Operation Theatre Sterilization by Fumigation

Introduction

Surgical site infections (SSIs) are the second most common cause of hospital acquired (Nosocomial) infections. These complications of surgical procedures cause considerable morbidity and, when these occur deep at the site of the procedure, can lead to mortality as high as 77%. The source of SSIs may be endogenous (normal flora of the patient’s skin, mucous membranes, or viscera) or exogenous, which includes surgical personnel (especially members of the surgical team), the surgical room environment (including air, floor & wall), and tools, instruments, and materials brought to the sterile field during surgery. By maintaining sterile environment in surgical theater we can control major part of exogenous infections.

Formaldehyde fumigation has long been an accepted method of sterilization for areas where microbiological cleanliness is required. Fumigation with formaldehyde vapor is the recognized and most commonly used method because of its cost effective procedure (Alternative: vaporized hydrogen peroxide; expensive).

Fumigation Procedure

Formaldehyde 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. But, concentrations encountered during fumigation is many hundred times higher than this, so fumigation procedure must be carried out only by trained personnel under strictly defined conditions. All workers using formaldehyde must be aware of safe handling procedures.

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.
3. So the fumigating person must be provided with the personal protective equipments (PPE).
4. Paste a warning notice on the front door indicating fumigation is in progress.

Step 3: Fumigation

1. Electric Boiler Fumigation Method (Recommended): For Each 1000 cubic feet, 500 ml of formaldehyde (40% solution) added in 1000 ml of distilled water (if not available use tap water) in an electric boiler. Switch on the boiler, leave the room and seal the door. 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).

or

2. Potassium Permanganate Method: Here the heat generation is induced by an oxidizer - Potassium permanganate (KMnO₄), which results in auto boiling and generates fume from formaldehyde.  Take 500 ml of formaldehyde (40% solution) in 1000 ml of distilled water (if not available use tap water) in a heat resistant bowel, preferably in a steel bucket and then add 450gm of KMnO₄ for 1000 cubic feet of theater volume. Repeat the same in separate bucket for every another 1000 cubic feet until it reaches the complete theater volume. It is important to add KMnO₄ to all buckets simultaneously to reduce the exposure to fume (i.e., need 3 or 4 persons at different location).
3. After the initiation of formaldehyde vapor, immediately leave the room and seal it for at least 12 to 24 hours.

Step 4: Neutralization

1. Before neutralization, formaldehyde fumigation system should be taken out from the surgical theater. Then the toxicity of formaldehyde vapor should be neutralized with ammonia solution.
2. Place a cotton ball and pour 300 ml of 10% ammonia (for each 500 ml of formaldehyde used) on the floor of surgical theater, at least 4 hours before (07 a.m.) the “Sterility Test”.
3. Formaldehyde gas reacts with ammonia gas and produce hexamine (synonym hexamethylenetetramine) which is considered a harmless substance.
4. Switch on the A/C, at least 2 hours before (09 a.m.) the “Sterility Test”.

Example:

Surgical Theater Volume = L×B×H = 20 × 15 × 10 = 3000 cubic feet

Note: Make it into nearest 1000, if the volume is in fractions

Formaldehyde required for fumigation = 500 ml for 1000 cubic feet

= So, 1500 ml of formaldehyde required (to be diluted in 3000 ml of distilled water)

Ammonia required for neutralization = 300 ml of 10% ammonia for 500 ml of formaldehyde

            = So 900 ml of 10% ammonia required

Guidelines to be adhered for Surgical Theater Sterility:

1.      A record (log book) should be kept and properly maintained for all fumigations with following details, date & time of fumigation, date & time of neutralization, personnel involved, and the dates of “sterility test visits” & their results.

2.      Construction layout plan of the surgical theater with measurement details should be attached with the log book.

3.      The construction must have, a. Separate dressing room for medical officer and staff nurses, b. Patient waiting room, c. Surgical room, d. Veranda

4.      Construction, carpentry, plumbing, electrical, cleaning and other works should be completed before the initiation of fumigation procedure.

