AMELİYATHANE HEMŞİRELİĞİNDE ENFEKSİYON KONTROLÜ
Özet
Ameliyathaneler, hasta güvenliğinin en üst düzeyde tutulduğu ve sağlık hizmeti ilişkili enfeksiyonların, özellikle cerrahi alan enfeksiyonlarının önlenmesi adına kritik öneme sahip özellikli birimlerdir. Bu alanlarda enfeksiyon kontrolünün sağlanması; çevre temizliği, cerrahi kıyafet standartları, el antisepsisi, ortam koşullarının yönetimi ve atık kontrolü gibi çok katmanlı uygulamalara dayanmaktadır. Çevre temizliği; günün ilk ameliyatından önce, ameliyat aralarında ve gün sonunda olmak üzere belirli protokollerle ve yüzeyin kirlilik durumuna göre seçilen uygun dezenfektanlarla titizlikle yürütülür. Cerrahi ekibin mikroorganizma yayılımını önlemek için yüksek ısıya dayanıklı antimikrobiyal kumaştan üretilmiş kıyafetler, boneler, özel terlikler ve maskeler kullanması zorunludur. Enfeksiyon yayılımını engellemede en etkili ve maliyetsiz yöntem olan el hijyeni ve cerrahi el antisepsisi, ameliyat öncesinde belirli aşamalar takip edilerek otomatik musluklar ve onaylanmış antiseptik solüsyonlarla gerçekleştirilir. Ayrıca ameliyathanelerde HEPA filtreli havalandırma sistemleri ile pozitif basınç korunmalı, sıcaklık 20-23 °C ve nem %30-60 arasında tutularak personel trafiği minimum seviyede sınırlandırılmalıdır. Tıbbi cihazların dezenfeksiyonu ve sterilizasyonu kritiklik düzeyine göre merkezî ünitelerde veya yüksek düzey dezenfektanlarla yapılırken, tüm tıbbi atıklar sızdırmaz kırmızı torbalarla uzaklaştırılır. Ameliyathane hemşireleri, tüm bu önlemlerin eksiksiz uygulanmasında ve denetlenmesinde primer sorumluluğu üstlenmektedir.
Operating rooms are specialized units where patient safety is prioritized, and infection control practices are vital to preventing healthcare-associated infections, particularly surgical site infections. Maintaining infection control in these environments relies on multi-layered practices, including environmental cleaning, surgical attire standards, hand antisepsis, environmental parameters, and waste management. Environmental cleaning is meticulously executed before the first surgery of the day, between procedures, and at the end of the day using appropriate disinfectants based on surface contamination. To prevent microbial shedding, the surgical team must wear attire made of heat-resistant, antimicrobial fabrics, alongside caps, dedicated footwear, and surgical masks. Surgical hand antisepsis, the most effective and cost-efficient method for preventing cross-contamination, is performed prior to surgery using automated faucets and approved antiseptic solutions. Furthermore, operating rooms must maintain positive pressure via HEPA-filtered ventilation systems, with temperatures regulated between 20-23 °C, humidity at 30-60%, and personnel foot traffic strictly minimized. Depending on their criticality, medical devices are processed through central sterilization units or high-level disinfectants, while medical waste is removed in leak-proof red bags. Operating room nurses hold the primary responsibility for ensuring full compliance with and monitoring of these comprehensive infection control measures.
Referanslar
Altındiş M, Karaaslan D. Ameliyathanelerde Sterilizasyon ve Havalandırma İlkeleri. Kocatepe Tıp Dergisi.2001;2:29-36. Şu adresten edinilebilir: https://dergipark.org.tr/tr/pub/kocatepetip/issue/17436/182639
Andersson A, Bergh I, Karlsson J, Eriksson BI, Nilsson K. Traffic flow in the operatingroom: an explorative and descriptive study on air quality during orthopedic trauma implant surgery. Am J Infect Control. 2012; 40 (8): 750– 755. doi: 10.1016/j.ajic.2011.09.015
Andersen BM. Operation department: ınfection control. Prevention and Control of Infections in Hospitals. 2018;Sep(25):453–489. doi: 10.1007/978-3-319-99921-0_35
Bali RK. Operating room Protocols and infection control. Oral and Maxillofacial Surgery for The Clinician. 2020; Jun (24):173-194. doi: 10.1007/978-981-15-1346-6_9
Braswell ML, Spruce L. Implementing AORN recommended practices for surgical attire. AORN J. 2012;95(1):122-140. https://doi.org/10.1016/j.aorn.2011.10.017
Branch R, Amiri A. Environmental surface hygiene in theor: strategies for reducing the transmission of healthcare–associated ınfections. AORN J. 2020;112(4):327-342. doi: 10.1002/aorn.13175.
