INFECTION CONTROL

Infection Control in Operating Department

Infection Control in Operating Department

Introduction

From 1996 to 2007, the rate of caesarean delivery in the United Kingdom increased 53% to 32 per 100 live births, and caesarean delivery rates increased across racial and ethnic, geographic, maternal age, and infant gestational age strata. Apart from increased medical costs for caesarean delivery compared with vaginal delivery, surgical site infection (SSI) remains a substantial cause of postoperative morbidity and increased health care cost because of maternal readmission. In addition, the psychologic costs of potential separation of the mother and newborn are considerable. According to recent data from Centres for Disease Control and Prevention (CDC) National Health Safety Network (NHSN), during the period 2006 to 2008, the pooled mean incidence of SSI per 100 caesarean section (C-section) procedures ranged from 1.46 for National Nosocomial Infection Study (NNIS) risk index 0 to 3.82 for risk index 2 and 3 combined.

The sources of post-C-section SSIs included ascension of vaginal bacteria into the uterine cavity and inoculation of bacteria in the surgical incision during operation. The most common pathogens causing postobstetric/ gynecologic surgery SSIs are Staphylococcus aureus (28.3%), coagulase-negative staphylococci (12.4%), Enterococcus species (10.1%), and Escherichia coli (9.6%). The Institute for Healthcare Improvement 100,000 Lives campaign promotes implementation of bundles in UK hospitals with the aim of preventing HAIs and avoidable deaths. Recent studies have demonstrated that many SSIs can be prevented through implementing a group of evidence-based interventions founded on best practice guidelines. Implemented together, the bundled interventions reduce the incidence of SSI and postoperative complications. Added to the basic pre-surgery prevention strategies, these preventive steps include the following: appropriate selection and timing of prophylactic antibiotics, eliminating use of razor shaving, postoperative glycemic control, optimizing tissue oxygen delivery, and maintaining perioperative normothermia. In addition, traditional surveillance for SSIs has proven to be a powerful tool in reducing SSI incidence.

The Causes of Infection Control in Operating Department

Regarding preoperative procedures, hair removal performed using a razor by nurses in the hospital ward on the day before the intervention, resulted completely divergent from international and national guidelines in nearly all the patients undergoing this procedure. In fact, recommendations state that if necessary, hair should be removed immediately before the operation, preferably with electric clippers. Interestingly, even though the evidence supporting this recommendation is strong and the correct procedure can be easily performed, suboptimal compliance with this preoperative item has been reported in other similar investigations as well. All the patients undergoing surgery had a preoperative shower, properly in most cases, using a common detergent as recommended by the current guidelines (Antoni, 2002, 143-145).

In more than 50% of the interventions for which UK guidelines did not recommend prophylaxis, it was provided anyway. Second, when its implementation was considered with respect to correct indication for administration, and proper choice of drug, overall compliance with best practices was still poor. Regarding the choice of antibiotics, the excessive use of third-generation cephalosporins is consistent with data previously reported in Italy, likely reflecting an incorrect belief by the physician that ...