Use and management of hospital laminar clean operating room

2019-02-18 15:27:57   Editor: jushong shares    0


With the rapid development of medical science and technology, with the continuous improvement of surgical technology, the clean conditions and functional requirements of the operating room are also getting higher and higher. The laminar flow clean operating room is the development trend of contemporary hospitals and an important symbol of modern hospitals. Our hospital officially launched the laminar flow clean operating room in March 2008. Due to the rational use of the operating room, the correct maintenance and cleaning of the laminar flow purification system, strict disinfection and isolation system, and other comprehensive and strict management, to a great extent Controlled the surgical infection, significantly reduced the infection rate of type I and II surgical incision, providing patients with a high quality diagnosis and treatment environment, providing a reliable guarantee for surgical safety.


The operating room is an important place for surgical treatment and rescue of patients, and is an important department for hospital infection control. The quality of the disinfection and isolation work in the operating room is related to the quality of each operation, and it is related to the rehabilitation of each patient, and is also closely related to social benefits. Our hospital officially launched the laminar flow clean operating room in March 2008. Due to our reasonable use, we have greatly controlled the surgical infection. The usage and management experience will now be reported as follows.

The concept and requirements of laminar flow clean operating room
 1、 concept  


The laminar flow clean operating room is the ability to pass air into the operating room through the primary, middle, and high efficiency filters to control the dust content in the room, and has the ability to remove 99.97% of particles having a diameter of 0.5 microns or more. The constant temperature, constant pressure, constant humidity, and clean air flow into the room as a streamline, and flow out through the room at a constant speed. The dust or microorganisms generated in the room will not spread to the surrounding area, and may be discharged to the outside through the return air outlet. Indoor air has a certain degree of biological cleanliness. The surgical environment is more scientific and safe, adapts to the needs of surgical development, and provides patients with a quality diagnosis and treatment environment.



 2、Claim


The laminar flow clean operating room belongs to the Class I environment, and the total number of bacteria in the air is required to be ≤10 cfu/m3, and the pathogenic bacteria are not detected as qualified for disinfection.



Comprehensive management of laminar flow clean operating rooms



 1 、Reasonable partition layout 


The laminar flow clean operating room is divided into a restricted area, a semi-restricted area and a non-restricted area in the center as a sterile area, the periphery is an operation room; the semi-restricted area is outside the restricted area, separated from the restricted area by a door, mainly for anesthesia recovery Room, office; unrestricted area on the outermost side, mainly for the dressing room, pick-up and transfer of patient carts; air purification in the restricted area from high to low (100-10000 level) from the restricted area to the semi-restricted area, guaranteed The rationality of the functional process avoids cross-infection.


 2、 Control the operator entering the operating room



The density of sedimentation bacteria in the operating area increased with the increase of the number of patients [1]. The personnel entering the operating room were strictly dressed according to the operating room regulations, and the shoes were entered. The number of visitors to the room should be strictly controlled. The small operation was controlled in 2-3 people. 3-4 people, special infection surgery is forbidden to visit. 



3、 Surgical room layout 


The operating bed is placed in the center of the area where the operation room is cleaned. A certain number of items are fixed indoors, and the patrolling nurses fill in the postoperatively to reduce the movement during the operation. Only necessary equipment such as anesthesia machine, high-frequency electric knife, monitor, etc., are allowed in the operating room. All items used are removed from the outer packaging to reduce dust ingress and items entering the operating room should be wiped clean.


Items should be placed away from the return air outlet to avoid affecting air return.



 4、Arrange the surgery reasonably 


According to different air cleanliness, the operation was performed, and the 100-level operation room arranged organ transplantation, cardiothoracic surgery, brain surgery and orthopedics, etc.; Class 1000 operation was arranged in the 1000-level operation room; Class III operation was arranged in the 10,000-level operation room. One of the 10,000-level rooms is used as an isolation surgery room for special infections. Studies have shown that the air quality in the operating room is closely related to the infection rate of the surgical incision. The three-stage filter used in the clean operating room blocks a large number of colonies, creating a clean air environment for surgery, and reducing the infection rate of the incision. Effective.


However, for Class III surgery, there was no correlation between air quality in the operating room and the infection rate of the incision. Contamination surgery is directly related to air pollution in the operating room. The number of colonies in the operation room of the contaminated operation is significantly higher than that in the aseptic surgery [2]. Therefore, the contaminated operation should be arranged in the operating room or the general operating room with the lowest cleanliness (class 10000) and relatively fixed.



 5、 Air purification system switch


The morning shift nurses open the operating room air conditioning system 1 hour ahead of schedule, and adjust the temperature to 22-25 °C as needed, and the humidity is controlled at 50-60%. After the end of the daily operation, clean the operation room and then turn it on again for 1 hour, otherwise the bacterial content will exceed the standard. The continuous operation was performed immediately after the end of the previous operation and the electric door was closed for 30 minutes before the next operation.


 6 、Ensure positive pressure between the operating rooms 


During the operation, the electric door and the door leading to the dirt corridor are kept closed, the number of switching is minimized, and the operation of opening the door is strictly prohibited. Because the operating room is a closed clean environment, the air pressure in the room is greater than the outdoor air pressure when the door is closed, thus ensuring that the clean air in the room can only flow to the outside, and the outdoor air does not enter the room. After the door is opened, the differential pressure system is destroyed, and the quality of the purification in the operation room is also affected.



7、Maintenance and cleaning of laminar flow operating room 


The entire air-conditioning system should be responsible for the regular inspection, repair and maintenance. Clean the filter in time and replace it regularly. Wipe the return air outlet with a damp cloth every morning, and thoroughly clean the return air outlet and the return air net cover every week. Clean technology has no processing power on the surface or sudden contamination of items in the operating room [4]. The surface of the articles should be disinfected daily according to the requirements of the disinfection and isolation system, and pollutants should be disposed of in time to prevent the spread of pollution. Post-operative contaminated dressings and garbage are separately loaded into dirt bags and garbage bags, and are transported away from the outer corridor through the dirt passage. If special infections are involved, the waste products should be incinerated.



8、Sterility monitoring and education


Regular monitoring is carried out. Every month, the operating room air, the hands of the operating room personnel, and the surface of the sterile object are sampled for bacterial culture to check the purification effect of the bacteria. Find out the reasons for failure and find effective measures in time. By testing we found that the number of planktonic colonies was the highest at the beginning of the surgery. We took the operation, walked softly, reduced the jitter and less use of fabric fibers, and reduced unnecessary personnel movements, restricted the number of visitors, timely removed potential risk factors, and received good results. Enhance the sterility of nurses and other surgical personnel and control the sensitivity of infection through training and learning. Prevent infection as a permanent goal for every member of the surgery group.

Discuss



The air quality in the operating room is closely related to the infection of the incision. The use of air laminar flow purification system in the operating room can significantly reduce the infection rate of type I and II surgical incisions. However, the operating room is a place where surgeons, anesthesiologists, and operating room personnel work together. The flow of people is large, and a large number of items flow, which affects the cleanliness of the air. The air purification of the laminar flow clean operating room can only ensure the sterility of the air and does not kill the bacteria adsorbed on the surface of the surgical room. Therefore, it is particularly important to strengthen the protection of clean areas, control pollution sources, and reduce pollution. The implementation of all-round integration and strict management of the clean operating room is the key to ensuring the air quality of the operating room. Only by combining hardware and software well can we effectively control infection and provide a reliable guarantee for surgical safety.