INFECTION CONTROL IN OPHTHALMOLOGY OR

1.Introduction

2.Possible infections in OR

3.What is wrong with our

practices .

4.OR etiquette .

5.Planning the OR complex .

6.Care of instruments .

7.Cleaning the OR .

8.Sterilization and disinfection

of the OR .

The operating room has become the most critical point of any hospital set up , and the surgical procedures are the most important event that happens to a patient.

Cleanliness of the hospital environment is the best starting

point to achieve the highest patient safety mandate.

There is a need to decrease the bio-burden present in the environment in an operating room.

A systematic method of precautions taken by operating team leads to a successful procedure.

POSSIBLE INFECTIONS IN OR :

•Post operative infection following eye surgery is a serious complication , leading to a marked loss of vision

the incidence of postoperative infection following cataract extraction to be as high as 11.6/1000.

Postoperative endophthalmitismay occur clinically as an isolated event or as a cluster of infections in the form of a surgical epidemic. The most common infecting organism is Staphylococcus.

WHAT IS WRONG WITH OUR PRACTICES ?

.11. Improper or absence of sterilisation of surgical instruments or environment .

.22. disinfectants used indiscriminately .

.33. used unnecessirly .

.44. concentration not adequate .

OR ETIQUETTE

1)Personnel entering the OR complex should be strictly controlled.

2)Anyone with overt infection should be barred.

3)All persons entering the OR should change into freshly laundered clothing.

4)Hair and beards should be clean and be well covered by caps and masks.

YES -- Hair Covered

NO -- Hair Exposed

HIGH-FILTRATION DISPOSABLE MASKS ARE TO BE WORN

AT ALL TIMES WHEN WITHIN THE ASEPTIC ZONE.

Nose & mouth covered (yes) Nose & exposed (NO)

Female health workers should take special care to trim nails and remove jewellery when working within the theatre complex.

All persons must wash their hands thoroughly before entering the OR.

THERE IS A STRONG RELATIONSHIP BETWEEN THE DESIGN, EFFICIENCY AND THE HUMAN ELEMENT. HENCE CONFIGURATION OF AN OR COMPLEX CAN INDIRECTLY AFFECT THE INCIDENCE OF SURGICAL INFECTIONS.

A) LOCATION : OR COMPLEX SHOULD ALWAYS BE SEGREGATED FROM THE HIGH TRAFFIC AREA OF THE HOSPITAL .

B)DESIGN : SEPARATING STERILE FROM NON_STERILE COMLEX NEED TO BE DESIGNED THOUGHTFULY TO MAINTAIN ASEPSIS , FOR STRICT ASEPSIS : AN EYE OR SHOULD NOT BE SHARED WITH ANY SURGICAL DISCIPLINE .THERE ARE 4 MAJOR ZONES IN OR COMPLEX :1.OUTER ZONE 2.CLEAN ZONE 3.ASEPTIC ZONE 4.DISPOSAL ZONE.

C)AIR HANDLING : IT SHOULD BE FILTERED AND VENTILATED .

Planning the OR complex

THE MAJOR ZONES OF OR COMLEX

a)The outer zone is a reception area and is accessible to all persons and supplies.

b)The clean zone is the space for circulation of OR staff after changing. It encompasses the (i)changing room located near the entrance of the OR complex; and (ii)transfer zone which is the space where patients are shifted from the transfer point to the OR.

c)The aseptic zone is the sterile area within the OR complex consisting of the scrub and gowning area, the preparation room and the OR.

d)The disposal zone is the area where used equipment and supplies are processed. Disposal of biohazardous waste is also done in this zone.

AIR HANDLING

The air in the entire surgical suite should be well filtered and ventilated. The operating room should be ventilated by an efficient bag filtered or high efficiency particulate air filter (HEPA) system (0.3μ).

The environment of such operating room has been shown to be effectively clean. Most bacteria and fungi are in the 0.5 to 5.0μ diameter range. Thus HEPA filtered air is virtually bacteria and fungus free.

CARE OF INSTRUMENTS

a) Cleaning the instrumentsprior to its sterilization Instruments should be cleaned as soon as possible after their use. Delicate and regular instruments should be separated

An ultrasonic cleaner is ideal for cleaning instruments. It thoroughly cleans every part of the instrument, including the depths of the cannulae, tubes and other unreachable parts.

If ultrasonic cleaner is not available, the instruments are to be first soaked in mild detergent (eg. savlon) for half hour and then washed thoroughly under running water using a soft brush .

B) STERILISATION AND DISINFECTION

Surgical instruments and drapes need to be sterilised adequately.

The goal of instrument processing is to protect patients by preventing

cross-contamination from instruments.

C) STORAGE & INSTRUMENT SETS

The instruments are dried completely before reassembling or storing.

. To avoid electrolysis, it is not advisable to mix instruments made of stainless steel with those made of aluminium, brass or copper.

Each delicate instruments must be

physically separated from adjacent ones to prevent damage, interlocking or crushing.

ENVIRONMENTAL DECONTAMINATION

1) Cleaning the ORCleaning essentially means the

removal of foreign matter (e.g. soil,

organic matter) from the concerned

surface.

All surfaces should be free from

visible dirt. It is normally

accomplished with water, mechanical

scrubbing and detergents.

CLEANING THE FLOOR IS NECESSARY WHILE THE WALL IS

CLEANED ONLY IN CASES OF DIERCT SPLASHES .

B) STERILIZATION AND DISINFECTION OF THE OR

Disinfection is a process of

freeing the concerned object

of all pathogenic

microorganisms which may

cause infection during its use.

Sterilisation is a process that

eliminates all living

organisms from the treated

object.

METHODS OF STERILISATION

.11) Formaldhyde fugmentation

.2Formaldehyde is an effective agent

commonly used to sterilise the OR.

.32) phenolic compounds

.4Phenol (carbolic acid) is one of the

oldest known germicides. The

hundreds of compounds derived

from it constitute phenolic

compounds, which are good

bactericides and are active against

fungi.

.53) paraform method

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