What are the steps to start operation theatre (operating room) sterilization?

Operating Theatre Sterilization Protocol

To start operating theatre sterilization, implement a systematic approach beginning with environmental preparation, followed by equipment sterilization, personnel protocols, and continuous maintenance between cases, with specific attention to cleaning contaminated surfaces with sodium hypochlorite and detergent water after each procedure. 1

Pre-Operative Environmental Setup

Room Configuration and Ventilation

• Ensure all operating theatre doors remain closed at all times to maintain ventilation system efficiency and reduce airborne contamination 1
• Verify adequate air exchange systems are functioning properly, with high air exchange rates (≥25 cycles/hour) when available to reduce viral and bacterial load 2
• Minimize general traffic in and out of the operating theatre to reduce airborne contamination 1
• Position equipment to include only what is strictly necessary for each procedure, replacing standard anesthetic trolleys with dedicated pre-prepared ones 2

Patient Scheduling and List Preparation

• Develop accurate printed theatre lists available prior to the scheduled date with a written hospital policy 1
• Identify and schedule "dirty cases" (patients likely to disperse high-risk microbes) last on the operating list to minimize cross-contamination risk 1
• When dirty cases cannot be scheduled last, allow a minimum of 15 minutes in plenum-ventilated theatres before proceeding to the next case 1

Personnel Preparation Protocols

Attire and Protective Equipment

• All staff must change into clean theatre suits before entering the operating theatre complex 1
• Visitors entering the operating theatre must change into theatre suits and wear designated footwear 1
• Wear disposable head caps, particularly in laminar flow theatres during prosthetic implant operations 1
• Don sterile gowns when performing invasive procedures; use full body, fluid-repellent gowns where extensive splashing of blood or body fluids is anticipated 1

Hand Hygiene and Glove Use

• Ensure alcohol-based hand rub is readily available at all entry points and throughout the theatre 1, 3
• Gloves must be put on immediately before patient contact and removed as soon as the activity is completed 1
• Change gloves between patients and between different procedures on the same patient 1, 3
• Perform hand disinfection with hydro-alcoholic solution immediately after removing all PPE 2, 3

Between-Case Sterilization Protocol

Surface Cleaning and Disinfection

• Clean operating theatres appropriately between all patients, focusing on airborne transmission routes and surfaces that contacted the patient 1
• When visible contamination with blood or body materials exists, disinfect the area with sodium hypochlorite (according to local protocols) and then clean with detergent and water 1
• Clean and disinfect all surfaces and electromedical devices after each procedure 3
• Disinfect floors of the operating room at the end of each session 1

Linen and Waste Management

• Handle all used linen safely to minimize environmental and staff contamination 1
• "Bag" bed linen by the bed or patient trolley to reduce release of small fomite particles into the air 1
• Change bed linen before transferring patients into the operating theatre 1
• Place dedicated containers for hazardous medical waste immediately outside the OR for disposal of contaminated materials 2, 3

Sharps and Instrument Sterilization

Safe Sharps Handling

• Sharps must not be transferred between personnel and handling should be kept to a minimum 1
• Never recap, bend, or break needles prior to disposal 1
• Discard used sharps into an approved sharps container at the point of use 1
• Seal and dispose of sharps containers by incineration when two-thirds full or after four weeks of use, whichever comes first 1

Instrument Processing

• Use steam or dry heat sterilizers at appropriate time and temperature for surgical instruments 4
• Ensure proper manual preparation and disinfection/sterilization procedures are followed, avoiding inappropriate use of "quick" sterilizers 5
• Rinse items in water after contact with glutaraldehyde before use 4

Critical Pitfalls to Avoid

Common errors that compromise sterility:

• Failing to keep operating theatre doors closed, which disrupts ventilation efficiency 1, 2
• Omitting hand disinfection after glove removal, a frequently observed lapse 5
• Using powdered gloves, which should be avoided 5
• Inadequate servicing of air conditioning systems 5
• Scheduling high-risk cases early in the day without adequate time for environmental decontamination 1
• Allowing excessive staff movement during procedures, which increases airborne contamination 1, 2

The evidence strongly supports that transmission between successive patients occurs primarily through airborne routes and contaminated surfaces/items that contacted the patient, making thorough between-case cleaning with appropriate disinfectants essential 1. While some practices like wearing theatre suits outside the theatre have limited evidence for increasing infection rates 1, maintaining strict protocols creates a culture of safety and addresses patient and visitor concerns 1.