Approach to the Surgical Theater: Epidemiological Survey in Orthopaedic Italian Private Hospitals

Abstract

Surgeons prepare for surgery in a reliable and reproducible manner and according to the guidelines published by the international health institutions. An epidemiological survey on 127 surgeons has shown that in everyday practice they have to follow the most recent knowledge based on evidence-based medicine (EBM) guidelines. However, more standardized approach to the surgical theater practices have to be defined by our health caregivers.

Keywords

infographic - survey - infections - orthopaedics - surgical practice

Epidemiologic survey is a common tool to study habits and behavior of a community. Orthopaedic surgeons perform surgical procedures as per the World Health Organization (WHO) guidelines for the prevention of surgical infections. Scientific societies implement these guidelines according to specific issues related to different countries in the world.[1] In such a scenario, the daily practice to approach surgical theater and procedures is an essential step to be standardized among hospitals and surgeons.[2] [3] [4]

Of the 850 surgeons e-mailed, 127 registered for this survey. Most of the surgeons were high volume and performed more than three surgeries per week ([Fig. 1]).

Fig. 1 Approach to surgical theater: Epidemiological survey on practice and World Health Organization global guidelines.

Results showed 48 % of the cases were referred always and 47 % sometimes to the preadmission clinic to prepare the patients for surgery. Hospital guidelines for surgical antibiotic prophylaxis are standardized in 89% of the cases as suggested by the WHO guidelines. Hair removal is a practice forbidden by the guidelines, but more than three-fourths of surgeons of the survey prepare the skin by shaving it. Personnel working in the operation theater wear cap, mask, and dress clothes as per the surgical practices. The cleaning and changing services were followed in 87% of the cases. The orthopaedic cases had a dedicated operating room (OR) in 75% of the hospitals, but one-fourth shared ORs with other surgical specialties. Hands were washed using proper antimicrobial soap. Double-layered surgical gloves were used and changed regularly as described by the international guidelines. Surgical helmets were used mainly for joint replacement surgeries. Surgical instruments were sterilized by a certified procedure in 90% of the cases. Meetings and audits for procedure with nurses and technical staff were common in two-fifths of surgeons.

Surgery reliability is one of the most important parameters for patient preparation and prevention of infection. Audit, survey, and guidelines represent essential tools of our surgical practice.

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• References

• 1 Global Guidelines for the Prevention of Surgical Site Infection. World Health Organization. World Health Organization; 2016. . Available at: www.who.int/gpsc/ssi-guidelines/en/
• 2 Spagnolo AM, Ottria G, Amicizia D, Perdelli F, Cristina ML. Operating theatre quality and prevention of surgical site infections. J Prev Med Hyg 2013; 54 (03) 131-137
• 3 Guidelines for safe surgery: safe surgery saves lives. World Health Organization; 2009. . Fifth report of the mandatory surveillance of surgical site infection in orthopaedic surgery. April 2004 to March 2009. London: Health Protection Agency; December 2009
• 4 McDonald R, Waring J, Harrison S, Walshe K, Boaden R. Rules and guidelines in clinical practice: a qualitative study in operating theatres of doctors' and nurses' views. Qual Saf Health Care 2005; 14 (04) 290-294