“DO NO HARM”. This is a phrase we often hear during our graduation and training years as a health professional. This is in fact the most basic principle of dealing with human life. One can very well imagine the mental state of a patient who goes to a hospital for the surgery of his inflamed & aching gall bladder, only to receive the shock later on that he’s got an MRSA (methicillin resistant staph aureus) in his blood.
Emphasis is laid on the sterilization and disinfection in operating rooms and that is quite understandable considering the number of surgical site infections we encounter every day. The patients are at the receiving end of almost everything that happens in operation theatres so it is only reasonable that health care facilities follow guidelines when dealing with patients requiring or undergoing surgery.
When we talk of patient’s safety in operating rooms, we are talking of the protection of patient from every visible and invisible factor present in operating rooms that may have negative impact on his or her health. There is no set pattern of guidelines for patient safety in OTs (operating tables) that is being followed world over, however some basic principles are common to all operating rooms and surgical complexes. A brief overview of these principles is mentioned in the following paragraphs.
Planning well before surgery and then reviewing those plans at appropriate intervals helps the surgeon and his team to effectively carry out the procedure with minimum fuss. A good way of doing that is to hold a conference and let every team member know as to what is expected of them and what can they expect in return.
Taking a time-out just before beginning the incision will ensure that the dreadful mistake of opening the wrong side or taking out the wrong sided organ or part does not occur. It is no wonder that wrong side surgeries are a major contributor to the law suits filed against surgeons and their hospitals.
Maintaining the sterile barrier is one thing that can save a lot of lives. A patient undergoing surgery is already in a lot of stress and introduction of microorganisms from outside is the last thing their immune systems want. Every person present in the surgical team should know their own sterile limits and in addition they must look for any compromise of sterile techniques by other team members. Proper methods of scrubbing and wearing gowns and gloves should be taught to all and under no circumstances such standing procedures be neglected.
Disinfection of the OT must be carried out after every surgery and the next surgery should be started only after a minimum gap of 30 minutes. OTs should be thoroughly washed with disinfecting solutions at the end of the day and fumigation carried out fortnightly. This can significantly reduce SSIs in these patients.
Understanding the language of the patient is of utmost importance in surgeries that are done under spinal or local anesthesia. An interpreter may be kept for patients who speak different language.
Changing the OT culture is something that can protect the patient as well as operating surgeon from a lot of troubles. Traditionally the surgeon is considered to be the boss of the whole procedure and no one dares to challenge anything that is being done by him. This trend has to change for the betterment of whole system plus the patient and all the team members should be allowed to give their input if they think it’s necessary.
Proper exposure of the patient is a must in order to ensure that hypothermia does not set in during surgery and the patient is not injured by sharp instruments.