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Surendran S, Bonaconsa C, Nampoothiri V, Mbamalu O, George A, Mallick S, OV S, Holmes A, Mendelson M, Singh S, Birgand G, Charani E. Visual Mapping of Operating Theater Team Dynamics and Communication for Reflexive Feedback and Surgical Practice Optimization. ANNALS OF SURGERY OPEN 2024; 5:e463. [PMID: 39310335 PMCID: PMC11415113 DOI: 10.1097/as9.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/17/2024] [Indexed: 09/25/2024] Open
Abstract
Background Effective operating theater (OT) communication and teamwork are essential to optimal surgical outcomes. We mapped the OT team dynamics and infection control practices using visual methods to guide reflexive feedback and optimize perioperative practices. Methods Data were gathered from adult gastrointestinal surgical teams at a tertiary hospital in India using observations, sociograms (communication mapping tool), and focus group discussions (FGDs). Our methods aimed to map team communication, roles and responsibilities in infection-related practices, and door openings. Qualitative data were thematically analyzed. Quantitative data were analyzed using descriptive statistics. Results Data were gathered from 10 surgical procedures (over 51 hours) using 16 sociograms, 15 traffic flow maps, and 3 FGDs. Senior surgeons directly influence team hierarchies, dynamics, and communication. While the surgeons, anesthetic residents, and technicians lead most tasks during procedures, the scrub nurse acts as a mediator coordinating activity among role players across hierarchies. Failing to provide the scrub nurse with complete details of the planned surgery leads to multiple door openings to fetch equipment and disposables. Traffic flow observed in 15-minute intervals corresponds to a mean frequency of 56 door openings per hour (min: 16; max: 108), with implications for infection control. Implementing the World Health Organization surgical safety checklist was inconsistent across pathways and does not match reported compliance data. Conclusions Human factors research is important in optimizing surgical teamwork. Using visual methods to provide feedback to perioperative teams on their communication patterns and behaviors, provided an opportunity for contextualized enhancement of infection prevention and control practices.
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Affiliation(s)
- Surya Surendran
- From the Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
- Health Systems and Equity, The George Institute for Global Health, New Delhi, India
| | - Candice Bonaconsa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Vrinda Nampoothiri
- From the Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - Oluchi Mbamalu
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Anu George
- From the Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - Swetha Mallick
- Department of Gastrointestinal Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - Sudheer OV
- Department of Gastrointestinal Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - Alison Holmes
- Department of Medicine, National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom
- Faculty of Life and Health Sciences, University of Liverpool, Liverpool, England
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Sanjeev Singh
- From the Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - Gabriel Birgand
- Department of Medicine, National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom
- Regional Center for Infection Prevention and Control, Region of Pays de la Loire, Nantes University Hospital, Nantes, France
| | - Esmita Charani
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Faculty of Life and Health Sciences, University of Liverpool, Liverpool, England
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Schafer M, Dixon H, Palladino K, Baumann S, Martinson J, Bolland M, Lakdawala M, Yassin M. Automated traffic monitoring of neurosurgical operating room. Am J Infect Control 2024; 52:630-634. [PMID: 38281684 PMCID: PMC11223673 DOI: 10.1016/j.ajic.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Operating room (OR) traffic disrupts airflow and increases particle count, which predisposes patients to surgical site infections, particularly in longer surgeries with hardware placement. The aim of this study is to evaluate the rate of traffic during neurosurgical procedures, as well as reasons for and perceptions of OR traffic. METHODS This is a single-center, multimethod study monitoring neurosurgical OR traffic through direct observation, automated monitoring, and interviews. Traffic was observed between the skin incision and closure. Personal interviews with OR teams including surgeons, anesthesia, and nurses were conducted to evaluate their perceptions of the frequency of OR traffic and reasons for OR traffic. RESULTS Direct observation reported OR door opening an average of 18 times, with 20 people entering or exiting per hour. The exact reason for traffic was not verified in all traffic cases and was able to be confirmed in only a third of the cases. Automated monitoring resulted in an average of 31 people entering or exiting the OR per hour. The procedure length was significantly associated with the number of people entering or exiting the OR per hour (P < .0001). Interviews highlighted that OR teams reported traffic to be significantly lower than observed and automated monitoring results, with approximately <6 people entering or exiting per hour. CONCLUSIONS OR traffic is higher than staff expected, and updated processes are required to reduce the number of times the OR door opens. Implementing automated observation of OR traffic could reduce the OR traffic and the risk for surgical site infection.
