Research for infection protection

Greater safety in ORs thanks to well-coordinated teams and optimised processes

Dr. Nils Farhan, orthopaedic trauma surgery specialist at the Centre for Orthopaedic Surgery of Tabea Hospital in Hamburg, Germany.
Dr. Nils Farhan, orthopaedic trauma surgery specialist

This year’s World Hand Hygiene Day on 5 May WHO dedicated to better infection protection for surgical procedures. In DISINFACTS, Dr. Nils Farhan, physician in the Centre for Orthopaedic Surgery at Tabea Hospital in Hamburg, Germany describes how he as surgeon perceives the hygiene safety during surgeries and what safety culture his clinic has established.

In surveys, patients claim that, when in hospital, they are more afraid of acquiring an infection than of experiencing improper treatment. Do you also experience this trend in the doctor-patient consultations?

Yes, these questions are raised more and more frequently. But we can reassure our patients that in our clinic we deal with another spectrum of microorganisms than other hospitals do. Clinics that, for example, have an A&E department or carry out major intestinal surgeries naturally have another risk profile due to the microorganisms present there.

What surgical procedures are carried out in your clinic and how do you assess the risk of infection?

At Tabea Hospital we have the Centre for Vain and Dermatosurgery and the Centre for Orthopaedic Surgery. We mainly perform dermatosurgical procedures and elective orthopaedic surgeries on all major joints. Superficial skin surgeries per se involve a lower risk of infection. Due to their nature, elective joint surgeries such as in endoprosthetics or spinal surgery are of course associated with a higher risk. Here, we therefore have special requirements in terms of experience and technical performance.

You have a low rate of infection in your clinic. What preventive measures have you established?

In case of complex procedures, we always carry out a laboratory screening before the operation. One frequent source of infection are the patient’s own microorganisms, so we need to determine the status preoperatively. Unclear infection parameters are then clarified using dental and internal medicine – our threshold values are very low. With a large number of surgeries that are planned we are also able to carry out risk-adapted MRSA screenings, and if necessary, an eradication therapy. Thus, we have already covered all crucial risks of infection.

How do you and your team ensure greater safety in the operating room itself?

Optimised processes that derive from the specialization and a well-coordinated team is very important. This way, we can considerably shorten the duration of a surgery. This again considerably decreases the risk of infection, especially in case of complex procedures.
We only work with experienced permanent staff, who not only perfectly master the processes, but also know and implement our hygiene plan.

In your opinion, what is integral part of a safety culture?

Certainly, the support from the clinic management is indispensible. All our employees undergo regular training. Furthermore, it is observed how hygiene is implemented in daily routine and the staff receives according feedback. Another part of our culture is that we deal with each other in an open manner and address colleagues in case we notice something.

Has your work changed due to the general increase in multidrug-resistant pathogens involving the risk of limited treatment options? If yes, how?

Yes, the preoperative risk-adapted MRSA screening, for example, has gained importance. And for the postoperative treatment, isolation and barrier precautions play a greater role.

What challenges do you believe your discipline will have to face in the future?

The number of multidrug-resistant microorganisms will probably further increase. It is not without reason that we do relatively much to identify risk patients. Because once a surgical site infection occurs it is difficult to treat. Of course, I would welcome the development of new antibiotics, but the only option at this stage is to minimise the risk of infection for our patients by ensuring an optimal technical performance during the surgery and consistently implementing hygiene.

Did you expect these challenges when you chose your profession?

Yes, and no. I mainly became surgeon because it is an exciting discipline that requires me to continually develop further. So, the kind of challenge is negligible in the first place. But what will always remain in this discipline: I can help the people directly. That is why I am particularly interested in sports traumatology. It is always a great pleasure to see competitive athletes regain their mobility after a surgery and achieve their goals again.

Dr. Nils Farhan is orthopaedic trauma surgery specialist at the Centre for Orthopaedic Surgery of Tabea Hospital in Hamburg, Germany. In its two departments for endoprosthetics, joint surgery and spinal and neurosurgery, the specialised centre carries out more than 2 200 surgeries per year, and has received multiple awards. Dr. Farhan’s passion is sports traumatology. In his spare time, he is the team doctor of the ladies’ national league hockey team of the Club an der Alster in Hamburg.