Patient Safety in the Operating Room-

Focus on Infection Control and Prevention

Annette Erichsen Andersson

Ingrid BerghBengt Eriksson

Jón KarlssonKerstin Nilsson

Post-operative wound infections

Understanding the presents by remembering the past

What about today?

• 0.5-3% Total hip arthroplasty

• 2-20% Fracture surgery

• 10-25% Colorectal surgery

What's the price for healthcare related injuries?

Sweden, 2013, 63 Hospitals, 19 414 Medical records review

• 1.5 million extra days in hospital

• 8.5 billons in extra costs

• 5.6% permanent injuries or dead

• Infections are the most common and costly avoidable adverse event

Patients’ perspective

Study IPatients’ experiences of acquiring a deep surgical site infection. An interview study

To elicit and evaluate patients’ experiences associated with acquiring a deep Surgical site infection

(explore and describe)

Method• Qualitative, explorative interviews

• Strategic sample selection (variation) age, gender and socio-economic background.

• 17 - 2 - 1 = 14

• Qualitative content analysis

Results- Paper I

Time sequence Themes Sub-themes From emerging problems to treatment

A troubled search for recognition and answers

– Insecurity confronting new signs and symptoms – Sudden pain – Searching for answers and help

The treatment period Enduring a turbulent period filled with discomfort, suspense and restraint

–Transfers and re-operations – Additional suffering due to side-effects – Waiting in a vacuum – Impact on everyday life

The time after treatment

Changes in life, for good and bad

– A changing body – Adapting to new conditions

One voice;

“Do you know what the doctor said to me? He showed me the X-rays, which told me nothing. Then he said, ‘There’s nothing wrong’. I replied that I was in pain. ‘You are going to have to learn to live with it,’ he said. I said that something had to be wrong. He said, ‘There is nothing wrong’.

That almost made me angry.”

What can we do to prevent post operative infections?

Optimizing

Risk factors in the OR environment – Airborne microorganisms

CoNS- Coagulase negative staphylococci

Staph. Aureus

P. acnes

Enterococci

Streptococci

Gram-neg rods

Study II

Traffic flow in the operating room: an explorative and descriptive study on air quality

during orthopedic trauma implant surgeryAims

to investigate the air quality, expressed as colony forming (CFU) units/m3, during orthopedic trauma implant surgery;

to explore how traffic flow and the number of people affect the air contamination rates and to delineate

reasons for door openings

Methods• Active air samples- Sartorius MD8

• Structured observations

• Field notes

Results

• 52 of 91 samples exceeded 10 CFU/m3

• m= 16 CFU/m3 range:0-55

• m/op= 60 CFU/m3 range: 7-187

Door-openings/operation• m= 17 range 0-67

• CFU/m3 and door-openings/op are highly correlated (r=0.74; P=0.001)

68% of the variance in CFU was explained by:length of surgery, door-openings and number of

people present

Traffic flow

Necessary1 door openings

n Semi-necessary door openings

n Unnecessary door openings

n

Expert consultations, e.g. help needed from senior surgeons, expert nurses or anesthesiologists

40 Surgical team members entering after incision or leaving before closure

76 Logistic reasons planning next or other operation

30

Instruments or other material needed

137 Lunch and coffee breaks 108 Social visits

45

No detectable reasons

93

Total

177 184 168 529

!

Mean per operation 17.6 min-max = 0-64

Study IIIThe application of evidence-based measures to reduce surgical site

infections during orthopedic surgery Aims

to explore the application of intra-operative evidence-based measures designed to reduce the risk of surgical site infections and device-related infections during orthopedic implant surgery

to investigate whether the type of surgery, i.e. total joint arthroplasty compared with fracture surgery, affected the use of protective measures

MethodsStructured observation; •Urinary tract catheterization

•Normo-thermia,

•Ab.prophylaxis “timing”

•WHO “time out”

•Hand disinfection/aseptic techniques

Results

Hand disinfection

Take home message• A SSI influences all aspects of every

day life in a negative way for a long time

• Using patients narrative as a diagnostic complement could contribute to secure early diagnosis

• Patients needs to be seen as partners in care and have one doctor to turn to in case of problems.

Questions?

Thank you for your attention!