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Affiliation(s)
- Mathea Schafer
- University of Pittsburgh Medical Center Mercy Hospital, Infection Prevention, Surgery and Anesthesia Departments, Pittsburgh, PA; University of Pittsburgh School of Public Health, Infectious Diseases, Microbiology, Behavioral and Community Health Sciences Departments, Pittsburgh, PA
| | - Heather Dixon
- University of Pittsburgh Medical Center Mercy Hospital, Infection Prevention, Surgery and Anesthesia Departments, Pittsburgh, PA
| | - Katie Palladino
- University of Pittsburgh Medical Center Mercy Hospital, Infection Prevention, Surgery and Anesthesia Departments, Pittsburgh, PA
| | - Sara Baumann
- University of Pittsburgh School of Public Health, Infectious Diseases, Microbiology, Behavioral and Community Health Sciences Departments, Pittsburgh, PA
| | - Jeremy Martinson
- University of Pittsburgh School of Public Health, Infectious Diseases, Microbiology, Behavioral and Community Health Sciences Departments, Pittsburgh, PA
| | - Monica Bolland
- University of Pittsburgh Medical Center Mercy Hospital, Infection Prevention, Surgery and Anesthesia Departments, Pittsburgh, PA; University of Pittsburgh School of Medicine, Anesthesiology and Perioperative Medicine Department and Division of Infectious Disease, Pittsburgh, PA
| | - Marilyn Lakdawala
- University of Pittsburgh Medical Center Mercy Hospital, Infection Prevention, Surgery and Anesthesia Departments, Pittsburgh, PA
| | - Mohamed Yassin
- University of Pittsburgh Medical Center Mercy Hospital, Infection Prevention, Surgery and Anesthesia Departments, Pittsburgh, PA; University of Pittsburgh School of Public Health, Infectious Diseases, Microbiology, Behavioral and Community Health Sciences Departments, Pittsburgh, PA; University of Pittsburgh School of Medicine, Anesthesiology and Perioperative Medicine Department and Division of Infectious Disease, Pittsburgh, PA.
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Gradisnik L, Bunc G, Ravnik J, Velnar T. Enhancing Surgical Safety: Microbiological Air Control in Operating Theatres at University Medical Centre Maribor. Diagnostics (Basel) 2024; 14:1054. [PMID: 38786351 PMCID: PMC11120459 DOI: 10.3390/diagnostics14101054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND the aim of the study was to assess microbiological air quality in operating theatres by determining the level of microbiological contamination of the air and critical surfaces using the passive air sampling method and compliance of the operating theatre staff with infection control measures. MATERIALS AND METHODS The prospective study was conducted in the surgical block of the University Medical Centre Maribor. For two months continuously, ten operating theatres were assessed for microbial contamination of air and surfaces during quiet and active times of the day. A passive air sampling method with Petri dishes on an agar specially adapted for this purpose (plate count agar) was used. In addition, ten surgical procedures were observed to assess staff compliance with recommended practises. RESULTS Air samples met microbiological standards in all operating theatres. In both sampling sessions of the day (quiet and active periods), microbial contamination of the air was always within the limit of 10 CFU/m3. The average number of bacterial colonies was zero to two during quiet phases and one to four during active phases. Approximately 60% of the isolates from the operating theatres belonged mainly to the genus Staphylococcus: S. epidermidis (36% of the isolates), S. hominis (17.5%) and S. haemolyticus (5.5%). The rest were identified as Streptococcus anginosus (23%) and Bacillus sp. (18%). Pathogenic bacteria and moulds were not present. In regard to staff compliance with good surgical practise, the former varied by behaviour and function, with non-compliance in pre-operative skin preparation and operating theatre congestion being notable. The cleanliness of the environment was satisfactory. CONCLUSIONS Microbiological air control is extremely important for the safety and success of both surgical and postoperative practises. In spite of good results obtained in the study, further improvements in surgical staff compliance with good surgical practise are essential to reduce surgical site infections.
