Theatre design and ventilation - SlideShare [PDF]

Jul 6, 2014 - AIRBORNE PARTICLES - Measured as BCP/MM3 – Bacteria carrying particles OR CFU/MM3 – Colony forming uni

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Theatre design and ventilation 11,699 views Share Like Download ...

CONCEPT • It was first introduced by SIR JOHN CHARNLEY

Lokesh Sharoff, Orthopaedic Surgeon at Mumbai,India Follow Published on Jul 6, 2014

This ppt is about operation theatre air filteration and asepsis in the OT ... Published in: Health & Medicine, Technology 0 Comments 45 Likes Statistics Notes

Full Name Comment goes here. 12 hours ago Delete Reply Spam Block ZONES IN THEATRE OUTER ZONE – rest of the hospital outside the theatre complex CLEAN ZONE – theatre complex outside the op... Are you sure you want to Yes No Your message goes here

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Khwar Nyo 1 week ago REQUIREMENTS AIR DELIVERY SYSTEM AIR FILTERATION SYSTEM TEMPERATURE CONTROL HUMIDITY CONTROL Sofia Sharaf 1 week ago

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md nadeem hasan 1 month ago Show More No Downloads Views Total views 11,699 On SlideShare 0 From Embeds 0 Number of Embeds 13 TEMPERATURE CONTROL - Ideal working temperature is 19-20 * C – to minimize perspiration - But causes pt. hypothermia - PT.... Actions Shares 0 Downloads 646 Comments 0 Likes 45 Embeds 0 No embeds No notes for slide

Theatre design and ventilation 1. 1. THEATRE DESIGN AND VENTILATION DR.LOKESH SHAROFF Orthopaedic surgeon, Mumbai, India 2. 2. CONCEPT • It was first introduced by SIR JOHN CHARNLEY 3. 3. ZONES IN THEATRE OUTER ZONE – rest of the hospital outside the theatre complex CLEAN ZONE – theatre complex outside the operating area ASEPTIC ZONE – Operating area DISPOSAL ZONE – Separate exit for contaminated / used linen and instruments 4. 4. REQUIREMENTS AIR DELIVERY SYSTEM AIR FILTERATION SYSTEM TEMPERATURE CONTROL HUMIDITY CONTROL 5. 5. TEMPERATURE CONTROL - Ideal working temperature is 19-20 * C – to minimize perspiration - But causes pt. hypothermia - PT. body temp. should be 24-26 * C TO AVOID HYPOTHERMIA 6. 6. HUMIDITY CONTROL - Should be around 40-60% - Fastest death of organisms occur at 50% humidity HUMIDITY CONTROL - Should be around 40-60% - Fastest death of organisms occur at 50% humidity 7. 7. AIRBORNE PARTICLES - Measured as BCP/MM3 – Bacteria carrying particles OR CFU/MM3 – Colony forming units - Each person emits 10k cfu/min at rest and 50k cfu/min with activity - This is reduced in SCRUBS to 140-830 cfu/min with fask mask and caps. 8. 8. AIRBORNE PARTICLES - CONVENTIONAL AC (well maintained)- gives 50- 500 cfu/mm3 - All particles are not viable – viable : non viable ratio is 1:1000 - Smallest particle in theatre seen in bright light is 12 microns - Smallest particle that can carry bacteria is 4-5 microns 9. 9. AIR FILTERS- 4 LEVELS - ROUGHING FILTERS removes Large particles and also protects sensitive final filters - PREFILTERS should be 95% efficient - FINAL FILTERS should be 95% efficient with a particle size of 3 microns - HEPA FILTERS should be 99.97% efficient with a particle size of 0.3 microns 10. 10. HEPA FILTERS - Each hepa filter has a manometer attached to it to measure the amount of resistance to filteration for clogging purposes. 11. 11. TYPES OF VENTILATION High velocity air flow - high speed jets towards operating table - high speed air at periphery Laminar air flow - horizontal - vertical 12. 12. CONVENTIONAL WALL DIFFUSER 13. 13. - Produces plenum - No control of air over operating area - Upto 500 bcp/mm3 – not acceptable for operation theatres 14. 14. HIGH VELOCITY AIR JET 15. 15. - Jets increase air turbulence - Flow at 0.6 m/s - Jets may not point at right place and may dessicate the wound 16. 16. Vertical laminar flow - Room within a room principle - Air is passed through hepa filters from ceiling downwards - Flow at 0.3 m/s - entrainment can happen by moving personnel 17. 17. Horizontal laminar flow - Forms part of a wall - Easy to install - Movement across it will cause uncontrollable turbulence - adequate clean zone is not possible 18. 18. PERIPHERAL LAMINAR 19. 19. CONVENTIONAL LAMINAR 20. 20. Vertical laminar with canopy and side panels - Canopy – to overcome peripheral entrainment - side panels – extend down to floor to within 20cms from floor - very successful – 10 bcp/m3 21. 21. Without side panels 22. 22. - Peripheral entrainment air 0.6 m/s - Higher energy consumption - movement causes deflection of contaminants 23. 23. EXPONENTIAL AIR FLOW 24. 24. - Trumpet shaped air flow - Downward and radially outward flow of air - fliteration down to 1 micron - Trays can be positioned even upto ½ m outside the actual canopy 25. 25. STANDARDS IN AIR FLOW - Direction of air flow shall be under positive control - max. viable organisms should be not more than 1 cfu/mm3 - ULTRA CLEAN ZONE – is AIRBORNE PARTICLES - Measured as BCP/MM3 – Bacteria carrying particles OR CFU/MM3 – Colony forming units - Each person emi... less than 10 cfu/mm3 26. 26. AIR CHANGES - ATLEAST 20-40 AIR CHANGES PER HOUR - Pressure gradient should be 1.3-2.5mm h2O (more pressure causes rapid drying of the wound) 27. 27. AIR QUALITY CONTROL - Done by CASTELLA SLIT SAMPLER 28. 28. WATER SUPPLY IN OT - Tanks and pipes – regular inspection for leakages - Bore well water should be avoided as far as possible - tanks and containers should have covers/lids to protect from dust - water sterilised by ultraviolet radiation 29. 29. ANTIBIOTIC PROPHYLAXIS - CHOICE OF AGENT Active against comon pathogens Take into account drug allergy and sensitivity cefazolin/cefotaxim preferred-long duration clinda/vanco in penicillin allergy pts. Modification for pre-existing cultures if already on abx – then continue same 30. 30. ANTIBIOTIC PROPHYLAXIS - TIMING Within 15-60 mins prior to incision Vanco should be given 2 hrs before - Infusion should complete before incision 31. 31. ANTIBIOTIC PROPHYLAXIS - DURATION Further dose efficacy is doubtful Max 24 hrs if only prophylatic intra-op – repeat if length of sx more than half life of drug repeat dose if blood loss >1500ml not to continue abx till drain removal 32. 32. ANTIBIOTIC PROPHYLAXIS - RISKS - PENICILLIN ALLERGY - ANAPHYLAXIS - ABX ASSOCIATED DIARRHOEA - CLOSTRIDIUM DIFFICLE INFECTION - ABX RESISTANCE - MULTI-RESISTANCE CARRIAGE – SCREENING SHOULD BE DONE IN HIGH RISK CASES 33. 33. THANK YOU *Pictures taken from journal of orthopedics today

