Clean operating rooms for optimizing surgical outcome

Abstract

The National President of orthopedic surgeons of India has dedicated his efforts this year to surgical training in order to optimize surgical outcome. With the ongoing technological advances taking leaps and bounds worldover, our concern has always been to keep pace with the art and science of surgery. Many of the rituals and beliefs about practices in the operation theater were derived from wishful thinking and good ideas rather than scientific evidence. In an effort to develop these guidelines it would be good to know the standards of practice worldover. In this editorial I hope to review few facts in world literature and would expect your thoughtful minds to be stimulated regarding this important issue. WHO has come out with guidelines for safe surgery and have propagated – Safe surgery saves life, surgical site infection being one of the important issues. Surgical wound infection accounts for 20% of all nosocomial infections which most commonly occur because of contamination of wound during surgery. 1 Improvement in theater techniques, antibiotics, theater clothings and ventilation has reduced postoperative infection to as low as 0.3%. 2 Wound contamination can be reduced by a number of practices including: Limiting the number of personnel in the operation theater, Disrupting the flow of bacteria to the wound, Filtering the bacteria from the theater air, Disinfecting the air and the wound, Use of systemic antibiotics and Removing bacteria by physical methods such as disinfection and surgical techniques. The traffic in and out of the operating room should be restricted and the number of personnel should also be minimized. It is known that addition of 5 operating room personnel increased the microbiological counts by more than 15 folds. Also bacterial contamination in an operating room has been shown to increase significantly when the door is left open to the corridor. 3 The contamination rate of surgical instruments exposed to the air in an operation theater was 1.18 times higher than that of instruments that have been covered with a sterile guard. 4 The exposure time also had a positive correlation with bacterial contamination rate. Research on the clean air technology has brought certain facts which can help designing the operating rooms. Firstly vertical laminar airflow units generally reduce airborne contamination better than horizontal units. Secondly there is an inconsistent relationship between the surface and air bacterial counts, indicating that measurement of air contamination represents an unhelpful method for assessment of