INFECTION PREVENTION

AND CONTROL IN THEATRE

BY NYIRONGO

NYIRONGO.S 05/23/2024 1
NYIRONGO.S 05/23/2024 2
INFECTION PREVENTION AND
CONTROL IN THEATRE
 It is the responsibility of all theatre personnel
to control infection in the theatre department
by observing aseptic techniques as the
execute their duties.
 Asepsis is the absence of pathological

organisms. In surgery it refers to the efforts

made to prevent the transfer of
microorganisms to the patient.
 Aseptic technique is the practice that

prevents the patient and staff from acquiring

infection.This is achieved by the following.
NYIRONGO.S 05/23/2024 3
INFECTION PREVENTION AND
CONTROL IN THEATRE
 THEATRE CLOTHING
 All personnel entering the theatre must

change from outside clothes to theatre attire.

 Theatre attire must not be worn outside

theatre
 The theatre dress and trousers must have

cuffed sleeves to prevent bacteria shading.

 Boots and clogs (scores) must be worn while

in theatre and cleaned at the end of each list.

NYIRONGO.S 05/23/2024 4
INFECTION PREVENTION AND
CONTROL IN THEATRE
 All theatre personnel must wear masks to
cover their nose and mouth before entering
the operating room.
 The mask must be changed after a long case

or at the end of the list.

 Theatre caps must also be worn to cover all

the hair and changed after each list.

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INFECTION PREVENTION AND
CONTROL IN THEATRE
 THEATRE PERSONNEL
The personnel must know infection prevention
and control policies.
 Scrubbing must be done with soap and sterile

brushes under running water for 3 -5 minutes

 Nails must be kept short to prevent piecing of

gloves and nail polish must not be worn.

 Staff with skin lesions or cuts on the hands,

face or neck must not be allowed to scrub.

 Those with sore throat must be given sick off

to avoid droplet infection

NYIRONGO.S 05/23/2024 6
INFECTION PREVENTION AND
CONTROL IN THEATRE
 No jewelry must be worn by staff.
 Talking must be minimized to avoid droplet

infection.
 In and out traffic must be kept to a minimum.
 Scrubbed personnel are considered sterile

only on the front from waist to shoulder level

including the sleeves.

NYIRONGO.S 05/23/2024 7
INFECTION PREVENTION AND
CONTROL IN THEATRE
 THEATRE ENVIRONMENT
 The operating room doors should be kept
closed throughout the procedure
 Cleaning must be done every morning between
cases ant at the end of the list
 Routine cleaning is done weekly.
 Bacteriological sampling tests are done twice or
yearly on the floors,furniture and operating
table.
 Separate trollies are used for collecting patients
from the wards from those used inside

NYIRONGO.S 05/23/2024 8
INFECTION PREVENTION AND
CONTROL IN THEATRE
 Only sterile sets are used during operations.
 The sets used must be sterile and the dates

checked.
 The autoclave must be tested for efficiency.
 Instruments for sterilization must be double

draped.
 Sterile surfaces must be kept dry
 Instruments dropped must not be used
 Sterile packs are opened on the side to avoid

contaminating with the trolley

NYIRONGO.S 05/23/2024 9
 DISINFECTANTS
 These are solutions which are used to
prepare the site of incision sterile to prevent
cross infection and contamination during
operations.
 The following are solutions used as

disinfectants
 Savlon 1:100
 Iodine 2%
 Methylated spirit 70%

NYIRONGO.S 05/23/2024 10
INSTRUMENT PROCESSING
BY NYIRONGO SANFORD

NYIRONGO.S 05/23/2024 11
INTRODUCTION
 Processing of instruments before use

is very important for the safety of

both patients and health care
providers. It is therefore very vital for
all health care providers to take time
in processing and preparation of
instruments before use as they
deliver health care needs to the
community
NYIRONGO.S 05/23/2024 12
INTRODUCTION
There are many steps involved in the processing and
preparation of sterile surgical instruments.
 All of these steps must be performed correctly to

ensure a safe product for the patient. When shortcuts

are taken, a failure in the process can result. Moreover,
this failure may not be identified by a biological
indicator, chemical indicator or sterilizer printout.
To truly understand the ramifications of the entire

process, this session will address the major factors of

cleaning, packaging and sterilizing of surgical
instruments in theatre department.

