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    Fumigation in Operation Theatres

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    Utkarsh Rai
    Fumigation using formaldehyde is no longer recommended due to its carcinogenic properties. However, for many Indian hospitals that lack proper heating, ventilation and air conditioning systems, alternative fumigation methods may be necessary. Silver-hydrogen peroxide fogging is a safer alternative that can effectively decontaminate surfaces and air. While fumigation does not replace rigorous cleaning, it may provide psychological benefits and reduce bacterial counts when better options are not available. Controlled studies are still needed to demonstrate the impact of fogging on infection rates in Indian hospitals with inadequate ventilation.

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    Fumigation in Operation Theatres

    Uploaded by

    Utkarsh Rai
    3K views22 pages
    Fumigation using formaldehyde is no longer recommended due to its carcinogenic properties. However, for many Indian hospitals that lack proper heating, ventilation and air conditioning systems, alternative fumigation methods may be necessary. Silver-hydrogen peroxide fogging is a safer alternative that can effectively decontaminate surfaces and air. While fumigation does not replace rigorous cleaning, it may provide psychological benefits and reduce bacterial counts when better options are not available. Controlled studies are still needed to demonstrate the impact of fogging on infection rates in Indian hospitals with inadequate ventilation.

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    Fumigation using formaldehyde is no longer recommended due to its carcinogenic properties. However, for many Indian hospitals that lack proper heating, ventilation and air conditioning systems, alternative fumigation methods may be necessary. Silver-hydrogen peroxide fogging is a safer alternative that can effectively decontaminate surfaces and air. While fumigation does not replace rigorous cleaning, it may provide psychological benefits and reduce bacterial counts when better options are not available. Controlled studies are still needed to demonstrate the impact of fogging on infection rates in Indian hospitals with inadequate ventilation.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    3K views22 pages

    Fumigation in Operation Theatres

    Uploaded by

    Utkarsh Rai
    Fumigation using formaldehyde is no longer recommended due to its carcinogenic properties. However, for many Indian hospitals that lack proper heating, ventilation and air conditioning systems, alternative fumigation methods may be necessary. Silver-hydrogen peroxide fogging is a safer alternative that can effectively decontaminate surfaces and air. While fumigation does not replace rigorous cleaning, it may provide psychological benefits and reduce bacterial counts when better options are not available. Controlled studies are still needed to demonstrate the impact of fogging on infection rates in Indian hospitals with inadequate ventilation.

    Copyright:

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    Download as PPT, PDF, TXT or read online from Scribd
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    of 22

    Do We Need Fumigation In Our Indian Operation Theatres??

    - Dr. Ajita Mehta


    President HIS-I Consultant Microbiologist P. D. Hinduja National Hospital & MRC Veer Savarkar Marg, Mahim (West) Mumbai 400 016

    Points to be discussed

    Critical Parameters for ideal Operation Theatre (OT) Indian Scenario about OT What is Fumigation / Fogging Do we need fumigation in India? What will be the Take Home Message?

    Critical parameters for OT

    Filter air through 2 layer beds in series


    (efficiency of the 1st filter bed being >30% & that of the 2nd filter bed being >90%)

    HEPA filters (to remove > 0.3 m with an efficiency of 99.97%) Positive pressure Requirement of 15-20 air changes /hour with a minimum of 3 air changes of fresh air (20%). Air should flow from the ceiling & be exhausted near the floor

    Temperature of 20- 220C, is comfortable & inhibits bacterial growth

    Relative humidity 30-60% to slow down bacterial growth

    Laminar airflow (ultra clean air) & UV radiation have been suggested as additional measures in certain situations (orthopedic operations)

    Heating Ventilation Air Conditioning (HVAC) Systems

    HVAC system maintain indoor air temp. & humidity, control odours, remove contaminated air & minimize the risk of transmission of airborne microorganisms

    Consists of air inlets, filter beds, humidity modification mechanisms, heating & cooling equipment, fan ducts

    & air exhausts

    Fumigation is no longer used in the Western Literature


    as they have all the modern critical parameters required for OT

    Indian Scenario

    In India, there are extreme situations in operation theater (OT) facilities, ranging from rooms with fans, window air conditioning, to the more sophisticated laminar airflow systems More than 60-80% of OTs, donot have air handling unit (AHU) & other modern facilities with critical parameters In hospitals that lack heat ventilation air conditioning (HVAC) systems the quality of air in the OT cannot

    be guaranteed

    What can we do in such circumstances??

