An outbreak of surgical site infections following craniotomy procedures associated with a change in the ultrasonic surgical aspirator decontamination process

Minimizing Sources of Airborne, Aerosolized, and Contact Contaminants in the OR Environment

“…The likelihood, severity, and type of an SSI can be dependent on intrinsic factors, such as the patient's age and underlying comorbidities and the type and length of the surgical procedure 4 . Extrinsic factors in the OR, such as health care provider (HCP) behavior and practices that modify air movement, the physical environment, equipment, or surgical instruments, also can increase microbial contamination and the risk of SSI development 5‐13 . Patients and HCPs can help control the effects of these intrinsic and extrinsic factors with practices such as cessation of smoking, preoperative bathing, preoperative prophylactic antibiotics, alcohol‐based patient skin antisepsis, and maintenance of body temperature 2,4 …”

“…The ATP results for one of the scopes exceeded the 200 RLU benchmark, and all scopes had protein detected with visual debris in the channels. 19 Sheitoyan-Pesant et al 11 reported an increase in SSIs related to a practice change in the decontamination of the ultrasonic surgical aspirator used during craniotomy procedures. The rate of SSI from 2002 to 2014 increased from 0.6% to 4.4%; from January to June 2015, the rate increased to 8.75% (N ¼ 80 patients).…”

“…4 Extrinsic factors in the OR, such as health care provider (HCP) behavior and practices that modify air movement, the physical environment, equipment, or surgical instruments, also can increase microbial contamination and the risk of SSI development. [5][6][7][8][9][10][11][12][13] Patients and HCPs can help control the effects of these intrinsic and extrinsic factors with practices such as cessation of smoking, preoperative bathing, preoperative prophylactic antibiotics, alcohol-based patient skin antisepsis, and maintenance of body temperature. 2,4 In the OR environment, microbial contamination can occur through an airborne or contact route.…”

“…The potential exists for microbes to infect the surgical incision through one of these routes, resulting in a reported association between OR contaminants and SSIs. 5,6,8,11 However, not every study has found a strong link between air or surface contamination and infection. 7 AORN's Guidelines for Perioperative Practice outlines the best practices to minimize OR contaminants.…”

“…14 When aligned with evidence-based standards, the behavior and practices of HCPs can reduce the degree of OR microbial contamination. 11,12,[15][16][17][18][19] Surgery has risks and benefits, but neither the patient nor the HCP expects an SSI to be one of the outcomes. Therefore, attempts to decrease risks from endogenous and exogenous sources remain an essential component of overseeing a harm-free operative environment.…”