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Infectious Risk Factors Related to Operating Rooms

Published online by Cambridge University Press:  02 January 2015

Didier Pittet*
Affiliation:
Infection Control Program, Division of Infectious Diseases, Department of Medicine, University Hospital of Geneva, Switzerland
Georges Ducel
Affiliation:
Hospital Hygiene, Division of Infectious Diseases, Department of Medicine, University Hospital of Geneva, Switzerland
*
Infection Control Program, Division of Infectious Diseases, Department of Medicine, University Hospital of Geneva, 24 rue Michelidu-Crest, 1211 Geneva 14, Switzerland

Abstract

Risk factors related to operating rooms include patient-associated risks, the operating room environment, ventilation systems, cleansing and sterilization, and operating room personnel. Although constantly debated, surgical wound infection surveillance with appropriate feedback to surgeons is one of the few effective measures that helps reduce surgical infection rates, and we strongly recommend its use. We also recommend the further study of other potential components of effective infection control programs for surgical patients.

Type
From the Third International Conference on the Prevention of Infection
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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References

1.Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG. The nation-wide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol 1985;121:159167.Google Scholar
2.Graves, EJ. National hospital discharge survey: annual summary, 1987. National Center of Health Statistics. Monthly Vital Statistics Report 1989;13:1116.Google Scholar
3.Mayhall, CG. Surgical infections including bums. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. 2nd ed. Baltimore, MD: Williams and Wilkins; 1993:614644.Google Scholar
4.Cruse, PJE, Foord, RA five-year prospective study of 23,649 surgical wounds. Arch Surg 1973;107:206210.Google Scholar
5.Farver, BF, Wenzel, RP. Postoperative wound infection rates: results of prospective statewide surveillance. Am J Surg 1980;140:343346.Google Scholar
6.Olson, MM, Lee, JT JrContinuous, 10-year wound infection surveillance. Results. advantages, and unanswered questions. Arch Surg 1990;125:794803.Google Scholar
7.Horan, TC, Culver, DH, Gaynes, RP. et al.Nosocomial infections in surgical patients in the United States, January 1986-June 1992. Infect Control Hosp Epidemiol 1993;14:7380.Google Scholar
8.Nichols, RL. Postoperative wound infection. N Engl J Med 1982;307:17011702.Google Scholar
9.Gamer, JS. CDC guidelines for the prevention and control of nosocomial infections: guideline for prevention of surgical wound infections, 1985. Am J Infect Control 1986;14:7180.Google Scholar
10.Nichols, RL. The operating room. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. 3rd ed. Boston, MA: Little, Brown and Company; 1992:461473.Google Scholar
11.Culver, DH, Horan, TC, Gaynes, RPet al.Surgical wound infection rates by wound class, operative procedure. and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991;91:152S157S.Google Scholar
12.Garibaldi, RA, Cushing, D, Lerer, T. Risk factors for postoperative infection. Am J Med 1991;91(suppl 3B):158S163S.Google Scholar
13.Richet, HM, Chidiac, C. Prat, A, et alAnalysis of risk factors for surgical wound infections following vascular surgery. Am J Med 1991;91(suppl 3B):170172.Google Scholar
14.Haley, RW, Culver, DH, Morgan, WM, White, JW, Emori, TG, Hooton, TM. Identifying patients at high risk surgical wound infection. A simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985;121:206215.Google Scholar
15.Haley, RW. Nosocomial infections in surgical patients: developing valid measures of intrinsic patient risk. Am J Med 1991;91(suppl 3B):145151.Google Scholar
