Nithya Gomatheswari, S (2010) Microbiological Surveillance of Operating Rooms at Tirunelveli. Masters thesis, Tirunelveli Medical College, Tirunelveli.
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Abstract
INTRODUCTION : “If I had the honour of being a surgeon, not only would I use absolutely clean instrument but after cleaning my hands with the greatest care would only use sponges previously raised to a heat of 1300-1500 Fahrenheit. I would still have to fear germs suspended in the air and surrounding the bed of the patient.” - Pasteur in his celebrated lecture to academie de medicine on April 30th 1873. Until the middle of the 19th century, when Ignaz Semmelweiss and Joseph Lister became the pioneers of infection control by introducing antiseptic surgery, most wounds became infected. In cases of deep or extensive infection this resulted in a mortality rate of 70- 80%. Even today, the major concern regarding hospital care that patients and doctors alike have is the concern about infections. The infections that the common man is exposed to in daily life can be controlled by steps that are taken on their own, but infections that occur within hospitals are the responsibility of the concerned hospital or nursing home and needs to be a high priority for them. This is especially true as of today, with the rising number of new and more resistant infective agents being identified. AIMS AND OBJECTIVES : This study was designed with the following objectives: To assess the trend and quality of air maintained between two subsequent fumigations. To compare the daily bacterial counts, assess the trend of variation if any and their relationship to various factors. To assess the results of different methods (Settle plate, air sampler, surface sampling peptone water & Robertson cooked meat medium) and to choose the right method according to the requirement. To compare the different agents (40% Formaldehyde and 1%Virkon) available for theatre sterilization for their efficiency. To assess the air quality maintenance in operation theatres without any special filter and theatres with HEPA filter. To correlate surgical site infection rate and microbiological air quality in the operation room. MATERIALS AND METHODS : Microbiological air qualities in the operation theatre were an independent important factor in the rate of surgical site infection. Yet there were no standard protocol accepted and followed by all particularly in country like India, where the resources were limited. Protocols have to be formulated which suits our condition. So the present study was conducted at Tirunelveli Medical College Hospital, Palayamkottai and a private multispecialty Hospital at Tirunelveli, TamilNadu from October 2008 to June 2009 to assess the three different Microbiological surveillance methods (Settle plate method, Air sampling method and Surface sampling method) in an operation theatre without any special filters and in modern theatres with HEPA filters.1 Inclusion criteria: From Tirunelveli Medical College and Hospital two operation theatres were included. 1. One emergency operation theatre (EOT). 2. Another major operation theatre (MOT) where elective cases were operated. Both the theatres were ventilated without any special air filters. Two operation theatres, from a private multi specialty Hospital: 1. One operation room for routine surgeries (Private OT I). 2. Another operation room for cardiac and orthopaedic surgeries (Private OT II). Both the theatres were equipped with HEPA filters and designed with modern facilities. The efficacy of 40% Formalin and 1% Virkon (peroxygen compound) were compared in both conventional and modern theatres using Settle plate method, Air sampling method and Surface sampling method. Patients who underwent surgery in these theatres were followed up post operatively for any surgical site infection. Exclusion criteria: Operation theatre where septic cases were done. Other sterilization agents like UV radiation and other chemicals were excluded. RESULTS : Two Operating Theatres in Govt. hospital without any special filters (EOT & Major) and two operating theatres (with HEPA filters) in a private multi specialty hospital were taken for study. All these theatres were assessed for the microbiological air quality maintenance by different methods (Settle plate, air sampler, surface sampling in peptone water & Robertson cooked meat medium). The disinfectants (Formalin & Virkon) used were also compared for their efficiency. This study was an attempt to adopt a simple, practical and cost effective method to suit our conditions. To correlate with surgical site infection the microbes isolated from operation theatre environment were identified to species level by standard microbiological methods. CONCLUSION : The maintenance of quality of air in the operating theatre equipped with special arrangement for air flow (plenum- positive pressure, horizontal or vertical laminar flow) was better than the counterparts with no special air filters. Fogging cannot replace manual cleaning and may in fact cause a false sense of security leading to the abandonment of more effective infection control measures. Use of formalin, an irritant, toxic, corrosive, and carcinogenic chemical should be discarded and any other agent or method like virkon with proven disinfectant efficiency may be used. Routine testing for the anaerobes may not be essential except when there were suspected cases of Tetanus or Gas gangrene or whenever any construction or structural alterations were done. The overall surgical site infection rate was 13.6% in patients operated in theatres without any special air flow arrangement. The infection rate was 0 % in patients operated in theatres equipped with laminar air flow. Virkon’s bactericidal activity of 1% concentration was effective at 10 minutes against the commonly isolated organisms. Using air sampler, requires trained personnel’s apart from its cost which may inhibit its use in small centers. Proper cleaning and maintenance of strict theatre protocol are more important. which doesn’t require technical expertise and a cost effective approach.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Microbiological Surveillance ; Operating Rooms ; Tirunelveli. |
| Subjects: | MEDICAL > Microbiology |
| Depositing User: | Subramani R |
| Date Deposited: | 14 Aug 2017 04:05 |
| Last Modified: | 14 Aug 2017 04:05 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1414 |
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