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Affiliation(s)
| | - Gorazd Bunc
- Department of Neurosurgery, University Medical Centre Maribor, 2000 Maribor, Slovenia; (G.B.); (J.R.)
| | - Janez Ravnik
- Department of Neurosurgery, University Medical Centre Maribor, 2000 Maribor, Slovenia; (G.B.); (J.R.)
| | - Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Maribor, 2000 Maribor, Slovenia; (G.B.); (J.R.)
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- AMEU-ECM Maribor, 2000 Maribor, Slovenia
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Borejsza-Wysocki M, Hermann J, Wallner G, Richter P, Torres K, Skoczylas T, Kenig J, Pawałowski P, Jozefowicz W, Bobkiewicz A, Banasiewicz T. The usefulness and effectiveness of interactive telemedicine in surgery classes - a survey of Polish medical students. POLISH JOURNAL OF SURGERY 2024; 96:50-57. [PMID: 39138985 DOI: 10.5604/01.3001.0054.4680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
<b>Introduction:</b> Computer-based interactive techniques are becoming an important tool in medical education. One of the important benefits of the use of telemedicine in surgical training is the reduction of the number of people in the operating room. As shown in the studies, this can lead i.a. to the reduction in the risk of surgical site infections.<b>Aim:</b> The aim of this survey as held among fifth-year medical students at three academic centers was to assess the usefulness and effectiveness of telemedicine as a surgery-teaching tool.<b>Material and methods:</b> A transmission of a surgical procedure was carried out by each of the three participating centers according to a previously prepared schedule. Each transmission was preceded by the diagnostics, indications, and the course of the surgical procedure being discussed by the facilitator physician who also coordinated the transmission throughout the procedure. After the class, students received anonymous surveys consisting of fourteen questions as per the attached protocol so as to evaluate the class using the rating scale of 1 (the lowest rating) through 5 (the highest rating). The survey assessed the educational value (the knowledge acquired from the class), the form (interactivity, facilitator complicity), and the usefulness of the class for overall surgical education.<b>Results:</b> The survey was completed by 232 students, with 95% of respondents rating the usefulness of telemedicine classes in surgical education as very good or good. As many as 97% of students declared that the transmission had been a good or a very good tool in terms of delivery or adding to their knowledge of topographical anatomy and basic aspects of surgical technique. Higher ratings were given to the usefulness of comments and remarks by the facilitating physician (96% of very good or good ratings) who had been watching the procedure along with the students as compared to those provided by the operating physician (81%).<b>Discussion:</b> The use of telemedicine-based teaching models in surgical education facilitates a better view of the operating field for the students, greater accessibility of educational content delivered simultaneously to multiple groups of students, increased safety of the surgical procedure by reducing the number of people in the operating room as well as reduced burden on the operating physician (thanks to the introduction of class facilitator).<b>Conclusions:</b> In our opinion, the advantages of the presented teaching model are: better view (particularly in case of open procedures), ability to pinpoint surgical field structures (on the participants' and operator's monitors), absence of additional people (students) in the operating room (increasing the safety of the procedure and reducing the risk of surgical site infections) and the ability to go back to recorded operations and perform various types of educational analyses.
