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

Abstract

SUMMARY A systematic literature review was performed to assess the impact of surgical-staff behaviors on the risk of surgical site infections. Published data are limited, heterogeneous, and weakened by several methodological flaws, underlying the need for more studies with accurate tools. OBJECTIVE To assess the current literature regarding the impact of surgical-staff behaviors on the risk of surgical-site infection (SSI). DESIGN Systematic literature review. METHODS We searched the Medline, EMBASE, Ovid, Web of Science, and Cochrane databases for original articles about the impact of intraoperative behaviors on the risk of SSI published in English before September 2013. RESULTS We retrieved 27 original articles reporting data on number of people in the operating room (n=14), door openings (n=14; number [n=6], frequency [n=7], reasons [n=4], or duration [n=3]), surgical-team discipline (evidence of distraction; n=4), compliance with traffic measures (n=6), or simulated behaviors (n=3). Most (59%) articles were published in 2009-2013. End points were the 30-day SSI rate (n=8), air-particle count (n=2), or microbiological air counts (n=6); 11 studies were only descriptive. Number of people in the operating room and SSI rate or airborne contaminants (particle/bacteria) were correlated in 2 studies. Door openings and airborne bacteria counts were correlated in 2 observational studies and 1 experimental study. Two cohort studies showed a significant association between surgeon interruptions/distraction or noise and SSI rate. The level of evidence was low in all studies. CONCLUSIONS Published data about the impact of operating-room behaviors on the risk of infection are limited and heterogeneous. All studies exhibit major methodological flaws. More studies with accurate tools should be performed to address the influence of operating room behaviors on the infectious risk.

Prevention of fracture-related infection: a multidisciplinary care package

“…Also, the doors of an OR must be closed as much as possible, because every time the door opens, the pressure drops and turbulence in air movements occur, contributing to wound contamination [80]. To reduce the frequency of door openings, Birgand et al suggest a more practical storage of frequently used materials, advanced communication systems and an improved organisation of surgical team shift changes [79,82].…”

Minimizing Sources of Airborne, Aerosolized, and Contact Contaminants in the OR Environment

“…In a literature review, Birgand et al 33 reported that in two studies, the number of personnel in the OR and SSI rates or airborne contaminants were correlated; they also reported that in an additional three studies, door openings and airborne contaminants were linked. Reducing traffic and door openings, especially involving the main door, may be a practical solution to maintaining optimal airflow with minimal circulating particles and contaminants; however, data were limited, and the level of evidence was low 33 .…”

“…In a literature review, Birgand et al 33 reported that in two studies, the number of personnel in the OR and SSI rates or airborne contaminants were correlated; they also reported that in an additional three studies, door openings and airborne contaminants were linked. Reducing traffic and door openings, especially involving the main door, may be a practical solution to maintaining optimal airflow with minimal circulating particles and contaminants; however, data were limited, and the level of evidence was low 33 . Esser et al 34 counted the number of OR door openings before and after developing a policy that included staff member education, reminder signs on OR doors, and use of communication devices such as voice‐activated phones to minimize the need to leave the OR for supplies or instruments.…”

“…Reducing traffic and door openings, especially involving the main door, may be a practical solution to maintaining optimal airflow with minimal circulating particles and contaminants; however, data were limited, and the level of evidence was low. 33 Esser et al 34 counted the number of OR door openings before and after developing a policy that included staff member education, reminder signs on OR doors, and use of communication devices such as voice-activated phones to minimize the need to leave the OR for supplies or instruments. Door openings diminished from an average of 37.8 to 32.8 per hour (P ¼ .001), which was a 13% reduction.…”

Operating Room Traffic as a Modifiable Risk Factor for Surgical Site Infection

“…Operating room traffic is often associated with transitions of care and handoffs, which are believed to contribute to adverse patient outcomes [27][28][29][30][31][32], including infection [33]. It is unclear whether operating room traffic in general or the traffic of specific personnel groups impacts SSI risk [34].…”