OR traffic increases risk of infection

Surgical teams put patients at risk for infection by frequently entering and leaving the operating room, according to a new study published in the journal Orthopedics.

The study of 100 knee replacement and 91 hip replacement surgeries at Johns Hopkins Bayview Medical Center in Maryland found that doors opened on average every 2.5 minutes. In total, the doors were open approximately 10 minutes during a 90-minutes surgery, or about 9 percent of the "cut-to-close" time.

Researchers found that in 77 of the 191 cases, doors "were open long enough to compromise the ORs' positive pressure systems, allowing air from surrounding corridors to flow inside."

Most operating rooms have systems to maintain higher atmospheric pressure than the outside corridors so air flows out of the OR, reducing the risk that germ-laden air will flow in, according to a study announcement. Frequently opening the doors, or openings that come too close together, threaten the positive pressure, and potentially the sterility of the operating room, according to the study.

Researchers recommended further study to determine why traffic is so high and identify ways to reduce the traffic and the associated risks.

One researcher thinks that black boxes similar to the devices on airplanes that record aircraft performance and pilot commands can improve OR safety. The researcher says the box can record video, conversations in the OR and other conditions such as room temperature, FierceHealthcare previously reported. The idea is to understand and prevent errors.

Another approach is to turn the OR into a high reliability organization focused on safety. Steps include empowering champions to advocate for patient safety, having those advocates train the rest of the team to develop a safety-first culture, and giving the OR team tools to improve safety.