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Affiliation(s)
- Maciej Borejsza-Wysocki
- Department of General, Endocrine and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poland
| | - Jacek Hermann
- Department of General, Endocrine and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poland
| | - Grzegorz Wallner
- Department of General and Gastrointestinal Surgery and Surgical Oncology of the Alimentary Tract, Medical University of Lublin, Poland
| | - Piotr Richter
- Department of General, Oncological, Gastroenterological and Transplant Surgery, Jagiellonian University, Krakow, Poland
| | - Kamil Torres
- Department of General and Gastrointestinal Surgery and Surgical Oncology of the Alimentary Tract, Medical University of Lublin, Poland
| | - Tomasz Skoczylas
- Department of General and Gastrointestinal Surgery and Surgical Oncology of the Alimentary Tract, Medical University of Lublin, Poland
| | - Jakub Kenig
- Department of General, Oncological, Gastroenterological and Transplant Surgery, Jagiellonian University, Krakow, Poland
| | - Piotr Pawałowski
- Poznan Supercomputing and Networking Center, Institute of Bioorganic Chemistry of the Polish Academy of Sciences, Poznan, Poland
| | | | - Adam Bobkiewicz
- Department of General, Endocrine and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poland
| | - Tomasz Banasiewicz
- Department of General, Endocrine and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poland
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Hammond JB, Madura GM, Chang YHH, Lim ES, Habermann E, Cima R, Colibaseanu D, Siebeneck ET, Etzioni DA. The influence of operating room temperature and humidity on surgical site infection: A multisite ACS-NSQIP analysis. Am J Surg 2023; 226:840-844. [PMID: 37482475 DOI: 10.1016/j.amjsurg.2023.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/18/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Literature evaluating intraoperative temperature/humidity and risk of surgical site infection (SSI) is lacking. METHODS All operations at three centers reported to the ACS-NSQIP were reviewed (2016-2020); ambient intraoperative temperature (⁰F) and relative humidity (RH) were recorded in 15-min intervals. The primary endpoint was superficial SSI, which was evaluated with multi-level logistic regression. RESULTS 14,519 operations were analyzed with 179 SSIs (1.2%). The lower/upper 10th percentiles for temperature and RH were 64.4/71.4 °F and 33.5/55.5% respectively. Low or high temperature carried no significant increased risk for SSI (Low ⁰F OR = 0.95, 95% CI 0.51-1.77, P = 0.86; High ⁰F OR = 1.13, 95% CI = 0.69-1.86, P = 0.63). This was also true for low and high RH (Low RH OR = 0.96, 95% CI 0.58-1.61, p = 0.88; High RH OR = 0.61, 95% CI = 0.33-1.14, P = 0.12). Analysis of combined temperature/humidity showed no increased risk for SSI. CONCLUSION Significant deviations in intraoperative temperature/humidity are not associated with increased risk of SSI.
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Affiliation(s)
| | | | - Yu-Hui H Chang
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - Elisabeth S Lim
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Robert Cima
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Darius S, Heinemann F, Meyer F, Boeckelmann I. [Working in the Operating Theatre - What does the Surgeon Need to Know About Occupational Medicine?]. Zentralbl Chir 2023; 148:33-42. [PMID: 34872135 DOI: 10.1055/a-1657-0451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Surgery is associated with numerous health hazards for the staff.The aim of this article is to show the risks to the health and ability to work of surgical staff and the possibilities for improving occupational health and safety in terms of behavioural and situational prevention, as well as secondary and tertiary prevention, especially with regard to cooperation with the occupational physician.The brief narrative overview is based on the author's own occupational medicine, surgery and interdisciplinary experience from daily practice and selective references from the current medical-scientific literature, using the example of the operating theatre work area.The possible activity-related health hazards and the risks to the working ability of medical staff as well as the possibilities for occupational health and safety in the sense of behavioural and situational prevention are an important matter in the interdisciplinary status of surgery that should not be underestimated (since it is also partly determined by law). Above all, this discipline must responsibly dedicate itself to the points of contact with occupational medicine (in addition to acquiring its own knowledge from the surgical side).
