Hazards associated with surgical plume and its prevention

Surgical plume is the smoke and aerosols produced during surgical procedures that involve the use of surgical instruments that generate heat, such as electrosurgery, laser surgery, and ultrasonic devices. This plume can contain harmful particles such as tissue debris, blood, and potentially infectious agents, and can pose health risks to both the surgical team and patients.

Some of the hazards of surgical plume include:

1. Inhalation of toxic substances: The plume can contain toxic substances such as benzene, hydrogen cyanide, and formaldehyde, which can be harmful if inhaled. Prolonged exposure to these substances can cause respiratory problems, cancer, and other health issues.
2. Transmission of infectious diseases: The plume can contain infectious agents such as viruses, bacteria, and fungi. If not properly managed, these agents can be transmitted to the surgical team and other patients, increasing the risk of infection.
3. Eye irritation and damage: The plume can cause eye irritation and damage, especially if the surgical team is not wearing appropriate eye protection. The heat and particles in the plume can cause corneal burns, conjunctivitis, and other eye injuries.
4. Skin irritation and damage: The plume can cause skin irritation and damage, especially if the surgical team is not wearing appropriate protective clothing. The heat and particles in the plume can cause burns, rashes, and other skin injuries.

Prevent Smoke During Surgery

Here are some ways to prevent smoke during surgery:

1. Use smoke evacuation systems: These are specialized devices that can remove smoke from the surgical site. They work by suctioning the smoke and filtering it through a series of filters before releasing it back into the air.
2. Use appropriate surgical instruments: Some surgical instruments produce more smoke than others. For example, electrosurgical instruments can produce a lot of smoke. Using alternative surgical instruments, such as laser instruments, may produce less smoke.
3. Use lower power settings: When using electrosurgical instruments, using lower power settings can help reduce smoke production. However, this may increase the risk of bleeding or incomplete tissue removal.
4. Use appropriate ventilation: Proper ventilation in the surgical room can help reduce the concentration of smoke. The use of negative pressure rooms, high-efficiency particulate air (HEPA) filters, and frequent air changes can help reduce the concentration of smoke.
5. Use personal protective equipment: Surgical staff should wear appropriate personal protective equipment, such as masks and goggles, to prevent exposure to smoke and other harmful substances.
6. Educate surgical staff: Educating surgical staff about the risks associated with smoke and the importance of using appropriate prevention measures can help reduce exposure to smoke during surgery.

By using these prevention measures, it is possible to reduce the amount of smoke produced during surgery and minimize the health risks associated with it.

Which suture is most likely to cause infection?

Which suture is most likely to cause infection?

Suture infection riskS

The likelihood of suture-related infections depends on various factors such as the type of suture material used, the surgical site, the patient's health status, and the surgeon's technique.

However, some suture materials are more prone to causing infections than others. For example: 

• Absorbable sutures made of natural materials such as catgut or silk have a higher risk of infection compared to non-absorbable synthetic sutures such as nylon or polypropylene. This is because natural materials can harbor bacteria and may break down too quickly, which can lead to inflammation and infection.
• Halsted,5 in 1913, expressed a strong preference for the use of silk in clean surgical wounds, but stated that it should be avoided in contaminated or infected ones. Whipple,8 in 1933, strongly advocated the use of silk in repair of clean wounds, indicating that the incidence of infection was actually less than when chromicized catgut was used.
•  Monofilament sutures, which have a single strand, have a lower risk of infection compared to multifilament sutures, which have multiple strands, as bacteria can get trapped within the multiple strands of the latter. 
• Chronic SSI can arise from underlying bacterial biofilms, which can invest implanted foreign bodies and associated soft tissue surfaces.

Ultimately, the best type of suture material to use depends on various factors, including the patient's individual needs, the surgical site, and the surgeon's preference and experience. Your surgeon will determine the best type of suture material for your case to minimize the risk of infection.

