Infection Control Manual

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2007 Operating Theatres Policy (79 kB)

 

 

 

 

 

 

 

 

Infection Control Guidelines for Operating Theatres

Key Points
Theatre dress code Discipline Hats and masks Wearing theatre clothes outside theatre is prohibited Infected cases in theatre Perform a risk assessment (do it last on the list) Recover patient in theatre Cleaning afterwards

Dress Code

The clothing to be worn by all staff working in the operating theatre complex and all those entering the operating rooms is as follows:

• Wear approved theatre suit
• Wear disposable hat or hood to completely enclose the hair
• Jewellery is a hazard in theatres; wristwatches and jewellery of any kind (including dress rings and bangles) must not be worn

Note: Earrings are dangerous in that they may fall into a wound. Wedding rings harbour bacteria so should be removed when scrubbing. They may be kept on a simple chain necklace, worn under the dress.

Specific dress codes for specific members of clinical staff is as follows:

• Masks: The scrubbed personnel should wear surgical masks to completely obscure the mouth and nose. The mask should be removed by the tapes and discarded in the OR at the end of a case. A fresh mask should be used for each case. The mask must not be touched other than by the tapes. (Note: Circulating personnel and anaesthetic team and surgeons performing certain operations need not wear a mask. This is at the disretion of the surgeon. Visors can be worn to prevent splashing blood into the eyes and mouth.)
• Full face visors or protective goggles/glasses will be available and should be worn for all operative procedures.
• Scrub gowns: Sterile gowns will be of a non-woven water-repellent material. Disposable gowns may also be worn. Plastic aprons may be worn under these gowns if additional protection is required (eg urology).
• Footwear: Dedicated personalised footwear is available for all regular staff in the theatre complex. Boots should be available and worn if there is a high risk of contamination of the feet with body fluids. Visitors (eg students) need not wear special theatre shoes even in the OR. Overshoes will not be available.

Note Theatre staff are responsible for keeping their footwear clean.

Some rare diseases are thought to require a greater degree of isolation than can be provided in these hospitals. Examples are pulmonary anthrax, diphtheria or viral haemorrhagic fevers.

Perform a Risk Assessment

Most of these patients will have been abroad. They are often first seen in the Hospital for Tropical Diseases, Infectious Diseases Unit, or an A/E department, but may well be admitted to general wards with a diagnosis of PUO, from abroad, and there is usually a very sketchy history.

These patients must not be transferred within the hospital but must be placed in Source Isolation according to the standard protocol.

Keep the number of staff and other contacts to a minimum.

Make a list of all contacts in case follow up surveillance is required (See Contact Tracing Sheet).

 

Action Required

• Inform the Consultant Microbiologist or Infectious Disease Physician.
• Transfer to the Regional Isolation Unit will be arranged by the medical staff in liaison with the Infection Control Team and Consultant in Communicable Disease Control. See lines of communication for contact telephone numbers for your hospital.
• For specific guidance on management of highly infectious diseases, See Viral Haemorrhagic Fevers.
• Do not admit anyone to a room that has been occupied by a patient transferred for these reasons without consulting the Infection Control Team. Proper decontamination may be necessary.

 

References

European Commission for Standardisation (Comite Europeen de Normalisation) [CEN] : Surgical clothing and drapes used as medical devices in healthcare facilities. Second Draft. CEN/TC 205/WG 14 N 61.

Granzow JW, Smith JW, Nicholls RL, Waterman R, Muzik AC. Evaluation of the protective value of hospital gowns against blood strike-through and MRSA penetration. Am J Infect Control 1998; 26: 85-93.

Hubble MJ , Weale AE , Perez JV , Bowker KE , MacGowan AP , Bannister GC . Clothing in laminar-flow operating theatres. J Hosp Infect 1996; 32: 1-7.

Humphreys H, Russell AJ, Marshall RJ, Ricketts VE, Reeves DS. The effect of surgical theatre headgear on bacterial counts. J Hosp Infect 1991; 19: 175-80

Lippert S , Gutschik E . Bacterial sedimentation during cardiac surgery reduced by dispoable clothing. Scand J Thorac Cardiovasc Surg 1992; 26: 79-82.

Mitchell NJ , Evans DS , Kerr A . Reduction of skin bacteria in theatre air with comfortable, non-woven disposable

clothing for operating-theatre staff. Br Med J 1978; 1: 696-8.

Moylan JA , Fitzpatrick KT , Davenport KE . Reducing wound infections. Improved gown and drape barrier performance. Arch Surg 1987; 122: 152-7.

Muller W , Jiru P , Mach R , Polaschek F , Fasching W . The use of disposable draping materials in the operating room and its effect on the postoperative wound infection rate Wien Klin Wochenschr 1989; 101: 837-42.

Verkkala K , Eklund A , Ojajarvi J , Tiittanen L , Hoborn J , Makela P . The conventionally ventilated operating theatre and air contamination control during cardiac surgery - bacteriological and particulate matter control garment options for low level contamination.. Eur J Cardiothorac Surg 1998; 14: 206-10.