Operating Theatres and Avoidance of Surgical Sepsis

Abstract

The Operating Room (OR) is the heart of any surgical hospital and it is the place where the most dangerous accidents can rarely occur either to the patients or to the operating team. Post-surgical infection is one of the most important complications, in particular in Orthopaedic surgery. A new aspect of the life in the OR is the personal protection of the staff: the OR is now under the severe regulation of the legislation regarding the safety in workplace.

The rule of the 5 D’s according to Joubert, the historical key-stone in the strategy of the fight against infection, can be still adopted in the more complex fight against OR errors for a good quality of life for patient and personnel: 1. Discipline, 2. Design, 3. Devices, 4. Defence mechanism of the patient, 5. Drugs. The first three of these are the subject of this article.

Discipline is a critical issue, as it has the capacity of decreasing the efficacy of other factors. It concerns the personnel and the patients, independently from the hierarchy, sex and job. Discipline must be considered a fundamental instrument for reducing the risk of infections related to surgery and for increasing the personal safety of each member of the operating team. Many points are discussed and the European directives mention: protocols and checklists, surgical team and risk management and the preparation of the personnel from the surgical hand washing to the clothing, gowns and masks.

Secondly, the building regulations for the ideal operating block and OR must be followed according to the actual regulations; the need to renovate old operating blocks and to adopt strategies, also in organisation, are discussed. The development of surgery, including Day and Week-End Surgeries, and of many new devices, and consequently of the need for more space, more instruments and more expert staff, are presented.

Thirdly, the ventilation and controlled-contamination air-conditioning systems (VCCAC) are presented, considering the classification of the level of air cleanliness, the risk of contamination due to chemical agents, the air changes, the thermal comfort conditions and technical aspects such as the pressure, noise and the recovery time.

The main difference from the past is that now a complete programme of risk management, checklists, protocols, group management and European directives have a role rather than the old “good sense” surgical practices.

Appendix 1 National and International Standards/Guidelines

• EN-ISO 14644– Cleanrooms and associated controlled environments.

  • Part 1: Classification of air cleanliness. Ed. 01/05/99

  • Part 2: Specifications for testing and monitoring to prove continued compliance with ISO 14644-1.

  • Part 3: Metrology and test metods.

  • Part 4: Desing, constraction and “start-up”.

  • Part 5: Operations

• France: Norme NF S 90-351:2003, Établissements de santé. Salles propres et environnements maîtrisés et apparentés. Exigences relatives pour la maîtrise de la contamination aéroportée.

• Germany: DIN 1946-4, 2005:02 Ventilation and air conditioning - Part 4: Ventilation in hospitals

• Switzerland: Swki 400/5/2003 R-99-3, Guidelines on Heating, Ventilating and Air Conditioning in Hospitals.

• Austria: ÖNORM H 6021-1-2003 Lüftungstechnische Anlagen – Reinhaltung und Reinigung.

• United Kingdom: Health Technical Memorandum HTM 2025: Ventilation in Healthcare Premises.

• Italy: ISPESL – Dipartimento igiene del Lavoro – Linee guida per la definizione degli standard di sicurezza e di igiene ambientale dei reparti operatori, 1999.