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Affiliation(s)
- Sabine Darius
- Bereich Arbeitsmedizin, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - Franziska Heinemann
- Bereich Arbeitsmedizin, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - Frank Meyer
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
| | - Irina Boeckelmann
- Bereich Arbeitsmedizin, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
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Carr DV. Reducing OR Traffic. AORN J 2022; 116:570-576. [PMID: 36440930 DOI: 10.1002/aorn.13831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
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Anis HK, Rothfusz CA, Eskildsen SM, Klika AK, Piuzzi NS, Higuera CA, Molloy RM. Does Surgical Trainee Participation Affect Infection Outcomes in Primary Total Knee Arthroplasty? JOURNAL OF SURGICAL EDUCATION 2022; 79:993-999. [PMID: 35300952 DOI: 10.1016/j.jsurg.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/10/2021] [Accepted: 02/06/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate whether the involvement of surgeons-in-training was associated with increased infection rates, including both prosthetic joint infection (PJI) and surgical site infection (SSI), following primary total knee arthroplasty (TKA). DESIGN This was a retrospective review of outcomes following primary total knee arthroplasty. Surgeries were divided into two groups: (a) attending-only and (b) trainee-involved. Association with PJI and SSI were evaluated with univariate analysis and multivariate analysis to adjust for sex, age, body mass index (BMI), Charlson Comorbidity Index (CCI), year of surgery, operative time, and hospital/surgeon volume. SETTING A single, large North-American integrated healthcare system between January 1, 2014 and December 31, 2017. PARTICIPANTS A total of 12,664 primary TKAs with a minimum of one-year (mean of 2-years, range 1-4.5) follow-up were evaluated. RESULTS Residents and fellows were more likely to participate in cases with longer operative times (p<0.001) than the attending-only group. A significant difference existed on univariate analysis between the trainee-involved group and attending-only group for PJI incidence (p=0.015) but not for SSI (p=0.840). After adjusting for patient- and procedure-related features, however, neither PJI nor SSI were independently associated with trainee involvement (PJI: p=0.089; SSI: p=0.998). CONCLUSIONS Trainee participation did not directly correlate with increased infection risk, despite their association with longer-operative times and increased medical complexity. Further approaches to mitigating the risk of SSI and PJI for patients with increased comorbidities and in complex TKA cases, which demand longer operative times, are still required.
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Affiliation(s)
- Hiba K Anis
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio
| | - Christopher A Rothfusz
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio
| | | | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio.
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation Florida, Weston Hospital, Weston, Florida
| | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio
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A bundle of infection control measures reduces post-operative sternal wound infection due to Staphylococcus aureus but not Gram-negative bacteria: a retrospective analysis of 6,903 patient episodes. J Hosp Infect 2022; 126:21-28. [PMID: 35341810 DOI: 10.1016/j.jhin.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/02/2022] [Accepted: 03/10/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Prevention of cardiac surgical site infection has largely focused on reducing infection due to Staphylococcus aureus although other bacteria also play an important role in this complication. AIM We assess the impact of an evolving infection control program on the incidence of sternal wound infection (SWI) and the changing incidence of non-staphylococcal infections. METHODS We conducted a retrospective cohort study of all patients who underwent primary sternotomy at a single UK centre between September 2010 and May 2018. Data were collated from two-years prior to the stepwise introduction of a broad-ranging infection control program, including S. aureus decolonisation. FINDINGS 6,903 primary sternotomies were performed of which 2.6% (n=178) were complicated by SWI. Gram-negative bacteria (GNB) and S. aureus were most commonly identified as causative pathogens (45.5% and 30.3% respectively). Following program introduction there was a reduction in the rate of SWI from 3.9 to 1.8 cases/100 patients/month. This was mainly due to a sustained reduction in S. aureus infected cases with no discernible impact on GNB. Multivariable logistic regression analysis identified coronary artery bypass grafting, procedural urgency and procedures performed in the 3rd quarter as independent risk factors for post-operative infection. CONCLUSION A multifaceted infection control program was successful at reducing the rate of SWI primarily due to a reduction in S. aureus infections. GNB also play an important role in SWI and traditional preventative measures fail to address these. Future intervention and impact assessments should consider Gram negative infection when measuring effectiveness.
