Compliance with clothing regulations and traffic flow in the operating room: a multi-centre study of staff discipline during surgical procedures

Loison, Guillaume; Troughton, Rachael; Raymond, Françoise; Lepelletier, Didier; Avril, C.; Birgand, Gabriel; Bauer-Grandpierre, M.; Brousseau, F.; Guerin, L.; Gallais, S.; Labaut, L.; Ledoux, M.C.; Quilliec, N. Le; Ferroniere, N.; Prouteau, M-D.; Rousseau, François; Tourres, J.

doi:10.1016/j.jhin.2017.03.026

Cited by 14 publications

(10 citation statements)

References 9 publications

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“…As regards the crowding of the operating room, this was due to the entrance of personnel unrelated to the operation, who also appear less attentive to best practices and are therefore more likely to contribute to the environmental contamination. Similar results about traffic flow during surgical procedures were described by Loison et al [ 21 ]. Various studies showed that the number people present and the frequency of door opening can lead to an increase in the level of bacteria and airborne particles [ 22 , 23 , 24 ].…”

Section: Discussionsupporting

confidence: 85%

Surveillance of Environmental and Procedural Measures of Infection Control in the Operating Theatre Setting

Dallolio

Raggi

Sanna

et al. 2017

IJERPH

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The microbiological contamination of operating theatres and the lack of adherence to best practices by surgical staff represent some of the factors affecting Surgical Site Infections (SSIs). The aim of the present study was to assess the microbiological quality of operating settings and the staff compliance to the SSI evidence-based control measures. Ten operating rooms were examined for microbiological contamination of air and surfaces, after cleaning procedures, in “at rest” conditions. Furthermore, 10 surgical operations were monitored to assess staff compliance to the recommended practices. None of the air samples exceeded microbiological reference standards and only six of the 200 surface samples (3.0%) were slightly above recommended levels. Potentially pathogenic bacteria and moulds were never detected. Staff compliance to best practices varied depending on the type of behaviour investigated and the role of the operator. The major not compliant behaviours were: pre-operative skin antisepsis, crowding of the operating room and hand hygiene of the anaesthetist. The good environmental microbiological quality observed is indicative of the efficacy of the cleaning-sanitization procedures adopted. The major critical point was staff compliance to recommended practices. Awareness campaigns are therefore necessary, aimed at improving the organisation of work so as to facilitate compliance to operative protocols.

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Section: Discussionsupporting

confidence: 85%

Surveillance of Environmental and Procedural Measures of Infection Control in the Operating Theatre Setting

Dallolio

Raggi

Sanna

et al. 2017

IJERPH

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“…We aimed to develop evidence-based guidelines for OR workflow design. Although the general assumption is that these flows occur to support tasks required for the surgical procedures, the traffic may also transfer bacteria and fungi within the OR 24 …”

mentioning

confidence: 99%

The Influence of Traffic, Area Location, and Other Factors on Operating Room Microbial Load

Taaffe

Lee

Ferrand

et al. 2018

Infect. Control Hosp. Epidemiol.

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OBJECTIVE To determine how the movement of patients, equipment, materials, staff, and door openings within the operating room (OR) affect microbial loads at various locations within the OR. DESIGN Observation and sampling study. SETTING Academic health center, public hospital. METHODS We first analyzed 27 videotaped procedures to determine the areas in the OR with high and low numbers of people in transit. We then placed air samplers and settle plates in representative locations during 21 procedures in 4 different ORs during 2 different seasons of the year to measure microbial load in colony-forming units (CFU). The temperature and humidity, number of door openings, physical movement, and the number of people in the OR were measured for each procedure. Statistical analysis was conducted using hierarchical regression. RESULTS The microbial load was affected by the time of year that the samples were taken. Both microbial load measured by the air samplers and by settle plates in 1 area of the OR was correlated with the physical movement of people in the same area but not with the number of door openings and the number of people in the OR. CONCLUSIONS Movement in the OR is correlated with the microbial load. Establishing operational guidelines or developing OR layouts that focus on minimizing movement by incorporating desirable internal storage points and workstations can potentially reduce microbial load, thereby potentially reducing surgical site infection risk. Infect Control Hosp Epidemiol 2018;39:391-397.

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“…Studies have shown that the type of scrub cap does not affect the incidence rate of postoperative infection, and hence it is not mandatory for the OR [20][21][22][23][24]. However, many studies still support the development of a dress code for the OR and believe that it is beneficial for the prevention of postoperative infections [25]. This study followed the dressing suggestions for the OR issued in 2015 by Association of Perioperative Registered Nurses (ARN) [26,27].…”

Section: Groupmentioning

confidence: 98%

Efficacy of infection control pathway in reducing postoperative infections in patients undergoing neurosurgery

Dong

Yuan

Ren

et al. 2020

J Infect Dev Ctries

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Introduction: The environment of the operating room (OR) is closely related to the postoperative complications of patients, and it is necessary to study, to what extent, the stringent management of the OR can reduce postoperative complications. Methodology: 426 patients who underwent surgery between January 2016 and December 2017 were selected from two class-100 laminar flow ORs of equivalent area, and were divided into an experimental group and a control group. Results: The experimental group had significantly lower total air-borne bacterial count in the OR than the control group 10 minutes before surgery (6.21 ± 4.14 vs. 11.58 ± 5.36 CFU/cm3), 10 minutes (15.67 ± 6.21 vs. 20.83 ± 5.78 CFU/cm3), 30 minutes (27.34 ± 8.18 vs. 39.56 ± 7.86 CFU/cm3) and 60 minutes (43.62 ± 7.66 vs. 51.63 ± 8.43 CFU/cm3) into surgery, and at the end of surgery (57.34 ± 7.67 vs. 69.33 ± 9.41 CFU/cm3) (all p < 0.05). The incidence rates of increased body temperature and leukocyte count 3 days post-surgery, and the duration of antibiotic therapy and hospital stay were significantly reduced in the experimental group compared to the control group (all p < 0.05). Furthermore, the total number of pathogens in the incision at 2 hours into surgery was also significantly lower in the experimental group than in the control group (p < 0.05). Conclusion: Stringent application of the infection control pathway is an efficacious measure for improving the air cleanliness of the neurosurgery OR, decreasing the incidence rates of postoperative complications and infection, as well as controlling pathogen transmission.

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Compliance with clothing regulations and traffic flow in the operating room: a multi-centre study of staff discipline during surgical procedures

Cited by 14 publications

References 9 publications

Surveillance of Environmental and Procedural Measures of Infection Control in the Operating Theatre Setting

Surveillance of Environmental and Procedural Measures of Infection Control in the Operating Theatre Setting

The Influence of Traffic, Area Location, and Other Factors on Operating Room Microbial Load

Efficacy of infection control pathway in reducing postoperative infections in patients undergoing neurosurgery

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