IntroductionSurgical site infections (SSIs) are implicated in poor outcomes in orthopedic surgical patients. Decreasing foot traffic in orthopedic surgical suites is correlated with the reduction of SSI risk. This review aims to understand the background and significance of the problem, isolate factors contributing to the movement in and out of operating rooms, and identify interventions that decrease traffic in procedure areas.MethodsA comprehensive search was completed using the databases Embase and Medline (Ovid). A PICOT question was used in the literature search to evaluate the efficacy of a standardized guideline on operating room door opening frequency. The Mixed Methods Appraisal Tool was used to appraise the literature critically, and conventional content analysis methodology identified themes within the publications.ResultsThe literature search yielded 18 articles providing 3 different themes of evidence: airborne bacterial counts and their association with foot traffic; specific personnel, namely, nurses demonstrating the greatest amount of foot traffic; and interventions aimed at minimizing this foot traffic.ConclusionsImplementing multiple evidence-based interventions can decrease foot traffic and reduce the risk of SSIs in orthopedic patients. Further studies are needed to directly link airborne bacterial counts to SSIs, increase the level of evidence, and isolate interventions.
A significant complication in allogeneic stem cell transplantation is graft versus host disease (GVHD). The use of multipotential mesenchymal stem cells (MMSC) for the amelioration of GVHD has shown promise as a therapeutic intervention. Given that MMSC can suppress allogeneic immune responses, there is a concern that using these cells may promote leukemic relapse. We describe a murine model of GVHD in the presence of leukemic cells (L1210). Acute GVHD was induced in DBA mice by transplanting bone marrow and spleen cells from C57Bl/6J mice with or without prior injection of L1210 cells. The recipient mice were monitored for signs of GVHD. The mice were then treated with primary MMSC or a C57Bl bone marrow derived cloned mesenchymal cell line (OMA-AD). The results without L1210 cells, demonstrated that mice treated with primary MMSC that had developed moderate GVHD had increased long-term survival when compared to controls. The group treated with OMA-AD cells showed minimal GVHD so cloned OMA-AD MMSC cells provided a significant protective effect against GVHD, and the survival rate was superior to * Corresponding author. B. J. O'Kane et al.
28that of animals treated with primary MMSC on the same day. In the presence of L1210, the control mice all died by day 11, and the mice receiving OMA-AD and L1210 cells died by day 9. Both had minimal GVHD. Only the mice receiving primary MMSC that developed moderate to severe GVHD survived long term. It appears that although MMSC and OMA-AD cells can ameliorate GVHD; the greater immunosuppressive effect of OMA-AD cells permitted the re-growth of the leukemic cells. In contrast, the moderate GVHD that remained after primary MMSC treatment eliminated the leukemia in the majority of mice. These studies demonstrated that in the mouse model, as in man, administration of primary or cloned MMSC ameliorated GVHD. However, complete suppression of GVHD permitted leukemic relapse.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.