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Akita S, Fujioka M, Akita T, Tanaka J, Masunaga A, Kawahara T. Effects of Hand Hygiene Using 4% Chlorhexidine Gluconate or Natural Soap During Hand Rubbing Followed by Alcohol-Based 1% Chlorhexidine Gluconate Sanitizer Lotion in the Operating Room. Adv Wound Care (New Rochelle) 2022; 11:1-9. [PMID: 33563102 PMCID: PMC9831244 DOI: 10.1089/wound.2020.1352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective: Hand hygiene using either 4% chlorhexidine gluconate (CHG) or natural soap during hand rubbing, followed by alcohol-based 1% CHG sanitizer lotion in the operating room was compared to assess bacterial reduction, skin moisture, skin texture, and hand hygiene using qualitative questionnaires. Approach: A crossover study with 36 professional scrub nurses at two medical centers was performed to compare 4% CHG followed by alcohol-based 1% CHG sanitizer lotion, the Two-stage method with handwashing using natural soap followed by alcohol-based 1% CHG sanitizer lotion, and the Waterless method, after a period of 10 days of use. The study completely followed CONSORT, www.consort-statement.org. Results: There was no significant difference in bacterial reduction based on the bacterial colony-forming units between the two methods. The skin moisture and skin roughness scores were not significantly different between the two methods. The Waterless method was significantly better than the Two-stage method regarding "foaming," "quality," "longevity" (p < 0.0001, p < 0.0001, and p < 0.0001, respectively), but "disappearance" was significantly better by the Two-stage method (p = 0.0095) during washing and rubbing. Immediately after washing and rubbing, the Waterless method was significantly better regarding "tightness" and "moisture," whereas the Two-stage method was significantly better regarding "stickiness" (p = 0.0114, p = <0.0001, and 0.0059, respectively) Innovation: The Waterless method using natural soap during handwashing followed by alcohol-based 1% CHG sanitizer lotion was as effective as the Two-stage method of 4% CHG followed by alcohol-based 1% CHG sanitizer lotion. Conclusion: Handwashing using natural soap is simple and superior to hand scrubbing in several aspects.
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Affiliation(s)
- Sadanori Akita
- Department of Plastic Surgery, Wound Repair and Regeneration, School of Medicine, Fukuoka University, Fukuoka, Japan.,Correspondence: Department of Plastic Surgery, Wound Repair and Regeneration, School of Medicine, Fukuoka University, Fukuoka 8140180, Japan
| | - Masaki Fujioka
- Department of Plastic and Reconstructive Surgery, National Hospital Organization, Nagasaki Medical Center, Nagasaki, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical & Health Science, Hiroshima University, Hiroshima, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical & Health Science, Hiroshima University, Hiroshima, Japan
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Taaffe K, Joseph A, Khoshkenar A, Machry H, Allison D, Reeves ST. Proactive Evaluation of an Operating Room Prototype: A Simulation-Based Modeling Approach. J Patient Saf 2021; 17:e1833-e1839. [PMID: 32175960 DOI: 10.1097/pts.0000000000000693] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES There is a pressing need to improve safety and efficiency in the operating room (OR). Postsurgical adverse events, such as surgical site infections and surgical flow disruption, occur at a significant rate in industrial countries where a considerable portion of such complications result in death. The aim of the study was to identify an ideal room design that improves the flow of staff members using risk and safety performance measures. METHODS Operating room designs were compared by using computer simulation modeling to analyze traffic flow inside an OR. The study was conducted in two phases. A historical data set was first created based on surgical flow data obtained from 23 video observations of actual surgical procedures. A detailed simulation-based model was then developed. RESULTS As room size increases, staff members have more available space to maneuver in the room, resulting in more distance walked but far fewer undesirable contacts. An angled table orientation is preferred with the circulating nurse workstation at the foot of the OR table, as it provides more space for staff to move across the room without increasing the number of contacts. Furthermore, when the nurse workstation is near the wall, staff members experience fewer undesirable contacts. CONCLUSIONS Simulation modeling was used to assess the impact of OR layout alternatives on three performance metrics, and the medium-sized OR prototype performs well across the metrics. Future research will consider the relative influence of several factors on traffic-based safety and efficiency performance metrics, resulting in a more predictive simulation design model.
