Measurement of Foot Traffic in the Operating Room: Implications for Infection Control

Lynch, Raymond; Englesbe, Michael J.; Sturm, Lisa; Bitar, Amira; Budhiraj, Karn; Kolla, Sandeep; Polyachenko, Y.L.; Duck, Mary; Campbell, Darrell A.

doi:10.1177/1062860608326419

Cited by 135 publications

(110 citation statements)

References 26 publications

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“…The opening of the operating room door disrupts the laminar airflow, allowing pathogens to enter the space surrounding the site of the operation [4,9,11,17]. These pathogens have the potential to lead to increased rates of infection.…”

Section: Discussionmentioning

confidence: 99%

“…Those responsible for obtaining instruments, implants, and communicating information were most culpable for the high level of traffic. In a series of 28 cases, Lynch et al [9] found that the circulating nurse and core staff generated 37% to 51% of door openings. Additionally, similar to our findings, the primary causes of these door openings were due to collection of information, checking on the case, and paperwork.…”

Section: Discussionmentioning

confidence: 99%

“…In rooms equipped with laminar airflow, the opening and closing of the operating room door disrupts the airflow in close proximity to the patient. This disruption reportedly allows microbes to enter the airspace above the surgical site, possibly contributing to an increased risk of infection [4,9,11,17]. It has been reported that increased OR traffic was one factor that adds to the increased incidence of PJI in revision as compared to primary TJA [12].…”

Section: Introductionmentioning

confidence: 99%

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Operating Room Traffic is a Major Concern During Total Joint Arthroplasty

Panahi

Casper

et al. 2012

Clinical Orthopaedics &Amp; Related Research

145

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Background Periprosthetic joint infection (PJI) is a challenging complication associated with total joint arthroplasty (TJA). Traffic in the operating room (OR) increases bacterial counts in the OR, and may lead to increased rates of infection. Question/purposes Our purposes were to (1) define the incidence of door opening during primary and revision TJA, providing a comparison between the two types of procedures, and (2) identify the causes of door opening in order to develop a strategy to reduce traffic in the operating room. Methods An observer collected data during 80 primary and 36 revision TJAs. Surgeries were performed under vertical, laminar flow. Operating room personnel were unaware of the observer, thus removing bias from traffic. The observer documented the number, reason, and personnel involved in the event of a door opening from time of tray opening to closure of the surgical site.Results The average operating time for primary and revision procedures was 92 and 161 minutes, respectively. Average door openings were 60 in primary cases and 135 in revisions, yielding per minute rates of 0.65 and 0.84, respectively. The circulating nurse and surgical implant representatives constituted the majority of OR traffic. Conclusions Traffic in the OR is a major concern during TJA. Revision cases demonstrated a particularly high rate of traffic. Implementation of strategies, such as storage of instruments and components in the operating room and education of OR personnel, is required to reduce door openings in the OR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Operating Room Traffic is a Major Concern During Total Joint Arthroplasty

Panahi

Casper

et al. 2012

Clinical Orthopaedics &Amp; Related Research

145

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“…Today, an estimated 15% of all revision hip and 25% of revision knee arthroplasties are performed for infections [6,7]. Several clinical, surgical, and environmental strategies have been shown to decrease infection rates after primary total joint arthroplasty (TJA) including the use of antibiotic-impregnated cement, decreasing traffic in the operating room, use of ultraviolet light, and, in some instances, use of laminar flow [3,19,22,25,27]. However, routine administration of prophylactic antibiotic 1 hour before surgical incision has been shown to be the most effective in decreasing the risk of SSI in primary TJA [9,16,28,29].…”

