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Review Article

Operation Theaters and Sterilization Requirements – Design

Consideration and Standards for Infection Control
T. Nirmal Fredrick, Murugesan Kumaran1
Eye Surgeon, Nirmals Eye Hospital, Consultant Eye Surgeon, Kumaran Eye Specialty Center, Chennai, Tamil Nadu, India
1

Abstract
An operation theater (OT) complex is the “heart” of any hospital. An operating theater, operating room (OR), surgery suite, or a surgery center
is a room within a hospital where surgical and other operations are carried out. The patient is the center point of a functioning OT complex.
He/she is in isolation for varying times, away from his near and dear ones and is physically sick. Efforts should be directed to maintain vital
functions, prevent infections/promote healing with safety, comfort, and economy. A “civil‑mechanical‑electrical‑electronic‑biomedical” combo
effort driven and coordinated by the needs, preferences, and safety of the medical/surgical team forms the basis for starting and maintaining
an OT. Hospitals should exercise great care in proper maintenance of the OR environment, heating ventilation and air‑conditioning system
(HVAC) system, and medical and nonmedical equipment inside the OR. Personnel involved in disinfection and sterilization process should
follow aseptic protocols. Aseptic protocols mean following safe and disciplined procedures to minimize or eradicate the microbiological load
in the environment and in the instrument brought into the sterile field during the surgery.

Keywords: Disinfection, HVAC standards, sterilisation, operation theatres, zoning

Introduction great care in proper maintenance of the OR environment,

Operating theaters were so‑called in the United  Kingdom
because they traditionally consisted of semicircular
amphitheaters to allow students to observe the medical
procedures. An operation theater (OT) complex is the “heart”
of any major surgical hospital. An operating theater, operating
room (OR), surgery suite, or a surgery center is a room within
a hospital within which surgical and other operations are
carried out. The patient is the center point of a functioning OT
complex. He/she is in isolation for varying times, away from
his near and dear ones and is physically sick. Efforts should be
directed to maintain vital functions, prevent infections/promote
healing with safety, comfort, and economy.
The establishment and working of the OT need specialized
planning and execution and is not a simple civil engineering
work. A  “civil‑mechanical‑electrical‑electronic‑biomedical”
combo effort driven and coordinated by the needs, preferences,
and safety of the medical/surgical team forms the basis for
starting and maintaining an OT.
Hospital‑acquired infection contributes to about 20% of
admissions in the developing world. Hospitals should exercise
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heating ventilation and air‑conditioning system  (HVAC)
system, and medical and nonmedical equipment inside the OR.
Personnel involved in disinfection and sterilization process
should follow aseptic protocols.
Sterilization means complete eradication of microorganisms
from the operating environment. The sources of bacteriological
contamination can be from air, water, medical, paramedical
staff, patients, and articles brought in to the sterile
environment, clothing, instruments, infected body fluids,
electronic gadgets, and personal items such as wallets, mobile
phones, and jewelry.
Aseptic protocols mean following safe and disciplined
procedures to minimize or eradicate the microbiological load
in the environment and in the instrument brought into the sterile
field during the surgery.
Address for correspondence: Dr. T. Nirmal Fredrick,
Nirmals Eye Hospital, 108, Ayyasamy Street, West Tambaram,
Chennai ‑ 600 045, Tamil Nadu, India.
E‑mail: nirmalfred@hotmail.com
This is an open access journal, and articles are distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non‑commercially, as long as appropriate credit
is given and the new creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com

DOI: How to cite this article: Fredrick TN, Kumaran M. Operation theaters
10.4103/tjosr.tjosr_62_18 and sterilization requirements — Design consideration and standards for
infection control. TNOA J Ophthalmic Sci Res 2018;56:84-90.

