Sources of exogenous infection in the operation theatre could be the air and the environment of the theatre. Standard cleaning, disinfection and sterilization procedures, good theatre practice and discipline can provide a microbiologically safe environment. Air borne contamination is mainly derived from the personnel in the theatre and their activities. The bacterial count in OT is influenced by number of individuals, ventilation and airflow. Failure to provide adequate operation theatre ventilation, associated with risk of post-operative infection, has been found to be a critical factor in specialty surgeries like prosthetic and joint surgery. In a multi-centric study of hip and knee operations performed under guided airflow incidence of sepsis was significantly lower than in operations performed under conventional ventilation.

Apollo Hospitals, Bangalore had recently installed the Guided Airflow System in 3 of their major operation theatres. The Guided Airflow System is an innovative technology of Johnson Medical, Malaysia and is represented in India by Trivitron. Since the hospital was newly constructed getting the operating theatres ready was quite a task as the theatres had to be critically analyzed for the fungal and bacterial growth, their characteristics and suitable disinfectant to sterilize the OT environment. We isolated plenty of non-specific bacteria and Staphylococcus species, Aspergillus species, Penicillium species and Neospora species in all the Operation theatres. To clear the surfaces, high level disinfectants (Virkon 1% and Bacillocid 2%) were used. To sterilize the air the area was fumigated with 20% Formaldehyde, continuously every once in 48 hours for 10 days. During the break-up time the Guided airflow system was switched on. The air analysis was done by Settle plates and by swab culture method. After such intense fumigation method we isolated Neospora species in all the theatres except the theatres that were installed with Ultraclean OT system from Johnson Medical. Intense fumigation in the next 10 days sterilized the theatres without the guided airflow. Moderate fumigation together with functional guided airflow removed all difficult fungus in the Ultraclean OT.

Guided Airflow System of Johnson Medical installed at one of the Major Operation Theatres in Apollo Hospitals, Bangalore

During the last 5 months after the theatres were opened for surgeries we did not isolate environmental contaminants during the weekly air sampling session in the Ultra Clean OT set-up by Johnson Medical while other theatre samples which use conventional ventilation techniques continue to isolate nonspecific fungal spores occasionally. Hence we find that Ultraclean OTs are necessary for all modern operation theatres in major and specialty surgeries which effectively bring down post-operative infection caused by environmental contamination. Moreover installing the Guided Airflow System puts our hospital at par with International standards in infection control.

Dr. Seemanthini Desai MD (Microbiology)

Consultant Microbiologist,

Chairperson, Infection Control Committee

Apollo Hospitals – Bangalore