Aseptic surgery forum - http://www.aseptic-surgery-forum.com

Electrosurgical smoke is an issue, which many surgeons, nurses and branch organisations have been discussing for years. The main worries are the presence of airborne chemicals, viable bacteria, viruses and mutagenic substances. During the workshop, we will summarise the common knowledge about this issue and consider the main type of solutions...

Schedule to be confirmed

Schedule to be confirmed...

During the past century, a number of significant developments in the field of surgery have made surgical procedures generally safe and relatively free from the risk of transmission of micro-organisms between surgeon and patient, and from patient to surgeon. These include technical developments and design modifications within the operation room (OR), but also medical devices used directly by members of the operating team. One important, and for some time overlooked medical device making aseptic surgery possible, is the surgical glove.

During surgical procedures, intact surgical gloves act as a physical barrier against the transmission of skin flora from the surgeon’s hand to the surgical site. The intact surgical glove is the most important barrier to protect bi-directional the passage of micro-organisms from the hand of the surgical team members to the patient and vice versa. However, several studies have demonstrated that unrecognized perforations of surgical gloves are not uncommon and that the frequency of defects increases with the duration of wear. Because of glove puncture and this potential breach of integrity, various strategies have been developed to reduce the risk of surgical site contamination with micro-organisms originating from the surgeon’s hands. In addition to double gloving, which is sometimes uncomfortable and reduces sensitivity, or routine change of gloves during surgical procedures, preoperative surgical hand preparation using an antimicrobial soap (surgical scrub) or an alcohol based hand disinfectant (surgical rub) is regarded as standard practice to decrease the microbial bio-burden on the surgeon’s hands. Preoperative surgical hand preparation can reduce but not eradicate the flora resident on the surgeon’s hands, thereby not eliminating the risk of transmission of such organisms into the surgical site in the event of glove puncture. Because of re-growth of skin flora during a surgical procedure, the original skin flora levels can be re-established after 3 to 6 hours of operative procedural time, depending on the formulation of the hand disinfectant product. The perfect solution for this would be a puncture proof, flexible surgical glove. Alternatively, surgical gloves actively reducing the number of microorganism on hands could help improving patient and healthcare worker safety.

Recently, a new sterile antimicrobial surgical glove featuring a chlorhexidine gluconate (CHG) coating on its inner surface has been developed. Gloves serve as a mechanical, protective barrier between the surgeon’s hand and the surgical site. Results of a randomized, controlled, double-blinded clinical trial are presented investigating the potential of antimicrobial gloves in reducing the risk of contamination of the surgical site in the event of an intraoperative breach in the integrity of the glove by suppressing re-growth of skin flora during the surgical procedure.

 in progress...

CSSD (Central Sterile Supply Department) cleans a
variety of items but some are more difficult than others :
• Understand why and what you can do about cleaning
them better.
• Do you have the right tools for the job.
We will talk about the DaVinci, lumens, suctions, scopes,
and other things

Steris, Gerald McDonnell, Research and Development, European affairs, Steris, UK

Cleaning is an essential step in the reprocessing of reusable medical devices, not only to ensure that subsequent disinfection/sterilization is effective but also to minimize toxicity risks to patients.  Recent reports suggest that even low levels of residuals can lead to adverse patient reactions. 

In addition, cleaning is an important step to ensure that protein-precipitating agents (such as prions) are safely removed if they are present due to their unique transmissibility and resistance to disinfection/sterilization methods.  There is currently no international standard for what may be considered as a clean surface or the test methods used to determine that endpoint.  The difficulty in achieving this can be understood by consideration of the complexity of various soils and soil components found on medical devices.  Following surgical or investigational use these soils are found to be complex mixtures of various components, including organic (or carbon-based) materials like proteins, carbohydrates, lipids and microorganisms, and inorganic (or non-carbon based) materials including various minerals and salts.  Soil may also include some specific components due to their presence in water used for reprocessing (e.g., calcium carbonate or scale) and device damage (e.g., iron oxide or rust). 

This review will consider the typical methods being used to validate cleaning.  Consideration will be given the development of international standards and test methods for cleaning.  Emphasis is being placed on the development of clinically relevant test soils and the use of analytical methods (in particular protein detection or other methods such as Total Organic Carbon, TOC, determination) to verify cleaning effectiveness.  In addition to detailed laboratory investigations on cleaning processes, it is envisioned that routine testing will be required in hospitals to ensure such cleaning processes are effective.