Introduction: Many of the guidelines that are generally accepted as main operating room best practices are not evidence based. They are based on the concept that if some sterility is good, more must be better. They are not derived from evidence-based sterility. Evidence-based sterility is the study of which of our various sterility practices increase or decrease our infection rates, as opposed to guidelines based on how many bacteria are in the operating room. Methods: This article adds the most important evidence we could find that is not included in the first paper on evidence-based sterility in hand surgery published in 2019. In this review, we also balance the evidence with common sense opinion. Results: The 21st century has seen a rapid rise in the number and reports of hand surgery procedures performed with field sterility outside the main operating room. There is now an abundance of good evidence to support that the rate of infection is not higher when many hand operations are performed with field sterility in minor procedure rooms. Conclusion: Moving hand surgery out of the main operating room to minor procedure rooms should be supported by healthcare providers. The higher cost, increased solid waste, and inconvenience of main operating room surgery are not justifiable for many procedures because it does not reduce the risk of postoperative infection.

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The recommended treatment for idiopathic congenital clubfoot deformity involves a series of weekly castings, surgery, and a period of bracing using a foot abduction brace (FAB). Depending on the age of the child, the orthotic should be worn for periods that reduce in duration as the child develops. Compliance is vital to achieve optimal functional outcomes and reduce the likelihood of reoccurrence, deformity, or the need for future surgery. However, compliance is typically monitored by self-reporting, which is time-consuming to implement and lacks accuracy. This study presents a novel method for objectively monitoring FAB wear using a single 3-axis accelerometer. Eleven families mounted an accelerometer on their infant’s FAB for up to seven days. Parents were also given a physical diary that was used to record the daily application and removal of the orthotic in line with their treatment. Both methods produced very similar measurements of wear that visually aligned with the movement measured by the accelerometer. Bland Altman plots showed a −0.55-h bias in the diary measurements and the limits of agreement ranging from −2.96 h to 1.96 h. Furthermore, the Cohens Kappa coefficient for the entire dataset was 0.88, showing a very high level of agreement. The method provides an advantage over existing objective monitoring solutions as it can be easily applied to existing FABs, preventing the need for bespoke monitoring devices. The novel method can facilitate increased research into FAB compliance and help enable FAB monitoring in clinical practice.