Role of disinfection as infection prophylaxis over the course of time - anesthesia, intensive care and emergency medicine, pain therapy.
It is alarming that anesthetists, just as in earlier years, have been shown to be the specialists with the poorest rate of compliance with simple, basis everyday rules of hygiene. Unfortunately, infection prophylaxis is something to which the physician ascribes importance only when he sees the consequences of his actions, that is to say when he has to diagnose and treat infections in "his" patient as a result of his "failure" to adhere to infection control regulations. That infection control measures have not been taken at the bedside highlights the need for enlightenment and education of staff and serves as the basis for their involvement. Such measures can be taken much less easily in emergency medicine. The emergency physician / anesthetist is rarely confronted with the patient's outcome. Any errors in infection prophylaxis have no perceptible consequences. "The threat posed to vital functions does not allow any time," said the emergency doctor. "During the time elapsing from first administering the anesthetic until full narcosis is reached or in the case of intrasurgical bleeding, I'm feeling stressed and then have no time for hygiene" admits the anesthetist in the OR. To improve this situation, the root cause of ignorance and thoughtlessness as regards hygiene must be addressed. Apart from general training and continuing education for correct conductance of hygienic measures and regarding the consequences of failure to observe the guidelines, today the individual aspect of motivation must be addressed. Each professional administering treatment makes a difference for the patient through his individual approach to hygiene. Each head physician and medical director makes a difference to the behavior of future anesthetists by acting as a role model. And within the hospital system the factors "overburdened personnel and time pressure" as the cause of inappropriate infection control must be clarified. Today hygiene does not merely denote "clean working practices" and reduced patient morbidity. Today reduced infection rates mean reduced costs in the healthcare sector and hence reserves for the future care of the population. Today we know that hygienic practices when attending to the patient are not an onerous burden but that they pay off. We must "only" get around to implementing them.
Lingnau
Werner
W
University Clinic for Anaesthetics and Intensive Care at the Leopold Franzens University Innsbruck, Austria.