Section: Introductionmentioning

confidence: 99%

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Courtney

Melnic

Zimmer

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background With increasing prevalence of methicillinresistant Staphylococcus aureus (MRSA) in patients undergoing hip and knee arthroplasty, some have advocated a dual-antibiotic regimen including vancomycin as prophylaxis against surgical site infections. However, routine administration of vancomycin may result in impaired renal functions in susceptible patients. Questions/purposes The purpose of this study was to determine whether patients receiving antibiotic prophylaxis with cefazolin and vancomycin have a higher risk of postoperative acute kidney injury (AKI) compared with patients receiving cefazolin alone before elective primary hip and knee arthroplasty. We also aimed to compare severity and recovery of AKI in these two cohorts and to determine independent risk factors for AKI. Methods We retrospectively evaluated a series of 1828 patients undergoing primary hip and knee arthroplasty over a 2-year period who received either cefazolin (n = 500) or cefazolin and vancomycin (n = 1328) as perioperative antibiotic prophylaxis. During the study period, a perceived high prevalence of MRSA infections at our institution led some surgeons to add vancomycin to the prophylactic antibiotic regimen. The patient characteristics, case mix, and preoperative renal function and baseline creatinine clearance were similar between the two groups. We defined AKI according to the published Acute Kidney Injury Network (AKIN) criteria, and the risk of AKI in both groups was compared. We also compared the proportions of patients by AKIN severity stage and assessed recovery as defined by creatinine levels showing kidney function reaching 50% baseline. The American Society of Anesthesiologists (ASA) classification, preoperative chronic kidney disease, intraoperative fluid requirements, and estimated blood loss were recorded. We analyzed the data using a multivariate logistic regression model to identify potential independent risk factors, including dual antibiotic therapy. Results Patients receiving dual antibiotics were more likely to develop AKI compared with those receiving cefazolin alone (13% versus 8%, p = 0.002). Dual-antibiotic prophylaxis also was associated with greater severity; patients in the dual antibiotic group had higher rates of Grade II and III acute kidney injury (3% versus 0%, p = 0.003). There was no difference in the rate of return to baseline renal function (2 ± 1.4 days versus 3 ± 3.4 days; mean difference, 0.5 days; 95% confidence interval [CI], À0.2 to 1.2 days; p = 0.155). Controlling for confounding variables, dual antibiotic prophylaxis (adjusted odds ratio [OR], 1.82; 95% CI, 1.25-2.64; p = 0.002), ASA class

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“…Patient-related and environmental factors 3 have been studied in order to reduce PJI. The number of staff in the operating room (OR) is exponentially linked to the incidence of door openings during surgical interventions.…”

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confidence: 99%

Traffic in the operating room during joint replacement is a multidisciplinary problem

Bédard

Pelletier-Roy

Angers-Goulet

et al. 2015

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Traffic in the operating room during joint replacement is a multidisciplinary problemBackground: Door openings disrupt the laminar air flow and increase the bacterial count in the operating room (OR). We aimed to define the incidence of door openings in the OR during primary total joint arthroplasty (TJA) surgeries and determine whether measures were needed and/or possible to reduce OR staff traffic. Methods:We recorded the number of door openings during 100 primary elective TJA surgeries; the OR personnel were unaware of the observer's intention. Operating time was divided into the preincision period, defined as the time from the opening of surgical trays to skin incision, and the postincision period, defined as time from incision to dressing application. Results:The mean number of door openings during primary TJA was 71.1 (range 35-176) with a mean operative time of 111.9 (range 53-220) minutes, for an average of 0.64 (range 0.36-1.05) door openings/min. Nursing staff were responsible for 52.2% of total door openings, followed by anesthesia staff at 23.9% and orthopedic staff at 12.7%. In the preincision period, we observed an average of 0.84 door openings/min, with nursing and orthopedic personnel responsible for most of the door openings. The postincision period yielded an average of 0.54 door openings/min, with nursing and anesthesia personnel being responsible for most of the door openings. Conclusion:There is a high incidence of door openings during TJA. Because we observed a range in the number of door openings per surgery, we believe it is possible to reduce this number during TJA.Contexte : Les ouvertures de porte perturbent le flux laminaire et accroissent la numération bactérienne au bloc opératoire. Nous avons voulu mesurer l'incidence des ouvertures de porte au bloc opératoire durant les chirurgies pour prothèse articulaire totale (PAT) et déterminer si des correctifs étaient requis ou s'il était possible de réduire la circulation du personnel au bloc opératoire. Méthodes :Nous avons dénombré les ouvertures de porte durant 100 chirurgies électives primaires pour PAT; le personnel du bloc opératoire n'était pas au courant de l'intention de l'observateur. Le temps opératoire a été subdivisé en une période pré-incision, définie par l'intervalle entre l'ouverture des plateaux chirurgicaux et l'incision chirurgicale, et une période post-incision, définie par l'intervalle entre l'incision et l'application du pansement.

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Measurement of Foot Traffic in the Operating Room: Implications for Infection Control

Cited by 135 publications

References 26 publications

Operating Room Traffic is a Major Concern During Total Joint Arthroplasty

Operating Room Traffic is a Major Concern During Total Joint Arthroplasty

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Traffic in the operating room during joint replacement is a multidisciplinary problem

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