lately a number of traditional prec...

lately a number of traditional precautions against the incidence of surgical hurt infection (SWI) have been questioned forward the grounds that they are sacred frightens and, instead of remaining untouchable, should be regarded as overkill.(1) Although individual may question the need for surgical masks, barrier materials, and certain other environmental sterile precautions, the evidence for abolishing or attenuating them still is lacking. Nevertheless, from the standpoint of preciousness there appears legitimate reason to question the perpetual use of a ever more costly devices and supplies.

to what extent STERILE SHOULD A STERILE FIELD BE?

A half hundred ago a British microbiologist asked the question, "How sterile should a sterile field be?"(2) Since then, a tremendous amount of research has been mannersed to answer this question. As the dust confirms following five decades of research in this area, certain facts truisms, and half-truths have emerg They include the following.

* Surgical courses that put patients at high risk for postoperative infections (eg organ transplantation) and patients already at high risk for postoperative infections (eg the actual young, the very old, those having concomitant diseases or impaired immunity) require more stringent infection-control precautions.

* Surgical measures on certain parts of the carcass require more exacting precautions than those forward other parts (eg, the peritoneal cavity is known to be more resistant to contamination than major joints and certain areas of the skin [eg the lower leg] because its congenitally attenuated family supply would be more at risk for potential infection than other areas [eg the face's vessel-rich skin]).

* Sources of postoperative infection may be endogenous (de produc within the organ or system) or exogenous (de from the patient or the external perioperative environment).

* Postoperative infections are more lying flat to occur in large incisions when expos to endogenous sources (eg the intestine) than would be the case in smaller incisions not expos to endogenous bacteria.

As single writer so astutely observed,

half-truths serve to have

half-lives, and veritys themselves

take onward different

meanings below different

circumstances. Truisms

belong more in the realm of

philosophy than in that of

science.(3)

Due to not absent day economic pressures, therefore, there may be real propertys for altering routines that have heretofore been considered sacred.

ALTERING "SACRED" ROUTINES

Already health care institutions are making efforts to carve costs without increasing risks to patients. For example, in a certain health care facilities, surgical team members are using half-body drapes, rather than whole-body drapes, to isolate the surgical field for certain narrowly focused surgical operations (eg, eye; ear, nose, and throat; greatest in number types of skin surgery). any individuals are challenging the ne for conventional surgical masks and suggesting designs for other images of face shielding to take their place.(4) In an other example, laminar liquefy air chambers, originally promoted as essential for a clean air environment in the performance of joint replacement surgery are now being declared unnecessary when the central air a whole is properly designed, installed, and maintained according to code(5)

Barrier materials. What about materials used for surgical gown and drapes? Since the divert of the century, the in the greatest degree popular and commonly used material for these items was referr to generically as muslin (de a relatively loosely woven readily permeable, all cotton, 140-thread hold fabric). In 1952, however, a famous close attention alerted the surgical community that the material missing its barrier properties once it became wet--even when multiple layers were used.(6)

For about time thereafter (de, approximately 10 to 12 years), principally hospitals continued to use the traditional muslin material until a novel generation of so-called barrier materials became available.(7) near health care providers simply incorporated the novel barrier materials in their gowning and draping practices assuming they would shield patients from another possible portal of note for exogenous contamination and thus help resolve into the incidence of SWI.

Reusable v single use items. Although the materials were available in the pair reusable and single-use (de, disposable) qualities, the popularity of single-use items mushroomed. This was primarily appropriate to provisions in the reimbursement classification that permitted costs of single-use items to be charged to the patients. This made whatever clinical benefit there was to be derived from use irrelevant.

Do gown and drapes diminish surgical wound infection? It was not until the early 1980 that clinical investigators began to report the accrues of studies designed to determine whether the use of barrier surgical gown and drapes could influence the incidence of SWI.(8) Unfortunately, as the two the gowns and drapes in all of the studies were made of barrier quality materials, it was not possible to distinguish whether it was the gown the drapes, or the combination of the sum of two units that provided the benefit.(9) Nor did the studies take into consideration the influence of other factors (eg the discipline of the surgeon surgical suite design, the patient's condition) or the myriad of other devices used.(10)