5.      Room allotted for surgery (as shown in the plan) should not be used for any other purposes.

6.  Entire block should be thoroughly cleaned before fumigation. All apparatus such as suction, table, focus lights, A/C units, etc., should be cleaned according to manufacturer instructions.

7.  Surroundings should be clean and free from garbage, open drainage, bushes, shrubs, wastes, etc.,

8.  Warning notice should be pasted on the front door indicating fumigation is in progress.

9.  Entry should be restricted to authorized persons (Label must be pasted on the main door).

10.  Separate footwear should be kept at the entrance (inside) of surgical theater.

11.  Theater dress (includes head cap, mask, apron, footwear, etc.,) should be made available for all persons who are entering into the surgical theater (surgeons, anesthetist, microbiologist team, nurses, theater assistants & helper).

12.  Surgical theater should be cleaned and fumigated periodically depending upon the case load.

Stanford University bans gifts from drug sales reps

The Stanford University medical center has joined with Yale University and the University of Pennsylvania in bans on gifts of any kind made from pharmaceutical sales representatives to doctors.

In addition to mugs, pens, free sporting event tickets and lunch spreads, doctors often receive prescription drug samples from sales reps -- which most likely skew the decision to give a patient more expensive prescription drugs instead of cheaper or over-the-counter alternatives.

The drug industry spends about $21 billion per year on marketing -- with 90 percent of that directed solely at physicians. Pharmaceutical companies say this new measure will make it harder for doctors to interact with, and learn from, sales representatives.

Research has shown that doctors don't have the time to learn and catch up on the latest medical knowledge. But critics of this practice say learning from a sole, biased source -- the pharmaceutical industry -- about prescription drugs might be just as bad as not learning newer, unbiased information at all.

"This rather hypocritical stance from Big Pharma and its direct meddling into the physician community may be slowly coming to an end," said conventional medicine critic Mike Adams, in response to the ban. He added, "If this Stanford ban makes it more difficult for Big Pharma to 'interact' with doctors, then the average patient should be rejoicing right now -- they'll finally have a non-biased doctor's perspective that respects the patient more than Big Pharma's massive profits.

Arthritis drug researchers apologize for undisclosed pharmaceutical industry ties

The Journal of the American Medical Association (JAMA) published an apology letter in today's issue from a team of researchers who failed to disclose pharmaceutical industry ties in an arthritis drug study published last May.

The study, conducted by Mayo Clinic professor of medicine Dr. Eric L. Matteson and colleagues, examined the association between tumor necrosis factor-alpha blockers (TNFs) -- used to treat rheumatoid arthritis -- and an increased risk of cancer and infections. Matteson's study found that certain TNFs, including Remicade, Enbrel and Humira, were linked to an increased risk of cancer -- particularly lymphoma -- as well as a higher risk of infection.

However, the researchers failed to alert JAMA editors that Abbot Laboratories, the maker of Humira, had been allowed to review the paper prior to publication. The researchers also failed to include a TNF drug made by Wyeth in their study, while the researchers were simultaneously working with the drug firm on a separate study. Finally, the Mayo researchers accepted $25,000 from Amagen, maker of Enbrel, for fellowship education training of one of the study's co-authors.

Matteson and his colleagues say the science behind their study is sound, and the omission of their conflicts of interest was an oversight.

"This was really a very embarrassing thing to me," Matteson said. "This occurred due to my inattention to our disclosure statement when we submitted our original paper. There were mistakes in the disclosure, not because I intended to mislead them, but simply because I was negligent."

Matteson says he informed JAMA editor-in-chief Dr. Catherine D. DeAngelis of the error a week prior to the study's publication on May 17, 2005. However, DeAngelis says she was first notified of the conflicts by one of the drug companies involved.

"It was very nice of [Matteson] to do it after the fact, since he knew we were about to initiate an investigation because someone let the cat out of the bag," DeAngelis said. "We are very serious about it. I don't like it when people don't fully disclose. I wanted this letter of apology."