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Fredrick and Kumaran: OT Design considerations and standards for infection control
Requirements to Maintain the Sterilisation in the
Operation Rooms or Theatre Complex
Infrastructure and engineering controls
1. Proper architecture and planning of hospital and OR
complex
2. Zoning inside the OT complex
3. HVAC system (air quality, cooling, pressure, particulate
count to maintain ISO class  5 cleanroom standards).
Managerial controls
4. Disinfection process of the OR and equipment.
5. Sterilization process of instruments.
6. Validation of sterilization process
7. Biomedical waste management (BMW).
Proper Architecture and Planning of Operating
Room Complex
In the present era of evidence‑based medicine, it is
imperative to give maximum importance in planning an
OT complex. Within the limitation of finance and space,
maximum benefit can be obtained by proper planning in
the initial stages.
Location
The OR should be preferably located where the movements of
patients are limited. It is best to avoid an operation room in the
ground floor, where maximum traffic of personals is located in
most hospitals. The materials used for the construction of the
OR needs to be long‑lasting, easy to maintain, and resistant
to the growth of microorganisms.
Zoning Inside the Operating Room
The four zones are planned depending on the layout and the
available space in an OR.[1-3] They are:
• Protective zone: This consists of the change rooms,
transfer bay, staffrooms, stores and records, recovery beds
• Clean zone: This intermediate zone is located between the
protective and the sterile zone. This houses the sterilization
area, induction area, and sterile disposables storing area
• Sterile zone: The main operating area along with the scrub
zones forms the sterile area
• Disposal zone: All unsterile items from the OR should
come out through a separate exit which leads to the
disposal area directly. Sterile and unsterile items should
not use the same entrance.
Proper planning is essential to incorporate the standards as laid
down by the local bodies and NABH [Table 1].
Heating Ventilation and Air‑Conditioning System
A proper HVAC system brings the entire personals inside
the hospital under the umbrella of protection as it eliminates
the pathogen at source. The quality of air inside an OR is
maintained by an HVAC system which regulates the quality of
air on the following parameters to achieve cleanroom standards
TNOA Journal of Ophthalmic Science and Research ¦ Volume 56 ¦ Issue 2 ¦ April-June 2018
Table 1: Minimum standards required for EYE OT
260 sq feet of Height ‑10 feet (not 5‑8 persons at
space mandatory) any point in time
Humidity 20‑60% AHU/Filtration‑ 2 Air changes‑20/h,
Temperature‑21C sets of pre filters & 1 10‑20% fresh air
+/‑ 3 Deg terminal HEPA filters change/hr.
Air Velocity Positive pressure Equipment
25‑35 FPM 2.5Psi load‑5‑7KW
Lighting‑1KW
as per ISO Class 6.[2,3] They are as follows:
• Temperature and humidity
• Pressure gradient between zones
• Particulate count.
The HVAC system consists of the air handling unit (AHU),
inflow and outflow ducts, air‑conditioning compressor, air
blower, pre‑HEPA filters (3 and 5 μ filters), and laminar air
flow (LAF) plenum with terminal 0.3 μ HEPA filter.
Plan of heating ventilation and air‑conditioning system
with air handling unit and laminar air flow plenum
The size of the AHU and HEPA filters are in accordance to
the volume of air inside the operation room. The number of
the pre‑HEPA filters in the AHU can be altered depending on
the volume and pressure of air that is to enter the Main OR.
Approximately, the volume of air entering the OR should
be equal to or greater than the volume of air in the OR. It is
easier to attain the required air quality standards with less
strain on the HVAC system when the AHU and the terminal
LAF plenum are placed close to each other, as this would
reduce the length of the inflow air ducts. Reduced inflow
duct length would translate as less strain on the compressor
to produce air cooling and less strain on the air blower to
achieve the required air pressure and air changes/hour. All
this has to be taken into consideration for planning the OT
and zoning.
The AHU has three chambers; the first chamber has provision
for fresh air inlet and returns air inlet. The air passes through
a set of 5 μ filters into the second chamber where it is cooled
by the condenser coils and blown by an air blower at a desired
pressure through a set of 3 μ filters into the third chamber.
The cooled, filtered air now passes through a thermoinsulated
aluminum air ducts into the terminal LAF plenum inside the
OR, which houses a 0.3 μ filter. The pressure, temperature, and
humidity are continuously monitored [Table 2].
The AHU should be operational throughout the clock to
maintain the quality of air. To reduce the electrical load
consumption, a variable flow device can be installed
which regulates the air‑exchanges in the OR without the
cooling effect. The pre‑filters installed in the AHU needs
to be cleaned regularly, at 3  monthly intervals and can
be reused. The terminal 0.3  μ terminal filter needs to be
changed when the required standards of particulate count
monitoring are not met or the air qualities are not up to the
required standards.
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Fredrick and Kumaran: OT Design considerations and standards for infection control

