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      Functional separation of septic and aseptic surgical procedures Translated title: Funktionelle Trennung von septischen und aseptischen OPs

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          Abstract

          Current evidence does not favour constructional over functional separation of septic and aseptic surgical procedures in terms of overall hygiene maintenance and incidence of skin and soft tissue infections. In both laminar and turbulent flow air operating theatres, air is not a relevant source of pathogens if surface disinfection is carried out properly.

          Final cleaning after a septic procedure includes a thorough wipe-disinfection of all potentially contaminated near and distant surfaces, including maintaining the necessary and effective exposure time of the chosen surface disinfectant. Cleaning utensils and clothes of all team members must be disposed of before leaving the theatre, and a complete change of gowns is mandatory before re-entering the operating room area.

          Strict adherence to this code of behaviour will allow for efficient functional separation of clean and contaminated surgical procedures without compromising patient safety.

          Translated abstract

          Es gibt keine epidemiologische Evidenz für den Einfluss der baulichen Trennung aseptischer/septischer OP auf die SSI-Rate. Im Ergebnis eines diesbezüglichen Risk Assessments geht sowohl bei Turbulenzarmer Verdrängungströmung (TAV) als auch bei turbulenter Belüftung nach Schlussdesinfektion des OPs von der Raumluft keine Infektionsgefährdung für die nächste OP aus.

          Die Schlussdesinfektion nach septischer OP beinhaltet die gründliche Wischdesinfektion aller potentiell kontaminierten Flächen auch im patientenfernen Umfeld mit Abwarten der deklarierten Einwirkungszeit, den Wechsel der Reinigungsutensilien und Bereichskleidung des Reinigungspersonals, die Ausschleusung des OP-Teams mit Wechsel der Bereichskleidung und erneute Einschleusung sowie den Wechsel der Bereichskleidung vons Anästhesieteam und Springer.

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          Most cited references22

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          Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates.

          During operations for total joint replacement done in operating rooms with conventional ventilation the mean air contamination varied considerably among the 15 hospitals studied. The range was from 51 to as many as 539 bacteria-carrying particles per cubic metre. When the data from all the hospitals were grouped according to the mean level of bacterial airborne contamination, including operations done in control and in ultraclean air, there was a good correlation between the air contamination and the joint sepsis rate. There was also a correlation between the mean values of air contamination and the numbers of bacteria isolated from wound wash-out samples; but the apparent efficiency of the sampling method varied a great deal among the hospitals carrying out this procedure. From this data it would seem that by far the largest proportion of bacteria found in the wound after the prosthesis had been inserted reached it by the airborne route. With the mean air contamination found in the control series, 164 bacteria-carrying particles per cubic metre, this proportion was as much as 95 per cent. The risk of joint sepsis varied widely among the 19 hospitals. The differences between the highest and lowest being probably as much as 20-fold. However, the effect of an ultraclean air environment was asimilar at all hospitals.
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            Dispersal of skin microorganisms.

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              A review of single-use and reusable gowns and drapes in health care.

              Gowns and drapes are used widely in healthcare facilities. Gowns have been used to minimize the risk of disease acquisition by healthcare providers, to reduce the risk of patient-to-patient transmission, and during invasive procedures to aid in maintaining a sterile field. Drapes have been used during invasive procedures to maintain the sterility of environmental surfaces, equipment, and patients. This article reviews the use of gowns and drapes in healthcare facilities, including the characteristics, costs, benefits, and barrier effectiveness of single-use and reusable products. Currently, gowns protect healthcare personnel performing invasive procedures from contact with bloodborne pathogens. Although gowns have been recommended to prevent patient-to-patient transmission in certain settings (eg, neonatal intensive care unit) and for certain patients (eg, those infected with vancomycin-resistant enterococci), scientific studies have produced mixed results of their efficacy. While appropriate use of drapes during invasive procedures is recommended widely as an aid in minimizing contamination of the operative field, the efficacy of this practice in reducing surgical-site infections has not been assessed by scientific studies. Based on an evaluation of the functional requirements, environmental impact, and economics of gowns and drapes, clear superiority of either reusable or single-use gowns and drapes cannot be demonstrated. The selection of particular gowns and drapes by individual healthcare facilities requires an assessment of the facility's requirements, available products, and costs and should be based on the desired characteristics of an ideal gown or drape as defined in this paper.
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                Author and article information

                Journal
                GMS Krankenhhyg Interdiszip
                GMS Krankenhaushyg Interdiszip
                GMS Krankenhaushygiene interdisziplinär
                German Medical Science GMS Publishing House
                1863-5245
                15 December 2011
                2011
                : 6
                : 1 , Prevention and therapy of nosocomial infections
                : Doc12
                Affiliations
                [1 ]Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
                [2 ]Clinical Institute for Hospital Hygiene, Medical University of Vienna, Vienna, Austria
                [3 ]Department of Anesthesia and Intensive Care Medicine, University Medicine Greifswald, Greifswald, Germany
                [4 ]Department of Trauma and Orthopaedic Surgery, Clinic of Surgery, Ernst-Moritz-Arndt-University, Greifswald, Germany
                Author notes
                *To whom correspondence should be addressed: Axel Kramer, Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Walther-Rathenau-Str. 49a, 17489 Greifswald, Germany, Phone: +49-3834-515542, Fax: +49-3834-515542, E-mail: kramer@ 123456uni-greifswald.de
                Article
                dgkh000169 Doc12 urn:nbn:de:0183-dgkh0001699
                10.3205/dgkh000169
                3252653
                22242093
                4882bea2-a1df-4bd9-8d04-687fe46ca74d
                Copyright © 2011 Kramer et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free to copy, distribute and transmit the work, provided the original author and source are credited.

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                Public health
                operating theatre,functional separation,laminar air flow,clean surgery,septic surgery,airborne infections

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