preventing infections in OR is very important to all team in OR (nurses.physicians,technicians, and environment)

2. Purpose
“Clean Care
is Safer Care”

3. Outlines
SSI definition
Known facts
Environmental issues
Prep of the surgical (team & field )
Detergent
Patient issues in OR
Summary

4. Surgical site infections
(SSI)
• is an infection that occurs after surgery in the
part of the body where the surgery took
place.

5. Known facts

6. Known facts
• 234 million operations performed annually
• Most SSIs arise from the patient’s endogenous
flora
• Exogenous contamination of wounds is also
important in the pathophysiology of SSIs
(e.g. airborne particles)
• Airborne bacteria in the OR originate
primarily from the skin and hair of individuals
in the room.

7. Known facts
• The number of persons present in the OR
influence airborne contamination
• Each SSI is associated with approximately 7-10
additional postoperative hospital days and
patients

8. WHO
LMICs
(low-and middle-income countries)
HICs
(high-income countries)
* >1 in 10 patients have surgery get SSI. * In Europe SSI affect >500,000 people
costing 19 Billion.
* Peoples risk of SSI in LMICs is 3 to 5
times higher in HICs.
* Around 1% of people who have surgery
in USA get SSI.
* SSI threaten the lives of millions of surgical patients each year and contribute to
the spread of antibiotic resistance.

10. AORN 2017 guidelines related to infection prevention
Aseptic Practice
•Patient Skin Antisepsis
•Environmental Cleaning
•Hand Hygiene in the Perioperative
Setting
•Surgical attire
•Sterile Technique
Patient and Worker Safety
•Sharps Safety
•Transmissible Infections
•Environment of Care
Sterilization and Disinfection
•Flexible Endoscopes
•High Level Disinfection
•Instrument Cleaning
•Packaging Systems
•Sterilization

11. 1889

12. Environment issues
• Layout of Operating Theatre
• Ventilation system of OR
• Cleaning and disinfections of OR

13. Layout of Operating theatre
• Outer Zone
• Clean/ Semi restricted zone
• Restricted zone

15. Ventilation system

16. Ventilation system of OR
• ORs should be equipped with positive-pressure systems
• Ventilation of ORs should filter air at a minimum of 20 air
changes/hour of which at least four changes should be with
fresh air.
• The temperature of ORs should be kept between (20-24 C)
and with humidity of 20% to 60%.
• HEPA filters

17. Cleaning and disinfections of OR
• Should follow a precise schedule: for example, floors should
be cleaned once a day, and at the end of each session.
• All surgical items (e.g., tables, buckets) should be cleaned
between procedures.
• Specific blood or body fluid spillages should be dealt with
immediately.
• Walls and ceilings are rarely heavily contaminated; therefore,
cleaning them twice a year is reasonable.
• Scheduling dirty cases at the end of the day.
• Fumigation of the Operating theatre

18. Fumigation
• Preventive Measure
• Curative Measure

19. UV Robot
Disinfecting Ceiling Light Units
Copper surfaces
New Technology

20. Prep of the surgical (team & field )

21. Prep. of the surgical team
• Surgical attire
• Hand scrubbing
• Detergents

22. Surgical attire
• Mask
• Headgear which fully covers hair, sideburns,
and neckline.
• Shoe covers
• Gowns
• Gloves

23. Hand Scrubbing
• scrub arms and hands with antiseptic solution
(chlorhexidine gluconate & povidone-iodine)
• Time for scrubbing 3-5 min
• After performing the surgical scrub, members of the surgical
team should keep hands up and away from the body so that
the water runs from the tips of the fingers toward the
elbows.
• Meticulous Surgeon and Nurse are reducing the risk of SSIs.

25. Detergents
• Chlorhexidine
gluconate Brush
• Iodophors (e.g.
povidone iodine)
Brush

26. Chlorhexidine gluconate
• binds to the top layer of the skin, which
results in persistent activity
• kills a range of Gram positive and Gram
negative bacteria viruses and fungi
• Chlorhexidine does not become inactivated in
the presence of organic material.

28. Iodophors (e.g. povidone iodine)
• kills a range of Gram positive and Gram
negative bacteria viruses and fungi
• releases its slowly, does not have a residual
effect
• Iodine is inactivated by organic material so
should only be applied to clean skin.

29. Alcohol
• kills a range of Gram positive and Gram
negative bacteria and many viruses and fungi
• The immediate antimicrobial activity of
alcohol is stronger and kills more quickly than
chlorhexidine gluconate or povidone iodine,
but has no residual effect

30. Skin Prep
Alcohol based surgical skin prep
Two types of preoperative skin preparations that
combine alcohol (which has an immediate and
dramatic killing effect on skin bacteria) with long-
acting antimicrobial agents appear to be more
effective at preventing SSI than povidone-iodine
(an iodophor) alone:
–Chlorhexidine plus alcohol
– Iodophor plus alcohol

31. Skin Antiseptic Agents
Antiseptic
agent
Rapidity of
action
Persistent
activity
Alcohol Excellent None
CHG Moderate Excellent
PI Moderate Minimal
CHG w/alcohol Excellent Excellent
PI w/alcohol Excellent Moderate

32. Showers
with Soap or Chlorhexidine gluconate
2017 AORN Guideline for Preoperative Patient
Skin Antisepsis:
• Recommendation I, Patients should bathe or
shower before surgery with either soap or an
antiseptic.
– If using CHG cleansing:
• Liquid chlorhexidine shower
• (night before surgery)

33. Patient Issues in the Operating Room
• Antibiotic prophylaxis
• Surgical Care Improvement Project (SCIP)
- Hair clippers
- Warming patient
- Increased oxygen
- Hyperglycemia
- Remove folly's catheter within 24 hrs

35. One thing could lead to the failure

37. ‫الكريم‬ ‫الرسول‬ ‫يقول‬–‫التسليم‬ ‫وأتم‬ ‫الصالة‬ ‫أفضل‬ ‫عليه‬-:
(‫يتقنه‬ ‫أن‬ ً‫ال‬‫عم‬ ‫أحدكم‬ ‫عمل‬ ‫إذا‬ ‫يحب‬ ‫هللا‬ ‫إن‬)
‫الشريف‬ ‫النبوي‬ ‫الحديث‬ ‫هذا‬ ‫إنسان‬ ‫كل‬ ‫ر‬ّ‫ب‬‫تد‬ ‫ولو‬‫وما‬‫فيه‬‫ألن‬ ‫إليه؛‬ ‫يوكل‬ ‫عمل‬ ‫في‬ ‫قصر‬ ‫لما‬ ،‫دالالت‬ ‫من‬
‫للعمل‬ ‫إتقانه‬–‫عليه‬ ‫ملقاة‬ ‫وأمانه‬ ‫واجب‬ ‫أنه‬ ‫على‬ ‫عالوة‬–‫هللا‬ ‫لمحبة‬ ‫مدعاة‬ ‫هو‬–‫وتعالى‬ ‫سبحانه‬–
‫شأنه‬ ‫عال‬ ‫أو‬ ‫صغر‬ ‫مهما‬ ‫العامل‬ ‫لهذا‬.