Managerial Controls and didecyldimethylammonium chloride 60  mg/g. This

provides complete asepsis within 30–60 min. Cleaning with
Operating room disinfection and cleaning detergent or carbolic acid is not required.
In OR with an HVAC system, proper surface disinfection is
crucial to maintain an infection‑free environment. Disinfection Bacillol
means cleaning an instrument/item to make it completely or Ethanol, 2‑propanol, and 1‑propanol can be used as spray for
partly free of any infection‑causing microorganisms. An ideal surface disinfection and does not act on spores. It is used for
disinfectant must kill all microorganisms and at the same time instant disinfection.
not cause any harm to humans. Certainly, no such disinfectant
Ultraviolet (UV) irradiation as a form of disinfection is not
exists.
standardized and not recommended as a routine disinfection
technique. However, it is used inside ducting of HVAC system,
Disinfectants Classified as per Efficacy pass boxes to disinfect the air.
Some of the commonly used disinfectants are given in Table 3.
Formaldehyde and glutaraldehyde are not recommended for Microbiological Monitoring
disinfecting ORs as they are carcinogenic in the concentration
With the development of fumigation free theaters and HVAC
used to disinfect. Hence, they have a limited role as a
systems, routine microbiological monitoring is not advised.
disinfectant. However, formaldehyde fumigation can be done
Unlike in Western countries, no standard exists in India on the
initially during a start‑up of a theatre or after an overhaul
frequency of microbiological surveillance. At present in the
cleaning process.
Indian scenario, microbiological surveillance is done based
Formaldehyde 6%, glutaraldehyde 6%, and benzalkonium on the individual knowledge, availability of resources, funds,
chloride 5% can be used using adequate personal protective access to microbiologist/laboratory, amount of surgical load,
devices. For example, for 4000 cft, 325 aldekol in 350 ml of occurrence of SSI, and the maintenance of air quality inside
water is sprayed for 30 min. OT must be closed for 2 h. the OT.[4]
Bacillocid Ideally, microbiological surveillance is done using the
It is a formaldehyde‑free disinfectant cleaner with low following methods [Table 4]:
use concentration. Ingredients are glutaral 100  mg/g, • Air sampling (bacterial counts)
benzyl‑C12‑18‑alkyldimethylammonium chlorides 60 mg/g, • Swabs – preferably peptide water swabs
• Settle plate method (duration of exposure should be equal
to the time taken for the shortest surgery).
Table 2: HVAC theatre standards
Temperature 21‑23 degree C Settle plate should be placed 12 inches above the operating
Humidity 50‑60% table. Minimum colony‑forming unit should be 10 but depends
Filter integrity using Poly Alfa Allowed leak is 0.01% on the bacteria isolated. Cultures incubated at 37° for 48 h.
olefin (PAO) 10 mcg/l Aerobic and anaerobic bacteria culture media need to be used.
Differential Pressure test >/= 15Pascals
Particulate count “At rest” 1 CF of sampled air
In HVAC systems, microbiological monitoring is replaced
condition (0.3 & 0.5 micron) for having <1000 particles by particulate count monitoring of 0.3 and 0.5  μ size and
ISO class 5 standards (14644:1) measuring <0.5 microns other parameters as shown in Table 5. The frequency of OT
Air Changes (minimum 20/h validation depends on the surgical volume. Ideally, it should
requirement) be done twice a year [Table 5].

