Operating Theatre
Operating Theatre
Operating Theatre
Introduction
Surgical site infections (SSIs) are the second to third most common site of health care associated infections (HAIs). These complications of surgical procedures cause considerable morbidity and, when these occur deep at the site of the procedure, can carry mortality as high as 77%. As illustrated below there are several key steps or “chains” that have to be connected to result in infection. However, for SSIs, the initial introduction of microbial pathogens occurs most often during the surgical procedure performed in the Operating Theatre (OT).
Fig. 8: Transmission cycle in OT
Susceptible Hosts
Clients Service providers Ancillary Staff Community members
Reservoirs
People Water and solutions Instruments and other items Equipment Soil and air
Places of exit Places of entry
Broken skin Parasite Puncture wound Surgical site Mucous membranes
Infectious Agents Microorganisms such as Bacteria, Viruses, Fungi
Respiratory, genitourinary, and vascular systems Gastrointestinal tract Skin Mucous membranes Placenta
Modes of transmission
Contact Droplet Vehicle Airborne
94
Operating Theatre
Thus, to reduce the risk of SSI, a systematic but realistic approach must be applied with the awareness that this risk is influenced by characteristics of the patient, operation, personnel, and health care facility. For most SSIs, the source of pathogens is the endogenous flora of the patient’s skin, mucous membranes, or hollow viscera. When mucous membranes or skin is incised, the exposed tissues are at risk for contamination with endogenous flora. These organisms are usually aerobic gram-positive cocci (e.g., staphylococci), but may include fecal flora (e.g., anaerobic bacteria and gram-negative aerobes) when incisions are made near the perineum or groin. When a gastrointestinal organ is opened during an operation gram-negative bacilli (e.g., E. coli), gram-positive organisms (e.g., enterococci), and
Operating Theatre
Introduction
Surgical site infections (SSIs) are the second to third most common site of health care associated infections (HAIs). These complications of surgical procedures cause considerable morbidity and, when these occur deep at the site of the procedure, can carry mortality as high as 77%. As illustrated below there are several key steps or “chains” that have to be connected to result in infection. However, for SSIs, the initial introduction of microbial pathogens occurs most often during the surgical procedure performed in the Operating Theatre (OT).
Fig. 8: Transmission cycle in OT
Susceptible Hosts
Clients Service providers Ancillary Staff Community members
Reservoirs
People Water and solutions Instruments and other items Equipment Soil and air
Places of exit Places of entry
Broken skin Parasite Puncture wound Surgical site Mucous membranes
Infectious Agents Microorganisms such as Bacteria, Viruses, Fungi
Respiratory, genitourinary, and vascular systems Gastrointestinal tract Skin Mucous membranes Placenta
Modes of transmission
Contact Droplet Vehicle Airborne
94
Operating Theatre
Thus, to reduce the risk of SSI, a systematic but realistic approach must be applied with the awareness that this risk is influenced by characteristics of the patient, operation, personnel, and health care facility. For most SSIs, the source of pathogens is the endogenous flora of the patient’s skin, mucous membranes, or hollow viscera. When mucous membranes or skin is incised, the exposed tissues are at risk for contamination with endogenous flora. These organisms are usually aerobic gram-positive cocci (e.g., staphylococci), but may include fecal flora (e.g., anaerobic bacteria and gram-negative aerobes) when incisions are made near the perineum or groin. When a gastrointestinal organ is opened during an operation gram-negative bacilli (e.g., E. coli), gram-positive organisms (e.g., enterococci), and