Rituals and behaviours in the operating theatre - joint guidelines of the Healthcare Infection Society and the European Society of Clinical Microbiology and Infectious Diseases

Prevention of surgical site infection (SSI) remains a main priority in operating theatres. This has previously led to the introduction of practices, often referred to as ‘rituals’ and ‘behaviours’ and sometimes labelled as ‘myths’, that are controversial and frequently disputed. Some of them are not underpinned by sound scientific evidence, but they are established in everyday practice and considered by many as traditional to help ensure discipline and professionalism in the operating theatre. Previous Healthcare Infection Society guidelines were published 20 years ago, and they aimed to debunk some of the practices. Since then, new technologies have emerged, and an update was required. These new updated guidelines, produced in collaboration between the Healthcare Infection Society and the European Society of Clinical Microbiology and Infectious Diseases, used methodology accredited by the National Institute for Health and Care Excellence (NICE) to provide further advice on which practices are unnecessary. The guidelines are intended for an international audience. Specifically, they discuss the current available evidence for different rituals that are commonplace in the operating theatre, and highlight the gaps in knowledge with recommendations for future research. Previous guidelines divided the operating theatre rituals and behaviours into essential, preferable (optional), and those that provide no clear benefit. In the light of new evidence and in line with the new NICE principles for recommendations, these have been updated and are divided into recommendations for use, good practice points, and recommendations against certain practices. These updated guidelines aim to minimize ritualistic behaviour without increasing the risk of SSI. The guidelines do not focus on those key prevention practices that are well researched and shown to be effective in preventing SSI (e.g. preventing hypothermia). These well-researched topics are addressed in other guidelines, and the Working Party has based their guidelines on an assumption that these evidence-based recommendations are followed.