Dr.T.V.Rao MD
FUMIGATION OF
OPERATION THEATRES CAN WE STOP IT ???
DR.T.V.RAO MD 1
FUMIGATION
A BIOHAZARD PROCEDURE ?
DR.T.V.RAO MD 2
WHAT IS FORMALDEHYDE?
DR.T.V.RAO MD 3
• Formaldehyde has the chemical elements carbon, hydrogen and
oxygen in its structure. Hydrocarbons are among the most
common of chemical compositions. The human body includes
hydrocarbons among its elements and compounds, and it
requires formaldehyde to metabolize biochemical substances.
• Formaldehyde is usually sold as an aqueous or watery solution
called formalin, which contains 37 to 50 percent formaldehyde
by weight. It is soluble in water, but not in most organic solvents,
except alcohol and ether. It is principally used to produce resins,
other industrial chemicals, and consumer items and as a
bactericide or fungicide.
HOW CAN FORMALDEHYDE AFFECT OUR
HEALTH?
DR.T.V.RAO MD 4
• Based on the best available evidence in OSHA’s record on formaldehyde,
OSHA determined that formaldehyde isgenotoxic, showing properties of both
a cancer initiator and promoter (early and late stage carcinogen). When
inhaled, formaldehyde is a carcinogen in rats. In humans, formaldehyde
exposure has been associated with cancers of the lung,nasopharynx and
oropharynx, and nasal passages
• When humans are exposed to excess levels of formaldehyde, adverse health
effects can result. Symptoms of excess exposure include respiratory
irritation; watery, itchy eyes; itchy, runny, or stuffy nose; dry or sore throat;
and headache.
• The EPA and OSHA recognize that contact with formaldehyde can cause
skin irritation and dermatitis.
FUMIGATION • Formaldehyde a Age old compound.
• Low temp heating produce vapor
• Vapor phase decontaminates the air/environment.
• Kills vegetative bacteria / Spore ?
• When Formaldehyde mixed with water and exposed to elevated temperature
• Gaseous formaldehyde is generated
Time X Temp
DR.T.V.RAO MD 5
FUMIGATION
• To sterilize the operation theatre formaldehyde gas (bactericidal & sporicidal,viricidal) is widely employed as it is cheaper for sterilization of huge areas like operation theatres. Formaldehyde kills the microbes by alkylating the amino acids and sulfhydryl group of proteins and purine bases.
• In spite of the gas being hazardous continues to be used in several developing countries
DR.T.V.RAO MD 6
FUMIGATION
• Fumigation usually involves the following phases: First the area to be fumigated is usually covered to create a sealed environment; next the fumigant is released into the space to be fumigated; then, the space is held for a set period while the fumigant gas percolates through the space and acts on and kills any infestation in the product, next the space is ventilated so that the poisonous gases are allowed to escape from the space, and render it safe for humans to enter.
DR.T.V.RAO MD 7
PROCEDURE OF FUMIGATION
• Thoroughly clean windows, doors, floor, walls and all washable equipment's with soap and water.
• Close windows and ventilators tightly. If any openings found seal it with cellophane tape or other material.
• Switch off all lights, A/C and other electrical & electronic items
• Calculate the room size in cubic feet (L×B×H) and calculate the required amount of formaldehyde as given in
DR.T.V.RAO MD 8
• Adequate care must be
taken by wearing cap,
mask, foot cover,
spectacles
• Formaldehyde is irritant to
eye & nose; and it has
been recognized as a
potential carcinogen.
• So the fumigating
employee must be provided
with the personal protective
equipment's.
PERSONAL CARE DURING FUMIGATION
DR.T.V.RAO MD 9
• Electric Boiler Fumigation Method: For Each 1000 cu.ft of the volume of the operation theatre 500ml of formaldehyde (40% solution) added in 1000ml of water in an electric boiler. Switch on the boiler, leave the room and seal the door. After 45 minutes (variable depending to volume present in the boils apparatus) switch off the boiler without entering in to the room .
CREATING THE FORMALDEHYDE GAS
DR.T.V.RAO MD 10
METHODS ON FUMIGATION
• In principle we have to
generate Formaldehyde gas.
• Can be done by Most easier
way to mix the needed
quantity of Formalin to water
and heating at lower
temperatures at 800c – 900c
Can done also with addition of
Formalin to potassium
permanganate
DR.T.V.RAO MD 11
ADDING POTASSIUM PERMANGANATE TO
FORMALDEHYDE..