16.Christou, NV, Nohr, CW, Meakins, JL. Assessing operative site infection in surgical patients. Arch Surg 1987;122:165169.Google Scholar
17.Classen, DC, Evans, RS, Pestotnik, SL, Horn, SD, Menlove, RL. Burke, JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281286.Google Scholar
18.Wiley, AM. Researches in orthopedic wound infections. Clin Orthop 1986;208:2829.Google Scholar
19.Lidwell, OM. Clean air at operation and subsequent sepsis in the joint. Clin Orthop 1986;211:91102.Google Scholar
20.Hambraeus, A. Aerobiology in the operating room-a review. J Hosp Infect 1988;11:6876.Google Scholar
21.Borst, M, Collier, C, Miller, D. Operating mom surveillance: a new approach in reducing hip and knee prosthetic wound infections. Am J Infect Control 1986;14:161167.Google Scholar
22.Vasey, H, Ducel, G, Allöwer, D. Zones protegees en Salle d'operation. Evaluation dune nouvelle enceinte de Charnley. Médecine et Hygiene 1987;45:16461651.Google Scholar
23.Charnley, J. A clean-air operating enclosure. Br J Surg 1964;51:202205.Google Scholar
24.Lidwell, OM, Lowbury, EJL, Whyte, W, Blowers, R, Stanley, SJ, Lowe, D. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomized study. By Med J 1982;285:1014.Google Scholar
25.Lidwell, OM, Elson, RA, Lowbury, EJ. et al.Ultraclean air and antibiotics for prevention of postoperative infection. A multicenter study of 8,052 joint replacement operations. Acta Ortkop Scand 1987;58:413.Google Scholar
26.Fitzgerald, RH JrTotal hip arthroplasty sepsis prevention and diagnosis. Orthop Clin North Am 1992;23:259264.Google Scholar
27.Lew, PD, Pittet, D, Waldvogel, FA. Infections that complicate the insertion of prosthetic devices. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore, MD: Williams & Wilkins. In press.Google Scholar
28.Salvati, EA, Small, RD, Brause, BD, Pellici, PM. Infections associated with orthopedic devices. In: Sugarman, B, Young, EJ, eds. Infections Associated with Prosthetic Devices. Boca Raton, FL: CRC Press Inc; 1984:181218.Google Scholar
29.Ducel, G, Nicollier, C. Flux exponentiel vertical: résultats bactériologiques 1985/1986. Presented at the Eighth International Symposium on Contamination Control; September 9-12, 1986; Milan, Italy. Abstract.Google Scholar
30.Eickhoff, TC. An outbreak of surgical wound infections due to Clostridium perfringens. Surg Gynecol Obstet 1962;114:11021108.Google Scholar
31.Bassett, DCJ, Stokes, KJ, Thomas, WRG. Wound infections with Pseudomonas multivorans. A water-borne contaminant of disinfectant solutions. Lancet 1970;1:11181119.Google Scholar
32.Gartenberg, G, Bottone, EJ, Keusch, GT, Weitzman, I. Hospital-acquired mucormycosis (Rhizopus rhizopodiformis) of skin and subcutaneous tissue. Epidemiology, mycology and treatment. N Engl J Med 1978;299:11151118.Google Scholar
33.Sheldon, DL, Johnson, WC. Cutaneous mucormycosis. Two documented cases of suspected nosocomial cause. JAMA 1979;241:10321034.Google Scholar
34.Everett, ED, Pearson, S, Rogers, W. Rhizopus surgical wound infection associated with elasticized adhesive tape dressings. Arch Surg 1979;114:738739.Google Scholar
35.Keys, TF, Haldorson, AM, Rhodes, KH, Roberts, GD, Fifer, EZ. Nosocomial outbreak of Rhizopus infections associated with Elastoplast wound dressing-Minnesota. MMWR 1978;27:3334.Google Scholar
36.Pearson, RD, Valenti, WM, Steigbigel, RI. Clostridium perfringens wound infection associated with elastic bandages. JAMA 1980;244:11281130.Google Scholar
37.Galle, PC, Homesley, HD, Rhyne, AL. Reassessment of the surgical scrub. Surg Gynecol Obstet 1978;147:215218.Google Scholar
38.Cruse, PJE, Foord, R. The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin North Am 1980;60:2740.Google Scholar
39.Church, J, Sanderson, I? Surgical glove punctures. J Hosp Infect 1980;1:84.Google Scholar
