Hand hygiene, has been cited as one of the most effective means of infection prevention in operating theaters (Cookson, Teare, May, Gould, Jeanes, Jenner, Pallett, Schweiger & Stone, 2001; Pittet and Boyce, 2001). Having acknowledged its effectiveness, the current study intends to investigate the psychosocial variables that influence compliance to hand hygiene practices in operating theaters - covering predisposing, enabling and reinforcing factors .
For majority of SSIs, pathogens stem from the endogenous flora of patient's skin, mucous membranes, or hollow viscera. When mucous membranes or skin is incised, the exposed tissues are at risk for contamination with endogenous flora, which more commonly include aerobic gram-positive cocci. However, this may also be fecal flora; for instance, anaerobic bacteria and gram-negative aerobes, specifically when such incisions are made at the vicinity of the perineum or groin. On the other hand, when a gastrointestinal organ is operated on, gram-negative bacilli, gram-positive organisms, and anaerobes are typically yielded as SSI isolates (Cookson, 2002; Horton and Parker, 2001).
Exogenous sources of SSI pathogens include members of the surgical team and other personnel present during the procedure, the operating room environment (including air), and all tools, instruments, and materials exposed to the sterile field. Exogenous flora are mainly aerobes, especially gram-positive organisms (e.g., staphylococci and streptococci). It is thus logical for SSI interventions to be aimed at eliminating or preventing microbial contamination of the patient's tissues or of sterile surgical tools. Other interventions include preoperative antibiotic prophylaxis, prudent surgical technique, optimal ventilation of the OT, among others.
Infection Prevention in the Operating Theater
Essentially, infection prevention in the operating theater is attained through the sensible use of aseptic techniques to be able to:
- Lower or eliminate the probability of contamination of the open wound;
- Isolate the operative site from the surrounding unsterile physical environment; and
- Create and sustain a sterile area in which surgery can be carried out safely;
Although all infection prevention procedures aim for these objectives, aseptic
technique refers to those practices carried out prior to or during clinical procedure including: (1) properly preparing a client for clinical procedures; and (2) handwashing (Center for Disease Control, 2002; Gopal, Jeanes, Osman, Aylott & Green, 2001; Rotter, 2001).
Hand hygiene by Operating Theater (OT) personnel is one of the most potent means of reducing the incidence of infections. Stringently, surgical hand wash or surgical handrub must be done prior to any operative procedure by surgical personnel to kill or reduce transient resident hand microorganisms. The warmth and moisture created by surgical gloves promotes the growth of flora (Girou, Loyeau, Legrand, Oppein & Brun-Buisson, 2002). Using antiseptics, surgical hand wash is done before any surgical procedure for the prevention of such growth, effectively