided and reliance placed on steel trolleys. X-ray viewers should be inset into the wall and kept in good repair, as should electric sockets.
Control of air quality
Because the nonvisceral bacteriological contamination of wounds is predominantly from the air in theatre, it is essen­tial that modern theatres are fitted with controlled ventila­tion and filters. For a general surgical theatre the maximum benefits can be obtained from 20 air changes per hour using a 5-mm pore size filter. In an unventilated operating theatre the bacteria present in air can be as high as 3000 colony forming units (CFU) per in3. With appropriate ventilation and air changes this can be reduced to 200 CFU/m3.
In general surgery there is conflicting evidence as to whether improvement in ventilation has reduced postopera­tive infection, but in orthopaedic surgery there is no such ambiguity as air is a significant factor in the development of postoperative infection and modern orthopaedic operating theatres utilise ultra-clean air where the bacterial count is kept below 10 CFU/m3. The principle includes the provision of a rapid high-volume flow of air over the operating theatre with high-efficiency particulate filters. Essential measures, in addition to efficient air ventilation and filtration, include:
•  reduction in the number of individuals in the theatre;
•  avoidance of excess movement of individuals in the theatre;
•  ensuring that the air vents are not obstructed and that the doors are closed.
Instruments
•  Cleaning is a process which removes contamination but does not necessarily destroy microorganisms. It is an essential prerequisite of decontaminating equipment before sterilisation or disinfection is undertaken.
•       Sterilisation results in the complete destruction or removal of all viable microorganisms including spores and viruses. In practice it may be difficult to establish. The term is usually applied to solid objects, such as instruments and equipment, but not to skin.
•       Disinfection reduces the number of viable microorganisms but will not necessarily inactivate viruses and bacterial spores. It may be classified into:
(a) high level — which is cidal to spores, bacteria and viruses;
(b)  medium — which is cidal to bacteria and viruses;
(c) low — which is cidal to only bacteria and viruses of low resistance.
It is applicable to delicate instruments that will be damaged by sterilisation.

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September 29, 2008 - Posted by | Sterile precaution | , , ,

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