Bug-busting guidelines for day centres and primary care settings

Recommendations address the physical environment and choice of medical devices

New guidelines have been produced to set out the optimum environment for surgical procedures outside of hospital operating theatres

With a growing number of medical procedures being carried out in primary and community care settings, the Healthcare Infection Society (HIS) has published the first UK guidance on minimising surgical contamination outside of hospitals.

Covering both the built environment and the optimum surgical equipment and devices to use, the document lays out the basic physical requirements for facilities in which procedures are performed other than conventional acute operating theatre environments.

The guidance aims to address fears that, while hospitals are becoming increasingly aware of the need for good infection prevention and control, services delivered in local settings could be putting patients at higher risk of contracting potentially-deadly bugs.

The trend to carry out more minor surgery in day centres and primary care is presenting new challenges – as some of these facilities are not appropriately set up to undertake minor surgery

“The trend to carry out more minor surgery in day centres and primary care is presenting new challenges – as some of these facilities are not appropriately set up to undertake minor surgery,” said Professor Hilary Humphreys, lead author of the guidelines and professor of clinical microbiology at the Royal College of Surgeons in Dublin.

The publication, entitled Guidelines on the facilities required for minor surgical procedures and minimal access interventions, adds: “There have been many changes in healthcare delivery in recent years, including the delivery of surgical services in primary care or in day centres, previously provided by acute hospitals. Also, some minor surgical procedures continue to be performed outside the conventional operating theatre.

”A recent survey of operating theatre ventilation facilities for minimally-invasive surgery in the UK found that most procedures were carried out in areas without specialist ventilation and/or in facilities that are often referred to as ‘treatment rooms’1.

“The primary objective in formulating standards for facilities is to protect patients from surgical site and other infections. We make recommendations on the design of new facilities to be used for the carrying out of minimal access interventions (MAI) including interventional radiology, and minor surgical procedures to minimise post-procedure infections. We also hope to raise awareness of all healthcare staff and patients of the importance of infection prevention.

The primary objective in formulating standards for facilities is to protect patients from surgical site and other infections. We make recommendations on the design of new facilities to be used for the carrying out of minimal access interventions and we also hope to raise awareness of all healthcare staff and patients of the importance of infection prevention

“We recognise that many minor surgical procedures in particular are currently being undertaken in facilities that do not meet these standards, and usually without reported adverse consequences in terms of increased infections. However, in response to the changing delivery of healthcare, increasingly in the non-acute hospital sector, and in response to requests for guidance, we have produced the following guidelines. These are based on best practice, evidence and current guidelines where available and appropriate, and expert consensus to primarily provide sensible and feasible advice. For existing facilities, consideration should be given to using these recommendations to improve facilities in part or in full over time.”

In terms of the physical environment, the recommendations include:

  • The need for solid ceilings to be made from a non-porous material that can be easily cleaned and disinfected. Suspended ceilings are not recommended for new facilities
  • Windows should be non-openable where specialist mechanical ventilation is provided, and where windows are able to be opened, fly screens must be fitted and they must not compromise patient privacy
  • Doors should be self-closing with a vision panel for observation that does not compromise patient privacy
  • Floors should be easy to clean and disinfect and be durable and strong enough to support all machinery
  • Taps or faucets should be hands-free
  • If scrub-up facilities are located within the operating area, they should be located so that instruments do not get splashed and they should be separate from basins used for other purposes
  • for minor procedures in primary care, single-use items eliminate the increasingly rigorous requirements to decontaminate surgical instruments to a standard that would be difficult to comply with outside specialised sterile supply departments

    The guidance goes on to address ventilation, with a recommendation of 15 air changes per hour for certain categories of procedure such as minimal access interventions. It also explores the devices used during surgery, with a recommendation for single-use instruments in primary and community-based environments.

    The guidance states: “Single-use instruments may be preferable and their use is encouraged if it is difficult to comply with the requirements for the appropriate decontamination and storage of reusable instruments. Also, for minor procedures in primary care, single-use items eliminate the increasingly rigorous requirements to decontaminate surgical instruments to a standard that would be difficult to comply with outside specialised sterile supply departments.”

    The society hopes these guidelines will improve the safety and quality of patient care in settings outside hospital operating theatres

    It calls for dedicated secure facilities for storage of devices of a design aimed at minimising dust and says instruments should be laid up only as required, not in advance.

    Dr Tim Boswell, consultant microbiologist at Nottingham University Hospitals NHS Trust and chairman of the HIS, said: “The society hopes these guidelines will improve the safety and quality of patient care in settings outside hospital operating theatres and also recommends that ongoing surveillance of outcomes, such as surgical site infection, takes place to guide future guidelines and practice.”

    Click here to view the guidance

    Reference:

    • Smyth ETM, Humphreys H, Stacey A, et al. Survey of operating theatre ventilation facilities for minimally invasive surgery in Great Britain and Northern Ireland; current practice and considerations for the future. J Hosp Infect. 2005;61:112–122