Microbial Isolations from Maxillofacial Operation Theatre and its Correlation to Fumigation in a Teaching Hospital in India

Abstract

Postoperative infection and sepsis remain a major cause of morbidity among patients undergoing surgery. Maintenance of strict asepsis is essential if postoperative infection and its consequences are to be minimized. In developing countries maintenance of asepsis in most operation theatres is limited to fumigation and mopping. Clinical trials have confirmed that 80-90 % of bacterial contaminants found in wound after surgery come from microbes present in air of operating theatre. A study was conducted to evaluate the microbiological contamination of maxillofacial operation theatres in India and its correlation to weekly fumigation. A total of 6,723 culture plates, including 2,241 air and 4,482 swab samples were studied. Samples were collected at prefumigation, midcycle and post-fumigation stages and were cultured over three different medias. Predominant bacteria identified were Staphylococcus aureus (76 out of 83 samples by active air sampling) followed by Streptococcus while Aspergillus was the main fungal isolate. Formaldehyde based fumigation decreased the colony forming units (cfu/m 3 ) of all organisms in different samples and was found to be highly effective against Fungi and E. coli. Literature suggests that for conventional operating theatres the bioload should not exceed 35 cfu/m 3 in an empty theatre. In our study the cfu levels were always lower immediately after fumigation was carried out; however they moved up beyond this limit as the days passed. This implies that once a week fumigation with formaldehyde is less than optimal to achieve acceptable levels of disinfection.

Comparative efficacy of 3rd generation quaternary ammonium compounds and formaldehyde for fumigation of operation theatres

“…Similar incidence was reported by a previous study. [22] In our study, 19.44 % (n=28) of bacteria were isolated after fumigation of operation theaters by formaldehyde. In our study 16.66 % (n=17) and 17.75% (n=19) positive bacterial isolates were obtained from the open culture plate method during the 1 st and 2 nd half of our study respectively.…”

“…The decrease in colony forming units of all organisms when formaldehyde was used for fumigation was reported by an earlier study. [22] In the latter half of our study (December 2012-January 2013), 74.3 % (n=107) of bacterial pathogens were isolated from the samples prior to fogging by 3 rd generation QAC. 13.88 % (n=20) isolates were obtained from the samples after spray fogging by 3 rd generation QAC.…”

Is fumigation enough for air conditioning units in operation theatres and Intensive care units?

“…Presence of Clostridium in these cultures were taken as marker for inadequate sterilization of the operating theatre. 14 …”

Operating Room Protocols and Infection Control

“…The incidence of postoperative infections reported among the developed countries like UK and USA was approximately 5% and 5–6%, whereas in developing countries like India it is much higher, accounting for approximately 10–25%. [ 3 , 4 ].…”