In July, DeAngelis announced that JAMA had updated its conflict-of-interest disclosure policy to help "improve the transparency of reporting of potential conflicts of interest and to encourage more accurate and complete disclosures."

Big Pharma Money Spent on Marketing Exceeds Drug Development Costs

(NaturalNews) Why are pharmaceuticals so expensive? This question has been asked for many years. In fact this was the question asked by Senator Estes Kefauver (D) in the late 1950s. Senator Kefauver was the first to put together an indictment against the business practices of the pharmaceutical industry. In fact he lobbed three charges at the pharmaceutical industry at the time.

They were the following:

1) Patents sustained predatory prices and excessive margins

2) Costs and prices were extravagantly increased by large expenditures in marketing

3) Most of the industry's new products were no more effective than established drugs on the market(1).

If you look at these charges they are much the same accusations that many people blame the pharmaceutical industry of practicing right now, fifty years later. Has anything changed in the past fifty years?

The core of this debate, especially in the U.S. where direct-to-consumer marketing is legal, is the amount pharmaceutical companies spend on marketing vs. the amount spent on research and development (R&D). Aren't we all lead to believe that the high cost of research and development is the reason that pharmaceuticals are so incredibly expensive? The Pharmaceutical Research and Manufacturers of America (PhRMA) uses data from IMS, a firm specializing in pharmaceutical market intelligence, to conclude that pharmaceutical companies spend U.S. $29.6 billion on R&D and U.S. $27.7 billion for all promotional activities (data from 2004). Even if these numbers can be trusted, and the pharmaceutical industry is altruistic, why are these expenses so close? An investigative article in the Public Library of Science (PLoS), who used proprietary databases to construct a new, and quite possibly more accurate estimate, states the money goes to marketing twice as often than R&D.

Show me the money.

It is important to note that the PLoS is an open source publication. In fact the publication states that you may use its articles and "download, copy, distribute, and use (with attribution) any way you wish." This means that the PLoS is not taking money from anyone and so are free to publish articles that go against the mainstream. Most importantly, they are not taking money from pharmaceutical companies and can publish content like this without fear of reprisal. What was published in "The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States" does go against the mainstream – by clearly stating that the pharmaceutical industry is spending more on marketing, much more than most people would expect.

As the U.S. represents 43% of global sales and global promotion expenditures, knowing the amount of money put into marketing is essential. It is also important to note that according to CAM, which is a global company that audits the promotional activities of the pharmaceutical industry, about 30% of promotional spending is not accounted for in their figures. The breakdown is not accurately known of unmonitored promotion, but CAM believes that approximately 10% is due to incomplete disclosure by surveyed physicians and 20% comes from promotion geared towards physicians not surveyed or unmonitored journals. Combining the information gathered from CAM, as well as IMS, the total amount of money spent on marketing by pharmaceuticals was U.S. $57.5 billion for 2004. The total spent on domestic industrial pharmaceutical R&D was U.S. $31.5 billion.

There is quite a bit of difference between the money spent on R&D and marketing. If we exclude direct-to-consumer marketing, of the U.S. $57.5 billion, CAM estimates that 80% of this money is spent on physicians. This means that, with 700,000 practicing physicians in the U.S., the pharmaceutical industry spent nearly U.S. $61,000 in promotion per physician! It is interesting to note that according to the U.S. census the real median household income (2003) was $43,318.

Is Kefauver right?

While knowing that the pharmaceutical industry spends nearly U.S. $57.5 billion on marketing and U.S. $31.5 billion on R&D, those that believe the industry is promotion based, and not entirely altruistic as the industry claims, have some proof to this claim. How can we continue to pump money into, and grant legislation to, an industry that would rather hide the truth than be honest? How far are we from formally proving Kefauver's other claims to be true? Whether or not we can all agree on the pharmaceutical industry's place in our society – no industry should go fifty years without ethical restrictions, while claiming they are the champions of society.