1.Sandeep Kathju, Laura Nistico, Luanne Hall-Stoodley, J Christopher Post, Garth D Ehrlich, Paul Stoodley surgical infections 10 (5), 457-461, 2009

Chronic surgical site infection due to suture-associated polymicrobial biofilm  

2.Role of suture Materials in the Development of Wound Infection J. Alexander, J. Z. Kaplan, W. Altemeie

• Published 1 February 1967
• Medicine
• Annals of Surgery

Why rigid closed container are better than peel pouches?

Why rigid closed container are better than peel pouches?

A rigid closed container is a container that is designed to maintain a specific environment inside by keeping external factors such as air, moisture, and contaminants out.

Use of rigid closed container : 

While sterilization wrap will continue to be used to some degree, hospitals are seeking ways to improve upon the current process, reduce resterilization needs, reduce the use of disposable or single-use products and reduce waste. 

One attractive option is the use of rigid sterilization containers for reusable medical instruments requiring sterilization. Sterilization packaging must allow for sterilant penetration during the sterilization process, prevent microbial penetration during storage and transport as a means of maintaining sterility of processed items, and facilitate aseptic presentation of the contents.1

 Rigid containers (also called reusable hard cases) are typically made of anodized aluminum or stainless steel, can require a filter or be filterless, and meet all of these criteria. Additionally, rigid containers can protect the instruments from inadvertent drops, can facilitate the organization of the instrument sets and are not subject to any of the breakthrough or resterilization issues prevalent with blue wrap. 

Cost benefit Analysis :

Disposable blue sterile wrap, used for the one-time sterilization of instruments before surgery, comprises a large portion of surgical waste—estimated by one study to comprise 19% of the OR waste stream.2 

 A recent onsite hospital study found that blue wrap may make up as much as 55% of the total volume of disposable plastics leaving the OR. 3. At Mills-Peninsula Medical Center, Central Processing estimated 5-10 torn blue wrap sets per week at a cost of $100/set—costing the organization between $500-$1000 per week and up to $50,000 annually,4 just from repackaging and resterilization efforts.

A transition to rigid sterilization containers can make long-termfinancial sense for a healthcare organization. Other noted benefits include a potential reduction in ergonomic wrapping injuries for Sterile Processing Department (SPD) staff, increased ease in keeping track of instruments, the avoided cost of blue sterile wrap and of course, the waste reduction benefits in the OR.

References :

1.  Flynn, S. Considerations for use of rigid sterilization containers. Healthcare Purchasing News. October 2010. Accessed on March 18, 2011.

2. Laustsen, G. Greening in Healthcare. Nursing Management. November 2010. Vol. 41, Issue 11. Pp: 26–31. Accessed on March 11, 2011

3. Brannen, L., Guity, A. and DeLoach Lynn, C. Improving Sustainability Performance in a High-Paced, “Big” Cost-Center, and Resource-Constrained O.R. Setting. ASHE 

International Summit and Exhibition on Planning, Design and Construction. 

March 15, 2011. 

4.  McGurk, J. Greening Healthcare Through Pollution Prevention: Overview of Waste 

Management. Greening of Hospitals Workshop 

Autoclave principle, working and its types

Autoclave  principle, working and its types 

Steam Sterilizer / Autoclave :  

The autoclave is a sealed device (similar to a pressure cooker) that kills microorganisms using saturated steam under pressure . 

Principle :  

The use of moist heat facilitates the killing of all microorganisms, including heat-resistant endospores which is achieved by heating the materials inside the device at temperatures above the boiling point of water. 

 Method : 

 Moist heat in the form of steam under pressure causes the denaturation & coagulation of proteins by following steps .

1.Conditioning :   The usual procedure is to heat at 1.1 kilograms/square centimeter (kg/cm2) [15 pounds/square inch (lb/in.)] steam pressure, which yields a temperature of 121°C. At 121°C, the time of autoclaving to achieve sterilization is generally considered to be 15-20 min, depending on the volume of the load.  

