INFECTION CONTROL CIRCLE OF SAFETY

Canadian Operating Room Nursing Journal, Dec 2006 by McKay, Marcy, Farley, Margaret

ABSTRACT

This article is based on a presentation given by the authors at the 42nd Congress of the Association for Perioperative Practice (AfPP), October 2006, in the United Kingdom. The conference theme was Circles of Influence and the Congress also hosted an International Federation of Perioperative Nurses (IFPN) Study Day featuring a safety theme.

This article contains a brief review of the influence of infection control practices on perioperative practice and surgical outcome. It reviews the Principles of Asepsis and accepted infection control practices.

Patient safety is more closely monitored today than ever before - not only by hospitals but also by consumers, health care reformers, governments and patients. The Canadian Institute for Health Information, (CIHI) shows one in nine Canadian adults acquire a hospital infection and that one in nine receives an incorrect medication or medication dosage. Our rates of patient deaths following an adverse event are higher than the combined death rates for Canadians involved in motor vehicle accidents, suffering from breast cancer, and HIV Positive.7 Each perioperative practitioner must use all available resources to assist in the safety of everyone involved in surgical interventions.

Patient safety is a challenge. Infection Control is a challenge. The increased awareness surrounding patient safety issues in turn means more attention is being paid to all aspects of patient care. The spotlight is illuminating practices contributing to adverse events. Adverse events (AE) are defined as an unintended injury or complication that results in disability, death or prolonged hospital stay and that is caused by health care management rather than by a patient's underlying disease process.8 Nosocomial or hospital acquired infections are considered one of the most common complication of hospitalized patients.11 Surgical Site Infections, (SSI) are considered an AE under the heading of hospital acquired infections or nosocomial infection.8-11 Surgical site infections should be considered a mortal enemy of perioperative practice and should also be considered a patient safety issue.

Every OR nurse can probably remember a time when she/he committed, or witnessed, a break in proper technique. While we hope it is not something that happens on a daily basis, it can be helpful to go back to basics and review the best practices and the reasons behind their development.

A 2002 submission to The Future of Health Care in Canada Commission included this quote from Donald M. Berwick, MD "We envision a system of care in which those who give care can boast about their work, and those who receive care can feel total trust and confidence in the care they are receiving."13

Surgical suites are dynamic environments that operate behind closed doors and are constantly undergoing change. The challenge for all perioperative practitioners is to be active in creating safe environments and to make use of all tools available to our practice. The end result will be the creation of an Infection Control Circle of Safety for all patients and perioperative team members. Available tools include:

* Surgical asepsis;

* Standard infection control practices;

* Sterile Technique;

* Infection Prevention Strategies;

* Professional standards and best practices;

* Hospital guidelines, policies, procedures, and protocols; and

* An awareness and understanding of current research.

In order to ensure the Circle of Safety is not broken, it is important for all perioperative nurses to ask themselves, on a daily basis "do I follow these safe practices? Am I making use of all the tools available to me". Hospitals are, inadvertently, a source of harm. While it is not possible to entirely eliminate infection, and microorganisms, the perioperative team has an obligation to "do no harm" by making use of all tools and adhering to best practices and policies.

SURGICAL ASEPSIS

Time, and the advancement of science, has not changed the basic principles of asepsis. Neither have they removed the need for adherence to basic infection prevention practices.

Our infection prevention foundation remains hand washing or hand cleansing. It is simple, cost effective, quickly and easily achieved, and, most importantly, it is proven to be successful! As far back as the 19th century perioperative practice included initiatives to prevent infection and ultimately death. Florence Nightingale led the way in nursing practice by instituting changes to infection control practices.1 Dr. Semmelweis (1818-1865), a Hungarian physician, noted that the rate of infection, and death, decreased if he simply washed his hands after performing autopsies and prior to delivering babies or conducting patient examinations.2

Hand washing or hand cleansing is the basis on which today's practices of infection control, and the Principles of Asepsis, have been built. When these practices and principles are adhered to without fail there is a decrease in infection rates.

NOW A BRIEF RE-CAP OF PRINCIPLES OF ASEPSIS: