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

Abstract

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.

Team composition and staff roles in a hybrid operating room: A prospective study using video observations

“…Our study showed that the hybrid OR was most crowded during phase 3 when the wound was open and the endovascular procedure was being performed. Traffic flow, which is associated with the risk for postoperative infections (Bedard, Pelletier‐Roy, Angers‐Goulet, Leblanc, & Pelet, ), was also judged to be high and largely avoidable (Katz, ). Beyond the high number of people during phase 3, our analysis showed that in this specific phase of the procedure, the work was restricted to a few number of staff categories while the rest of the attending people were less active or not at all involved in the patient care.…”

Prevention of fracture-related infection: a multidisciplinary care package

“…The laminar airflow system is equipped with high-efficiency particulate air (HEPA) filters, which filter the recirculated air [13,38,79]. The movement and presence of staff in the OR may negatively influence the laminar flow, so the number of people in the OR must therefore be minimised [13,80,81]. Also, the doors of an OR must be closed as much as possible, because every time the door opens, the pressure drops and turbulence in air movements occur, contributing to wound contamination [80].…”

“…The movement and presence of staff in the OR may negatively influence the laminar flow, so the number of people in the OR must therefore be minimised [13,80,81]. Also, the doors of an OR must be closed as much as possible, because every time the door opens, the pressure drops and turbulence in air movements occur, contributing to wound contamination [80]. To reduce the frequency of door openings, Birgand et al suggest a more practical storage of frequently used materials, advanced communication systems and an improved organisation of surgical team shift changes [79,82].…”

General Assembly, Prevention, Operating Room - Personnel: Proceedings of International Consensus on Orthopedic Infections

“…Several studies have evaluated the incidences and causes of DOs during elective total joint arthroplasties (TJAs) [8,18,20e22]. Rates of 0.19/min to 0.65/min DOs for primary, and 0.84/min for revision TJAs have been reported [3,18,20,21]. The highest percentage of DOs occurs during the preincision [18] or postincision periods [10].…”

“…The highest percentage of DOs occurs during the preincision [18] or postincision periods [10]. The majority of the traffic constitutes the circulating nurses, followed by surgical implant representatives, and then the anesthesia and orthopedic staff [18,20,21]. The most frequently reported single reason for DOs is getting supplies, along with gathering and transferring information.…”