• Potassium Permanganate Method: For every 1000 cubic feet add 450gm of Potassium permanganate (KMnO4) to 500 ml of formaldehyde (40% solution). Take about 5 to 8 bowels (heat resistant; place it in various locations) with equally divided parts of formaldehyde and add equally divided KMnO4 to each bowel. This will cause auto boiling and generate fume.
• After the initiation of formaldehyde vapour, immediately leave the room and seal it for at least 48 hours.
DR.T.V.RAO MD 12
FUMIGATION TO BE NEUTRALIZED
• Neutralize Residual
formalin gas with
Ammonia by exposing
250 ml of Ammonia per
liter of Formaldehyde
used.
• Place the ammonia
solution in the centre of
the room and leave it for 3
hours to neutralize the
formalin vapour
DR.T.V.RAO MD 13
AN EXAMPLE IS SET AS..
• Operation Theatre Volume = L×B×H = 20 × 15 × 10 = 3000 cubic feet
• Formaldehyde required for fumigation = 500 ml for 1000 cubic feet
• = So 1500 ml of formaldehyde required
• Ammonia required for neutralization = 150ml of 10% ammonia for 500 ml of formaldehyde
• = So 450 ml of 10% ammonia required
DR.T.V.RAO MD 14
• Inhaling formaldehyde can
lead to symptoms such as
a burning sensation and
irritation in eyes, nose and
throat, coughing, wheezing,
tightness in throat, watery
eyes and runny nose. It can
also lead to breathlessness.
Pulmonary edema and
pneumonitis can be caused
if it injures the respiratory
tract.
WHAT ARE THE SYMPTOMS OF
FORMALDEHYDE ALLERGY?
DR.T.V.RAO MD 15
• Formaldehyde allergy
symptoms include redness,
burning sensation, skin
rash, scaling, cracking,
white discoloration and
irritation of skin and might
cause hives as well. Eye
contact can cause pain,
inflammation, blurred vision
and excess tearing.
FORMALDEHYDE ALLERGY
DR.T.V.RAO MD 16
First thing to do in case of any allergy is to
avoid contact with the substance causing
allergic reaction. With formaldehyde
present in so many things, it might be
difficult to do so. If your skin or eyes come
in direct contact with formaldehyde, you
must soon flush that part with a lot of cold
water. If you observe the formaldehyde
allergy symptoms after consuming food,
then you must drink a lot of water or milk
so as to dilute it and consult a physician
soon. In case of a skin reaction, topical
ointments used for eczema and contact
dermatitis might be prescribed by your
doctor for allergy relief
WHAT IS THE FORMALDEHYDE ALLERGY TREATMENT?
DR.T.V.RAO MD 17
• Formaldehyde is listed by the International Agency for Research on Cancer as probably carcinogenic to humans, on the basis of animal evidence and at least limited human data (IARC group 2A); listed by the National Toxicology Program as reasonably anticipated to be carcinogenic; listed by ACGIH as an A2 Industrial Substance Suspect of Carcinogenic Potential for Man; and OSHA, in its formaldehyde standard (29 CFR 1910.1048), considers formaldehyde potential carcinogen. Formaldehyde (gas) is a chemical known to the state of California to cause cancer.
FORMALDEHYDE AS CARCINOGEN
DR.T.V.RAO MD 18
NEED FOR NEWER CHEMICAL AGENTS IN
HOSPITAL USE
• 1. A need for Non Aldehyde based Chemicals is growing concern
• 2 Need for quicker sterilization methods with ever increasing work loads.
• 3. Need for non toxic safe agents.
DR.T.V.RAO MD 19
DR.T.V.RAO MD 20
THE WORLD IN SEARCH OF NEW SAFE
CHEMICAL AGENTS
BACILLOCID® RASANT
• Formaldehyde-free disinfectant cleaner with low use concentration very good cost/benefit ratio good material compatibility excellent cleaning properties virtually no residue
DR.T.V.RAO MD 21
• Bacillocid special® Is a surface
and environmental disinfectant®
Has a very good cleansing
property along with bactericidal,
virucidal , sporicidal and
fungicidal activity
• ®Composition • ® Each 100 g contains: • 1.6
Dihydroxy 11.2G ® ( Chemically
bound formaldehyde) •
Glutaraldehyde 5.0• Benzalkonium
chloride 5.0 • Alkyl urea
derivatives 3.0g
COMMERCIALLY AVAILABLE
DISINFECTANT
DR.T.V.RAO MD 22
BACILLOCID® RASANT
• Active ingredients: Glutaral 100 mg/g, benzyl-C12-
18-alkyldimethylammonium chlorides 60 mg/g,
didecyl-dimethylammonium chloride 60 mg/g.
