Reducing environment contamination
Several procedures were adopted in order to reduce contamination of surfaces [17]. Beside standard disinfection practice, we minimized the amount of equipment inside the OR to operatory bed, lamps, anaesthesiology ventilator, and monitor. All implants, screws, drugs, sutures, and every disposable device were stored outside the red zone. Great attention had to be payed to keep OR doors closed since the patient entered the red zone, as our ventilation system warrants a complete air change over a four minute period and our surgical unit consists in positive pressure theatres. Every OR has a window that opens on the white zone, through a double sliding glass with a “no man’s land” space in between; therefore, it was possible to bring all the necessary to the theater reducing contaminated air leaks. Scrub nurses communicated across the window, using walkie-talkies or writing on magnetic boards. After the end of every surgical procedure, as the patient left the surgical unit, disinfection of every horizontal and vertical surface, using a solution of dichloroisocyanurate (2 tbs in 3000 ml of water, equal to 1000 ppm chlorine) or electrolytic chloroxidant 2.8% (40 ml in 1000 ml of water, equal to 1100 ppm chlorine) and chlorhexidine 0.5% + alcohol 70% for metallic surfaces, started. Complete disinfection time was 60 min. Furthermore, every 60 min or after every patient transited, all surfaces in the gray zone were cleaned with chloro-derivate solution.