Surgical Tribune America

Minimizing OR traffic may help decrease surgical site infections

By Surgical Tribune
July 22, 2016

WHITE ROCK, British Columbia, Canada: Reducing traffic in and out of the operating room (OR) during total joint replacement procedures could contribute to a decrease in orthopedic surgical site infections (SSIs), according to a new study. The research was conducted in response to a survey of surgeons and nurses, who stated that entering and exiting the OR for several reasons caused harm to patients.

Two years ago, OR staff at Peace Arch Hospital in White Rock launched a Comprehensive Unit-Based Program (CUSP) to improve patient and staff safety. The team asked nurses, surgeons, anesthesiologists and others who spend at least 60 percent of their time in the OR to complete a questionnaire about what they thought caused patients harm and what to do to prevent it. Nurse and surgeon survey participants stated that too much traffic in and out of the OR caused harm.

According to Dr. Jason Forbes, a general surgeon at Peace Arch, the hospital staff also learned from its National Surgical Quality Improvement Program data that they had an excessively high rate of wound infections from orthopedic operations like knee and hip joint replacements, which are frequently performed in their hospital, a community hospital with 20 surgeons serving an aging population. "Those SSIs were a high outlier and an area that needed urgent correction," said Forbes.

The team conducted the study over two days in November 2014. Two nursing students did a manual count of door openings during nine total joint replacement operations and one revision procedure and counted between 42 and 70 door openings per operation from incision time to joint capsule closure time. Operations averaged 75 minutes. Reasons for entering and exiting the OR during operations included retrieving charts, instruments or equipment, and taking a break.

In response to these results, the CUSP team brainstormed ways to reduce door openings. Key changes included stopping all traffic in and out of the OR between total joint capsule opening and closure, communicating by phone and increasing the use of templates to identify implant size prior to each operation. Also, a sign was placed on the OR door to remind staff to minimize traffic and to ask them to record their reason for entering the OR during an operation. According to study leader Dr. Susann Camus, subsequent traffic audits taken every six months indicated a significant reduction in OR traffic to 3.2 door openings per case. This intervention may have contributed to a decrease in orthopedic SSIs from 2.8 percent to 2.1 percent since implementing traffic control, according to the study authors. The team will continue to conduct six-monthly audits and eventually expand practices to other services, including general surgery, urology and gynecology.

“The idea is to be very mindful to make minimal traffic an everyday practice, and it is very close to that now,” Camus said.

The results of the study were presented at the 2016 American College of Surgeons National Surgical Quality Improvement Program Conference, held from 16 to 19 July in San Diego, US. The American College of Surgeons' National Surgical Quality Improvement Program is a nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in the private sector.

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