Definition
Fumigation is a process or gaseous sterilization used for killing of microorganisms and prevention of microbial growth in air and surfaces o walls and floors. It is generally used in pharmaceuticals, operation theatres, other areas of hospitals, offices and wherever required.
Chemicals used for Fumigation
Chemicals used for fumigation include:
- Formaldehyde
- Carbon disulfide
- Ethyl acetate
- Sulfuryl fluoride
- Ethylene dichloride
- Methyl bromide
- Carbon tetrachloride
- Chloroform
Fumigation with formaldehyde vapor is most commonly used because of its cost effectiveness. Liquid fumigation acts quicker than solid fumigation and this type of fumigation is usually performed in an enclosed area.
Articles
Required articles include:
- Personal protective equipment, such as cap, mask, foot cover, spectacles
- Formalin (40% solution of formaldehyde in water)
- Distilled or tap water
- Potassium permanganate (KMnO4)
- Electric boiler
- Steel buckets 3-4
Procedure
| NURSING ACTIONS | RATIONALE | |
| 1. | Clean all the windows, doors, walls and floors, operation tables and all washable equipment meticulously with soap and water. Clean and mop the floor with disinfectant. | To remove all visible contamination. |
| 2. | Seal the openings to the room, such as windows and ventilations manually or with cellophane tape or other similar material. | To avoid the leakage of fumes. |
| 3. | Turn off all electrical and electronic items, such as lights, air conditioner, etc. | To avoid electrical hazard. |
| 4. | Determine the size of operating room in cubic feet (L×B×H) and compute the required amount of formaldehyde to be used. | To prevent over usage of formaldehyde (chemical), |
| 5. | Wear all the personal protective equipment, such as utility gloves, cap, mask, foot cover, spectacle, etc. | Formaldehyde is a serious irritant recognized as carcinogen. |
| 6. | Caution other persons by putting a warning notice on the front door indicating that the process of fumigation is being carried out. | To prevent unnecessary exposure to the chemical to persons. |
| 7. | In an electric boiler mix 500 ml of formaldehyde to 1000 ml of distilled water or (tap water) for a room size of 1000 cubic feet. | Makes 1500 ml solution for fumigation. |
| 8. | Seal the room after turning on the boiler and leave the room closed for approximately 45 minutes depending upon the volume in the boiler or its heating efficiency. | For a bigger room and volume, give longer time proportionately. |
| 9. | At the completion of waiting time, turn off the main switch of the boiler from outside without entering the room. If potassium permanganate (KMnO4) is used: Use a heat-resistant container, such as steel bucket, put 500 ml (40%) of formaldehyde to 1000 ml of distilled/tap water. Add 450 gram. of KMnO4 for a room size of 1000 cubic feet. Seal the room after turning on the boiler and leave the room for approximately 45 minutes depending upon the volume in the boiler or its heating efficiency. Leave the room immediately, once the formaldehyde vapors are visible and seal it for at least 12-14 hours | To avoid inhalation of fumes. |
| 10. | Take out the boiler/bucket from the operation theater/room. | |
| 11. | Wet a cotton piece with 300 ml of 10% ammonia for each 500 ml of formaldehyde used and leave it on the fumigated floor for at least 4 hours before using the area. | Ammonia solution is used to counteract the adverse effects of formaldehyde. This is known as sterility test. Ammonia reacts with formaldehyde gas and produces methenamine, hexamine, or urotropin (also called hexamethylenetetramine) which is a harmless substance. |
| 12. | Document the date and time of fumigation, neutralization, personnel involved and result of sterility test in the record book. | For a record that fumigation and sterility test are done. |
An Example of Calculating the Chemicals
- Operating room volume: L × B x H=20 × 15x 10= 3000 cubic feet.
- Formaldehyde required: 500 ml for 1000 cubic feet= 1500 ml of formaldehyde required (to be diluted in 3000 mI of distilled/tap water).
- Ammonia required for neutralization = 300 ml of 10% ammonia for 500 ml of formaldehyde = 900 ml of 10% ammonia if required.
Precautions to be Taken
- Formaldehyde acts as an alkylating agent and is an extremely effective bactericidal agent.
- For fumigation, a room temperature of 20°C and relative humidity of 6% is favorable.
- The procedure must be carried out by trained personnel under strictly defined conditions.
- All safe handling procedures must be clearly known to the workers.
- Record of all details of fumigation and neutralization must be entered in a record book.
- Personnel performing the procedure must use all protective articles, e.g., head cap, mask, apron and separate footwear.
- Warning label must be placed on the door for the entire period of fumigation of the facility.
- Only authorized personnel should have access to the room.
- After fogging, do an air sampling (testing of the air) and keep the record.
Special Considerations
- Ensure that the room for fumigation must be free from hydrochloric acid and chlorine containing disinfectants, such as hypochlorite as these can react with formaldehyde to form chloromethyl ether, a potent carcinogen.
- Fumigation should be done periodically depending upon the caseload in the OR.
REFERENCES
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