Cracking the case: should orthopaedic case carts be subjected to more stringent regulations?

Abstract

Background: Long periods of time with opened, uncovered sterile case carts and high rates of operating room (OR) traffic are correlated with contamination risk. We studied the length of time the case cart was open before incision and compared room traffic frequency before and after surgical incision. Methods: Thirty-three orthopaedic implant cases were observed at three hospitals over an 8-week period. Observation began at the opening of the implant case cart and concluded when the final dressing was placed. The length of time the sterile case cart was open before the patient was in the room and before an incision was made was recorded. Traffic was counted any time a surgical door opened and stratified on a per-hour basis. The traffic rate was counted before and after incision. Results: The average length that the case cart was open prior to the patient being in the room was 43.2 (±29.7) mins, (range, 0-153). On average the case cart was open 91.5 (±31.2) mins, (range, 45-189) prior to the incision. The room traffic was significantly greater during preincision period (45.0±12.8), than during postincision period (26.6±12.8) (P<0.0001). The average number of people in the operating room was 6.9 (±2.7). Conclusions: Room traffic during orthopaedic implant cases is high, with more than one door opening every 2 min. The highest frequencies of traffic occurred before incision but after case carts were opened. Case carts usually were opened more than 1 hr before incision for orthopaedic implant cases.