Table 3: Some of the commonly used disinfectants are

Phenols and Phenolics
Halogens: Iodide
Alcohols (60‑90%)
Halogen‑Chloride: Hypochlorite
4‑6%, 1:50 (liquid form NaHOCl,
Solid‑Calcium hypo chloride or
sodium dichloroisocynurate)
Stabilized Hydrogen peroxide
11% (Ecoshield)
Glutraldehyde 6%
Lipid membrane damage
Lipid membrane damage
Denatures proteins
Lipid membrane damage
Alkylation the amino acid
and sulfhydryl group bases
Active in presence of organic
matter and stable for long hours.
Bactericidal, Sporicidal,
Fungicidal, Virucidal
Bactericidal, Fungicidal,
Virucidal‑envelope
Active on enveloped/
non‑enveloped viruses, algae,
fungi, Hepatitis B and HIV
viruses
Highly effective on anaerobic
bacteria
Bactericidal, Sporicidal,
Fungicidal, Virucidal.
Not effective‑Spores & non‑enveloped
viruses.
Prolonged contact time
Not effective‑Spores & non‑enveloped
viruses. Ineffective on organic matter, needs
time to act, evaporates quickly & expensive
Corrodes metals, Bleaches fabrics.
Ineffective on spores
Toxic and damages tissues
Highly toxic & needs PPD

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Fredrick and Kumaran: OT Design considerations and standards for infection control

Cleaning Process of surgical instruments.[5-7]

Adequate cleaning with a proper disinfectant is important as
it removes all dust, bacterial flora, organic matter, and other
contaminants. The disinfectant used should noncarcinogenic,
easily available, and safe to be used by the hospital staff.
Most disinfectant removes almost 90%–95% of the infectious
microbes except spores. Keeping the operating complex dry
would make microbes and even spores unviable.[5]
Only wet mopping of walls and floor should be employed
inside the OR complex. Use the three bucket system to mop
the OT. The first two buckets contain RP purified water and the
third bucket contains the disinfectant diluted with RO water.
A clean and dry mop is immersed sequentially into the buckets
before the figure of eight methods of cleaning is used. The
walls also cleaned with a lint free cloth using the three bucket
system taking care to mop from clean to unclean area [Table 6].
Instruments Processing for Sterilization
The American OR Nursing [1] Recommended Practices
Committee has provided guidelines for the care and cleaning
Table 4: Disinfection levels
High Bactericidal, Fungicidal, Virucidal, Parasiticidal
& even Mycobacterium. E.g.: Glutraldehyde
Intermediate Kills most viruses, bacteria, fungus.
Low Kills vegetative bacteria, fungi & few viruses.
Table 5: Swab’s to be taken from
OT table head end Crash cart Terminal HEPA filter
Phaco tray Refrigerator Scrub basin
Mayo trolley Surgeon & nurse gloves Microscope handles
Boyle’s Door handles/walls Light Pendant handles
1. The cleaning process includes separation of sharp and
blunt instruments. The instruments are initially rinsed
using distilled water
2. After ensuring that the instruments are removed of dirt
and organic matter, they are processed in an ultrasonic
cleaner using cetrimide 15% and chlorhexidine gluconate
3% for 10–20  min. The ultrasonic cleaner generates
sound waves at frequency of 100,000 Hz in liquid and
generates submicroscopic bubbles which later implode
and create a minute vacuum that separates particles from
instruments[6,7]
3. The next process of cleaning involves the three bin
technique, in which mechanical scrubbing is done
sequentially using a soft bristle brush and care is taken
not to damage the fine tips of the ophthalmic instruments.
Hollow instruments are thoroughly flushed with distilled
water to ensure no residual organic matter is present
4. The washed, cleaned, and scrubbed instruments are
air‑dried using a high flow jet air gun. This removes the
moisture from them instantaneously
5. The cleaned and air‑dried instruments should be packed
or wrapped for sterilization to prevent dust accumulation.
Alternatively, the instruments can be stored in a UV
irradiated chamber before sterilization
6. Packing is done using woven or nonwoven fabrics.
Peel pouches can also be used when the visibility of
instruments is crucial. Heat‑resistant stainless steel
304‑grade bins are used for surgical instruments
sterilization
7. Every item that is packed for autoclave must have a date
and time. Steam‑sterilized items must be used within
48 h. Once the sterile pack is opened, the contents become
unsterile even if they are not used. Have a separate storage
area for sterile goods.

