Acknowledgements

1. Acknowledgements Dr RohintonMulla, Director of Infection Prevention & Control & Sue Fox, Head of Infection Prevention & Control Luton & Dunstable University Hospital, Luton for their guidance and support of the audit. Professor Jennie Wilson for her encouragement. One Together for their kind invitation. To all of you for being here today.

2. Disrupting the flow –Theatre access during orthopaedic surgery. Karen Denman Infection Control Surveillance Nurse Luton & Dunstable University Hospital NHS Trust

3. Look how far we’ve come – from this…. • Hygiene & cleanliness? • Equipment? • Theatre attire? • Instruments? • Lighting? • Ventilation? • Auditorium – to enjoy the show! Theatre of old

4. …to this…. Modern theatre Hand hygiene. Sterilisation of instruments, drapes, gowns, gloves, dressings, sutures, etc. Cleaning of theatre. Theatre attire. Antibiotic prophylaxis. Skin preparation. Lighting. Ventilation/filtration.

5. …. or have we? • Infection prevention & control measures are • imperative in all aspects of patients’ surgical care – from pre-operatively → theatre → ward → wound healing. • to prevent SSI’s as well as other preventable HAI’s. • effective only if properly utilised!

6. Consider this … …healthcare is at the heart of what we do, so how ‘healthy’ is our practice?

7. ‘Disrupting the Flow’ Audit

8. Introduction to the Audit. Aims & Objectives • To investigate the amount of times theatre doors were opened during joint replacement surgery. • To reduce SSI risk and improve patients’ SSI outcomes. Method • Covert, observational audit – 5 hip/5 knee replacements ‘chosen at random’ from operating list. • Staff informed that I was observing theatre ‘culture’. • Sat quietly, discreetly observing & jotting down door movements in a notebook.

10. Number

11. The purpose of pre-operative skin cleansing is to reduce bacterial load!

15. Understanding Why …. ..when theatres should be on ‘lockdown’ during surgery! • Communication issues – no intercom/ outdated theatre. • Storage issues – ‘running’ for required equipment. • Staff planning issues – breaks, end of shifts. • Staff behaviour issues – education, social conversation, adjusting behaviours to ‘fit’ within their ‘dysfunctional’ environment. • Unnecessary movement within theatres?

16. Where to from here? • Audit results were acted upon and appropriate infection prevention strategies were deployed. • Needs re-auditing, but staff are likely to be suspicious of my reason for being in theatre and change their behaviours accordingly! • Audit other aspects of care/practice along patients’ surgical pathway that may be contributing to SSI’s.

17. Conclusion. • The battle against micro-organisms is ongoing. • The greater the attempt to eradicate pathogens, the more they fight back. • Duty of care to protect our patients from avoidable and harmful infections. • Be mindful of infection prevention strategies and use ‘best practice’ at all times. • Investigate where things might be going wrong, so that they can be put right!

18. Do you know What is happening In your theatres? Thank You.