Theatre
staff
Bacterial
infection
The presence of an infected skin lesion, such as a boil, paronychia or
carbuncle, known carrier state, particularly in the nares and the presence of an
acute bacterial infection, particularly an upper respiratory tract infection,
must lead to the exclusion of such a person from the team. There is good
microbiological evidence to show that failure to do so will lead to an
increasing number of infections.
Showering
Showering is preferable to bathing and the utilisation of a 4 per cent
chlorhexidine gluconate soap by the surgical team is of benefit before the start
of an operating list, and has been recommended for the operating surgeon between
cases when the procedure is long.
Clothing
and gowning
Desquamation principally occurs from the lower half of the body and the
changing from normal clothes to clean linen reduces the bacterial count; cotton
pores are 100 pm in size whereas skin scales are 5—60 pm, and thus
cotton clothing
will not serve as a barrier. Cotton suits worn below cotton gowns
results in a decrease in bacterial count in air by 30 per cent. The newer
bacterial impermeable fabrics further reduce the count but are of no value when
worn over cotton pajamas because the desquamation process continues and bacteria
still escape, particularly at the ankles but also at the neck. The wearing of
elastic anklets on trousers will reduce bacterial counts by 47 per cent. The
most effective reduction of airborne bacteria is obtained by using the Charnley
exhaust gowns — this is particularly important in orthopaedic procedures, but
probably not significant in general surgery.
Caps
are usually worn, although the amount of pathogenic bacteria dispersed is
unlikely to be of any significance in general surgery, but may again be
significant in implant surgery.
• Pajamas with elasticated ankles and wraparound breathable membrane
fabrics will reduce the bacterial count.
• In orthopaedic surgery, use of the Charnley exhaust gown is optimal.
Masks
The oropharynx is a low-level source of bacteria (36 bacteria per 100
words spoken are generated), the number of bacteria that settle on culture
plates is not affected by wearing a mask and several studies exist to show that
the wearing of masks in general surgery does not affect the wound infection
rate, although the wearing of masks in implant surgery is appropriate as their
use has been shown to decrease the number of bacteria detected at the operating
site.
• Their use is indicated in implant and orthopaedic surgery.
• They offer protection to the wearer.
• Reduction of speech at the operating table is important.
Gloving
Although gloving or double gloving is widely practised there is little
evidence that wound infection is related to glove puncture. This would suggest
that disinfection of the hands is important in keeping the incidences of wound
infection low.
Scrubbing
up
Brushes should only be used for cleaning finger nails. A scrub-up time
of 3—S minutes with chlorhexidine soap or povidone iodine soap is utilised;
the former is a broad-spectrum rapidly active agent with persistent activity,
whereas the latter has a relatively short duration. The technique should include
thorough washing of the hands to the elbows, with removal of the soap in the
direction hand to elbow.