References:

1) The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States

Widespread Ghostwriting of Drug Trials Means "Scientific" Credibility of Pharmaceutical Industry is a Sham

(NaturalNews) The discovery that drug companies have been ghostwriting scientific studies using in-house writers, then paying (bribing) doctors and high-level academics to pretend they were the author of the article is making shockwaves across conventional medicine. This latest revelation of scientific fraud exposes a massive, widespread system of fraud involving not only the drug companies, but also hundreds of different peer-reviewed, "scientific" medical journals that have published these ghostwritten articles. This scam is the latest embarrassment to conventional medicine; a system built on such a foundation of scientific fraud that the admission of dishonesty no longer surprises anyone. The pharmaceutical industry, it seems, is now supported almost entirely by fraudulent science fabricated by marketing personnel.

Remember, it is these studies -- the very ones now discovered to be ghostwritten by Big Pharma's in-house authors -- that the FDA uses to approve these drugs, unleashing them onto the public where potentially hundreds of millions of doses of the drug may be sold in just the first few years of its approval. But what we're learning now is that the whole system is an elaborate scam. For these studies, there's no real science involved at all.

To back this up, let me explain how this scam works in seven simple steps:

Step 1: A drug company runs an in-house study (using fraudulent study design from the start) to "prove" that their drug is both safe and effective. If the study produces negative results, it is thrown out. If it produces positive results, proceed to step 2.

Step 2: That same drug company uses in-house writers ("ghost writers") to write up the results of the study in a favorable light by discarding any data that doesn't fit the desired outcome. Note that these in-house writers are marketing people, not doctors or scientists, and they are on Big Pharma's payroll!

Step 3: The drug company contacts a noted doctor or academic and offers to pay them a bribe (a "writing fee") to put their name on the paper as if they were the original author. In reality, the paper has already been completely written and the doctor needs to write nothing.

Step 4: The paper is submitted to peer-reviewed academic journals (such as JAMA) for publication. Since the paper appears to have been independently written by an outside scientist or doctor, the journal is far more likely to consider it credible. Thus, it gets more easily published. The drug company reveals nothing about the true origins of the paper.

Step 5: The drug company that sponsored all this forwards the peer-reviewed, published study to the FDA, claiming this is now "scientific fact" that proves their drug is both safe and effective. Since the study was published in a peer-reviewed medical journal, it must be true, right?

Step 6: The FDA, which conducts no drug safety studies of its own, automatically believes the conclusions of the study (since it was published in a credible journal, after all), and therefore approves the drug for sale! From there, the FDA claims its decisions are based on the "gold standard of evidence-based medicine!"

Step 7: Once the drug is approved by the FDA, the drug company then claims the drug has been declared safe and effective by an independent government agency, and therefore the drug must indeed be both safe and effective. In other words, even though the drug company fabricated much of the evidence used by the FDA to make their approval decision, the drug company still claims that the FDA's decision is an independent, science-based approval of their drug! Furthermore, the drug companies are now arguing that FDA approval should immunize them from any lawsuits or claims of harm stemming from their drugs. Amazing, huh?

GenerationRx Documents Chemical Abuse of Children by Pharmaceutical Industry, Modern Psychiatry

NaturalNews) Filmmaker Kevin Miller has just launched a shocking new documentary that exposes the crimes and deceptions of modern psychiatry and the drug companies that now control the industry. His film, entitled GenerationRx sheds light on the shadowy practices of psychiatric doctors who are increasingly drugging children with mind-altering drugs. Trailers and DVDs are available at www.GenerationRxFilm.com

The film features an impressive collection of interviews with skeptical physicians, industry critics and even the former deputy director of the FDA. Together, their testimony paints a disturbing picture of the deceitful -- even predatory -- behavior of the psychiatry industry, calling into question the very existence of so-called "disorders" that have been used to put tens of millions of children on dangerous mind-altering drugs that have earned billions of dollars in profits for Big Pharma.

The teen who recently committed "live" suicide on his web cam was taking psychiatric drugs. So was Heath Ledger, the Columbine school shooters and even the wife of famed comedian Phil Hartman, who shot and killed Mr. Hartman in a murder-suicide. In fact, if you want to know who's taking psychiatric drugs in America today, just follow the trail of blood. Wherever there's violence, you find Big Pharma's brain-altering chemicals behind it.