AIRBORNE PARTICLES - CONVENTIONAL AC (well maintained)- gives 50- 500 cfu/mm3 - All particles are not viable – viable : no...

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Osteogenesis imperfecta - By Dr. Lokesh Sharoff Lokesh Sharoff English Español Português Français Deutsch About Dev & API Blog Terms Privacy Copyright - Jets increase air turbulence - Flow at 0.6 m/s - Jets may not point at right place and may dessicate the wound Support

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- Peripheral entrainment air 0.6 m/s - Higher energy consumption - movement causes deflection of contaminants

EXPONENTIAL AIR FLOW

- Trumpet shaped air flow - Downward and radially outward flow of air - fliteration down to 1 micron - Trays can be positi...

STANDARDS IN AIR FLOW - Direction of air flow shall be under positive control - max. viable organisms should be not more t...

AIR CHANGES - ATLEAST 20-40 AIR CHANGES PER HOUR - Pressure gradient should be 1.3-2.5mm h2O (more pressure causes rapid d...

AIR QUALITY CONTROL - Done by CASTELLA SLIT SAMPLER

WATER SUPPLY IN OT - Tanks and pipes – regular inspection for leakages - Bore well water should be avoided as far as possi...

ANTIBIOTIC PROPHYLAXIS - CHOICE OF AGENT Active against comon pathogens Take into account drug allergy and sensitivity cef...

ANTIBIOTIC PROPHYLAXIS - TIMING Within 15-60 mins prior to incision Vanco should be given 2 hrs before - Infusion should c...

ANTIBIOTIC PROPHYLAXIS - DURATION Further dose efficacy is doubtful Max 24 hrs if only prophylatic intra-op – repeat if le...

THANK YOU *Pictures taken from journal of orthopedics today

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