Croke L. Guideline For Environmental Cleaning. AORN J. Special Focus Issue: Infection Prevention. Periop Briefing. 2019;110(6):P8-P10. doi: 10.1002/aorn.12903.
Centersfor Disease Control and Prevention. Guideline for Disinfection and Sterilization in Healthcare Facilities (2008). Şu adresten edinilebilir: https://www.cdc.gov/infectioncontrol/guidelines/disinfection/tables/table1.html Son Erişim Tarihi: 15 Haziran 2021.
Centersfor Disease Control and Prevention. Healthcare-Associated Infections (HAI). Preventing Haıs.Environmental Cleaning in Resource-Limited Settings. Appendix B2 – Cleaning Procedure Summaries for Specialized Patientareas. Operating room. Şu adresten edinilebilir: https://www.cdc.gov/hai/prevent/resource-limited/special-areas.html#anchor_1585592126579. Son Erişim Tarihi: 15 Haziran 2021.
Centers for Disease Control and Prevention. Healthcare-associated Infections (HAI). Preventing HAIs. Environmental Cleaning in Resource-Limited Settings. Environmental Cleaning Procedures Best Practices for Environmental Cleaning in Healthcare Facilities: in RLS. Şu adresten edinilebilir: https://www.cdc.gov/hai/prevent/resource-limited/cleaning-procedures.html. Son Erişim Tarihi: 15 Haziran 2021.
Croke L. Recommended Practices for Surgical Hand Antisepsis. Special Focus Issue: Infection Prevention. AORN J. 2019; 109(5): 8-10. doi: 10.1002/aorn.12705
Cowperthwaite L, Holm RL. Guideline Implementation: Preoperative Patient Skin Antisepsis. AORN J. 2015;101(1): 71-80. doi: 10.1016/j.aorn.2014.11.009.
Esser J, Shrinski K, Cady R, Belew J. Reducing or traffic using education, policy development and communication technology. AORN J.2016; 103(1): 82-88. doi: 10.1016/j.aorn.2015.10.022.
Gerba CP, Kennedy D. Enteric virus survival during household laundering and impact of disinfection with sodium hypochlorite. Appl Environ Microbiol. 2007; 73(14): 4425– 4428. doi: 10.1128/AEM.00688-07
Guideline for Environmental Cleaning. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2021;145-176.
Guideline Quick View: Surgical Attire. Special Focus Issue: Nursing Certification. AORN J. 2019:110(3):335-337. https://doi.org/10.1002/aorn.12807
Guideline for Surgical Attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2020;989-1006.
Guideline For Preoperative Patient Skin Antisepsis. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2021;591-618.
Goldberg JL. Guideline Implementation: Hand Hygiene. AORN J. 2017; 105(2): 203-212. doi: 10.1016/j.aorn.2016.12.010.
Hamilton WG, Balkam CB ,Purcell RL, Parks NL, Holdsworth JE. Operating room traffic in total joint arthroplasty: identifying patterns and training the team to keep the door shut. American Journal of Infection Control. 2018;4: 633-636. doi: 10.1016/j.ajic.2017.12.019.
International Organization for Standardization- ISO 14644-1:2015: Clean Rooms And Associated Controlled Environments Part 1: Classification of Air Cleanliness by Particle Concentration. Second edition, Switzerland; 2015. Şu adresten edinilebilir: https://www.iso.org/obp/ui/#iso:std:iso:14644:-1:ed-2:v1:en
İnangil G. Ameliyathane Alanlarında Temizlik ve Dezenfeksiyon Uygulamaları. 7. Ulusal Sterilizasyon Dezenfeksiyon Kongresi.16-20 Mart 2011, Antalya. Kongre Kitabı, s: 323-330. Şu adresten edinilebilir : https://www.das.org.tr/index.php/yayinlarimiz/7-das-kongre-kitabi .
