Infection control in ambulatory surgical centers (ASCs) extends beyond traditional aseptic techniques, good hygiene practices, sterilization methods, and environmental controls. This article explores the less obvious sources contributing to surgical site infections (SSIs) and how to address them effectively.
The Silent Carriers: Mobile Devices, Wearables, and Water Quality
Identifying hidden sources of infection is essential for maintaining a sterile surgical environment. One often overlooked risk is mobile devices, which are ubiquitous in modern healthcare settings.
While necessary, mobile phones can be a significant source of contamination. Qureshi et al. (2020) conducted a cross-sectional study analyzing microbiological cultures from 110 mobile phones used by orthopedic surgeons, residents, and operating room staff. The study found that 93% of the phones were contaminated with coagulase-negative Staphylococcus (62%), Micrococcus (41%), and Bacillus species (26%) as the most common organisms detected. Contamination was higher in phones with covers or ones that were cracked. Implementing a mobile phone use protocol—requiring sterilization before, during, and after operating room access, and designating specific areas for mobile phone use—can reduce this risk.
Moreover, it is crucial to ensure staff compliance with policies regarding other wearables, such as jewelry, artificial nails, excessive makeup, and headgear. Are these policies in your ASC regularly reviewed?
The American Society of Anesthesiologists (ASA) (2022) highlights the vital role of the Committee on Occupational Health (COOH) in evaluating scientific data and expert opinions on infection risks related to anesthesia practices. This committee has established guidelines on appropriate surgical attire to reduce the spread of infections in surgical settings.
Skin cells and hair shed by operating room personnel can act as carriers of bacteria. These particles may contaminate surgical wounds or compromise sterile instruments, gloves, and sponges. This risk is increased during “clean” surgeries, such as joint replacements and spine procedures, where even a small bacterial presence can lead to infection. Coagulase-negative Staphylococcus species, such as Staph. epidermidis, is frequently detected in operating room air samples. Since humans shed thousands of skin cells and hairs daily, larger particles (ranging from 10 to 25 microns) pose a significant risk for contamination. Headgear is essential in maintaining particles and minimizing the likelihood of infection during surgery.
Jonathan A. Wilder, PhD, highlighted the hidden risks of poor water quality in surgical facilities in Outpatient Surgery Magazine (2024). He emphasized that challenges such as corrosion, deposits, and rust are costly consequences of an inadequate water system which can affect instrument sterilization. To mitigate these risks, regular monitoring of particulates, hardness, chloride levels, and pH, in compliance with standards outlined in ANSI/AAMI ST108 by the Association for the Advancement of Medical Instrumentation (AAMI), is critical. Wilder shared a case involving a surgical site in a region with heavy snowfall. While the site enjoyed clean water during the summer, fall, and winter, snowmelt in the spring caused particles and minerals to seep into the municipal water supply, significantly degrading water quality.
To prevent such failures, investing in comprehensive water quality testing and monitoring—at an estimated cost of $5,000 annually—is worth it to avoid costly water issues at your facility.
Screen to Prevent: Winning the Battle Against MDROs
Your ASC can use various resources to determine the presence of multidrug-resistant organism (MDRO) outbreaks in the area, helping to prevent SSIs before they begin. Public health agencies, such as the Centers for Disease Control and Prevention (CDC) and state health departments, provide detailed regional data on MDRO prevalence through tools like the Antibiotic Resistance & Patient Safety Portal and the National Healthcare Safety Network (NHSN). Partnering with local hospitals, clinical labs, and regional healthcare networks can provide important information, such as antibiograms, that can highlight resistance trends in the community. Utilizing these resources helps identify outbreaks in the community. For example, sports-related outbreaks from high-contact sports, where skin-to-skin contact and shared equipment place athletes at a higher risk for methicillin-resistant staphylococcus aureus (MRSA) colonization and infection. Preoperative MRSA screening should identify these risks. Other populations at risk include diabetics, frequent hospitalizations, recent rehabilitation or outpatient treatment, and previous skin infections.
References
American Society of Anesthesiologists. (2022, October 26). Statement on surgical attire (Developed by Committee on Occupational Health). American Society of Anesthesiologists. https://www.asahq.org/standards-and-practice-parameters/statement-on-surgical-attire
Centers for Disease Control and Prevention. (n.d.). Management of multidrug-resistant organisms in healthcare settings (MDROs). Retrieved January 6, 2025, from https://www.cdc.gov/infection-control/hcp/mdro-management/prevention-control.html
Vlessides, M. (2022). Cellphones linked to contamination in the OR. OR Management News. https://www.ormanagement.net/Infection-Control/Article/09-22/Cellphones-Linked-to-Contamination-in-the-OR/68116)
Wilder, J. A. (n.d.). How’s the water in there? Instrument reprocessing and care infection prevention. Retrieved from https://www.aorn.org/outpatient-surgery/article/how-s-the-water-in-there