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Affiliation(s)
- Kevin Taaffe
- From the Department of Industrial Engineering, Clemson University, College of Engineering, Computing and Applied Sciences
| | - Anjali Joseph
- Clemson University, School of Architecture, Clemson, South Carolina
| | - Amin Khoshkenar
- From the Department of Industrial Engineering, Clemson University, College of Engineering, Computing and Applied Sciences
| | | | - David Allison
- Clemson University, School of Architecture, Clemson, South Carolina
| | - Scott T Reeves
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina
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Aganovic A, Cao G, Fecer T, Ljungqvist B, Lytsy B, Radtke A, Reinmüller B, Traversari R. Ventilation design conditions associated with airborne bacteria levels within the wound area during surgical procedures: a systematic review. J Hosp Infect 2021; 113:85-95. [PMID: 33930488 DOI: 10.1016/j.jhin.2021.04.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Without confirmation of the ventilation design conditions (typology and airflow rate), the common practice of identifying unidirectional airflow (UDAF) systems as equivalent to ultra-clean air ventilation systems may be misleading, but also any claims about the ineffectiveness of UDAF systems should be doubted. The aim of this review was to assess and compare ventilation system design conditions for which ultra-clean air (mean <10 cfu/m3) within 50 cm from the wound has been reported. Six medical databases were systematically searched to identify and select studies reporting intraoperative airborne levels expressed as cfu/m3 close to the wound site, and ventilation system design conditions. Available data on confounding factors such as the number of persons present in the operating room, number of door openings, and clothing material were also included. Predictors for achieving mean airborne bacteria levels within <10 cfu/m3 were identified using a penalized multivariate logistic regression model. Twelve studies met the eligibility criteria and were included for analysis. UDAF systems considered had significantly higher air volume flows compared with turbulent ventilation (TV) systems considered. Ultra-clean environments were reported in all UDAF-ventilated (N = 7) rooms compared with four of 11 operating rooms equipped with TV. On multivariate analysis, the total number of air exchange rates (P=0.019; odds ratio (OR) 95% confidence interval (CI): 0.66-0.96) and type of clothing material (P=0.031; OR 95% CI: 0.01-0.71) were significantly associated with achieving mean levels of airborne bacteria <10 cfu/m3. High-volume UDAF systems complying with DIN 1946-4:2008 standards for the airflow rate and ceiling diffuser size unconditionally achieve ultra-clean air close to the wound site. In conclusion, the studied articles demonstrate that high-volume UDAF systems perform as ultra-clean air systems and are superior to TV systems in reducing airborne bacteria levels close to the wound site.
