THEATRE DESIGN AND VENTILATION презентация

Содержание

CONCEPT It was first introduced by SIR JOHN CHARNLEY

Слайд 1THEATRE DESIGN AND VENTILATION
DR.LOKESH SHAROFF Orthopaedic surgeon, Mumbai, India

Слайд 2CONCEPT
It was first introduced by SIR JOHN CHARNLEY

Слайд 3ZONES 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

Слайд 4REQUIREMENTS
AIR DELIVERY SYSTEM AIR FILTERATION SYSTEM TEMPERATURE CONTROL HUMIDITY CONTROL

Слайд 5TEMPERATURE 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

Слайд 6HUMIDITY CONTROL
- Should be around 40-60% - Fastest death of organisms occur

at 50% humidity

Слайд 7AIRBORNE 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.

Слайд 8AIRBORNE 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

Слайд 9AIR 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

Слайд 10HEPA FILTERS
- Each hepa filter has a manometer attached to it

to measure the amount of resistance to filteration for clogging purposes.

Слайд 11TYPES OF VENTILATION
High velocity air flow - high speed jets towards

operating table - high speed air at periphery Laminar air flow - horizontal - vertical

Слайд 12CONVENTIONAL WALL DIFFUSER

Слайд 13
- Produces plenum - No control of air over operating area - Upto

500 bcp/mm3 – not acceptable for operation theatres

Слайд 14HIGH VELOCITY AIR JET

Слайд 15
- Jets increase air turbulence - Flow at 0.6 m/s - Jets may

not point at right place and may dessicate the wound

Слайд 16Vertical 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

Слайд 17Horizontal laminar flow
- Forms part of a wall - Easy to

install - Movement across it will cause uncontrollable turbulence - adequate clean zone is not possible

Слайд 18PERIPHERAL LAMINAR

Слайд 19CONVENTIONAL LAMINAR

Слайд 20Vertical 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

Слайд 21Without side panels

Слайд 22
- Peripheral entrainment air 0.6 m/s - Higher energy consumption - movement causes

deflection of contaminants

Слайд 23EXPONENTIAL AIR FLOW

Слайд 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

Слайд 25STANDARDS 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 less than 10 cfu/mm3

Слайд 26AIR 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)

Слайд 27AIR QUALITY CONTROL
- Done by CASTELLA SLIT SAMPLER

Слайд 28WATER 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

Слайд 29ANTIBIOTIC 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

Слайд 30ANTIBIOTIC PROPHYLAXIS
TIMING Within 15-60 mins prior to incision Vanco should

be given 2 hrs before

Infusion should complete before incision

Слайд 31ANTIBIOTIC 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

Слайд 32ANTIBIOTIC PROPHYLAXIS
- RISKS - PENICILLIN ALLERGY - ANAPHYLAXIS - ABX ASSOCIATED DIARRHOEA - CLOSTRIDIUM DIFFICLE

INFECTION - ABX RESISTANCE - MULTI-RESISTANCE CARRIAGE – SCREENING SHOULD BE DONE IN HIGH RISK CASES

Слайд 33THANK YOU
*Pictures taken from journal of orthopedics today

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