AMC Hospital Amman, Jordan Clinical Specialty: General Surgery, Gastrointestinal, Hepatobiliary and Laparoscopic Surgery

“We have noted that the design of the scrub is eliminating risks of infection in the OR by touch-free operation, proper dosage of solutions and the sink edges design. Also, we find that the Alvo Premium scrub sink managed effectively the usage of detergent which directly can be reflected financially, increase working ergonomics (user-friendly design, storage, waste management, one-module station, prevention from splashing the water). And it’s beautiful!” – Dr. Taha Al-Zboun CEO, Arab Medical Center.

Background

Hand cleansing is the primary action to reduce health-care-associated infection and cross-transmission of antimicrobial-resistant pathogens. Patient-to-patient transmission of pathogens via health-care workers’ hands requires five sequential steps: (1) organisms are present on the patient’s skin or have been shed onto fomites in the patient’s immediate environment; (2) organisms must be transferred to health-care workers’ hands; (3) organisms must be capable of surviving on health-care workers’ hands for at least several minutes; (4) handwashing or hand antisepsis by the health-care worker must be inadequate or omitted entirely, or the agent used for hand hygiene inappropriate; and (5) the caregiver’s contaminated hand(s) must come into direct contact with another patient or with a fomite in direct contact with the patient. i (D. Pittet, B. Allegranzi, H. Sax, S. Dharan, C. L. Pessoa-Silva, L. Donaldson, J. M Boyce).

Objective of surgical hand preparation, according to WHO

Surgical hand preparation is aimed at reducing the release of skin bacteria from the hands of the surgical team for the duration of the procedure, in case of an unnoticed puncture of the surgical glove that would release bacteria to the open wound. In contrast to the hygienic handwash or handrub, surgical hand preparation must eliminate the transient and reduce the resident flora. It should also inhibit the growth of bacteria under the gloved hand.ii

Why surgical scrub sinks happen to be a challenge for epidemiology nurses and hospital managers?

Surgical Site Infections

Scrub rooms are usually small spaces. Sometimes they are attached to 2-3 operating rooms. Planners naturally tend to equip these spaces with big, long multi-tap sinks, making the room bulky and narrow. At AMC we have discovered, that a 2-station scrub sink serves enough for one OR. This is because surgical staff seldom scrubs simultaneously, maximum 2 people will wash hands at the same time. The preset dosage of liquids, released touch-free helps control the use of soap and disinfectant, keeping an eye on the cost side as well.

Another challenge in the scrub room is often accessories storage and waste management. If the surgical staff has to reach for sponge or a sterile towel, they would naturally move around with water dropping from their elbows. Muddy puddles right in front of the surgery room are epidemiologists’ nightmare and create slippery risk.

How the Alvo Premium Scrub sink has significantly improved the surgical hand preparation and lowered the risk of SSI?

The Alvo Premium Scrub Sink installed in the Arab Medical Center (AMC Hospital) has improved compliance with WHO hygiene guidelines:

  • The scrub room stays clean and tidy – all functions are covered in one complete module
  • It has been noted that the usage of soap and disinfectant is lower compared to elbow-activated dispensers
  • Surgeons appreciate performing surgical hand preparation in a comfortable upright position, with smooth, higher edges protecting from splashing the water
  • Touch-free operation, as recommended by WHO (World Health Organization)
  • Water drains disinfection through Alvo CleanDrains siphon – automatic disinfection process to inhibit the production of infectious bio-aerosols and thus the transfer of pathogens from the scrub sink to the user

Prevention of surgical site infections (SSI) is very important in hospital management. Cases of SSI mean high costs (patient legal claims, longer hospital stays, spendings related to introducing reparatory programs) and lost reputation. Surgical hand preparation procedures and SSI records are constantly monitored at the AMC Hospital. So far, the results allow for conclusion that the Alvo Premium Scrub Sink will significantly improve clinical performance and prevent further SSI incidents.


i Evidence-based model for hand transmission during patient care and the role of improved practices
The Lancet Infectious Diseases, Volume 6, Issue 10, Pages 641-652
Didier Pittet, Benedetta Allegranzi, Hugo Sax, Sasi Dharan, Carmem Lúcia Pessoa-Silva, Liam Donaldson, John M Boyce
ii Global Guidelines for the Prevention of Surgical Site Infection. ISBN 978 92 4 154988 2
© World Health Organization 2016