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PROCESSINF OF INSTRUMENTS
 Instruments are processed to effectively prevent
patients from acquiring infection during and
after the procedure.
 The following are ways of rendering the
instruments free from pathogens
 Disinfection; this is the process of killing a
disease causing organism but not its spores.
 High Level Disinfection; it is the use of chemicals
such as cidex to destroy all vegetative fungi and
viruses but not necessarily all spores.
 Steriolization;it is the rendering of objects free
of all organisms including bacteria, spores and
viruses
NYIRONGO.S 05/23/2024 14
DECONTAMINATION
 It is the process of destroying non-spore
forming micro-organisms.
 In I.P we use physical or chemical means

to remove, inactivate, or destroy blood

borne or other pathogens on a surface or
item, to the point where they are no
longer capable of transmitting infectious
particles, and the surface or item is
rendered safe for handling, use, or
disposal.
NYIRONGO.S 05/23/2024 15
DECONTAMINATION
 Immediately after using instruments, they should
be placed in approved disinfectants such as 0.5%
chlorine solution for 10 minutes to inactivate
micro-organisms including HBV and HIV.(1 Part
of chlorine into 6 Parts of H2O).E.g. if you want to
make 5% of chlorine from 3.5% strength.

 Total parts of H2O= % Concentrate

% Dilute solution
 Have/Want i.e. (3.5%/0.5%=7)-1=6 Parts of H 2O

NYIRONGO.S 05/23/2024 16
DECONTAMINATION
 Calculations using powder concentrate
 Grams/litre of H2O= % Dilute solution

%Concentrate

Multiplied by 1000

NYIRONGO.S 05/23/2024 17
Steps in the Cleaning Process

After decontamination of instruments are

performed, personnel must don personal
protective equipment (PPE) which include:
 Impervious gown with sleeves
 Head cover
 Cuffed gloves
 Shoe covers (if shoes will be exposed to
fluids containing body fluids)
 Face shield
NYIRONGO.S 05/23/2024 18
Cleaning

The decontaminated instruments in 0.5% chlorine

solution for 10 minutes must be cleaned.
Cleaning is the removal—usually with cleaning

agent and water—of adherent visible soil (i.e.,

blood, pus, tissue, etc.) from the surfaces,
crevices, serrations, jaws and lumens of
instruments, devices and equipment, by a manual
or mechanical process that prepares the items for
safe handling and/or further decontamination.

NYIRONGO.S 05/23/2024 19
Principles of Cleaning
To ensure effective cleaning, all items must be in the
open position.
If possible, multi-part items should be disassembled.

Handle all instruments carefully to prevent damage.

When using an ultrasonic cleaner it is important to

keep different metal types separated (i.e., stainless

steel with non-anodized aluminum, brass, copper,
chrome plating).
Electrolysis can occur in wet, hot chambers of

ultrasonic cleaners which can cause one metal plating

to transfer to another metal.

NYIRONGO.S 05/23/2024 20
 Cleaning Agent Selection
Follow the recommendation of the instrument manufacturer
regarding the appropriate use of cleaning agents. No single
cleaning agent will remove all types of soil, or is safe to use
with all types of reusable devices.
Many facilities use a neutral-pH cleaning agent for cleaning

and soaking surgical instruments.

Liquids are preferred since they mix easier than powders.

However, it is essential that cleaning agents are used

according to the cleaning agent manufacturer’s instructions
for use including:
 Dilution
 Soak time
 Maximum water temperature
 Water quality
NYIRONGO.S 05/23/2024 21
Rinsing
Rinsing is the most important part of the
cleaning process. It removes the debris loosened
with manual and/or ultrasonic cleaning and
residual cleaning agent.
Sterile deionized/distilled water is preferred for

the final rinse to prevent mineral deposits and

reduce the potential for pyogens.
The water should not be reused. Follow the

instrument manufacturer’s recommendations

regarding the volume and quality of rinse water,
water temperature, and number of rinses.

NYIRONGO.S 05/23/2024 22
Preparation for sterilization
 After rinsing, dry the instruments ,pack
them and wrap with drapes and label the
set/ instruments.
 Use an indicating tape to show that the

instrument has been fully autoclaved to

ensure safety of the patients.

