Fumigation ProcedureFormaldehyde vapor is an extremely effective biocidal agent. It acts as an alkylating agent, inactivating micro-organisms by reacting with carboxyl, amino, hydroxyl and sulphydral groups of proteins as well as amino groups of nucleic acid bases. Fumigation is effective at above the temperature of 20ºC and relative humidity of 65%. Formalin is commercially available as 40% solution of formaldehyde in water. When formalin is heated formaldehyde vapor is generated. Formaldehyde is a Schedule 1 chemical under the COSHH (Control of Substances Hazardous to Health) Regulations and has a Maximum Exposure Limit (MEL) of 2 ppm. Under certain conditions formaldehyde can react with hydrochloric acid and chlorine containing disinfectants such as hypochlorites to form chlormethyl ether, a potent lung carcinogen. So hydrochloric acid and chlorine-containing disinfectants must be removed from the room before fumigation. Step 1: Preparation 1. Thoroughly clean windows, doors, floor, walls, surgery table and all washable equipments with soap and water. 2. Close windows and ventilators tightly. If any openings found seal it with cellophane tape or other material to avoid the leak of fume. 3. Switch off all lights, A/C and other electrical & electronical items. 4. Calculate the room size (surgical theater only) in cubic feet (L×B×H) and calculate the required amount of formaldehyde as given in step 3. Step 2: Precaution 1. Adequate care must be taken by wearing cap, mask, foot cover, spectacle etc., 2. Formaldehyde is irritant to eye & nose; and it has also been recognized as a potential carcinogen. need 3 or 4 persons at different location).Potassium permanganate (KMnO4).. 4. leave the room and seal the door. formaldehyde fumigation system should be taken out from the surgical theater.e. It is important to add KMnO4 to all buckets simultaneously to reduce the exposure to fume (i. or 2. which results in auto boiling and generates fume from formaldehyde. After 45 minutes (variable depending to volume present in the boils apparatus/its heating proficiency) switch off the boiler without entering in to the room (Switch off the main from outside). Switch on the boiler. Step 4: Neutralization 1. Then the toxicity of formaldehyde vapor should be neutralized with ammonia solution. Step 3: Fumigation 1. Repeat the same in separate bucket for every another 1000 cubic feet until it reaches the complete theater volume. . 500 ml of formaldehyde (40% solution) added in 1000 ml of distilled water (if not available use tap water) in an electric boiler. Electric Boiler Fumigation Method (Recommended): For Each 1000 cubic feet. Potassium Permanganate Method: Here the heat generation is induced by an oxidizer . preferably in a steel bucket and then add 450gm of KMnO4 for 1000 cubic feet of theater volume. immediately leave the room and seal it for at least 12 to 24 hours. So the fumigating person must be provided with the personal protective equipments (PPE). Before neutralization. After the initiation of formaldehyde vapor. Paste a warning notice on the front door indicating fumigation is in progress. Take 500 ml of formaldehyde (40% solution) in 1000 ml of distilled water (if not available use tap water) in a heat resistant bowel. 3. 3. A record (log book) should be kept and properly maintained for all fumigations with following details. nurses. microbiologist team. 2. Switch on the A/C.. Surgical room. Guidelines to be adhered for Surgical Theater Sterility: 1. 5. Construction. c. open drainage.) the “Sterility Test”. focus lights. Theater dress (includes head cap. All apparatus such as suction. date & time of fumigation. Separate footwear should be kept at the entrance (inside) of surgical theater. table. Construction layout plan of the surgical theater with measurement details should be attached with the log book. bushes. b.) should be made available for all persons who are entering into the surgical theater (surgeons. personnel involved. theater assistants & helper). Separate dressing room for medical officer and staff nurses. 3. A/C units. at least 4 hours before (07 a. mask. anesthetist. Entry should be restricted to authorized persons (Label must be pasted on the main door). shrubs.m. should be cleaned according to manufacturer instructions. Room allotted for surgery (as shown in the plan) should not be used for any other purposes. 6. Veranda 4. 11. Formaldehyde gas reacts with ammonia gas and produce hexamine (synonym hexamethylenetetramine) which is considered a harmless substance. 10. The construction must have. d. Surroundings should be clean and free from garbage. Entire block should be thoroughly cleaned before fumigation. Surgical theater should be cleaned and fumigated periodically depending upon the case load. carpentry. wastes. cleaning and other works should be completed before the initiation of fumigation procedure. 8. footwear. 12. 4.. etc. etc. . Patient waiting room. Place a cotton ball and pour 300 ml of 10% ammonia (for each 500 ml of formaldehyde used) on the floor of surgical theater. Warning notice should be pasted on the front door indicating fumigation is in progress. apron. electrical. plumbing.m. a. 2. 3..) the “Sterility Test”. 7. etc. at least 2 hours before (09 a. and the dates of “sterility test visits” & their results. 9. date & time of neutralization. mask. Movement of the sterile and containated items between CSSD & OT should be planned in such a way that they do cross path of eah other 14. d. personnel involved. Veranda 4. anesthetist. Room allotted for surgery (as shown in the plan) should not be used for any other purposes. wastes. Entire block should be thoroughly cleaned before fumigation. 15. 6. carpentry. Surgical room. 16. electrical. 10. Patient waiting room. bushes. table. 7. 2. etc. a. cleaning and other works should be completed before the initiation of fumigation procedure. nurses. 8.. date & time of neutralization. Separate dressing room for medical officer and staff nurses. A/C units.) should be made available for all persons who are entering into the surgical theater (surgeons. 3. 9. 13. Warning notice should be pasted on the front door indicating fumigation is in progress when fumigation is in progress. Construction layout plan of the surgical theater with measurement details should be attached with the log book. c. A record (log book) should be kept and properly maintained for all fumigations with following details. Theater dress (includes head cap. should be cleaned according to manufacturer instructions. Hand hygiene to be praticed . Dediated lifts or closed trollys to be provided for sterilised and unsterilised items. All apparatus such as suction. Management of BMW according to standards. focus lights. The construction must have. 12.. b. Construction. etc. 5. and the dates of “sterility test visits” & their results. plumbing. microbiologist team. 11. Surroundings should be clean and free from garbage. Entry should be restricted to authorized persons (Label must be pasted on the main door).. open drainage. etc. shrubs. Surgical theater should be cleaned and fumigated periodically depending upon the case load. theater assistants & helper). Separate footwear should be kept at the entrance (inside) of surgical theater. date & time of fumigation. apron. footwear. Guidelines to be adhered for Surgical Theater 1. No bar soaps to be used in Ots 18. All area used for one patient should be disinfected properly with approved disinfectant before shifting to another patient.17. Infetion to the infetion control officer 19. Surgeon incharge should report any post op. . Sterile person should remain in sterile area and non sterile ones in non sterile area 20.