Attitudes, risk of infection and behaviours in the operating room (the ARIBO Project): a prospective, cross-sectional study

Abstract

IntroductionInappropriate staff behaviours can lead to environmental contamination in the operating room (OR) and subsequent surgical site infection (SSI). This study will focus on the continued assessment of OR staff behaviours using a motion tracking system and their impact on the SSI risk during surgical procedures.Methods and analysisThis multicentre prospective cross-sectional study will include 10 ORs of cardiac and orthopaedic surgery in 12 healthcare facilities (HCFs). The staff behaviour will be assessed by an objective, continued and prolonged quantification of movements within the OR. A motion tracking system including eight optical cameras (VICON-Bonita) will record the movements of reflective markers placed on the surgical caps/hoods of each person entering the room. Different configurations of markers positioning will be used to distinguish between the staff category. Doors opening will be observed by means of wireless inertial sensors fixed on the doors and synchronised with the motion tracking system. We will collect information on the OR staff, surgical procedures and surgical environment characteristics. The behavioural data obtained will be compared (1) to the ‘best behaviour rules’ in the OR, pre-established using a Delphi method and (2) to surrogates of the infectious risk represented by microbiological air counts, particle counts, and a bacteriological sample of the wound at closing. Statistics will be performed using univariate and multivariate analysis to adjust on the aerolic and architectural characteristics of the OR. A multilevel model will allow including surgical specialty and HCFs effects. Through this study, we will develop an original approach using high technology tools associated to data processing techniques to evaluate ‘automatically’ the behavioural dynamics of the OR staff and their impact on the SSI risk.Ethics and disseminationApprobation of the Institutional Review Board of Paris North Hospitals, Paris 7 University, AP-HP (no 11-113, 6 April 2012). The findings will be disseminated through peer-reviewed journals, and national and international conference presentations.

Influence of Staff Behavior on Infectious Risk in Operating Rooms: What Is the Evidence?

“…Video systems may help to describe and understand movements during operations. 52 In conclusion, published data about the impact of OR behaviors on the infectious risk are limited, heterogeneous, and weakened by several methodological flaws. More studies should be performed with accurate tools to address the influence of OR behaviors on the infectious risk.…”

Legal perspectives on black box recording devices in the operating environment

“…This means that written informed consent does not necessarily have to be obtained from the patient. According to the general privacy rules, an opt‐out option is sufficient and should be provided to the patient in a timely manner, with their decision clearly noted in the medical record.…”

“…An official informed consent stating the purpose of the data recordings, where the data recordings are analysed, what the expected benefits for the participants are, and how the data are stored securely may help in gaining support and momentum for the MDR initiative. It should be emphasized that their safety and personal privacy is protected, ensuring full transparency of the methods used. Based on this review and the authors' experience, an overview of the recommended practice and legal guidelines is presented in Table .…”

Reducing bacterial contamination in an Orthopedic Theatre ventilated by natural ventilation, in a Developing Country

“…Any colony formation was counted and recorded. from the theatre table 2 , the traction table foam (not seen), the surgeons soap dish 4 , the operative theatre light handle 5 , the surgeons needle holder, the cauterization handle and the surgeon's scalpel blade.…”

“…In these settings it is important to remember that the air flow into theatre is not the only potential source of contamination. Other important sources of infection are; poorly decontaminated equipment, the theatre built environment, theatre utilities [3] and inappropriate staff behavior [4]. Skin cells are constantly shed from theatre personnel.…”