Frequent Door Openings During Cardiac Surgery Are Associated With Increased Risk for Surgical Site Infection: A Prospective Observational Study

Abstract

Background Preliminary studies that analyzed surrogate markers have suggested that operating room (OR) door openings may be a risk factor for surgical site infection (SSI). We therefore aimed to estimate the effect of OR door openings on SSI risk in patients undergoing cardiac surgery. Methods This prospective, observational study involved consecutive patients undergoing cardiac surgery in 2 prespecified ORs equipped with automatic door-counting devices from June 2016 to October 2017. Occurrence of an SSI within 30 days after cardiac surgery was our primary outcome measure. Respective outcome data were obtained from a national SSI surveillance cohort. We analyzed the relationship between mean OR door opening frequencies and SSI risk by use of uni- and multivariable Cox regression models. Results A total of 301 594 OR door openings were recorded during the study period, with 87 676 eligible door openings being logged between incision and skin closure. There were 688 patients included in the study, of whom 24 (3.5%) developed an SSI within 30 days after surgery. In uni- and multivariable analysis, an increased mean door opening frequency during cardiac surgery was associated with higher risk for consecutive SSI (adjusted hazard ratio per 5-unit increment, 1.49; 95% confidence interval, 1.11–2.00; P = .008). The observed effect was driven by internal OR door openings toward the clean instrument preparation room. Conclusions Frequent door openings during cardiac surgery were independently associated with an increased risk for SSI. This finding warrants further study to establish a potentially causal relationship between OR door openings and the occurrence of SSI.

In‐Room Ultraviolet Air Filtration Units Reduce Airborne Particles During Total Joint Arthroplasty

“…In live surgical procedures, mixing of aseptic air from door openings may render traditional air disinfection strategies, such as positive‐pressure airflow and in‐duct UV systems, which disinfect air before entering the OR, less effective . Mears et al studied 191 hip and knee arthroplasties at a large academic center and found that the effects of positive‐pressure airflow were reversed with frequent door openings, as seen in 77 of the cases.…”

“…Our findings demonstrated that in‐room C‐UVC filtration led to a significant reduction in both total and viable particles even after accounting for door openings and the potential reversal of positive‐pressure airflow during live operating conditions. This is particularly important given that the frequency of door openings, and therefore mixing of aseptic air, at large academic institutions have recently been reported to be 2–3 per minute …”

<p>Optimizing compliance with surgical antimicrobial prophylaxis guidelines in patients undergoing gastrointestinal surgery at a referral teaching hospital in southern Iran: clinical and economic impact</p>

“…Surgical site infection (SSI) is the leading cause of unplanned and potentially preventable hospital readmission in surgical patients. 1,2 It is considerably involved in surgery-related morbidity and increased health-care costs. 3 Depending on the operative site and degree of contamination, SSIs occur in up to 10% of surgeries.…”

A comprehensive unit-based safety program for the reduction of surgical site infections in plastic surgery and hand surgery

“…5) Limiting operating room door opening to 30 seconds at a time. [47][48][49][50][51] The implementation period started on October 1, 2016, and all measures were fully implemented by February 28, 2017.…”