Liu Z, Liu H, YinH ,Rong R, Cao G, Deng Q. Prevention of surgical site infection under different ventilation systems in operating room environment. Front. Environ. Sci. Eng. 2021; 15(3): 36. doi:10.1007/s11783-020-1327-9
Link T. Guideline Implementation: Sterile Technique. AORN J. 2020;112(4):415-425. doi: 10.1002/aorn.12803.
Link T. Guidelines in Practice: Surgical Attire. AORN J. 2020;111(4): 425-439. https://doi.org/10.1002/aorn.12991
Link T. Guidelines in Practice: Environmental Cleaning. AORN J. 2021;113(5):487-499. doi: 10.1002/aorn.13376.
Lynch RJ, Englesbe MJ, Sturm L, et al. Measurement of Foot Traffic in The Operating room: Implications for İnfection Control. Am J Med Qual. 2009; 24, (1): 45– 52. doi: 10.1177/1062860608326419.
Petersen C. ed. Infection. In: Perioperative Nursing Data Set. 3rd ed. Denver, CO: AORN, Inc; 2011:254-276.
Pokrywka M, Byers K. Traffic in the Operating room: a review of factors influencing air flow and surgical wound contamination. Infectious Disorders Drug Targets. 2013; Jun;13(3):156-61. doi: 10.2174/1871526511313030002.
Rovaldi CJ, King PJ. The effect of an interdisciplinary qı project to reduce or foot traffic. AORN J. 2015; 101(6): 666-681. doi: 10.1016/j.aorn.2015.03.011
Romney MG. Surgical facemasks in the operating theatre: re-examining the evidence. J Hosp Infect. 2001; 47(4): 251– 256. doi: 10.1053/jhin.2000.0912
Süngü A. Ameliyathane Havalandırma Sistemleri IVF ve Genetik Laboratuvar Havalandırma Sistemleri. 5. Ulusal Sterilizasyon Dezenfeksiyon Kongresi. 4-8 Nisan 2007, Antalya. Kongre Kitabı, s: 466-485. Şu adresten edinilebilir: https://das.org.tr/kitaplar/kitap2007/yazi/ali.sungu-das-2007-yazi.pdf
Spruce L. Wood A. Back to basics:environmental cleaning. AORN Journal. 2014;100(1):54-63. doi: 10.1016/j.aorn.2014.02.018.
Sağlık Bakanlığı. Sağlıkta Kalite Standartları Güncel Standartları Sürüm 6.0.1. Baskı: Ankara, Haziran 2020. Şu adresten edinilebilir: https://shgmkalitedb.saglik.gov.tr/Eklenti/38654/0/skshastanesetiv62020revize29082020pdflinkpdf.pdf
Stanton C. Guideline for Preoperative Patient Skin Antisepsis. Special Focus Issue: Staff Safety. AORN J. 2021; 113(4): 5-7. https://doi.org/10.1002/aorn.13380
Spruce L. Backto Basics: Hand Hygiene and Surgical Hand Antisepsis. AORN J. 2013; 98(5): 449-460. doi: 10.1016/j.aorn.2013.08.017.
World Health Organization. Global Guidelines for the Prevention of Surgical Site Infection .Geneva, Switzerland: World Health Organization; 2016. Son Erişim Tarihi: 06.06.2021. Şu adresten edinilebilir: https://apps.who.int/iris/bitstream/handle/10665/277399/9789241550475-eng.pdf.
Wood A. Clinical Issues. Personnel Wearing Hijabs in the OR. AORN J. 2015; 102 (4): 441-448. https://doi.org/10.1016/j.aorn.2015.07.001
The Society of Gastroenterology Nurses & Associates. Guidelines for the Use of High-Level Disinfectants and Sterilants for Reprocessing of Flexible Gastrointestinal Endoscopes.2013;27(4):198-206. Son Erişim Tarihi: 06.10.2021 Şu adresten edinilebilir: https://www.sgna.org/Portals/0/Issues/PDF/Infection-Prevention/6_HLDGuideline_2013.pdf
