In addition to preventing the occurrence of infection, it is equally important to prevent transmission of infection from one patient to another. One of the most effective, but widely underutilized techniques is simple hand washing. The effectiveness of hand washing in the prevention of disease transmission was first demonstrated by Ignac Semmelweis in the obstetrical wards of Vienna in the 1840s (35). Despite having this knowledge for over 150 years, compliance with hand-hygiene techniques in the hospital setting remains poor (36). Hand washing using appropriate technique before and after every patient encounter should be considered mandatory.
Beyond this basic technique, certain infections require special precautions to prevent transmission, known as isolation techniques (37). These involve combinations of masks, gowns, and gloves to prevent contact with infected skin, body ﬂuids, or airborne particles. It includes special handling of trash, linens, and environmental surfaces. The level of precautions to be taken will be determined by the hospital’s infection control personnel. The key point is to adhere rigorously to the isolation instructions posted outside the patient’s room.
Operating Room Safety The operating room is by its nature a highly complex health care environment. It is a potential site for adverse events, which can be catastrophic. These include wrong patient surgeries, wrong site surgeries, and retained foreign objects. All of these occur in hospitals, despite recognition that these events should never take place (38,39). The Joint Commission, a national accrediting body for hospitals, has developed the Universal ProtocolTM that all surgeons and operating rooms should follow (40). There are three major components of the Universal Protocol. First is to conduct a preprocedure verification process that confirms the identity of the patient and his or her understanding of what procedure is to be performed. Second is marking of the operative site by the surgeon, which is especially critical in cases involving bilateral structures. This is to be done in the preoperative area with the patient awake as a confirmation of accuracy. Third is the performance of a surgical “time out” in the operating room prior to the start of the surgery to confirm the correct patient identity and correct planned procedure. Failure to perform any of these steps increases the risk of performing the wrong operation on the wrong patient.
The traditional use of checklists resulted in dramatic increases in the safety of aviation (41). Their use in medicine is recent but is demonstrated to decrease complications significantly when used consistently to verify that procedural steps are not overlooked. A simple five-step checklist for central-line placement in the intensive care unit was shown to reduce the incidence of catheter-related sepsis almost to zero (42,43). Similarly, checklists are advocated for use in the surgical suite to ensure that critical steps for error prevention and patient safety are not overlooked. The World Health Organization (WHO) released a surgical checklist in 2009 under their “Safe Surgery Saves Lives” program (44). It involves items to be reviewed and documented before the induction of anesthesia, before the skin incision, and before the patient leaves the operating room. Use of the WHO checklist was shown to reduce major complications of surgery from 11% to 7% and the inpatient death rate from major surgery from 1.5% to 0.8% (45). The use
Application of Safety Technology of checklists such as this to improve patient safety in the operating room should become more widespread.