Kevin Miller's movie, GenerationRx, explains how this massive chemical conspiracy manages to keep operating today. It's all based on a system of under-the-table payments to hospitals (http://www.naturalnews.com/News_000...), journalists (http://www.naturalnews.com/News_000...), med schools, medical journals, politicians and physicians. It's a network of bribery and corruption so large that it has now even invaded the media!

The conspiracy will fall, of course, and in time the criminal masterminds who ran it will be indicted for their crimes against humanity. When that happens, stunned people will look back on documentaries like GenerationRx and see 2007 - 2009 as the turning point that exposed the truth about the industry and woke people up to the chemical atrocities being committed against their own children in the name of medicine.

Part of that turning point, of course, also involves the film Making A Killing, created by CCHR. You can view much of the film online by going here: http://www.cchr.org/#/videos/making...

Other films, too, are working to expose the criminal psychiatry industry, and NaturalNews will be bringing you news and exclusive video clips from those films as they become available.

In the mean time, don't let your children be chemically abused by doctors or psychiatrists. Keep them away from vaccines, psych drugs and all medications. Feed them healthy foods, lots of omega-3s, superfoods, supplements and home-prepared meals. Your children will be happier and healthier, and in a generation when half the American population has been reduced to babbling, brain-numbed zombies (from all the medication), your children will retain powerful cognitive function that will make them the future leaders of human civilization.

India's Waterways A Toxic Stew of Pharmaceutical Chemicals Dumped from Big Pharma Factories

NaturalNews) Many of the pharmaceuticals consumed in the United States are made in India, where labor is cheap and environmental laws are lenient on powerful corporations. U.S. drug companies are exploiting this situation to manufacture hundreds of millions of doses of high-profit pharmaceuticals in India, where ingredients purchased for a few cents can be re-sold to U.S. health patients for hundreds of dollars (the markup on some drugs is literally over 500,000%).

There's something else Big Pharma doesn't want you to know about its drug operations in India: Big Pharma's manufacturing facilities dump millions of doses of toxic pharmaceutical chemicals directly into India's waterways.

Researchers were recently stunned to discover that 100 pounds of a powerful antibiotic called ciprofloxacin was being dumped into a local stream every day! That's a quantity of antibiotics that could treat an entire city of 90,000 people every day.

But that's not all: The same waterway contained an astonishing 21 pharmaceutical chemicals reports the Associated Press, some at levels that were 150 times the highest levels of contamination found in U.S. waterways. (And even the levels found in the U.S. were quite alarming.)

Big Pharma as a major chemical polluter

These findings are now added to the revelations of pharmaceutical contamination unveiled by the Associated Press last year, which found that the public water supplies in virtually all U.S. cities tested were contaminated with pharmaceutical chemicals.

What's emerging from these disturbing discoveries is a picture of Big Pharma as a global corporate polluter that's dumping chemicals into the world's sensitive waterways, polluting villages, cities and aquatic ecosystems around the world.

Under the Bush Administration, the U.S. Environmental Protection Agency outright refused to regulate pharmaceuticals as environmental hazards. With Obama in the White House, it remains to be seen whether the new administration will clamp down on pharmaceutical pollution.

Big Pharma now has something in common with Exxon, Cargill, Alcoa and Chevron: The outrageous pollution of the environment with toxic chemicals. But in many ways, Big Pharma's chemicals are far more dangerous. HRT drugs, for example, are toxic at parts per billion, and they're now being found in public water supplies around the world.

Municipal water treatment facilities, by the way, don't remove pharmaceutical chemicals from the water! Whatever HRT drugs, psychiatric drugs or other chemicals that exist in the water are passed right through the water treatment centers which unwisely add yet more chemicals (fluoride and chlorine, typically) to the toxic brew. Citizens drinking public water supplies in India, the U.K., Canada and the United States are now verifiably participating in a grand experiment involving the mass medication of the population with low levels of utterly untested pharmaceutical combinations