EOC 65 - Are Sinks in the Operating Theatre Clean?

Background: A surgical site infection associated with Serratia marcescens following hip arthroplasty was reported on September 23. A quick look back for the year was performed and another six cases with post-operative healthcare-onset Serratia marcescens were identified. Five of the seven cases were diagnosed with surgical site infections. Sinks are well known to harbor gram-negative bacteria, and there were concerns about cross-transmission. Therefore, environmental samples were taken from sinks in the operating theatre where these patients had procedures.

Methods: Various interventions were taken to clean and disinfect all the sinks in the operating theatre which included steaming, change of sink traps, and daily pouring of bleach. An additional measure of manual cleaning of the sink drain to the sink trap was performed for the sinks identified with Serratia marcescens isolate. This was a collaborative effort involving the Operating Theatre Nurse Manager, Facility Management and Engineering, and Environmental Services personnel. In addition, surgeons were recommended to perform surgical hand rub instead of hand scrub prior to surgery and to don sterile gowns in the operating room instead of the scrub room.

Results: Twenty-two of 169 samples (13%) taken from sink faucets, sink drains and traps were positive for Serratia marcescens. A total of 16 sinks were affected. Re-sampling of the positive sinks was performed one month after the inventions, and they were cleared of Serratia marcescens.

Conclusions: Ensuring optimal sink hygiene in the operating theatre is imperative to prevent cross-transmission. The sink, a critical element in this environment, demands meticulous attention to minimise biofilm development. Future operating theatre design should consider adequate and appropriate location for gowning without risk of water splashing.