Hygienic procedures in operation theatres--guidelines and reality. Data obtained on hygiene control measures by public health service at Frankfurt am Main

Abstract

Good hygienic practice in hospitals and other medical institutions is mandatory to avoid or to minimise nosocomial infections. In Germany, official recommendations of the commission for hospital hygiene and infection control have been published as guidelines for hygiene management in hospitals as well as guidelines for control measures of the public health services who are obliged by law to control the hygienic situation in hospitals. In this paper the degree of implementation of these guidelines in the hospitals is studied in respect of the hygiene management in the operation theatre. The constructive and functional situation and the personal hygienic management were documented in 22 community and private hospitals in Frankfurt am Main, including 40 operation suites with 111 operation theatres. Data of the layout of the rooms were obtained by questionnaire and the hygienic management was observed by means of standardised checklists. Layout of rooms was not compatible with the recommendations of the Guidelines of 1990 and 2000 in many cases--especially with regard to the demand that doors to the operating theatres be closed. Automatic door closers were often either not available or defective. In some theatre areas correct hand disinfection while entering the suite was not possible for lack of disinfectant distributors at appropriate sites. Recommendations regarding surgical drapes and gowns were correctly observed in most cases, with the exception of changing gowns after having gone to the toilet room. Quite often, omission of hand disinfection after glove removal was observed. A discrepancy in hygienic procedures of nursing service and physicians was seen. In 40 % of the operation suites, powdered gloves were still in use. Though in all but one suite air conditioning systems were available, they were not correctly serviced in many cases. Cleaning and disinfection after single operations and at the end of the operating day were carried out correctly in most cases--except in operation theatres for ophthalmologic operations. Here too, manual preparation and disinfection/sterilisation of surgical instruments was common, and inappropriate use of sterilisers as well as the use of so-called "quick"-sterilisers. The recommendations of the commission for hospital hygiene and infection prevention are generally accepted as guidelines, although the degree of translation into practice was often unsatisfactory.