INFECTION CONTROL

Infection is a real hazard to any patient undergoing surgery. This may create a devastating effect for the patient causing pain, increasing the length of their hospital stay, loss of income, stress, and possibly the loss of or use of a limb. In the worst case a patient may die of infection, for example, pneumonia. The best form of control is prevention.

The infection process requires a source, which may be an individual, for example, a nose that may harbour the bacteria staphylococcus. The means of transmission to the host may be the hands, respiratory secretions or clothing of the staff member. Operating theatre personnel are the most likely source of infection. Staff or patients can harbour microorganisms that can potentially cause infection. Microorganisms are easily transmitted via droplet that can remain in the air for long periods of time or by spreading after settling in dust particles.

Three factors are essential to the infection process:

•A pathogenic organism (a microorganism that can cause disease or illness).

•A means of transmission.

•An entry route into the host.

In healthy individuals, defence mechanisms such as intact skin, and mucous membranes function as natural barriers. When the barrier is broken or other circumstances decreasing a person's immunity such as poor diet, insufficient blood supply, and/or radiotherapy, the passage of microorganisms into their body and their growth is made easier.

Certain hospitals require that you have screening prior to employment that may include:

Hepatitis B, exposure or immunity.

• Measles, mumps and rubella.

• Tuberculosis (Mantoux and chest x-ray).

• Varicella zoster virus (chickenpox).

Other conditions that may affect your work placement may include a weeping skin condition.

The Queensland Health Infection Control Guidelines (2010) provide a framework assisting hospitals in providing a safe and high quality infection control program. Also you will find the hospital infection control policies and procedures provide the foundation for a safe health care environment for staff and patients.

To prevent the patient from being exposed to potentially infectious microoganisms, routine cleaning should be performed to eliminate any contaminants. The procedures used should be consistent and each patient considered as infectious, this will protect both patients and staff from any potentially infectious material.

Cleaning should occur before, during, and after all surgical procedures. At the beginning of the day horizontal surfaces should be dusted with a damp cloth( Tuffy Wipe) including the surface of the theatre light. At the end of the case soiled linen should be discarded in fluid impervious bags, contaminated and general waste segregated into the correct receptacles. Equipment and theatre furniture should be cleaned with the appropriate disinfecting agent and the floor cleaned around the operating bed and where visibly soiled.

In-between operating cases the OR table, arm board, lights, accessory equipment should all be wiped over. The floor should be mopped using clean detergent solution for each case. At the end of the list all surfaces should be cleaned. This should include the booms housing electrical/gas outlets, light arms, ledges, tops of x-ray boxes, furniture, and equipment including wheels, scrub sinks. Refillable soap dispensers should be disassembled and cleaned before being refilled because they can serve as reservoirs for microorganisms.

The staff in theatre should all contribute to theatre cleaning. General cleaning is often the responsibility of theatre orderlies. A cleaning roster is used to ensure everybody knows and shares the responsibility of maintaining a dust free environment.

Standard Precautions

They are workplace practices that are to be used on all patients regardless of their known or assumed infectious status.

They are designed to protect the patient and healthcare workers.

They are the minimum requirements for the control of infection in all settings and situations, including those where a high risk of infection transmission may occur, for example, the operating theatre.

Standard precautions include:

1.Handwashing

2.Use of appropriate personal protective equipment (PPE) to provide a barrier to contact with blood body fluids, non-intact skin or mucous membranes.

3.Immunisation of healthcare workers

4.Use of aseptic technique to reduce patient/client exposure to microorganisms

5.Management of sharps, blood spills, linen, and waste to maintain a safe environment

6.Routine environmental cleaning.

Additional Precautions

To prevent transmission of specific infectious diseases additional precautions may be used.

They require: 'Isolation' of the infectious source to prevent transmission of the infectious agent to susceptible people in the health care setting.

Methods of alerting people entering an isolation area of the need to wear particular clothing to prevent transmission.

Handwashing is the most important strategy to reduce the risk of infection. All healthcare workers should wash their hands prior to entering the workplace, the washing of hands should also occur following contact with blood, body fluids, excretions, secretions and items contaminated with body fluids, whether or not gloves were worn. Hands should be washed between patients, and between different patient activities, prior to eating and after eating, and after using the toilet and as required to reduce the risk of microorganisms being transferred. The actual routine handwash should involve thoroughly wetting hands and lathering vigorously for 10-15 seconds using an approved soap, rinse well, and pat dry with a paper towel.