Operating room traffic and door openings

[Cath Murphy]

This article published in the most recent edition of AJIC may be of interest to ACIPC members. I have included the abstract below. It shows the impact of a relatively simple and inexpensive strategy to reduce the potential for SSI. Whilst the paper looks at avoidance of arthroplasty-related infections the strategy should be effective for all surgical cases. Very recently I have been working with some of Australias best orthopaedic surgeons and overall they seem to be very concerned and committed to reducing infection risk. The new HAC-related financial penalties coming into effective from 1 July 2018 will also be a great driver of more vigilant infection control and SSI prevention.

Cheers

Cathryn Murphy RN B. Photog MPH FSHEA FAPIC CIPC-E PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
Adjunct Assoc. Professor Faculty of Health Services & Medicine
Bond University
QLD, Australia

E: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.au

William G. Hamilton, Colleen B. Balkam, Richard L. Purcell, Nancy L. Parks, Jill E. Holdsworth,
Operating room traffic in total joint arthroplasty: Identifying patterns and training the team to keep the door shut,
American Journal of Infection Control,
Volume 46, Issue 6,
2018,
Pages 633-636,
ISSN 0196-6553,
https://doi.org/10.1016/j.ajic.2017.12.019.
(http://www.sciencedirect.com/science/article/pii/S0196655318300075)

Abstract: Background
Surgical site infections after joint arthroplasty are devastating complications and are influenced by patient, surgical, and operating room environmental factors.
Methods
In an effort to reduce the incidence of door openings (DOs) during total joint arthroplasty cases, this prospective observational study consisted of 3 phases. Phase 1 determined the baseline incidence of DOs, followed by installation of a mechanical door counter (phase 2). Finally, an educational seminar was presented to all personnel (phase 3) regarding the implications frequent DOs have on patient and surgical outcomes.
Results
The average openings per case (OPC) for each of the 3 phases were 33.5, 34.2, and 27.7, respectively. There was a 17% reduction in OPC between phases 1 and 3 (P=.02). There were no significant differences between knee and hip arthroplasty cases during the 3 phases (P=.21, P=.46, and P=.81, respectively). There was a strong correlation between length of surgery and OPC, with a Pearson coefficient of r=0.87 during phase 3. To account for differences in average operative time between phases, data were normalized for the length of surgery with the ratio of door openings per minute determined (0.36, 0.34, and 0.32 for each phase, respectively).
Conclusions
We were able to show that simply monitoring door openings during joint arthroplasty was not effective in reducing the occurrences. However, after a novel educational seminar given to all personnel, we were able to significantly reduce the incidence of operating room door openings, reducing a potential risk factor for surgical site infections.
Keywords: Total hip arthroplasty; Total knee arthroplasty; Total joint arthroplasty; Laminar airflow; Door opening; Infection

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