Eliminating and Preventing Microorganisms in the Operating Room

This year, 1 in 31 surgical patients in the United States will develop a Surgical Site Infection (know as SSI), translating to over 157,000 cases annually. These infections not only cause needless patient suffering but also account for a significant proportion of healthcare-associated infections, driving up healthcare costs and taxing medical resources. Moreover, the rise of antibiotic-resistant microorganisms adds a new layer of complexity to this already critical issue, making prevention and management even more challenging.

Even with modern sterilization techniques, certain resilient strains, such as Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, can persist and cause hospital-acquired infections. This article delves into the specific challenges microorganisms pose in the OR, their modes of entry into a patient’s body, potential consequences, and mitigation strategies.

• Surgical instruments: Inadequately sterilized equipment remains a leading cause of infection

• Airborne transmission: The OR’s air, despite filtration systems, can contain microorganisms, leading to infections, especially during prolonged procedures

• Healthcare workers: Hands, even when gloved, can transmit pathogens if proper hand hygiene and glove protocols aren’t followed

• The patient’s own flora: The skin and mucous membranes harbor organisms that can enter surgical incisions if not adequately prepared

If these microorganisms aren’t effectively addressed, a myriad of complications can arise, including delayed healing, chronic inflammation, surgical site complications and infections, and the formation of abscesses and fistulas. Biofilm formation can occur in as little as 12 hours, making it critical to take immediate action.

Recently, several strategies have emerged to help eliminate and prevent the spread of microorganisms in the operating room. These include:

• Effective Sterilization: Adhere to guidelines and regularly audit sterilization practices to ensure the efficacy of autoclaves and other sterilization equipment

• Air Quality Control: Regular maintenance and monitoring of HEPA filters and positive pressure ventilation systems are crucial

• Hand Hygiene and Gloving Protocols: Regular training and strict adherence to hand hygiene and gloving protocols reduce the risk of transmission

• Patient Preparation: Adequate skin preparation using recommended antiseptics and maintaining patient normothermia can reduce SSIs.

• Interoperative Surgical Irrigation Solutions: Utilizing surgical irrigation solutions is recommended by the Academy of Orthopedic Surgeons as a way to reduce risk factors associated with infection.

These techniques have helped to reduce the overall incidence of SSIs by 5% in the last five years.

Despite the advancements in surgical techniques, microorganisms remain a formidable challenge in the OR. Vigilance, continuous training, and adherence to established guidelines, as well as the introduction of modern antimicrobial techniques and products, are vital in ensuring the best patient outcomes.

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CITATIONS

• Centers for Disease Control and Prevention (CDC). (2020). Surgical Site Infection (SSI) Event. National Healthcare Safety Network (NHSN). Retrieved from: https://www.cdc.gov/nhsn/acute-care-hospital/ssi/index.html

• Sievert DM, et al. (2013). Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infection Control & Hospital Epidemiology.

• Weber DJ, Rutala WA. (2013). Role of the environment in the transmission of Clostridium difficile in healthcare facilities. American Journal of Infection Control.

• Lynch RJ, Englesbe MJ. (2010). Aerobiology and the global spread of airborne infectious agents. Anesthesiology.

• Pittet D, et al. (2011). Evidence-based model for hand transmission during patient care and the role of improved practices. The Lancet Infectious Diseases.

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• Rice LB. (2012). Mechanisms of resistance and clinical relevance of resistance to β-lactams, glycopeptides, and fluoroquinolones. Mayo Clinic Proceedings.

• Rutala WA, Weber DJ. (2013). Guide to infection control in the hospital. International Society for Infectious Diseases.

• Whyte W, et al. (2012). Laminar flow operating theatres: total particle counts and their implication. Journal of Hospital Infection.

• Boyce JM, Pittet D. (2013). Guideline for Hand Hygiene in Health-Care Settings. MMWR.

• https://www.aaos.org/quality/quality-programs/quality-toolkits/intraoperative-irrigation/.

• 1. “Surgical Site Infection Event Module” National Health and Safety Network January 2022. cdc.gov/nhsn