 2. Exposure : Direct saturated steam contact is the basis of the steam sterilization process. For a specified time and at a required temperature, the steam must penetrate every fiber and reach every surface of the items to be sterilized.

3. Condensation :  When steam enters the sterilizer chamber under pressure, it condenses on contact with cold items. This condensation liberates heat, simultaneously heating and wetting all items in the load and thereby providing the two requisites : moisture & heat . 

 4. Drying:  At the end of the cycle, re-evaporation of water condensate must effectively dry contents of the load to maintain sterility; the water is dried from the sterilized pack or item.

Types of Autoclave : 

1.  Gravity displacement sterilizer : 

Principle :  

A steam sterilizer that uses steam in a downward motion to remove air from the sterilizing chamber. Air exits near front lower drain. 

Method :

It  contains two shells that form a jacket and a chamber. Steam fills the jacket that surrounds the chamber. After the door is tightly closed, steam enters the chamber at the back, near the top, and is deflected upward. Air is more than twice as heavy as steam. Thus by gravity, air goes to the bottom and steam floats on top.The air passes through a filtering screen to a waste line.

Many gravity displacement steam sterilizers operate on a standard cycle of 250° F to 254° F (121° C-123° C) at a pressure of 15 to 18 pounds per square inch (psi). The size and contents of the chamber determine the exposure period;  the minimum exposure time is 15 minutes. 

2. Prevacum sterilizer :

Priniciple :  A faster steam sterilizer that removes air by a vacuum before filling the chamber with steam. Also known as dynamic air removal steam sterilization.

Method :  In this high-vacuum sterilizer, air is almost completely evacuated from the chamber before the sterilizing steam is admitted using a pump and a steam injector system. A vacuum period of 8 to 10 minutes effectively removes the air to minimize the steam penetration time.  As a result, the sterilizing steam almost instantly penetrates the center of the packages when admitted to the chamber.

A post-vacuum cycle draws moisture from the load to shorten the drying time. The Bowie-Dick test is performed daily to ensure that the air vacuum pump is functioning properly.

Temperatures in the pre-vacuum sterilizer are controlled at 270° F to 276° F (132° C-135.5° C) at a pressure of 27 psi.  All items are exposed to a temperature of at least 270° F (132° C) for a minimum of 4 minutes. A complete cycle takes approximately 15 to 30 minutes, depending on the sterilizer's capacity.

FLASH (IMMEDIATE-USE) STERILIZER

A high-speed pre-vacuum sterilizer is used in the operating room and in other areas of the hospital to sterilize items for immediate use. Steam sterilization using an abbreviated cycle at a high temperature is necessary for rapid sterilization. 

However, advanced technology leading to new materials and complex equipment has led to equally complex guidelines for ensuring patient safety. 

In the past, the term flash sterilization was used to describe the process of a shortened sterilization cycle for uncovered items. Now, however, there are situations in which items are covered in a variety of ways, even for immediate use following sterilization.

A standards committee composed of members of accredit-action bodies, research professionals, and key health professionals agreed in 2010 that the term flash sterilization does not reflect the complexity of sterilization for immediate use. The term has been replaced with immediate-use sterilization. 

Standards for immediate-use sterilization have been adapted by the Association of Surgical Technologists as well as other 

professional organizations.

The statement on adaptation to the new terminology can be found on the AAMI website, http://www.aami.org/

publications/standards/ST79_Immediate_Use_Statement.pdf. 

This website also provides references for the standards and practices currently approved by accrediting and professional agencies.

Sterilizers employed for immediate use are usually located just outside the operating suite, in the sub sterile or core area. 

This type of sterilizer is used only when no alternative is available. Items are sterilized just before use. Ideally, items to be sterilized for immediate use should be in a covered metal tray. 

However, some immediate-use sterilizers can be used with a drying cycle that is suitable for items wrapped in a single layer of woven material. Unwrapped items coming from the an immediate-use sterilizer will be wet, as there is no drying cycle for unwrapped goods.