Table 6: Cleaning protocol Sterilization

Area Disinfectant Frequency Sterilization is a process in which all microorganisms including
Roof 2% Bacillocid Once in 3 months bacterial spores are destroyed completely. The common
Walls 2% Bacillocid Daily twice methods of sterilization are as follows [Table 7].[8]
Floor 2% Bacillocid Daily twice
Flash autoclaves and glutaraldehyde forms of sterilization are
Refrigerator Defrost & Clean with Soap and water Weekly once
not applicable and safe for ophthalmic instruments. However,
Sink Soap, Water/Sodium Hypochlorite Daily once
if used must be done with caution [Table 8].
OT furniture Alcohol based spray Daily once
AHU & Water Once in 3 months Ethylene oxide  (ETO) sterilization was first reported in
Pre‑filters 1859. The sterilization cycle consists of five stages  –  gas

Table 7: Sterilization methods

Method
Steam under
pressure‑Autoclave
Dry Heat (Ethylene oxide
gas)
Dry heat (Plasma‑Activated
hydrogen peroxide gas)
Time Advantage Disadvantage Suitable Materials
125*C, Lethal to all bacteria, Items need to be heat & All Linen, metallic instruments
25 min Viruses & Spores Moisture resistant
5 psi‑12 h, Low temperature Toxic to humans and explosive. Heat labile instruments, tubings,
10 psi‑6h Needs standoff time of 24 h Phaco, Vitrectomy, cryo probes.
90 min Low temperature, items Specific packing and expensive Heat labile instruments, tubings,
can be used immediately Phaco, Vitrectomy, cryo probes.

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Fredrick and Kumaran: OT Design considerations and standards for infection control

introduction, evacuation with humidification, exposure, for objects that cannot sustain the high temperature and
evacuation, and air washes, taking about 2 1/2 h. Mechanical moisture necessary for autoclave sterilization, and its low
aeration takes between 8 and 12 h at +50°C to +60°C, and on temperatures– +25° to +50°C make it suited for medical
completion of aeration, the sterilized objects are removed. devices which may have electronics.
ETO Sterilization is suited for objects which cannot sustain
the high temperature and moisture necessary for steam such
as with autoclave sterilization. Autoclave Indicators
The chemical indicators are classified into six groups.[6‑8]
Plasma Sterilizer The indicators within each group are further subdivided
by the sterilization process for which they are intended
1. Hydrogen peroxide sterilization  –  Hydrogen peroxide
to be used. The classification has no hierarchical significance.
was discovered by LJ Thenard in 1818 and is a
The appropriate chemical indicator should be used to obtain
popular alternative to ETO. It is known for its use in
the pharmaceutical industry and can be used in two the information needed to determine the effectiveness of the
ways–  hydrogen peroxide plasma sterilization and sterilization process [Table 9].[9.10]
vaporized hydrogen peroxide sterilization
2. Vaporized hydrogen peroxide  (VHP) sterilization is Biological Indicator
made up of three stages – conditioning including vacuum This is the only indicator that confirms the sterility of the
generation, aeration, and H202 injection, taking about
autoclaved load. It is also used to validate the sterilization process.
60 min, including aeration time. VHP sterilization is suited
This consists of a sealed vial with two chambers. The inner
chamber contains the broth and outer chamber has the spores
Table 8: Autoclave types of the most heat‑resistant bacteria bacillus thermophillus. For
Class N Class B every load, one vial is packed and placed in the most challenging
Principal Gravity air Vacume air removal. part of the load intended to be sterilized. After the sterilization
displacement process, the processed vial and an unprocessed control vial are
Pre‑Vacume No yes crushed so that the inner chamber breaks mixing the broth and the
Cold air removal
spores. These crushed vials are then incubated at 57°C for 48 h in
Pre‑Vacume Hot No yes
air removal a biological indicator incubator.[10,11] The vials are inspected and
Drying effect Present Best findings documented at 12 h, 18 h, and finally at 48 h.
Specific use Solid Unpacked Solid , porous, non‑porous &
In a successful sterilization cycle, the processed vial does not
instruments hollow packed & unpacked
only instruments change color and remains violet, while the unprocessed vial
Time more Less shows color change from violet to yellow indication growth
Steam Not Effective Effective removal with pulses of bacteria in the vial. The BI should be ideally used in every
penetration of steam‑vacume cycles load of the autoclave cycle.

