W. Kasperczyk

2.1 Perioperative hygiene in traumatology - 8

2.2 Guidelines for formulating hygiene measures - 8

2.3 Concrete measures - 8

2.3.1 Clothing in the operating suite - 8

2.3.2 Cleaning and disinfecting hands - 9

2.4 Preoperative patient preparation - 10 References - 11

2.1 Perioperative hygiene in traumatology

Wound infection is the most frequent nosocomial infection in surgery. Medical literature describes a large number of factors triggering and promoting infections. The starting point for infections can be patients, staff, equipment and instruments, materials, surfaces and the air. »The ten most important points for preventing infections are the ten fingers of every single person involved in the operation«. This somewhat pithy statement does make it clear that personal hygiene measures must be given prime attention. The following descriptions refer to hygiene measures for preventing infections associated directly with the patient, the staff and the operation.

One of the first things a young surgeon experiences in the surgical department consists of all the instructions and warnings about »sterility«. It is clear to anyone that surgical medicine creates possibilities for the penetration of germs or for the release and spreading of germs, so that there is an increased risk of infection. Consequently there is a logical demand for special measures over and beyond the general hygiene requirements in a hospital, with high a priori acceptance of such surgical hygiene measures. Most people working in operating suites today are relatively well informed about the most important aspects of perioperative behaviour. But from time to time, drastic discrepancies emerge between required and actual behaviour. The causes of inadequate hygiene behaviour are frequently psychological in nature, resulting on the one hand from the contradictions between hygiene standards and recommendations and on the other hand from barriers to motivation [20].

2.2 Guidelines for formulating hygiene measures

Germany does not have a Federal Hygiene Law for comprehensive stipulation of how hygiene is to be monitored in the hospitals. It is up to the individual states to issue legal regulations referring to hygiene [22]. The (former) Federal Health Agency (now: Robert Koch Institute, Berlin) has appointed a committee for hospital hygiene and the prevention of infection.The committee regularly publishes guidelines for hospital hygiene and the prevention of infection (available through Fischer Verlag, Stuttgart). The hygiene guidelines have the status of expert recommendations. But this does not mean that the guidelines are without any essential significance in the case of legal disputes [22]. The guidelines are published in the Federal Health Gazette.

Other expert recommendations are issued by the German-Speaking Working Group for Hospital Hygiene (founded 1986). The group publishes its work in the maga zine »Hygiene und Medizin« [Hygiene and Medicine]. The so-called BGA guidelines and the working group recommendations are also regularly featured in the »Mitteilungen und Nachrichten der Deutschen Gesellschaft für Unfallchirurgie« [Notifications and News from the German Society for traumatology].

Very interesting current monographs have been published by: Adam & Daschner, 1993 [1], Bennett & Bachmann, 1993 [3], Daschner, 1992 [6], Hansis, 1994 [10], Hierholzer & Hierholzer, 1990 [14], Sander & Sander, 1992 [18] and Bühler, 1992 [4].

2.3 Concrete measures

Wound infection is a treatment-specific risk of surgical operations. This risk must be minimised by methods corresponding to good medical practice and standards (hygiene status). In the event of any disputes, a medical expert decides whether avoidable hygiene violations were involved.

2.3.1 Clothing in the operating suite

Operating suite clothing. Everyone releases a large number of microorganisms all the time, particularly when walking. Normal hospital clothing (usually white healthcare workwear) is regularly affected by (facultative) pathogenic germs. This is joined by microorganisms released through the nose and throat when talking, coughing and sneezing. The hair of hospital staff has been proven to have a large number of germs, including in particular Staphylococcus aureus [9]. It is advisable to reduce the ent-rainment and release of germs in the operating suite as far as possible. The guidelines for hospital hygiene and the prevention of infections therefore require the staff to change their clothing completely in the staff sluice of an operating suite. The hospital clothing should be removed down to the underwear and replaced by germ-free surgical clothing (trousers, shirt, surgical shoes). The suite clothing must be disinfected and cleaned, and transported and stored with protection from contamination. Surgical clothing must not be worn outside the operating suite. This prohibition cannot be bypassed by wearing something else (e.g. white coat) on top. This strict rule makes it possible to monitor what goes into and out of the operating suite, underlining its special character.

Headgear and face mask. In the op erating suite, everyone must wear hair covering which completely covers facial hair and hair on the head in order to prevent the exposure of the contaminated hair. The face mask fulfils two tasks: it prevents the transport of pathogenic germs into the sterile operating suite and into the wound, and protects the

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