Infection control in the hybrid OR

April 11, 2017
By Robert Dewey

On any given day, roughly one in 25 hospital patients in the U.S. acquires at least one health care-associated infection (HAI), according to the Centers for Disease Control and Prevention. The CDC estimates that a staggering 1.7 million HAIs occur each year in the U.S., contributing to as many as 99,000 deaths annually. And with HAIs costing the U.S. health care system an estimated $20 billion each year, every effort within health care to reduce HAIs is also an effort toward reducing health care’s overall costs.

Concerns regarding HAIs are heightened in the operating room (OR) environment, with surgical site infections (SSIs) making up 31 percent of all HAIs among hospitalized patients. And anxiety over HAIs extends to the hybrid OR, where minimally invasive procedures are performed routinely in a growing number of hospitals. With the global market for minimally invasive procedures expected to double between 2012 and 2019, likely giving rise to a commensurate increase in those procedures, interest in HAIs in the hybrid OR won’t abate anytime soon. How can facilities combat infection in this surgical environment?

The most significant way in which hospitals can help curb infection within the hybrid OR is to consider the physical orientation of the room’s angiography system. A system that is fixed to the floor of the hybrid OR, as opposed to mounted on the ceiling or moving across the floor, is the best design choice to help reduce HAIs. Because infection in hybrid ORs is frequently attributed to an obstruction of air flow from the ceiling, a ceiling-mounted angiography system is not desirable. Floor-moving angiography systems also are problematic, as they can spread infectious material across the floor.

Floor-mounted systems were the standard when hybrid ORs debuted in the late 1990s. Those early image intensifier-based systems not only provided surgeons with the flexibility to place lights above the patient table, but they also enabled sterile airflow above the table. Then came the highly desirable form of imaging known as rotational angiography, which, on a floor-mounted system, could be performed only from the head side, limiting the field of view from head to diaphragm and preventing the imaging of abdominal aortic aneurysms (AAAs), particularly in taller patients.

Because they coveted rotational angiography, vascular surgeons began selecting ceiling-mounted angiography systems over floor-mounted units for the hybrid OR, despite ceiling mounts obstructing airflow, and positioning concerns regarding lights and booms with respect to the C-arm’s range of motion. These days, however, hospitals with hybrid ORs can select floor-mounted angiography systems that combine the benefits of a free ceiling (unrestricted airflow and improved light/boom positioning) with the kind of whole-body imaging coverage that once made ceiling systems preferable to floor-mounted systems.

Another way to help ensure infection control in the hybrid OR is to cover the fixed angiography system with customized sterile drapery. While various types of sterile covers are available for an angiography system, not all of them are customized to conform to a system’s unique shape, which is essential to help prevent exposed system surfaces from breaching the sterile field of the hybrid OR.

A third way to foster infection control in the hybrid OR is to obtain detailed information from the manufacturer regarding protocols to optimally clean and disinfect the angiography system. What types of cleaning materials are best suited to disinfect it, and are those same materials also appropriate for disinfecting the surrounding floor space? Are the steps required for intermediate disinfection of the system identical to procedures necessary for terminal disinfection? What is the manufacturer-recommended frequency for cleaning the angiography system — and with which tools and processes can a hospital verify the efficacy of the cleaning process?

Hospitals that raise these questions soon come to the sobering realization that the medical device manufacturing community as a whole has been late to the game in addressing these issues. Most vendors do not provide comprehensive documentation of system-specific cleaning and disinfection protocols. Expect that oversight to be rectified in an emerging era of health care where heightened sensitivity to HAIs is a hallmark of patient care.

Hospitals can help control the spread of HAIs in the hybrid OR by selecting angiography systems with hermetically sealed surfaces. The most vigorous cleaning and disinfection efforts can be undermined if bacteria find sanctuary in the crevices and nooks of hybrid OR equipment. By considering these points pertaining to infection control, hospitals can mitigate the rise of HAIs in the hybrid OR, better ensuring patient well-being as well as contributing to cost containment. In this rapidly changing and increasingly unpredictable health care landscape, achieving those twin goals is more important than ever.

About the author: Robert Dewey is vice president of Advanced Therapies, Surgery and Cross-Modality Solutions, at Siemens Healthineers North America.