40.Whyte, W, Hambraeus, A, Laurell, G, Hoborn, J. The relative importance of routes and sources of wound contamination during general surgery. I. Non-airborne. J Hosp Infect 1991;18:93107.Google Scholar
41.Lowbury, EJL, Lilley, HA. Disinfection of the hands of surgeons and nurses. Br Med J 1960;1:14451450.Google Scholar
42.Dodds, RDA, Guy, PJ, Peacock, AM, Duffy, SR, Barker, SGE, Thomas, MH. Surgical glove perforation. Br J Surg 1988;75:966968.Google Scholar
43.Beck, WC. The hole in the surgicalglove: a change in attitude. Bull Am Coll Surg 1989;74:15.Google Scholar
44.Orr, NWM. Is a mask necessary in the operating room? Ann R Coll Surg Engl 1981;63:390392.Google Scholar
45.Tunevall, TG. Postoperative wound infections and surgical face masks: a controlled study. World J Surg 1991;15:383388.Google Scholar
46.Lowenfels, AB, Wormser, GP, Jain, R. Frequency of puncture injuries in surgeons and estimated risk of HIV infection. Arch Surg 1989;124:12841286.Google Scholar
47.McKinney, WP, Young, MJ. The cumulative probability of occupationally acquired HIV infection: the risks of repeated exposures during a surgical career. Infect Control Hosp Epidemiol 1990;11:243247.Google Scholar
48.Gerberding, JL, et al.Risk of exposure of surgical personnel to patients' blood during surgery at San Francisco General Hospital. N Engl J Med 1990;322:17881793.Google Scholar
49.Jagger, J, Hunt, EH, Pearson, RD. Sharp object injuries in the hospital: causes and strategies for prevention. Am/Infect Control 1990;18:227231.Google Scholar
50.Smith, JW, Nichols, RL. Barrier efficiency of surgical gowns: are we really protected from our patients' pathogens? Arch Surg 1991;126:756763.Google Scholar
51.White, A, Hambraeus, A, Laurell, G, Hoborn, J. The relative importance of the routes and sources of wound contamination during general surgery. II. Airborne. J Hosp Infect 1992;22:4154.Google Scholar
52.Pegues, DA, Shireley, LA, Riddle, CF, et al.Serratia marcescens surgical wound infection following breast reconstruction. Am J Med 1991;91:173S178s.Google Scholar
53.Pittet, D. Nosocomial bloodstream infections. In: Wenzel, RP, ed. Prevention and Control of Nosocomia1 Infections. 2nd ed. Baltimore, MD: Williams & Wilkins; 1993:512555.Google Scholar
54.Isenberg, DD, Tucci, V, Cintron, F, Singer, C, Weinstein, GS, Tyras, DH. Singlesource outbreak of Candida tropicalis complicating coronary bypass surgery. J Clin Microbial 1989;27:24262428.Google Scholar
55.Richet, HM, Craven, PC, Brown, JM, et al.A cluster of Rhodococcus (Gordona) bronchialis sternal-wound infections after coronary-artery bypass surgery. N Engl J Med 1991;324:104109.Google Scholar
56.Condon, RE. Schulte, WJ, Malangoni, MA, Anderson-Teschendorf, MJ. Effectiveness of a surgical wound surveillance program. Arch Surg 1983;118:303307.Google Scholar
57.Olson, M, O'Connor, M, Schwartz, MI, Surgical wound infections. A 5-year prospective study of 20,193 wounds at the Minneapolis VA Medical Center. Ann Surg 1984;199:253259.Google Scholar
58.Mead, PB, Pories, SE, Hall, P, Vacek, PM, Davis, JH JrGamelli, RL. Decreasing the incidence of surgical wound infections. Validation of a surveillance-notification program. Arch Surg 1986;121:458461.Google Scholar
59.Haley, RW, Culver, DH, White, JW, et al.The efficacy of infection surveillance and control programs in preventing nosocomial infections in U.S. hospitals. Am J Epidemiol 1985;121:182205.Google Scholar
60.Scheckler, WE. Surgeon-specific wound infection rates-a potentially dangerous and misleading strategy. Infect Control Hosp Epidemiol 1988;9:145146.Google Scholar
61.Haley, RW, Morgan, WM, Culver, DH, et al.Hospital infection control: recent progress and opportunities under prospective payment. Am J Infect Control 1985;13:97108.Google Scholar
62.Sherertz, RJ, Garibaldi, RA, Kaiser, AB, et al.Consensus paper on the surveillance of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:599605.Google Scholar