• Bacillocid® rasant is suitable for the disinfectant
cleaning of washable surfaces using the wet-wipe-
procedure.
• Especially suitable for economic short-term
disinfection in risk areas that are likely sources of
infection DR.T.V.RAO MD 23
• Provides complete asepsis
within 30 to 60 mts.
• ® Cleaning with detergent
or carbolic acid
• not required
• ® Formalin fumigation not
required
• ® Shutdown of O.T. for 24
hrs not required
BACILLOCID
® ADVANTAGES
DR.T.V.RAO MD 24
• A Chemical compound VIRKON gaining importance as non Aldehyde compound.
• Virkon proved to be safe
Virucidal
Bactericidal,
Fungicidal
Mycobactericidal
NEWER AND NON TOXIC COMPOUNDS.
DR.T.V.RAO MD 25
VIRKON A MULTIPURPOSE DISINFECTANT
DR.T.V.RAO MD 26
• Virkon is a multi-purpose disinfectant. It contains oxone
(potassium peroxymonosulphate), sodium
dodecylbenzenesulfonate, sulphamic acid; and inorganic
buffers. It is typically used for cleaning up hazardous spills,
disinfecting surfaces and soaking equipment. The solution is
used in many areas, including hospitals, laboratories, nursing
homes, funeral homes, medical, dental and veterinary facilities,
and anywhere else where control of pathogens is required.
• Virkon has a wide spectrum of activity against viruses, some
fungi, and bacteria. However, it is less effective against spores
and fungi than some alternative disinfectants.
• As a Chemical disinfectant.
• Disinfects Medical devices.
• Disinfects Laboratory equipment.
• Decontaminate spillages with Blood and body fluids.
• Finding usefulness in replacing autoclaving and saving time.
VIKRON IS FINDING PLACE IN
DR.T.V.RAO MD 27
• Virkon® S has a unique
formulation; no other disinfectant
has the same powerful
composition. In terms of efficacy
Virkon® S has been proven highly
effective against 65 strains of virus
in over 19 viral families, 400 strains
of bacteria and over 100 strains of
fungi. This list of proven efficacy
includes the major OIE List A
diseases of concern; Avian
Influenza (H5N1), Newcastle
Disease, Classical Swine Fever
(Hog Cholera) and Foot and
Mouth Disease.
VIRKON® S HAS A UNIQUE
FORMULATION
DR.T.V.RAO MD 28
• Do not use
UVGI in the operating
theatre to
prevent Surgical
site infections.
ULTRAVIOLET GERMICIDAL IRRADIATION
(UVGI)
DR.T.V.RAO MD 29
INFECTION CONTROL IS MULTIDISCIPLINARY
APPROACH • Despite the limited time spent by patients in the operation
theatre (in majority of circumstances), the environment of
operation theatre plays a great role in the onset and spread of
infection due to multifactor causation of infection.
• Hence, it becomes essential to study the epidemiology of
infection as a multidisciplinary approach. In resource poor
circumstances as in most developing countries, it is believed
that though routine Microbiological monitoring is most essential,
in reality it is not practicable. But it is the responsibility of every
hospital to pay good attention in proper maintenance of air
conditioning plants, ventilator systems, and to have greater
control on mechanisms and personnel involved in disinfection
and sterilization of materials used in the theatres in operative
procedures.
•
DR.T.V.RAO MD 30
• Several Chemicals
are available but
the Economic
Limitation are great
hurdle in exploring
the Utility in
Developing
countries
ECONOMIC CONSIDERATIONS COMPROMISES SAFE
CHEMICAL APPROACHES
DR.T.V.RAO MD 31
WHO/WHAT IS IMPORTANT IN PREVENTION
OF INFECTIONS
REMEMBER WE ARE MORE IMPORTANT
THAN MANY CHEMICALS
DR.T.V.RAO MD 34
FOR ARTICLES OF INTEREST ON
ANTIBIOTICS FOLLOW ME ON
• Created by Dr.T.V.Rao MD for ‘e’ learning
resources for Microbiologists and Health
care Workers in Developing World
DR.T.V.RAO MD 35
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