Operating Room Traffic is a Major Concern During Total Joint Arthroplasty

Panahi, Pedram; M, Stroh; Casper, David S.; Parvızı, Javad; Austin, Matthew S.

doi:10.1007/s11999-012-2252-4

Cited by 147 publications

(108 citation statements)

References 17 publications

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“…A previous study 11 reported a door opening rate of 0.65 door openings/min for primary TJA, which is similar to the rate of 0.64 door openings/min found in our study. The weakness of the previous study was a change during the investigation regarding counting start time, which could have modified their true rate of door openings per minute.…”

Section: Discussionsupporting

confidence: 92%

“…4 Door opening is believed to disrupt the laminar flow 5 and could thus lead to more bacteria and contamination over the wound and possibly lead to intraoperative infection. 4,[6][7][8][9][10][11] Thus far, only 1 study has measured the incidence of door opening during TJA. 11 Other studies defining OR traffic patterns were either not specific to orthopedic procedures or had a very limited number of orthopedic cases.…”

mentioning

confidence: 99%

“…4,[6][7][8][9][10][11] Thus far, only 1 study has measured the incidence of door opening during TJA. 11 Other studies defining OR traffic patterns were either not specific to orthopedic procedures or had a very limited number of orthopedic cases. 3 In order to reduce the infection rate in our centre, we sought to define the incidence of door openings in the OR during primary TJA and to determine whether measures were needed and/or possible to reduce staff traffic.…”

mentioning

confidence: 99%

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

Bédard

Pelletier-Roy

Angers-Goulet

et al. 2015

cjs

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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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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Bédard

Pelletier-Roy

Angers-Goulet

et al. 2015

cjs

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“…A possible explanation may be that contamination of the sterile field occurs during the extended preoperative setup time. Possible contamination sources include direct contact with the sterile field, airborne contamination from traffic, 19 or loss of sterile technique. Dalstrom et al conducted a study in a simulated operating room environment and found a significant correlation between the length of time that the sterile tray is exposed to the air and the contamination rate of the instruments.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for delayed infections after spinal fusion and instrumentation in patients with scoliosis

Shen

Liang

et al. 2014

SPI

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Object There are limited published data about the risk factors for the development of delayed infections after spinal fusion and instrumentation in the population with scoliosis. The objective of this study was to evaluate the predictive factors of development of delayed infections in patients with scoliosis who underwent surgical treatment. Methods A total of 17 patients with scoliosis and delayed infections were identified from 3463 patients with scoliosis who received surgical treatment. The control group was composed of 85 patients with scoliosis without infections, matched for sex, age, approximate date of surgery, and diagnosis. These 2 groups were compared for demographic distribution and clinical data to investigate the predictive factors of delayed infections. Results The overall incidence rate of delayed infections was 0.49%. The variables of age, body mass index, and number of levels fused were similar between the 2 groups. The average primary curve magnitude for the delayed infection and control (uninfected) groups was 80.4° ± 27.0° (range 47°–135°) and 66.3° ± 11.6° (range 42°–95°), respectively (p = 0.001). Operation time in the group with delayed infections was 384.7 ± 115.9 minutes versus 254.4 ± 79.2 minutes in the control group (p = 0.000), and estimated blood loss was 1342.2 ± 707.2 ml versus 833.9 ± 235.6 ml (p = 0.000) in these 2 groups, respectively. The perioperative mean red blood cell transfusion requirement in the delayed infection group was significantly higher than that found in patients without infections (2.8 ± 2.3 units/patient versus 1.1 ± 1.6 units/patient, respectively; p = 0.000). Logistic regression analysis showed that operation time and allogenic blood transfusion were the 2 independent predictors of delayed infections (odds ratio [OR] 1.021, 95% confidence interval [CI] 1.010–1.033, and OR 1.546, 95% CI 1.048–2.278, respectively). Conclusions The occurrence of a delayed infection in patients with scoliosis who undergo surgical treatment is most likely multifactorial and is related to surgical time and the use of allogenic blood transfusion.

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“…[16][17][18][19] In addition, ample evidence exists for deficits in hand hygiene during anesthetic care, [20][21][22][23][24] intraoperative patient warming during surgery, [19] and restricted traffic flow during surgical procedures. [25][26][27][28] These results show a substantial "knowdo gap" [29] between what is known about safe and effective practice and what is actually done in the OR, supporting an urgent need for implementing evidence-based practice for preventive innovations in order to enhance the safety of patients.…”

Section: Introductionmentioning

confidence: 86%

Improving care in surgery – a qualitative study of managers’ experiences of implementing evidence-based practice in the operating room

Andersson

Gifford²,

Nilsson

2015

JHA

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Background: More knowledge is needed on the preconditions and circumstances for leading implementation of evidence based practice in the operating room (OR). Effective leadership support is critical to enhance the provision of safer care. The aim of this study was to explore managers' and clinical leaders' experiences of implementing evidence-based practice to increase patient safety in the operating room. Methods: The study had a qualitative descriptive design. In all, 25 managers were interviewed, with different surgical specialities (orthopedics, general and pediatric surgery) and operating room suites, from eight hospitals and 15 departments. Results: The organizational structures were defined as key obstacles to implementation. Specifically, lack of a common platform for cooperation between managers from different departments, organizational levels and professional groups impeded the alignment of shared goals and directions. In cases where implementation was successful, well-functioning and supportive relationships between the managers from different professions and levels were crucial along with a strong sense of ownership and control over the implementation process. Whilst managers expressed the conviction that safety was an important issue that was supported by top management, the goal was usually to "get through" as many operations as possible. This created conflicts between either prioritizing implementation of safety measures or production goals, which sometimes led to decisions that were counter to evidence-based practice (EBP). While evidence was considered crucial in all implementation efforts, it might be neglected and mistrusted if hierarchical boundaries between professional subgroups were challenged, or if it concerned preventive innovations as opposed to technical innovations. Conclusions: The preconditions for implementing EBP in the OR are suboptimal; thus addressing leadership, organizational and interprofessional barriers are of vital importance.

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Operating Room Traffic is a Major Concern During Total Joint Arthroplasty

Cited by 147 publications

References 17 publications

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

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

Risk factors for delayed infections after spinal fusion and instrumentation in patients with scoliosis

Improving care in surgery – a qualitative study of managers’ experiences of implementing evidence-based practice in the operating room

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