What are different methods of sterilization?

What are different methods of sterilization?

Sterilization methods

Sterilization is the process of killing or eliminating all forms of microbial life, including bacteria, viruses, fungi, and spores. Here are some common methods of sterilization:

• Autoclaving: It is a process of sterilization that involves subjecting items to high-pressure saturated steam. The autoclave is a sealed device (similar to a pressure cooker) that kills microorganisms using saturated steam under pressure . Autoclaves are commonly used in medical and laboratory settings to sterilize instruments, glassware, and other materials.
• Chemical sterilization: It is a process of sterilization that uses chemicals such as ethylene oxide or hydrogen peroxide gas to kill microorganisms. It is commonly used in healthcare settings to sterilize heat-sensitive equipment.

• Radiation sterilization: It is a process of sterilization that uses ionizing radiation (such as gamma rays or X-rays) or non-ionizing radiation (such as ultraviolet light) to kill microorganisms. This method is commonly used to sterilize medical equipment, food products, and other materials.

• Filtration: It is a process of sterilization that uses filters to remove bacteria and other microorganisms from a liquid or gas. This method is commonly used to sterilize liquids such as intravenous fluids and vaccines.

• Dry heat sterilization: It is a process of sterilization that uses dry heat to kill microorganisms. This method is commonly used to sterilize glassware, metal instruments, and other materials that can withstand high temperatures 
•  Heat is carried from its source to load by radiation, convention and to a small extent by conduction

• Boiling: It is a simple and effect method of sterilization that involves boiling items in water for a set period of time to kill microorganisms. It is commonly used in home settings to sterilize baby bottles, kitchen utensils, and other items.
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It is important to note that not all methods of sterilization are suitable for all types of materials or microorganisms. The choice of sterilization method depends on the type of material being sterilized, the type of microorganisms present, and the intended use of the sterilized material.

How to prevent urinary tract infection?

How to prevent urinary tract infection?

UTIs are common infections that happen when bacteria, often from the skin or rectum, enter the urethra, and infect the urinary tract. The infections can affect several parts of the urinary tract, but the most common type is a bladder infection (cystitis). Kidney infection (pyelonephritis) is another type of UTI.

There are some specific preventative measures that patients cana take to avoid urinary tract infections:

1. Patients with catheters should make sure that their catheter is clean and properly cared for to prevent bacteria from entering the urinary tract.
2. Patients with a history of recurrent UTIs may benefit from long-term antibiotic therapy or prophylactic antibiotics.
3. Patients with diabetes should work to manage their blood sugar levels, as high blood sugar can increase the risk of UTIs.
4. Patients with anatomical abnormalities or other underlying medical conditions may need additional testing or treatment to prevent UTIs.
5. Patients who are at high risk for UTIs, such as pregnant women, should discuss prevention strategies with their healthcare provider.
6. Drink plenty of fluids, especially water. This helps keep bladder tissue hydrated and healthy.
7. Empty your bladder often.
8. 
   
    

Latex Powdered Glove Risks

Latex Powdered Glove Risks

Latex powdered gloves pose several risks to users and patients, including:

Allergic reactions: Some individuals may have an allergic reaction to latex, which can lead to skin irritation, itching, hives, and in severe cases, anaphylaxis.

Respiratory irritation: The powder used in latex gloves can cause respiratory irritation, especially when inhaled, leading to coughing, sneezing, and breathing difficulties.

Contamination: The powder in latex gloves can carry bacteria and other particles, which can potentially contaminate wounds or create infection in patients.

Decreased sensitivity: Wearing gloves that are too thick or too loose can reduce the wearer's tactile sensitivity, making it difficult to perform delicate procedures accurately.

Increased risk of injury: The powder in latex gloves can cause friction and increase the risk of cuts or tears, leading to exposure to hazardous materials and potential injury.