NYIRONGO.S 05/23/2024 23
Sterilization
 Sterilization is a process intended to kill
all microorganisms and their spores and is
the highest level of microbial kill that can
be achieved.
 A process cannot be called a sterilization

process unless it has been shown to be capable

of killing high numbers of bacterial spores, the
most difficult of microorganisms to kill.
 The CDC views steam under pressure, dry heat,

chemical vapor and ethylene oxide gas as

appropriate sterilization methods.
NYIRONGO.S 05/23/2024 24
STERILIZATION
 Instrument sterilization is one of the most
important parts of infection control. The cardinal
rule of infection control is "Do not disinfect
when you can sterilize."
 The approach is to sterilize all reusable

instruments contaminated with blood, or that have

penetrated tissue or touched bone (universal
sterilization).
 This is better than to sterilize some instruments

and disinfect others and is the safest approach to

prevent spreading disease to patients.
NYIRONGO.S 05/23/2024 25
Autoclave/Sterilizater

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Corrosion Control and Lubrication
 Always dry cleaned instruments to be
processed through a dry heat, chemical
vapor or ethylene oxide gas sterilizer or
packaged in a paper wrap. Drying
reduces the chances of corrosion and
rupture of the paper wrap. A rust
inhibitor can be applied to non-stainless
items to be processed through the
steam autoclave.
NYIRONGO.S 05/23/2024 27
STERILIZATION TIME
 Sterilization fails when the sterilizing agent--
steam, hot air, or chemical vapor--does not
come contact the processed items for the
appropriate length of time.
 Sterilization requires varying degrees of time,

depending on the load, arrangement, packaging

material, and temperature as well as the type of
sterilizing agent.
 Follow the manufacturer's direction and define

the proper sterilizing time by results of routine

spore-testing.

NYIRONGO.S 05/23/2024 28
STERILIZATION MONITORING
 Sterilization can be monitored by chemical indicators
(color change) but effectiveness cannot. Chemical
indicators are strips, tapes and markings on bags and
pouches that change color or physical form after
exposure to the sterilizing agent.
 They immediately indicate that the items have been
processed through the sterilizer and have been
exposed to heat, steam or chemical vapor.
 Since chemical indicators do not analyze for microbial
kill, they should be used in conjunction with, but never
as a replacement for spore-testing, which provides the
main guarantee of sterilization.

NYIRONGO.S 05/23/2024 29
STERILIZATION MONITORING
 Routine spore-testing (biological monitoring) of the
sterilizer helps assure the quality of patient care.
 Sterilization failure from improper use or

malfunction of the sterilizer increases the chances

for spread of disease agents from patient to patient
via the processed instruments.
 Routine spore-testing can detect these failures and

alert the office to check and correct packaging

procedures and sterilizer loading, operating and
functioning. Spore-testing is a very important form
of risk management.

NYIRONGO.S 05/23/2024 30
STERILIZATION METHODS
 A. Methods of Sterilization
1. Heat/Physical Methods
 Steam Thermal - Autoclave:
 This method involves the use of moist

heat (steam) under pressure and dry

heat.
 Definition -a self-locking apparatus for the

sterilization of material by means of

steam under pressure.
NYIRONGO.S 05/23/2024 31
 STERILIZATION METHODS
 MOIST HEAT STERILIZATION
 Autoclaves are used to sterilize articles which can
withstand heat and moisture.
 This is the commonest method used in hospitals.
 Steam from the boiler used to overate the autoclaves
whose process begins with condensation of moisture
 Moist heat sterilizes by the process of condensation
where steam is introduced in the chamber to come
into contact with the cool layer of the instruments.
 The steam then condenses leaving moisture on the
fabrics. Steam is continuously introduced until all the
fabrics are heated. Temperatures are maintained
constant at 134℃ for 3.5 minutes or 121℃ for 12
minutes to ensure sterilization takes place.
NYIRONGO.S 05/23/2024 32
STERILIZATION METHODS
 Once sterilization is complete the drying
process starts. This is followed by breaking
the vacuum after which the instrument set is
ready for use.
 Sterility teats are conducted every 3 months

to ensure efficiency of the autoclave.

 Normally the bowie dick test is used to test

the efficiency of the autoclave machine by

turning the indicating tape black from white.

NYIRONGO.S 05/23/2024 33
 HOW THE AUTOCLAVE WORKS
 The auto works by introducing a vacuum using
a high vacuum pump in the chambers before
sterilization.
 This helps to remove all the air in the chambers

before steam is introduced in the chambers

containing a load at a high temperature of
about 134℃ for 3.5 minutes to sterilize
instruments. The whole process undergoes 4
stages.
 Pre-vacuum stage; where air is removed from

the chamber by a vacuum pump.