    Fogging

    Nebulization of a disinfectant to decontaminate rooms

    vacated by patients with communicable diseases.


    The origin of fogging can be

    traced to the 19th century when


    Lister aerosolized carbolic acid to improve antisepsis in

    operative practice

    What Is Fumigation?

    Fumigation consisted of a mixture of formalin (280 ml) and potassium permanganate (150 gm) being placed in a bowl. The room would then be sealed & opened 12-24 hours later. Later on this changed formalin being sprayed with humidification by a spraying device or automist.

    Temperature 180C & Humidity should be maintained to 600C

    Different Methods
    1. Carboxyl acid & fumigation with Formaldehyde Advantages Established age old technique Cost effective Disadvantages a. Carboxylic acid has efficacy as scouring and disinfecting agent b. Time consuming, min 24 hrs turn around time c. Self defeating OT fumigated with Formaldehyde needs to be force de-aired with unclean air d. Unsafe Formaldehyde is carcinogenic

    2. Aldehyde based germicides Glutaraldehyde & formaldehyde (200 ml in 10 liters of water i.e 2%) through fogging machine is the commonly used procedure. AdvantagesEffective

    Disadvantages a. Leaves sticky residue because of surfactant base


    b. Self defeating OT fumigated with Formaldehyde needs to be force de-aired with unclean air c. Unsafe- Formaldehyde has been

    identified as a carcinogen

    3. Silver (Ag) and Hydrogen Peroxide (H2O2) Advantages a. Has deep penetrating capability b. Has no known resistant strains

    c. Effective against Bacteria, Viruses, Mycobacteria, Amoeba, Fungi and spore forming organisms

    A fogging system Droplets~7microns thrust by a motor running at 20,000 RPM to a distance of 15 m

    Solution
    Ecoshield 11% Hydrogen Peroxide and 0.01% dilute sliver nitrate

    Efficacy of Fumigation / Fogging method

    Viable bacteria may fail to grow when cultured in the presence of disinfectants

    Neutralization of disinfectant (ammonia vapours or water) is must before collecting air samples or swabs Lecithin & Tween 80 in appropriate concentrations are suitable neutralizing agents
    Environmental contaminants are generally associated with organic residues that bind & deactivate most disinfectants, (least likely to be benefit in those areas contaminated
    with organic materials such as blood, feces or pus)

    Fogging hastens the process of setting of airborne microorganisms. Mist, generated by a disinfectant or water would achieve the same process

    Air

    sampling is useful to detect aerosols or particles of

    microorganisms. (requires particle counter & practical method for


    evaluating efficiency of filters)

    Air sampler

    The Unresolved issues of microbiologic sampling are:

    Lack of standards Lack of Standard protocols for testing Sensitivity of sampler used Such sampling should largely be reserved for epidemiological investigations during outbreaks

    No studies to demonstrate that fogging actually reduces


    the incidence of nosocomial infection. The role of contaminated environmental surfaces in causing nosocomial infection remains to be elucidated*

    Controlled studies at CDC have demonstrated that quaternary ammonium fog does not produce a significant (one log )reduction in bacterial counts of S. aureus or E. coli, even in areas in completely saturated with residual

    disinfectant*
    *CDC: National Nosocomial Infections Study Quaterly Report, Third Quarter. 1971: isuued May 1972)

    In India, studies have not compared standard cleaning practices with fumigation/fogging. No substitute for vigorous scrubbing, washing of surfaces & removing the organic matter

    Safety of repeated exposure of humans to disinfectant & fog has not been established Inspite of these drawbacks it is the best alternative for - litigation - good & safe hospital practices, - check up of human default - favourable psychological effect on staff & patients - to improve the standard of hospital hygiene & asepsis

    Points to support

    Significant reduction in the number of bacteria in the ambient air Effective decontamination of exposed environmental surfaces

    Decreased risk of infection for housekeeping personnel


    engaged in terminal cleaning

    Decreased housekeeping costs


    Secondary psychological benefits for hospital personnel

    Take Home Message

    Fumigation is the only alternative however following precautions should be taken Replace formalin with a safer agent like a H2O2 stabilized with a silver salt It has no role in OTs with modern day HAVCs

    For litigation after fogging do the air sampling & keep the record
    This is not an alternative to mechanical cleaning of surfaces If surgeries are being performed with window airconditioners fogging would be required on a daily basis not on weekends alone as is practiced (WHO guidelines on
    prevention & control of Hospital Associated infections SEA-HLM-343. Jan 2002)

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