Quality standard

Quality statement 4: Intraoperative staff practices

Quality statement 4: Intraoperative staff practices

Quality statement

People having surgery are cared for by an operating team that minimises the transfer of microorganisms during the procedure by following best practice in hand hygiene and theatre wear, and by not moving in and out of the operating area unnecessarily.

Rationale

In order to reduce the risk of surgical site infection, the risk of microbial contamination of the surgical site from the theatre environment needs to be minimised. Staff practices aimed at achieving this are known collectively as theatre discipline. In order to maintain theatre discipline, a number of practices should be followed that include using appropriate theatre wear and minimising movement of people in and out of the operating area. Effective hand decontamination will also reduce the risk of transferring microorganisms during the procedure, and this is most likely to be achieved if hand jewellery, artificial nails and nail polish are removed before decontamination takes place.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

a) Evidence of local arrangements to ensure that operating teams remove any hand jewellery, artificial nails and nail polish before starting surgical hand decontamination.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that operating teams follow practices for surgical hand decontamination in accordance with NICE's guideline on surgical site infections, recommendations 1.3.1 and 1.3.2.

Data source: Local data collection.

c) Evidence of local arrangements to ensure that staff wear specific non-sterile theatre wear in all areas where operations are undertaken.

Data source: Local data collection.

d) Evidence of local arrangements to ensure that operating teams minimise any staff movements in and out of the operating area.

Data source: Local data collection.

e) Evidence of local arrangements to ensure that spot checks are carried out in relation to structure measures a), b), c) and d).

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that policies and procedures are in place and implemented to ensure that operating teams minimise the transfer of microorganisms during surgery by following best practice in hand hygiene and theatre wear, and by not moving in and out of the operating area unnecessarily.

Operating teams follow practices that minimise the transfer of microorganisms during surgery by following best practice in hand hygiene and theatre wear, and by not moving in and out of the operating area unnecessarily.

Commissioners commission services from service providers that have policies and procedures to ensure that operating teams follow practices that minimise the transfer of microorganisms during surgery by following best practice in hand hygiene and theatre wear, and by not moving in and out of the operating area unnecessarily.

People having an operation are cared for by an operating team that minimises the chances that microorganisms will be transferred during the operation by following best practice when cleaning their hands and by wearing the correct type of clothing, and by not moving in and out of the operating area unnecessarily.

Source guidance

Surgical site infections: prevention and treatment. NICE guideline 125 (2019), recommendations 1.2.7, 1.2.8, 1.2.10, 1.2.11, 1.3.1 and 1.3.2

Definitions of terms used in this quality statement

Best practice in hand hygiene

Best practice in hand hygiene includes the following:

  • The operating team should remove hand jewellery, artificial nails and nail polish before operations.

  • The operating team should wash their hands prior to the first operation on the list using an aqueous antiseptic surgical solution, with a single-use brush or pick for the nails, and ensure that hands and nails are visibly clean.

  • Before subsequent operations, hands should be washed using either an alcohol hand rub or an antiseptic surgical solution. If hands are soiled then they should be washed again with an antiseptic surgical solution.

[NICE's guideline on surgical site infections, recommendations 1.2.10, 1.2.11, 1.3.1 and 1.3.2]

Best practice in theatre wear

Best practice in theatre wear includes the following:

  • Staff should wear specific non-sterile theatre wear (scrub suits, masks, hats and overshoes) in all areas where operations are undertaken.

  • Staff wearing non-sterile theatre wear should keep their movements in and out of the operating area to a minimum.

[NICE's guideline on surgical site infections, recommendations 1.2.7 and 1.2.8]