Hygienic monitoring of environmental surroundings in office-based ambulatory surgery units--an instrument for infection control.
Out-patient operations cause lower costs and they are a method the patients are less burdened with than it is the case with usual operating methods. Avoiding nosocomial infections is regarded as another advantage. The rate of infection can be given by a carefully kept nosocomial infection surveillance. Ambulatory surgery units have difficulties in keeping these statistics because they often do not take over the after-treatment of this patients. Out-patient operations in surgeries must guarantee the same standard of hygiene which can usually be found in hospitals. Hospital epidemiologists, health authorities and professional associations have published corresponding guidelines with organizational/functional and structural requirements. These requirements, however, are only met by few ambulatory practices. Surgery holders justify the non-observance of the guidelines by supposing that the spectrum of germs in their office differs from that in a hospital and that there aren't any pathogens. The standard of hygiene in ambulatory surgery units is not controlled regularly. Therefore the hygienic conditions and the microbial burden of five surgeries that carry out out-patient operations under general anaesthesia were determined within the scope of microbial monitoring of the surroundings. Only two surgeries achieved a standard of hygiene which is comparable with that of a hospital. Up to 42% of the taken samples were sterile. The other three surgeries did not meet the requirements. The microbial burden in these surgeries was distinctly higher. The spectrum of detected microorganisms was very wide and there were pathogens too. Hygienic controls and monitoring of the surroundings should be carried out regularly as a measure to guarantee the production and maintenance of quality. Thus the actually achieved hygienic standard in the surgeries can be controlled and improved if necessary. Ambulatory surgeries should be liable to similar hygienic controls as hospitals.