Adherence to international guidelines by operating room staff

Background Surgical site infections (SSI) have always been a major challenge for surgeons, and represent one of the most important public health problems due to their seri-ous repercussions on both the patient and the community. Epidemiological studies have shown that the onset of infections is not linked to the presence of microorganisms in the environment only, but, above all, to the way in which they enter into contact with a susceptible host. Therefore, a key role is played by the various steps taken to prevent the transmission of microorganisms through the adoption of care practices based on the relevant international guidelines. Aims The aim of this study was to observe the behavior of healthcare workers during surgery at the 'G. Martino' University Hospital of Messina, in order to assess adherence to care practices (CDC Recom-mendations, Category IB) for surgical site infection (SSI) control. Methods The study, conducted from May 2012 to April 2013, consisted in direct observa-tion of a sample group of healthcare workers (HCW), including 127 surgeons, 39 anesthetists, 62 nurses and 80 prac-ticing doctors and students, during 201 surgical operations. Direct observation of healthcare workers during the course of surgery was carried out by appropriately trained personnel, who recorded the data on care practices recommended by inter-national guidelines on a specific card. Moreover, correct ventilation system operation, closure of the doors and the number of HCW present during surgery were documented. The standard duration of surgery follow-up was about 30 min-utes. Results The direct observation revealed an in-complete adherence to the international guidelines by the 308 HCW. The results highlighted several problems: workers, except for some anaesthetists, used the headgear incorrectly in 53% of cases; the surgical mask was worn by 92.5% of workers but it completely covered the nose, mouth and beard only in 78% of cases. The doors were closed during the surgical operation in 65% of the observa-tions and the mean number of HCW pre-sent in the operating room was 8 (range 7-9). Conclusions As documented in literature, the main purpose of surgical clothing is to prevent bacterial contamination of the surgical site. Our results showed that some be-haviors of the operating team need to be subjected to revision; in this regard, staff training is an essential element for achieving a greater adherence to interna-tional guidelines.