It is important to consider these risks when choosing gloves for medical or other applications, and to consider alternatives such as powder-free latex gloves or gloves made from alternative materials such as nitrile or vinyl.

Prons and cons of washer sterilizer over manual cleaning

Prons and cons of  washer sterilizer over manual cleaning 

Manual cleaning :

Pros:

• Parts can be cleaned without complete immersion in solution
• Microsurgical & opthalmic instruments are cleaned through this method ; not put in washer sterilizer
• Additional cleaning equipment such as wash & rinse tank is not necessary  

Cons:

• Cleaning efficacy is less
• Required additional time to complete
• Labor intensive process 
• Cleaning solution consumption is higher
• Limitation on use of aggressive chemical
• Personnel requires PPE to prevent accidental spray from contaminated body fluids 
• Cost analysis : 50 -60 thousands to buy ; 30,000 for staff monthly ; 30,000 for its maintainance & repair .

Washer sterilizer :

Pros: 

•  can handle a large capacity of instruments
• It has  a fully automated cycle
•  It result in reduced instrument handling. 
• It can include thermal disinfection from 176 to 194 degrees Fahrenheit (80 to 90 degrees Celsius)
• Instruments may be safely handle without gloves

Cons : 

• It depends on liquid spray as the method for removing dirt and debris. 
• If parts of instruments are not exposed directly to the spray, they may not get cleaned.  
• More costly to purchase
• Cost - 40 - 50 lakh to buy with automatic repair option 

The first, and perhaps most significant, is the advancement made in upgrading from manual or  decontamination to an automatic

washer/disinfector alone can help CPD develop a quality decontamination system that will do more for less.

The second advancement has been in automating material handling systems that support automated single-chamber washers, and containing or reducing the amount of staff required to keep them humming.

References :

1 . Efficacy of a Washer-Disinfector in Eliminating Healthcare-Associated Pathogens from Surgical Instruments , William A. Rutala ,Maria F. Gergen & David J. Weber by cambridge university , 10 may 2016

2.  Evaluation of the effectiveness of an enzymatic cleaner & glutaraldehyde-based disinfectant for chemothermal processing of flexible endoscopes in washer-disinfectors in …B Zühlsdorf, G KampItf Endoscopy 38 (06), 586-591, 2006 

3. Natural bioburden levels detected on flexible gastrointestinal endoscopes after clinical use and manual cleaning Nancy S.ChuMSPatricia A.Antonoplos

4. Automating CPD Instrument Cleaning & Decontamination By Michael Cain

What is mechanism of HEPA filter?

What is mechanism of HEPA filter?

HEPA filtration : HEPA filter, also known as high-efficiency particulate absorbing filter and high-efficiency particulate arrastance filter, is an efficiency standard of air filters. 

HEPA Filters are designed to meet requirements of very fine filtration up to 0.3 micron at high efficiency of 99.99 %.  Standing for high efficiency particulate air, HEPA filters trap small, harmful particles, such as pollen, pet dander, smoke and dust mites by forcing air through a fine mesh. In consumer products, these fine mesh filters are most often used in vacuums and air purifiers.

Mechanism

HEPA filters are composed of a mat of randomly arranged fibres. The fibers are typically composed of fiberglass and possess diameters between 0.5 and 2.0 micrometers. Key factors affecting its functions are fiber diameter, filter thickness, and face velocity. The air space between HEPA filter fibers is typically much greater than 0.3 μm.HEPA filters are designed to target much smaller pollutants and particles. 

These particles are trapped (they stick to a fiber) through a combination of the following three mechanisms:

1. Diffusion : The particles traverse the flow stream, they collide with the fiber & are collected.

2. Interception: These mid-sized particles follow the flow stream as it bends through the fiber spaces. Particles are intercepted or captured when they touch a fiber.

3. Inertial impaction : particle inertia causes it to leave the flow streamlines & impact on the fibre.

4. Electrostatic attraction : It contain layers meant to charge particles as they pass through , making the job of attractive layer of filter easier.