Infection Prevention and Control in the Operating Theatre

How is a sterile field actually maintained?

Sterility in an operating theatre is a state maintained by discipline rather than achieved once. Drapes, gowns, gloves and instruments are sterile when the pack is opened, and remain so only while they are handled correctly. Anything that touches a non-sterile surface is contaminated and must be replaced, which is why the scrub team works within defined boundaries and why movement in the room is restricted.

The logic extends to the whole room. Air handling, traffic through the theatre, and the separation of clean and contaminated areas all matter. A theatre that is busy but disciplined carries less risk than one that is quiet and casual.

Instrument processing, step by step

Instruments pass through cleaning, inspection, packaging, sterilisation and storage. Cleaning is the part most often underestimated: residual organic material protects microorganisms and can prevent sterilisation from working. Instruments are then inspected for damage, assembled into sets, and sterilised by a method appropriate to the device.

Each cycle is monitored, and each pack is labelled so that it can be traced to a batch and a date. If a problem is found later, the label is what allows the hospital to identify everything from the same cycle. Reusable devices with complex channels and single-use devices follow different rules, and using a single-use device more than once is not an acceptable economy.

What does antibiotic prophylaxis do, and what does it not do?

Prophylaxis is used for operations where the expected benefit outweighs the risk. The agent is chosen for the likely organisms, given within a defined window before the incision, and re-dosed if the operation runs long or blood loss is heavy. The timing exists so that tissue levels are adequate when contamination risk is highest.

Prolonging antibiotics beyond the recommended period does not reduce infection and increases resistance and side effects, so a department that stops on time is following good practice rather than being stingy. Prophylaxis is a targeted measure, not a substitute for sterility.

Who is responsible for what?

Responsibility is distributed across the room and beyond it. The scrub team holds the sterile field and replaces anything contaminated. Everyone in the theatre shares the traffic rule, because restricted movement and the separation of clean and contaminated areas only work if everyone present keeps to them. The department that processes instruments owns the chain from cleaning to storage, including cycle monitoring and pack labelling. The prescribing team owns prophylaxis: the agent, the dose, the timing window before incision, re-dosing when an operation runs long or blood loss is heavy, and stopping on schedule. The hospital owns the record and the surveillance, because the pack label is what allows it to trace a cycle, and it is the hospital that tracks surgical site infection rates and decides what to do when a rate rises. Patients have a part as well, in skin preparation, hair removal practice and what they do in the days before an operation.

What should patients ask before surgery?

You can ask how instruments are processed and monitored, and whether sterilisation monitoring amounts to more than the machine handling it. You can ask whether the hospital tracks its surgical site infection rates, and what it does when a rate rises. You can ask about screening for resistant organisms before surgery, about hair removal and skin preparation practice, and about what you should do yourself in the days before an operation.

When should you seek care after surgery?

If you develop fever, spreading redness, discharge or a wound that will not heal after surgery, seek care promptly rather than waiting.

Warning signs in the answers

• Instrument reprocessing cannot be described, or sterilisation monitoring is described only as something the machine handles.
• Antibiotics are continued for days after surgery as a matter of routine, with no protocol for stopping.
• Infection surveillance is dismissed as unnecessary on the grounds that the hospital does not have a problem.