FUMIGATION IS HAZARDOUS PRACTICE TIME TO CHANGE FOR SAFER METHODS IN STERILIZATION OF OPERATION THEATERS
Post created by Dr.T.V.Rao MD Copyright 2017 © Docplexus Time to end fumigation of operation theaters look for better alternatives. Fumigation aims to create an environment, which will contain an effective concentration of fumigant gas at a given temperature, for a sufficient period of time to kill any live infestations.
Aldehyde are potentially carcinogenic and it is therefore recommended that other agents such as hydrogen peroxide, hydrogen peroxide with silver nitrate, peracetic acid and other chemical compounds of formaldehyde should be used in place of the currently prevalent practice of using formaldehyde.
One of the best answers receive from
Dr. A. Kumar MBBS, MD, FMMC, Fellowship in Infection Control USA d Former student MD Microbiology of CMC Vellore

Thank you Dr. Rao for bringing the topic for discussion. Infact the current Centres for Disease Control, Atlanta, Georgia, USA, doesn't recommend for routine fumigation with any of the available disinfectants. The operating theaters are not classified any more for clean and dirty infected surgical procedures. If adequate terminal cleaning is performed any operating room can be used for any kind of surgery. During our internship we used to have septic theaters for handling dirty/infected operative procedures. Here, we currently operate even transplant surgical procedures following an abdominal lapartatomy procedure as well but after adequate terminal cleaning. For cleaning & disinfection of the operating room, the right disinfectant is chosen and is usually done with infection control committee consultation & we currently use clorox solution which is diluted to 40% and if there is obvious spill of blood or body fluids we disinfect with 10% clorox solution or we could even use any of the Quaternary ammonium compounds viz. present tablets 4 tablets in 5 liters of potable water. Each tablet contains 250mgm quarterly ammonium compound. This product approved environmental protection agency (EPA). This disinfection procedure takes just around 25-30 minutes before a new patient is taken in. the most important thing to be remembered is that right disinfectant is chosen and right contact time is observed before cleaning is performed. The mops used for these cleaning process should be frequently changed and if a known infected patient is operated, color coded single use mop heads are used. But, if at all a patient following road traffic accident is brought into the OR, where during evaluation, you find that the patient is diagnosed with an airborne infectious disease such as open pulmonary tuberculosis, or a chicken pox with florid lesions, we make sure we use disinfection with fumigation machine available from Johnson & Johnson (USA) now take over by the French company & this machine uses calculated amount of hydrogen peroxide mixed with silver ions and this destroys aerosols suspended in air. This procedure takes around 30-45 minutes and this product doesn't damage any of the electronic devices and doesn't leave any residual toxic chemical following the procedure. Of course this fumigation process is initiated after thorough terminal cleaning. This product destroys even spores as per the manufacturer's report. we do face increasing number of patients affected with Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) & we utilize this fumigation process with good effect and this product has prevented occurrence of cross infection among patients with MERS-CoV as it was evident that after patient discharge from a room, this virus lives in the aerosol for almost 36 hours even after terminal cleaning. In addition, its mandatory for having all the environmental and engineering controls in place to have a safe operating room for handling surgical procedures. Restricted entry of Unwarranted staff to the OR. Color coded zone line demarcation for permitting staff with street dress and recommendation to change to the OR dress code beyond the red line. Always keep the OR closed during surgical procedure Make sure that the OR is continuously monitored electronically for positive air pressure (> 18 air exchange / hour). Keep equipment's and machines necessary only for the designated surgical procedure. because many times we have noticed that c arm machines, operating microscopes for a neurosurgical procedure or an ENT procedure will be kept in the OR during an unrelated procedure. If kept unrelated to the procedure, these unused machines could get colonized from infectious aerosols and if not adequately disinfected as per the manufacturers recommendation cross infection could occur between patients. Many at times, we have noticed that the exhaust vents within the OR would be obstructed by the OR nursing staff without realizing the importance of the vent. Always perform surveillance for surgical site infections for all surgical procedures performed and if you find a cluster of patients with surgical site infection with a similar organism and antibiogram will warn that some kind of cross infection has occurred and needs immediate investigation. Even re-admission of surgical patients will be a cause of concern for cross infection and surgical site infection or even catheter associated urinary tract infection or hospital acquired pneumonia or even central line associated blood stream infections. So, its a team work where the OR chief should get involved in prevention of infections by working closely with the hospital housekeeping staff, hospital engineering services who controls the operating room air ventilation system, involve the hospital infection control team, and others as needed. The above team should be involved in the decision making before a disinfectant product is purchased by the hospital management or authorities.
HOPE WE ALL CAN CHANGE FOR BETTER PRACTICES
Dr.T.V.Rao MD Freelance Clinical Microbiologist On line contributor on Infectious disease portals
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