Protection of the patient in the operating suite.

Hospital infection is still an important problem and numerous investigations have been published in this field. According to the National Research Council of Canada about 2450 papers had been published on hospital infection caused by Staphylococcus aureus or other bacteria up to 1962. As many have probably been published since then, and many of them deal with postoperative wound infection. The frequency of postoperative wound infection differs from time to time, but in several large and well controlled studies during the last 15 years infection rates between 7 and 9 per cent have been reported (Ad Hoc Committee, National Research Council, 1964; Altemeier, 1971; Brote, 1976; Bengtsson, Hambraeus & Laurell, 1979). Attempts have been made to correlate the frequency of infection with improvement of the physical environment in operating suites or with new working routines. Many researchers have placed particular importance on the prevention of airborne transmission (Hart, 1936; Wells & Wells, 1936; Bourdillon & Colebrook, 1946; Blowers, Mason, Wallace W Charnley, 1964, 1972; Charnley & Eftekhar, 1969). The importance of the general layout of an operating suite in the maintainance of high hygienic standards has interested architects, surgeons and microbiologists, but few systematic studies have been done in this field. In Sweden the design of many new operating suites has been greatly influenced by the recommendations of the Operating Theatre Hygiene Subcommittee of the Medical Research Council in England (1962). According to their recommendations an operating suite can be divided into four different zones: (a) protective zone including entrance lobby, recovery rooms and changing rooms; (b) clean zone including anaesthetic rooms, scrub-up rooms and inner lobby; (c) sterile zone including operating rooms, sterilizing rooms and lay-up rooms; (d) disposal zo12e including sink rooms. The influence of these recommendations on the layout of a modern operating suite in Sweden will be discussed as will the significance of different hygienic routines used in this suite and those reported by other workers.