References
An evidence-based approach to infection control in the operating theatre
Abstract
The aim of operating theatre infection control is to minimise risk of surgical site infections (SSIs). The emergence of multi resistant micro-organisms and the increased awareness of appropriate antibiotic use have made the process of theatre infection control and its evidence base ever more relevant. Many theatre practices are widely accepted as ‘common sense’ measures and have become ‘ritualistic’ behaviours. However some practices have little, weak or inconclusive evidence to substantiate them. The multifactorial nature of SSIs means that no single measure is likely to completely eradicate risk and currently the exact nature of the raft of measures necessary requires further investigation. Hand disinfection of the operating team prior to surgery, wearing of sterile surgical gloves by ‘scrubbed’ personnel and disinfection of the surgical site have a strong evidence base and should be mandatory practices however the exact processes require a stronger evidence base. It is likely that the practice of wearing theatre ‘uniforms’ contributes to theatre discipline via behavioural attitudes rather than by specific SSI risk reduction. Future research in this area is also likely to further evaluate the growing evidence base in support of the use of triclosan-coated suture material to possibly reduce SSI.
Surgical site infections (SSIs) are complications of surgery that cause significant post-operative morbidity (Gibbons et al, 2011). SSIs are reported to occur in 0.8% to 18.1% of small animal surgical procedures with significant variation associated with surgery type (Nelson, 2011). It is widely recognised that aetiology of SSIs is complex and multifactorial and that patient, surgeon and environmental factors all contribute to the risk of developing an SSI (Humes and Lobo, 2009). It is therefore logical that all theatre protocols should be designed in order to minimise the risk of SSIs and reduce their occurrence. There are many current practices in both human and veterinary operating theatres that are supposedly aimed at controlling infection and reducing SSI rates. This article aims to critically assess whether there is a clear evidence base for these practices or whether they are simply rituals or myths that have become habitual in everyday working practices. The practice of cleaning theatres, disinfectants and damp dusting is beyond the scope of this article which will instead focus on recent evidence pertaining to theatre wear and asepsis with regard to the surgeon, surgical site and patient.
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