NYIRONGO.S 05/23/2024 34
 HOW THE AUTOCLAVE WORKS
 Sterilization stage; Steam is introduced into the
chambers where all parts of the loaded sets are
exposed to the temperature of 134℃ for 3.5
minutes to sterilize instruments.
 Breaking the vacuum; it is completed within 3

minutes where the chambers are unloaded with

the packs and put on the shelves which should
be dust free for storage.
 Drying stage; This is when steam is removed

from the chambers through the outlet valve and

air is allowed to fill the chamber creating a post
vacuum. 05/23/2024 35
NYIRONGO.S
HOT AIR OVENS/DRY HEAT
 This method of sterilization requires higher
temperatures and exposure time.
 It is used to sterilize glass wear or

instruments which may rust when exposed to

moist heat.
 It sterilizes articles at 160℃ for an hour.
 It used convection currents to sterilize

articles where hot air rises while cooler air

descends to displace the heated air.

NYIRONGO.S 05/23/2024 36
COLD STERILIZATION
 This involves the use of gamma irradiation,
ethylene oxide gas and ultra violet light
radiation.
 Gamma irradiation; it is used to sterilize articles
at commercial level. It is used for disposable
items such as syringes, needles and surgical
blades which require sterilization once only. It
uses cobalt.
 Ethalyene oxide gas; It is used to sterilize heat
liable articles which include cardiac
catherters,endocsopes etc.
 Ultra violat light;It is used to sterilize small
articles such as blades bone graft and bone
chips because its light penetrates poorly.
NYIRONGO.S 05/23/2024 37
HEAT DISINFECTION
 This is achieved by boiling and pasteurization
 BOILING; This is when instruments are

submersed in boiling water after being

disinfected for 20 minutes at the temperature of
100℃ in a tightly closed container before being
used.
 The process does not kill spores.
 PASTEURIZATION;This is the process of emesion

of articles in distilled water to a temperature of

between 75℃ -85℃ for 10 minutes.It is used to
disinfect articles such as endoscopes and
cystoscopes.

NYIRONGO.S 05/23/2024 38
 COLD DISINFECTION METHODS
 This is the process of using various chemicals
to disinfect articles to render them free from
micro-organisms. This method should only be
used where heat sterilization not practical.
Effectiveness of chemicals depend on the
following.
 Chemical strength ie higher strength more

effective.
 Duration of free surface contact between

chemical and object

 Temperature of chemical
 Resistance of an organism.

NYIRONGO.S 05/23/2024 39
COLD DISINFECTION METHODS
Chemical Methods
 It is a method of rendering an article free from micro-

organisms by using Ethylene Oxide Gas

 Gamma irradiation

 Ultra-violate light

 Microorganism destruction is caused by a chemical

reaction
 Materials sterilized need to be aerated in well ventilated

room or placed in an aerator.

 Length of time required for aeration depends on items

sterilized.
 Effective sterilization is dependent on concentration of

gas, exposure time, temperature, and relative humidity .

NYIRONGO.S 05/23/2024 40
Chemical Methods
 Cold Sterilization
 Instruments should be completely dry before soaking

to prevent dilution.
 Instrument soaking solution - 10-20 minute immersion

only disinfects.
 Incomplete destruction of spores, unless soak is for 10

hours.
 Examples: Instrument Germicide (Phenol and Ethyl

alcohol), CidexTM (Gluteraldehyde)

 Most require thorough rinsing before using instrument.
 Contact time required varies with product used.

NYIRONGO.S 05/23/2024 41
B. Sterilization Shelf Life of
Packaged Supplies

1. The following wrapped items, if carefully

maintained, are sterile for up to one (1) month:
 Double cloth wrapped instruments
 Double paper wrapped instruments
 Inexpensive peel pouches for gauze sponges

2. Two (2) packaging methods are sterile for

up to six (6) months:
 Sterility Maintenance Covers -- Sealable plastic covers

to place over freshly autoclaved and cooled packs to

extend shelf life by diminishing air penetration

NYIRONGO.S 05/23/2024 42
C. Sterility Check List
 Before assuming a pack is sterile,
always evaluate the following before
opening the pack:
 Expiration or sterilization date
 Indicator color change
 General condition of wrapper and how it

had been stored

 Always check for holes or moisture

damage
NYIRONGO.S 05/23/2024 43
High level disinfection
Boil or steam
 Completely immerse in boiling water in a

processing vessel with a lid on for 20

minutes.
Chemical
Gluteraldehyde 2% for 20 minutes
Formaldehyde 8% for 20 minutes
Chlorine 0.1% for 20 minutes
NB: Rinse the instruments with NS before use
to prevent skin irritations on the patient.

NYIRONGO.S 05/23/2024 44
 Conclusion
 Instrument processing is an important
task to ensure effective infection
prevention in the health care system.
 This calls for all of us to be cautious

and mindful of the correct processing

and preparation of instruments we
use as we execute our duties to serve
lives of the people.

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