Healthcare Infection Society Issues New Guidelines to Prevent Infection in Minor Surgery

New guidelines from the Healthcare Infection Society (HIS) aimed at minimizing surgical infection in day centers (outpatient facilities) and primary care are now published in the Journal of Hospital Infection.

"These guidelines are the first ever published guidance in the UK that define, from an infection prevention and control perspective, the basic physical requirements for facilities in which surgical procedures may be performed outside conventional operating theatres and carried out within day centers and primary care," says professor Hilary Humphreys, lead author on the HIS guidelines and professor of clinical microbiology at the Royal College of Surgeons in Ireland in Dublin.

Recent changes in healthcare include the provision of more surgical services in primary care and day centers where it may be cheaper and easier for patients to access them, rather than admit patients to an acute hospital. In addition, developments in certain areas of medicine, such as interventional radiology and cardiology, have expanded the range and complexity of procedures now undertaken outside an acute hospital setting. However, not all of these new settings are suitably equipped to prevent and control infection when undertaking minor surgery.

"The trend to carry out more minor surgery in day centers and primary care is presenting new challenges as some of these facilities are not appropriately set up to undertake minor surgery," Humphreys adds.

To address this issue, HIS convened a multi-disciplinary group tasked with producing the first ever UK guidelines to minimize infection occurring outside conventional operating theatres. The guidelines, published in the February 2012 issue of the Journal of Hospital Infection, cover topics such as appropriate ventilation, use of instruments, flooring/ceiling requirements, etc.

These guidelines should now be referred to by all UK infection prevention and control teams and others (e.g., practice managers) involved where minor surgical procedures are to be carried out in day centers or primary care settings. They should also be considered when developing new facilities or updating/refurbishing pre-existing facilities.

The recommendations include the need for solid ceilings, floors that are easily cleaned and disinfected, single use instruments rather than re-usable instruments owing to the difficulty of accessing sterilisation facilities and ventilated facilities with up to 15 air changes per hour for certain categories of procedure, i.e. minimal access interventions, which include laparoscopy or 'key-hole' surgery. Sterile gloves and a plastic apron are sufficient for minor procedures but full precautions, including sterile gowns, are required for more complex procedures. All the staff involved must be able to provide evidence of competency with appropriate mandatory training and ongoing professional development.

Dr. Tim Boswell, consultant microbiologist at Nottingham University Hospitals, and chairman of HIS, comments, "The Society hopes that these guidelines will improve the safety and quality of patient care in settings outside hospital operating theatres and also recommends that on-going surveillance of outcomes, such as surgical site infection, takes place to guide future guidelines and practice."

The guidelines are published as: "Guidelines on the facilities required for minor surgical procedures and minimal access interventions" by H. Humphreys, J.E. Coia, A. Stacey, M. Thomas, A.-M. Belli, P. Hoffman, P. Jenks, C.A. Mackintosh (doi:10.1016/j.jhin.2011.11.010). The article appears in the Journal of Hospital Infection Volume 80, Issue 2 (February 2012) published by Elsevier.