General Assembly, Prevention, Operating Room - Personnel: Proceedings of International Consensus on Orthopedic Infections

Baldini, Andrea; Blevins, Kier; Gaizo, Daniel Del; Enke, Oliver; Goswami, Karan; Griffin, William R; Indelli, Pier Francesco; Jennison, Toby; Kenanidis, Eustathios; Manner, Paul; Patel, Robin; Puhto, Teija; Sancheti, Parag; Sharma, Rahul; Shetty, Rjajendra; Sorial, Rami; Talati, Naasha J; Tarity, T. David; Tetsworth, Kevin; Topalis, Christos; Tsiridis, Eleftherios; W‐Dahl, Annette; Wilson, Melissa A.

doi:10.1016/j.arth.2018.09.059

Cited by 18 publications

(6 citation statements)

References 92 publications

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“…26 Moreover, OR personnel traffic patterns, which are inherently linked to the number of door swings, have been investigated as a cause of increased infection risk. Baldini et al 27 found that large numbers of OR personnel and frequent door openings can predispose arthroplasty procedures to PJIs. Wathen et al 28 studied personnel in 12,000 neurosurgery procedures to help elucidate modifiable workflow-related factors associated with SSIs.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Operating Room Size on Orthopaedic Surgical Site Infection Rates

Tantillo

Petrone

Stapleton

et al. 2021

J Am Acad Orthop Surg

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Objective: With many preventable causes of surgical site infections (SSIs) identified, the effect of operating room (OR) size on SSI rates has not been assessed. This study investigated the effect of OR size on incidence of SSIs for orthopaedic procedures. Background: SSIs remain a common complication within the perioperative realm. Responsible for increasing length of hospitalization and costs, SSIs result in a decreased quality of life for patients. Methods: A retrospective review of 11,163 patients who underwent orthopaedic surgery-including total knee and hip arthroplasties, laminectomies, and spinal fusions-between January 2018 and January 2020 were reviewed. Total net square footage (NSF) of all ORs was recorded, and incidence of SSIs was calculated. Cases were categorized based on the size of the OR (small: 250 to 399 NSF; medium: 400 to 549 NSF; and large: 550 to 699 NSF). Chi-square analysis compared infection rates between the different OR sizes, and a binary logistic regression model identified other predictors of infection. Results: Overall, 137 patients (1.2%) developed an SSI. Of these infections, 16 (11.7%) occurred in small ORs, 83 (60.6%) in medium ORs, and 38 (27.7%) in large ORs. The incidence of SSIs was 0.7% in small ORs, 1.3% in medium ORs, and 1.8% in large ORs. Factors found to significantly impact SSI's included medium-sized ORs, younger patients, procedure type (fusions and emergencies/traumas), longer procedures, and higher American Society of Anesthesiologists scores (.3). Conclusion:Our study shows that OR size in addition to various other perioperative parameters plays a role in the rate of SSIs for orthopaedic procedures. Level of Evidence: Retrospective Cohort Study; Level III Evidence D efined as a superficial or deep infection occurring within 30 days postsurgery or within 90 days if implantable hardware is present, surgical site infections (SSIs) comprise 38% of nosocomial infections among surgical patients and 14% to 17% of all hospital infections; thus, SSIs

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Section: Discussionmentioning

confidence: 99%

The Effect of Operating Room Size on Orthopaedic Surgical Site Infection Rates

Tantillo

Petrone

Stapleton

et al. 2021

J Am Acad Orthop Surg

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“…A host skin and people working in the operating room environment are a source of bacteria contaminating surgical wounds, tools, and implants ( Figure 2). Many studies have demonstrated the significance of operating room quality, including controlling traffic and airflow for the number of surgical site infections (SSIs) [92][93][94][95]. Therefore, measurements contributing to a decrease in the bacterial load during a surgery are extremely worthwhile.…”

Section: Perioperative Strategiesmentioning

confidence: 99%

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Gallo

Nieslanikova

2020

JCM

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A projected increased use of total joint arthroplasties will naturally result in a related increase in the number of prosthetic joint infections (PJIs). Suppression of the local peri-implant immune response counters efforts to eradicate bacteria, allowing the formation of biofilms and compromising preventive measures taken in the operating room. For these reasons, the prevention of PJI should focus concurrently on the following targets: (i) identifying at-risk patients; (ii) reducing “bacterial load” perioperatively; (iii) creating an antibacterial/antibiofilm environment at the site of surgery; and (iv) stimulating the local immune response. Despite considerable recent progress made in experimental and clinical research, a large discrepancy persists between proposed and clinically implemented preventative strategies. The ultimate anti-infective strategy lies in an optimal combination of all preventative approaches into a single “clinical pack”, applied rigorously in all settings involving prosthetic joint implantation. In addition, “anti-infective” implants might be a choice in patients who have an increased risk for PJI. However, further progress in the prevention of PJI is not imaginable without a close commitment to using quality improvement tools in combination with continual data mining, reflecting the efficacy of the preventative strategy in a particular clinical setting.

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“…Thus, the rationale behind limiting traffic and movement in the operating theater is to reduce the number of airborne particles shed from skin of personnel and possible contamination by air entering from outside [64,69]. The ICM, Society for Healthcare Epidemiology of America, and National Institute for Health and Care Excellence (NICE) preventive guidelines all agree that operating theater traffic should be kept to a minimum [1,28,70]. The second ICM document highlighted multiple strategies to reduce traffic in the OR during orthopedic procedures that should be implementeddsuch as restriction of the number of nonessential persons present during orthopedic procedures [61,64]; storage of frequently used instruments within the OR; education of OR personnel regarding the potential correlation between OR traffic and infection [62,64,71,72]; locking the external door immediately after the entry of the patient into the OR and allowing personnel to enter only through the inner door [62,72,73]; minimizing staff rotation during each TJA ideally to zero [73]; use of an intercom for communication with the outer door [61]; and opening the necessary equipment as close as possible to the time of incision to reduce the exposure of sterile instruments to the increased traffic [64,70].…”

Section: Operating Theater Trafficmentioning

confidence: 99%