Table 9: Autoclave Indicators

Indicator class Use
Class 1 chemical indicator (ISO11140‑1:2005) Process indicators .Eg. Indicator tape, Differentiates processed from unprocessed loads
Class 2 Indicator Intended to check a specific test procedure as defined by relevant sterilization standards. Eg.
Specialty indicators Bowie dick test strip/paper. It tests steam penetration with dynamic air removal in class B
autoclaves. Used in an empty cycle at 134*C for 3.5 minutes or 125*C for 15 min
Class 3 Indicator These indicators react to one of the critical process parameters of the sterilization .Critical
Single Variable Indicators parameters chosen for steam sterilization are time and temperature. Temperature tube where
a pellet melts at a specific temperature. Used to determine that a specific temperature was
achieved. Used in ETO.
Class 4 Indicator Designed to react to two or more of the critical variables and is intended to indicate exposure
Multi‑Variable Indicators process at the stated value of the chosen variables. Eg. Time and temperature are the chosen
variables in steam sterilization and time and concentration of ethylene oxide are chosen for ETO
Class 5 Chemical Integrators Integrating integrators designed to react to all critical variables. The Stated values are generated
to be equivalent to, or exceeds the performance[9.10] requirements given in ISO 11138 series for
Biological Indicators. Indicates 3 autoclave parameter of Steam quality, Temperature and Time
and correlates with Biological indicator.
Class 6 Indicator Emulating Indicator Cycle verification indicators which shall be designed to react to all critical variables for specific
sterilization cycles. Eg “Process challenge device” (PCD)/Helix test denotes steam ability to
penetrate hollow instruments. Does not correlate with Biological indicator.

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Fredrick and Kumaran: OT Design considerations and standards for infection control

