13 March

    Hygiene – singularly good.

    Singe-use products in the OR.

    Undergoing surgery is a matter of trust. Trust in the expertise and experience of the doctors and OR staff, but also in the hospital’s hygiene standards. Because even with routine procedures patients continue to acquire – avoidable – wound infections. Now hospitals can position themselves well, in terms of competition for patients, and make patients feel good about them by, for example, using single-use materials for surgeries and setting up streamlined processes. This also benefits patient’s safety. 

    Twice a week Christiane Auras spends time in the OR. Her job is to assist during ligament, joint and other orthopedic surgeries. Auras is the practice manager for Sporthomedic, an orthopaedic surgical centre and medical practice specialising in sports medicine in Cologne. “Our patients assume that their surgery is being performed in accordance with the highest standards. And at our clinic this is the case, including our use of single-use OR textiles.” The materials protect both our patients and practice employees from infections. “Single-use ensures that potentially contaminated, infectious products are disposed of immediately, without anyone else having to touch them”, explains Auras.

    But this optimal situation is not the case everywhere. According to information from the European Centre for Disease Prevention and Control (ECDC), around 3.2 million people acquire nosocomial infections in Europe every year. Around 37,000 patients die from nosocomial infections caused by surgeries every year. The percentage of surgical site infections (SSI) makes up a substantial portion, nearly one-fifth, of infections. The ECDC feels that 20 to 30 percent of all nosocomial infections could be avoided by putting intensive hygiene and control programmes in place. 

    Throughout Europe, around 37,000 patients die from noso­comial infections caused by operations annually.

    (Source: cited from: Frohner U., Keiblinger K., Kunze M., Schmidhammer R. (2014): Die Rolle von OP-Abdeckungen und -Mänteln in der Prophylaxe operationsbezogener Infektionen. Experten/-innen-Papier der Initiative Sicherheit im OP.) (The role of OR drapes and coats in the prevention of surgery-related infections. Expert paper by the initiative Safety in the OR.)

    The consequences of poor hygiene are often life-threatening for patients. Furthermore, they are also relevant in terms of liability – for hospitals and doctors. “The public is becoming more aware of this situation and there will be more lawsuits and a greater desire for damages”, explained Dr Monika Ploier at an event organised by the “Safety in the OR” initiative which took place in Vienna in November 2017. Ploier is an attorney with the Vienna-based law firm HLMK and an expert in medical law. “Before, nosocomial infections were thought to be an unavoidable part of staying in hospital”, she said. “However, this way of thinking has been changing – not least because there are now a number of studies that show that these types of infections can often be prevented.”

    For example, recent studies show that single-use surgical gowns and drapes keep infection rates lower than the equivalent reusable products, in particular during surgeries involving a high risk of infection. This is especially true of cardiothoracic procedures, implant-based breast reconstructions and surgical procedures involving implants. 

    The reasons are obvious: Single-use medical devices have never been used before, so there is no chance of there being any residue left over from earlier uses. In contrast to reusable materials, single-use drapes and gowns do not wear out. To ensure an optimal microbial barrier, materials must be impermeable to microbes, free from microorganisms and organic residues, as well as be lint-free, impermeable to fluid, tear- and pressure-resistant and have a high tensile strength. The cotton used in reusable products cannot guarantee these properties 100 percent of the time even with regular waterproofing and sterilisation.

    • According to information from the European Centre for Disease Prevention and Control (ECDC), around 3.2 million people acquire nosocomial infections in Europe every year.
    • According to estimates, treatment costs due to wound infections are 2.9 times the costs of standard treatments.
    • 19.6% of nosocomial infections develop during surgical procedures during a hospital stay. Based on this figure, 500,000 people in Europe develop these infections annually.

    A study published in the medical journal “Journal of Cardiothoracic Surgery” showed that the rate of infection in the study group with single-use OR drapes was 68 percent lower than in the group in which reusable OR drapes were used. The authors of the study concluded that the “generous use of single-use OR drapes can reduce post-operative infections due to poor hygiene.”

    “Of course hygiene mistakes are not made out of malicious intent”, says Ploier. She explains that often it is just a fleeting moment of thoughtlessness. The stress caused by ongoing downsizing surely also plays a role, she says. “However that is not an excuse a hospital can use in a court of law. In these types of cases, the hospital is always liable.” Ploier explains that if it is shown that a treatment mistake is due to negligence with regard to existing hygiene requirements, from a criminal liability perspective, this is a physical injury resulting from negligence, in the worst case it can even be deemed negligent homicide.

    To prevent things from ever getting to this point in the first place, many practices are increasingly using single-use materials. 

    One in ten hospital patients in Europe becomes infected with microorganisms in hospital.

    The orthopaedic surgical centre and medical practice Sporthomedic has only used single-use textiles for their operations for years. “Considering the vast number of microorganisms today, I think it is unsafe to reprocess OR textiles”, says practice manager Auras.

    There are defenders of reusable surgical gowns, though, as indicated by a survey of 865 hospitals by the TU Dresden. The main pros listed for reusable textiles were wearing comfort and ecological considerations. Auras does not really understand these objections because she has never noticed less comfort or breathability with single-use textiles. In any case, if there is any doubt, hygiene should prevail over comfort. “For us, single-use products are better products. Fabric also always contains dust. And dust is a killer in the OR.” This is why Sporthomedic uses L&R Kitpack OR Custom Procedure Trays. They contain all of the single-use medical devices needed for an operation packed together under clean room conditions. Auras says this is how to best avoid sources of contamination. She is convinced that the single-use textiles will become more popular because this is how infection rates can be reduced. 

    Another key is education, says medical law expert Ploier. Because hygiene is a topic which still receives little attention by the medical community on a day-to-day basis. “Clinics should seek out regular training about hygiene-related laws”, recommends Ploier. “Hygiene experts who are familiar with and follow the relevant regulations.” And patients should find out about the hospital’s hygiene standards before getting an operation. Because knowledge about the proper measures builds trust and inspires con­fidence – even before setting foot in the OR.

    And this is why L&R is offering its new campaign: the “hygiene in practice” movement.

    38 % of post-operative fatalities are attributed to wound infections.

    Surgical site infections (SSI) make up a substantial percentage of nosocomial infections. They have serious economic and medical consequences. The medical consequences range from delayed wound healing to very severe complications, which can significantly extend the hospital stay. Also, up to 38 percent of post-operative fatalities are attributed to wound infections.

    With its “hygiene in practice” campaign, L&R aims to help minimise infection rates. This campaign is a movement for anyone who advocates for a clean and sterile work environment. Because high hygiene standards are the only way to ensure that healthcare professionals can be safe and protect both their own health and that of their patients. We offer both information and solutions on our “hygiene in practice” online platform. We support healthcare professionals by posting articles on the latest scientific insights in the area of hygiene, microbiology and epidemiology that combine science with practical guidelines, useful facts and the everyday experiences of health experts concerning questions about protection and comfort.