Role of the environment of the operating suite in surgical wound infection.

Most surgical wound infections are acquired in the operating room from the patient's own microbial flora. The remainder are acquired mainly from the staff in the operating room during surgery. The inanimate environment (e.g., walls, floors, and surgical instruments) has little relevance to the spread of infection. Because the air is an important route of spread in joint prosthesis operations, the routine use of an ultraclean air system and exhaust-ventilated clothing is frequently recommended. The value of such a system in other types of clean surgery is doubtful, but other measures, such as the following, may provide similar results at less cost: reduction of the number of persons in the operating room; a policy of not opening doors during operations; the use of comfortable, washable, bacteria-impermeable clothing by the operating-room staff; and concentration of the airflow over the operation site rather than over the whole operating room.

[1]  R. Blowers,et al.  DISPERSAL OF STAPHYLOCOCCUS AUREUS BY PATIENTS AND SURGICAL STAFF. , 1965, Lancet.

[2]  M. Parker.  Postoperative Clostridial Infections in Britain , 1969, British medical journal.

[3]  R. Blowers,et al.  Bacteria isolated from deep joint sepsis after operation for total hip or knee replacement and the sources of the infections with Staphylococcus aureus. , 1983, Journal of Hospital Infection.

[4]  D. R. Barry,et al.  Postoperative infection with Pseudomonas aeruginosa in an eye hospital. , 1966, Lancet.

[5]  D. Vesley,et al.  Bacterial dispersion in relation to operating room clothing , 1976, Journal of Hygiene.

[6]  C. W. Walter,et al.  THE INCIDENCE OF AIRBORNE WOUND INFECTION DURING OPERATION. , 1963, JAMA.

[7]  J. Burke.  IDENTIFICATION OF THE SOURCES OF STAPHYLOCOCCI CONTAMINATING THE SURGICAL WOUND DURING OPERATION. , 1963, Annals of surgery.

[8]  D. Maki,et al.  Relation of the inanimate hospital environment to endemic nosocomial infection. , 1982, The New England journal of medicine.

[9]  G. Laurell,et al.  Bacterial contamination in a modern operating suite. 3. Importance of floor contamination as a source of airborne bacteria , 1978, Journal of Hygiene.

[10]  B. Collins,et al.  Ward floors and other surfaces as reservoirs of hospital infection , 1967, Epidemiology and Infection.

[11]  A. Hambraeus,et al.  The influence of the total body exhaust suit on air and wound contamination in elective hip-operations. , 1983, The Journal of hospital infection.

[12]  O M Lidwell,et al.  Air, antibiotics and sepsis in replacement joints. , 1988, The Journal of hospital infection.

[13]  G. Ayliffe.  The effect of antibacterial agents on the flora of the skin. , 1980, The Journal of hospital infection.

[14]  G. Ayliffe,et al.  STAPHYLOCOCCAL CROSS-INFECTION IN SURGERY: EFFECTS OF SOME PREVENTIVE MEASURES , 1959 .

[15]  O M Lidwell,et al.  Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates. , 1983, The Journal of hospital infection.

[16]  P. Sanderson.  The choice between prophylactic agents for orthopaedic surgery. , 1988, The Journal of hospital infection.

[17]  G. Ayliffe,et al.  HOSPITAL INFECTION WITH PSEUDOMONAS AERUGINOSA IN NEUROSURGERY. , 1965, Lancet.

[18]  B. Collins,et al.  Wound infections acquired from a disperser of an unusual strain of Staphylococcus aureus , 1967, Journal of clinical pathology.

[19]  G. Ayliffe,et al.  Sources of Gas Gangrene in Hospital , 1969, British medical journal.

[20]  W. Noble,et al.  Dispersal of bacteria on desquamated skin. , 1962, Lancet.

[21]  J. Charnley,et al.  Postoperative infection in total prosthetic replacement arthroplasty of the hip‐joint with special reference to the bacterial content of the air of the operating room , 1969, The British journal of surgery.

[22]  L COLEBROOK,et al.  Air hygiene in dressing-rooms for burns or major wounds. , 1946, Lancet.

[23]  R. Shooter,et al.  Postoperative wound infection. , 1956, Surgery, gynecology & obstetrics.

[24]  T. Bucknall.  Factors affecting the development of surgical wound infections: a surgeon's view. , 1985, The Journal of hospital infection.

[25]  B. Collins,et al.  Transfer areas and clean zones in operating suites , 1969, Journal of Hygiene.

[26]  D. Raahave.  Effect of plastic skin and wound drapes on the density of bacteria in operation wounds , 1976, The British journal of surgery.

[27]  R. Blowers,et al.  Control of wound infection in a thoracic surgery unit. , 1955, Lancet.

[28]  W. Altemeier.  Manual on Control of Infection in Surgical Patients , 1984 .

[29]  W Whyte,et al.  The role of clothing and drapes in the operating room. , 1988, The Journal of hospital infection.

[30]  B. Collins,et al.  Cleaning and disinfection of hospital floors. , 1966, British medical journal.

[31]  D. Prothero,et al.  A bacteriological study of the effect on the environment of using a one- or two-trolley system in theatre. , 1990, The Journal of hospital infection.

[32]  R. Williams,et al.  Epidemiology of airborne staphylococcal infection. , 1966, Bacteriological reviews.

[33]  P. Jalovaara,et al.  Air bacterial and particle counts in total hip replacement operations using non-woven and cotton gowns and drapes. , 1989, The Journal of hospital infection.