Biomedical Waste Management • HUB cutters shall be placed throughout the Hospital in
locations, which facilitate their immediate use. These
A proper BMW process is needed for the proper functioning of
locations shall be such that they exclude injury to patients,
any healthcare facility. “biomedical waste” is any waste, which
visitors, and staff
is generated during the diagnosis, treatment, or immunization
• Lancets and other sharps shall be placed in sharps
of human beings or animals or in research activities
container (HUB cutters) unless used in areas with special
pertaining to or in the production or testing of biological and
procedures, such as the OR
categories [Tables 10 and 11].
• When sharps containers securely removed and disposed
daily
Proper Disposal of Sharps: To Prevent • Used syringes shall be placed in blue bins and removed
Needlestick Injuries from unit
• Used disposable needles and syringes and other sharps shall • Recapping of needles should be avoided where at all
be placed in the sharps container (HUB cutters) containing possible. When it is absolutely necessary (e.g., because
1% sodium hypochlorite, designated for this purpose there is no sharps container available for disposal, etc.)
needles are recapped using the scoop method, as follows:
a. Place the cap on a flat surface
Table 10: Categories of Biomedical waste
b. Without holding the cap, use the needle to scoop the
Hazardous (10‑25%) Non‑Hazardous (75‑90%) cap onto the needle
Infectious: c. Shake the cap down over the needle
Sharps d. Press the cap firmly into place.
Non‑Sharps
Plastics Blades shall be removed by an appropriate tool and discarded
Liquid waste by the use of a tool. Sharps shall never be left “lying around.”
Others: Loose needles shall never be placed or left in the patients’
Radioactive waste linen.
Discarded glasses
Expired medicines
Pressurized containers BMW Water Treatment
Cytotoxic waste All the water used in the OT complex and Laboratories
Incinerator ash should be treated in a water chamber, with 5% sodium
Chemical waste hypochlorite for 30 min in a ratio of 1:3 (part of 5% sodium
hypochlorite for 3 parts of wastewater) before let out into
the main sewer.
Table 11: Colour Coding of BMW disposal
YELLOW ‑ ANATOMICAL RED ‑ SOLID WASTE Proper personal protection devices such as gloves, cap, mask,
WASTE Soiled cotton aprons, and shoes should be used by the personals while handling
Placenta Dressings the biomedical waste. Segregation of biomedical waste at source
Human body parts Linens and proper transportation to the site of disposal is important.
Blood and blood products Diapers
Items saturated with blood Swabs Financial support and sponsorship
Microbiological waste Nil.
BLUE ‑ NON‑BIODEGRADABLE BLACK ‑ DISCARDED
WASTE DRUGS/CHEMICALS Conflicts of interest
Plastic bottles Discarded Medicines There are no conflicts of interest.
Tubings Outdated Medicines
Dialysis kits Cytotoxic drugs
Blood bags Chemical waste
References
Urine bags Lab chemicals 1. Laufman H. The Operating Room. In: Benett JV, Brachman PS, editors.
Hospital Infections. Boston: Little Brown & Co; 1986. pp 315-24.
Catheters Disinfectants
2. Rice NS, Harry J. Ophthalmic operating theatre design: Methods of
Disposable Syringes sterilization. Proc R Soc Med 1969; 62:1203-04.
Gloves 3. Sehulster LM. Chinn RYW, Arduino MJ, Carpenter J, Donlan R,
GREEN ‑ BIODEGRADABLE WHITE ‑ WASTE SHARPS Ashford D, et al Guidelines for environmental refection control in
WASTE Broken bottles health care facilities. Recommendations from CDC and the Healthcare
Office waste Broken ampoules Infection Control Practices Advisory Committee (HICPAC) November
Wrapping paper Needles 2003.
Food waste 4. Senior BW. Examination of water, milk, food and air. In: Collee JG,
Blades
Duguid JP, Frase AG, Marmion BP, Simmons A, editors. Mackie &
Cupboards Slides McCartney’s. Practical Medical Microbiology. New York; Churchill
Paper cups Livingston,1989. p. 204-39.

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Fredrick and Kumaran: OT Design considerations and standards for infection control

5. Sharma S, Bansal AK, Gyanchand R. Asepsis in the ophthalmic
operating room. Indian J Ophthalmol 1996;44:173-77.
6. Recommended practices for the care and cleaning of surgical instruments
and powered equipment. AORN Journal 1997;6:124-28.
7. Recommended Practices for Sterilization in Perioperative Practise
settings.Associations of Perioperative Registered Nurses.AORN
Standards,Recommended Practises and Guidelines.2008.
8. Reichert, Marimargaret and Young, Jack, Sterilization Technology for
the Health Care Facility. Aspen Publication, Gaithersburg, Maryland,
1997:129-49.
9. Association for the Advancement of Medical Instrumentation.
Comprehensive guide to steam sterilization And sterility assurance in
health care facilities. ANSI/AAMI ST79:2017.
10. Vesley D, Langholz AC, Rohlfing SR, Foltz WE. Fluorimetric detection
of a bacillus stearothermophilus spore bound enzyme, a D-glucosidase
for rapid identification of flash sterilisation failure. Appl. Environ.
Microbial 1992;58:717-9.
11. Rutala WA, Gergen MF, WeberDJ, Evaluation of a rapid readout biological
indicator for flash sterilisation with three biological indicators and three
chemical indicators. Infect. Control Hosp. Epidemiol 1993;14:390-4.

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