Significant infection control problems in operating rooms

April 10, 2015

Hospital managers and staff need to increase efforts to reduce infection by implementing effective methods, a new study has suggested.

The 'Hygiene and Aseptic Techniques during Routine Anesthetic Care - Observations in the Operating Room' article, published in the Antimicrobial Resistance and Infection Control journal found that 90 per cent of opportunities are being missed to reduce infection through hand disinfection and/or aseptic techniques.

To compile the data, researchers from the Sahlgrenska Academy identified 2,393 opportunities for hand disinfection and/or aseptic techniques at a large hospital in Sweden. However, they found that doctors and nurses missed 90 per cent of theses chances to control infection, suggesting that other practices such as sharps safety may also not be being adhered to.

The study, which is the first of its kind to take place in northern Europe, also witnessed a number of risk-prone invasive procedures in connection with intubation and local anesthesia, as well as insertion of catheters in the bloodstream and urinary tract.

According to the research, healthcare workers failed to take advantage of more than 90 per cent of the opportunities for using alcohol-based handrub and aseptic techniques.

"An operating room is radically different from other clinical settings in that anesthesia-related tasks are so frequent," said Dr Anette Erichsen Andersson, a researcher at Sahlgrenska Academy. "We counted an average of 30 opportunities, many of which were missed, for aseptic techniques every 24 minutes." 

Much like many infection control practices, problems with aseptic techniques and insufficient teamwork led to a substantial increase in situations where hand disinfection should have been used. 

According to the research, protective gloves, which are intended to reduce infections and sharps injuries, are being worn in an unsystematic manner that heightens the risk of hospital-acquired infections. However, the study itself did not examine the underlying reasons for inadequate use of aseptic techniques. 

"Gloves often take the place of hand disinfection and are reused for a number of different tasks," Dr Andersson said. "Bacteria may be transmitted from the airways to the bloodstream as a result, increasing the risk of infection."
One explanation for low adherence levels could be that neither hygiene or infection prevention is a mandatory subject at medical school or during specialist training for doctors and nurses.

"There is little doubt that all doctors and nurses are familiar with the benefits of hand rub," Dr Andersson said. "But simply possessing that knowledge is not good enough in the demanding setting of an operating room whose interdisciplinary teams rarely if ever have the chance to practice new working methods together, either in training or clinical situations.

"Awareness that you need to employ aseptic techniques must be supplemented by specific skills that work under complex, risky circumstances. The potential for interdisciplinary learning is enormous and additional research is needed to maximise the prospects for safe, aseptic care in the operating room."

Studies like these, which look at adherence levels to infection control practices, can help hospital managers and healthcare professionals to examine areas where practices may be being over-complicated or training is not addressing specific issues. As well as increasing hand hygiene, the same techniques can be used to increase the number of staff in hospitals that carry out needlestick prevention measures. 

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