الفهرس | Only 14 pages are availabe for public view |
Abstract This study aimed at assessing the air quality in operating room of Pediatric Surgery department, Ain Shams University; developing and implementing a surveillance system to decrease surgical site infections (SSIs) rates and assessment of the effectiveness of electronic air filtration (A novel air filtration device) in improving air quality in operating rooms Poor ISO classification of pediatric surgery OR could be attributed to the old central air conditioning system and flowing of air in an uncontrolled manner in addition to direction changes, in spite of the fact that there is HEPA filter installed. But after intervention with GENANO device, the operation room moved up to (ISO 6) which is a breakthrough despite the fact that we weren’t able to connect all operating theatre air inlets with Genano filtration devices, so the Genano system could not work with its full capacity. Hospital environmental control procedures can be an effective support in reducing health care associated infections. This study was divided into 2 phases, Phase I: Descriptive study: assessment of air quality in operating rooms at pediatric surgical hospital, the evaluated air quality indices were: suspended particulate matter, culture media and microbial identification of bacteria and fungi using active and passive air sampling. Phase II: Interventional study for improving air quality by new electronic air decontamination unit (Genano® 4500). After intervention the operation room moved up from (ISO 8) to (ISO 6) there is a highly statistical significant difference between particulate matter count before and after intervention also there is significant difference in active bacterial sampling and fungi sampling before and after applying electronic filtration device where fungal colony count dropped significantly to zero. All virulent bacterial species as E.Coli, klebsiellaspecies and Pseudomonas Aeroginosa. disappeared from sample with few micrococci and bacillus species were preset in few samples. This study revealed that 25.8% only of health care workers had good knowledge about Air Quality in operating rooms and 67.7% of them had poor knowledge, 76.7% of health care workers had good attitude about Air Quality in operating rooms and zero% of them had poor attitude. (77.4%) agreed that Air quality is one the factors that shares in SSI prevention and (76.7%) of HCWs agreed that Adequate Air Quality can help decrease SSI This study involved 321 surgical procedures. A prospective surveillance study was done on pediatric patients undergoing elective and emergency general surgical operations. The incidence rate of SSI during the surveillance period among all studied cases was 78\321 (24%) cases developed SSI in this study participants’ characteristics in both control and intervention group was matched and didn’t show any difference regarding Age, Sex or presence of any chronic illness. That allowed fair comparison. Both intervention and control group undergone major surgical producers from April 2017 to March 2018, done at pediatric surgery department with GIT procedures was the leading procedure (65.1 %) (for example appendectomy, colostomy formation or closure)followed by kidney and urologic procedure (14%) e.g. pelvi-uretric obstruction procedures, Hernia repair (7.8%). There is highly significance difference between control and intervention group regarding discharge room after surgery with (p value=0.000) with 49.9% admitted to intensive care in intervention group in comparison to 19.6% in control group and despite this difference you will find that the rate of SSI was lower in the intervention group and a significant difference regarding Indication of surgery (p value=0.023) but, duration of operation (p value=0.025), which was higher in intervention group (2.99 hrs) and although it has longer duration of exposure it yielded less SSI. Also a highly significance difference between control and intervention group regarding surgical site infection presence (p value=0.008) which decreased significantly after intervention. It’s a main finding in this study proving that the intervention helped in decreasing SSI with both group matched in characteristics and operating rooms with the only changed variable in the electronic air filtration device, results suggest the importance of environmental and surface contamination control to prevent SSI. The risk factors significantly associated with presence of SSI were discharge room after surgery, surgical wound class, duration of surgery, chronic illness presence. There was significant association in occurrence of postoperative SSI in patients with prolonged surgery lasting three hours or longer than those who had shorter surgery time in our work. |