Surgical site infection : an exploration of infection control practices among health care professionals

Abstract

Quality aspects of the health care offered in hospitals have become recognized as of increasing importance. Acquired surgical site infections (SS1) are a challenging problem in all health care systems and are a reflection of a number of preventable measures of health care neglect. SS1s result in a number of adverse outcomes since they are a major cause of postoperative morbidity and mortality and generate considerable additional health care and societal costs. Despite this, data about the prevalence and incidence of surgical site infections in Malta is lacking. Besides, data on infection control procedures of health care workers' has been minimal. The exploratory descriptive research design utilised to conduct this study aimed to determine what the current infection control practices of health care workers in the operating room at Mater Dei hospital are. A structured observation checklist formulated and validated by other authors was used to collect data from the available sample of all health care professionals (cardio-thoracic surgeons, anaesthetists, nurses, cardiopulmonary bypass technicians and orderlies) practicing in the cardiac operating room during open-heart surgery (n=30).

Findings from the observation revealed non-compliance rates in categories such as environment disinfection, hand hygiene and operating room traffic. Inadequate infection control practices and poor compliance rates were demonstrated particularly by anaesthesiologists, cardiopulmonary bypass technicians, nurses and orderlies. Whilst, infection control procedures of anaesthetist performing invasive procedures were congruent with intemational recommendations. Furthermore, a post-discharge surveillance of patients following cardio-thoracic surgery from the same hospital was conducted to quantify a subjective estimate of surgical site infections in this group. Data was collected from a sample of all SurvivingIng patients (n= 140) who underwent open-heart surgery during the data collection period (5 months) and consented to participate. A telephone survey was utilised to collect data for the identification of SSI frequency. A response rate of 90% was achieved. Quantitative data was analysed using both descriptive and inferential statistics.

This study's findings indicated a high surgical site infection frequency which incorporated both sternal and harvest-site infections in patients who underwent open-heart surgery. The majority of surgical site infections identified here were leg wound infections after saphenous vein harvesting. The results also indicated a significant association between a history of diabetes mellitus or peripheral vascular disease and the development of surgical site infections in patients following cardio-thoracic surgery. In the light of this study's findings various management implications and recommendations were highlighted. A multidisciplinary educational programme targeted to the specific needs of the various health professionals could strive to achieve standardization of sanitary procedures in the operating room. Active monitoring or auditing of infection control practices may prove a simple, useful, and cost-effective tool to help increase and sustain improved compliance of health workers to infection control practices in the operating room. Since many acquired surgical site infections appear after hospital discharge, when patients have returned to the community, the creation of a system of post-discharge surveillance is essential for targeting SSI prevention methods. Developing strategies to prevent SSIs and to allow for recognition of patients at high-risk and who may need more careful monitoring is thus recommended.