How to manage infection control in the operating theatre
Abstract
A common complication following surgery in all species is infection of the surgical site which leads to increased morbidity and in some cases mortality. Not only does the patient incur more stress, but it is also distressing for the owners and the cost of treatment is often increased significantly when dealing with surgical site infections (SSI). Prevention of SSI is by no means possible all of the time due to the many factors which contribute to development of SSI, however it is essential to try to limit development of SSI throughout the surgical procedures performed and during the perioperative period where possible. This article focuses on the preparation of the patient for surgery and infection control in the operating theatre, and highlights the important areas, such as hand hygiene, which can be improved to try to limit the spread of infection within the operating theatre.
Surgical site infections (SSI) are one of the most common causes of morbidity in the surgical patient despite preventative methods and use of prophylactic antibiotics to reduce the incidence in humans and in veterinary patients (Melling et al, 2001; Eugster et al, 2004). Normal, intact skin prevents microorganisms entering the body by two mechanisms: intact epidermis prevents physical passage of microorganisms; and cell-mediated immunity and production of antibodies prevents microbial invasion (Dohmen et al, 2006). The skin's flora exists on the host skin in a very delicate and complex ecosystem which is disrupted at surgery along with the body's immune system, which lowers the body's natural defense barriers.
Recently there has been further concern regarding SSI due to multi-drug resistant (MDR) bacteria emerging as veterinary and zoonotic pathogens, e.g. meticillin-resistant Staphylococcus aureus (MRSA) (Weese et al, 2006). In a recent human study, mortality rates following cardiac surgery were as high as 74% due to mediastinal infection with MRSA (Dohmen et al, 2006). It is important to prevent infection of the patient and to prevent yourself and other co-workers becoming colonized with these MDR bacteria.
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