Back in 2013/14, there were more than 2.4 million hospital admissions in Australia that involved a surgical procedure within an operating theatre.*1 Within Australia there are approximately 168,000 annual cases where a surgical procedure has led to post-discharge surgical site infections (SSIs) *2. This represents about 8 per cent of all surgical discharges.
About 1,600 people die annually in Australia from infection where existing antibiotic treatments are no longer effective.*3
The above facts ably demonstrate the magnitude of the issue regarding SSIs, and provide some understanding of the related cost – not only in losses to the Australian economy but to the wellbeing of the Australian population in general. We need to also note that these statistics do not record instances where a patient’s outcome was terminal. Not all infection ends with a good outcome.
In an article titled Operating Room Air Quality*4, the Institute of Healthcare Engineering, Australia (IHEA) noted that there is a lack of applicable standards around air cleanliness targets for operating theatres. The article further noted a lack of understanding in the market on how to manage the air cleanliness within existing operating theatres.
Although there is an existing Australian Standard, AS1668.2*5, plus a number of state guidelines, these publications do not provide comprehensive design guidance for operating theatres. The lack of both design guidance and minimum standard definitions allows too much flexibility within a design. This is then manifested in a compromised clinical environment, with consequential failure of the control of infection.
Additionally, when we compare the available Australian standards and guidelines with other international standards – for example the German and British standards – it is also evident that there is a lack of compulsory third-party certification testing to verify that the design and installation meets requirements – either notional requirements or standards.
Patients having a hospital surgical procedure in Australia are under a greater risk of infection than in other countries. This risk can be exacerbated by inadequate operating theatre design, construction, commissioning, certification and service practices. Substantial consequential issues are evident. These include the increase of antibiotic resistance, economic losses and devastating personal losses to our fellow Australians.
*1 AIHW – Australian Institute of Health and Welfare. Statistics 2013/14
*2 Reducing harm to patients from healthcare associated infection – the role of surveillance, Australian Commission on Safety and Quality in Healthcare
*3 Reducing antibiotic prescribing in Australian general practice, led by Professor Chris Del Mar from Bond University's Centre for Research in Evidence-Based Practice, Bond University, Australia
*4 Operating Room Air Quality, Institute of Healthcare Engineering Australia Magazine, September 2014
*5 Australian Standard AS1668:2 The use of ventilation and airconditioning in buildings. Ventilation design for indoor air contaminant control.
The purpose of the AIRAH Infection Control and Operating Theatre Practices Special Technical Group is to provide members with strategic leadership in the development, implementation and sustainability of programs, activities and strategies that seek to analyse the current standards and guidelines for operating theatre design, construction, commissioning, certification and service practices to improve the minimum set of parameters while always having infection control as a main consideration.
The Committee aims to:
Provide advice, support and assistance to designers, facility managers and hospital engineers. This includes strategies that support the improvement of existing operating theatre environmental control.
- Assist in the promotion of a good practice culture for the design, construction, commissioning, certification and service practices of operating theatre environmental control.
- Monitor both identified and emerging risks to patients and medical staff within the operating theatre environment, and advise on their prevention, mitigation and management as appropriate.
- Recognise barriers and enablers for good infection control practices related to the physical environment within operating theatres, and assist in developing initiatives to address these.
- Act as a motivator to other organisations directly and indirectly related to the operating theatre workplace to promote internal analysis and further cooperation with this group.
- Monitor trends in Australia and the world regarding operating theatre design, construction, commissioning, certification and service good practices that can be implemented locally.
- Identify group limitations and assist in the incorporation of solutions to these limitations.
- Analyse the financial and energy consumption factors that can affect an operating theatre design and properly address them by comparison with the cost of infection based on national and international infection control surveillance systems.
- Seek government and private sector support for the group aims.
- Draft a minimum set of standards and design characteristics that enable the adoption of best practices for design, construction, commissioning, certification and service of operating theatre environments to be presented to Standards Australia, government and health departments.
- Be a reference point for government in shaping relevant policy relating to the environmental, economic and social impact of HVAC&R and related systems in operating theatre environments.
- Make submissions on behalf of members to influence policy setting, as collectively agreed by members, and work with government at all levels to establish workable regulations, frameworks and guidelines.
- Identify and seek external funding for collaborative projects that support the objectives and aims of AIRAH and its members in operating theatre environments.
- Provide guidance to the HVAC&R industry to develop a considered, integrated and technically objective approach to infection control and operating theatre practices.
Although the committee comprises AIRAH members and has a focus on HVAC&R elements of operating theatre design and practice, there is recognition that the committee must consider a wider view and engage with the broader operating theatre design and infection control community. This includes experts and leaders in other related disciplines. AIRAH members and the committee must only operate within their area of competence, but the committee will engage widely to ensure that it can achieve the greatest possible impact.
Deliverables and Communications
The STG Committee aims to deliver the following:
- Advice, good practices culture, initiatives and guidance to the HVAC&R Industry in relation to operating theatre environments.
- Input to AIRAH’s formal responses to government and stakeholder policies and papers.
- White papers, workshops, guidelines, and manuals.
The Committee will communicate its activities and publications through:
**All external communications must be approved by AIRAH management before publication.
- Ecolibrium, HVAC&R Nation, HVAC&R News, AIRAH newsletters, online forums and discussion groups.**
- Abraham Corona M.AIRAH (Chair)
- Neil Caswell, M.AIRAH (Deputy Chair)
- Bradley George, M.AIRAH (Associate Director)
- Garry Castle, M.AIRAH
- Stephanie Donelly
- Kevin Eaton, Affil.AIRAH
- Kristian Kirwin, Affil.AIRAH
- Daniel McCaffrey, M.AIRAH
- Ken McCarthy, F.AIRAH
- Jan Merchant, Affil.AIRAH
- John Mihalinac
- Paul Morgan, Affil.AIRAH
- Graeme Perry, Affil.AIRAH
- Jack Reynolds
- James Smith
- Scott Summerville, M.AIRAH
- Andrew Watson.
Membership is open to any financial AIRAH member. If you are interested in being involved please email STGS@airah.org.au or call 03 8623 3000.