As an operating department practice student, I know that infection control and prevention is a vital part of life in an operating theatre. But was it always? And how have times changed?
In the 18th century surgeons used to wear their outside clothes in the theatre with just an apron over them, which wasn’t changed between patients. They would then pack patients’ wounds with sawdust that had come off the floor of sawdust mills; and ventilation within the theatre was poor.
Operations were often a public event with crowds able to go and watch. All of these things contributed to high infection rates and patients often died as a result.
Picture credit: The Old Operating Theatre, London http://oldoperatingtheatre.com/
There was a desperate need for change and, over the years, different ways of working have been put in place. Here’s an insight into how we minimise the risk of infection to our patients in today's operating theatres.
When we arrive at placement we change into scrubs and put on a surgical hat, this minimises the risk of us carrying bacteria from outside into the operating theatre. At the end of the day staff place worn scrubs in a laundry bag and they are taken off to be laundered before being re-worn.
Before the scrub, staff set up their trolleys of instruments. They must do what is called 'scrubbing up'. This involves the nurse or operating department practitioner (ODP) putting a face mask on, washing their hands thoroughly using a six-step technique, then putting on a gown and sterile gloves.
Surgical masks are worn during surgery for two reasons: firstly to prevent germs from the surgical team entering the patient's wound and secondly, as protection for staff from splashes and spray (safety goggles are also available for this reason).
The aim of the sterile area is to ensure that the patient's wound is protected from harmful bacteria during surgery. The operation site is cleaned with an antimicrobial solution to kill bacteria and the patient is then covered with sterile drapes, which again minimises infection.The trolley which holds the instruments, swabs, sutures etc is also covered with sterile drapes. Sterile items must be passed over carefully using an appropriate method to prevent contamination.
Some other ways we work to prevent infections are:
- after each patient we have equipment such as the operating table wiped down and rubbish disposed of before the next patient enters
- at the very end of the theatre list we wipe down everything and push it outside the theatre. This allows a cleaning team to come in and give the floor a deep clean
- there is a ventilation system; the pressure in the theatre is higher than outside it, which forces the air out of the door when opened. This prevents bacteria from entering
- used surgical instruments head off to the sterile services unit. They clean, re-pack and sterilise the sets, ready for the next patient
- there are strict cleaning protocols for theatres for patients with a variety of known infections
- we advise patients who come to us for elective procedures to wash in an antimicrobial soap for a few days before their operation.
Infections can range from a minor skin infection to a life-threatening condition such as sepsis. We've come a long way from sawdust and aprons. Today, we have a responsibility to ensure we adhere to policies and procedures that have been put in place to protect patients – and ourselves – from infection and disease.
Published for International Infection Prevention Week 2019.
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