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Affiliation(s)
- A Aganovic
- Department of Automation and Process Engineering, The Arctic University of Norway, Norway.
| | - G Cao
- Department of Energy and Process Engineering, Norwegian University of Science and Technology - NTNU, Norway
| | - T Fecer
- Department of Computer Aided Engineering and Computer Science, Faculty of Civil Engineering, Brno University of Technology, Czech Republic
| | - B Ljungqvist
- Department of Civil and Environmental Engineering, Chalmers University of Technology, Sweden
| | - B Lytsy
- Department of Medical Sciences, Clinical Microbiology, Uppsala University, Sweden
| | - A Radtke
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Norway
| | - B Reinmüller
- Department of Civil and Environmental Engineering, Chalmers University of Technology, Sweden
| | - R Traversari
- Netherlands Organization for Applied Scientific Research, Netherlands
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Patel PG, DiBartola AC, Phieffer LS, Scharschmidt TJ, Mayerson JL, Glassman AH, Moffatt-Bruce SD, Quatman CE. Room Traffic in Orthopedic Surgery: A Prospective Clinical Observational Study of Time of Day. J Patient Saf 2021; 17:e241-e246. [PMID: 29112032 DOI: 10.1097/pts.0000000000000330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE High rates of operating room (OR) traffic may contribute to surgical air contamination and surgical site infections (SSIs). The purpose of this study was to evaluate room traffic patterns in orthopedic implant procedures to determine the frequency of door openings and if time of day had an effect on room traffic. METHODS In 2015, OR traffic was assessed in orthopedic implant cases. Room traffic was reported as the number of door openings per minute. Counts of how many people were present in the operating room were noted in 5-minute intervals from the time of sterile case opening to dressing placement. Operative cases were observed and categorized into 3 periods (6:00-9:59, 10:00-13:59, and 14:00-17:59) to assess if time of day affected room traffic. RESULTS Forty-six cases were observed for the present study. Among all cases, the mean room traffic rate was 35.2 openings per hour (SD, 10; range, 13.2-60.8). One-way analysis of variance revealed no statistically significant difference among groups (6:00-9:59 [n = 29], 10:00-13:59 [n = 10], and 14:00-17:59 [n = 7]) as it relates door openings per minute (room traffic rate) (P = 0.9237) or mean number of people in the OR (P = 0.3560). Pearson correlation revealed no correlation between case start time and room traffic rates (P = 0.6129, r2 = 0.0059) or between case start time and mean number of people in the OR (P = 0.3435, r2 = 0.0214). CONCLUSIONS Room traffic rates and mean number of people in the OR do not correlate with time of day of case in orthopedic implant procedures.
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14
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Montiel V, Pérez-Prieto D, Perelli S, Monllau JC. Fellows and Observers Are Not a Problem for Infection in the Operating Rooms of Teaching Centers. Trop Med Infect Dis 2021; 6:43. [PMID: 33807317 PMCID: PMC8103268 DOI: 10.3390/tropicalmed6020043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The aim of the present study was to determine whether the risk of complications increases with the number of people in the operating room (OR). Several studies have stated that an increased number of people in the OR increases not only the risk of infection but also the risk of intraoperative complications due to distractions during the surgery. MATERIALS AND METHODS This retrospective study included all patients who had surgery between January 2017 and January 2018 in an OR with the usual surgical team and three or more observers. Patient demographic data, surgical details (duration of the surgery, the surgery being open or arthroscopic, and whether a graft was used), and intraoperative and postoperative complications were recorded. RESULTS A total of 165 surgeries were recorded, with a mean operating time of 70 min (40% open surgeries, 37% arthroscopic surgeries, and 23% combined open and arthroscopic procedures). The main intraoperative complications were vessel damage, nerve damage, premature cement setting, and leg-length discrepancy, with 1 case each. The main postoperative complications were rigidity (8 cases), unexplained pain (11 cases), failed meniscal suturing (3 cases), a postoperative stress fracture (1 case), correction loss in osteotomy (1 case), and wound problems not related to infection (1 case). There were no cases of infection. DISCUSSION The present study shows that the complication rate when having observers in the OR is comparable to the reported data. The key to avoiding complications is for everyone to comply with basic OR behavior.
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Affiliation(s)
- Verónica Montiel
- Orthopedic Surgery and Traumatology Department, Clínica Universidad de Navarra, Av. Pio XII, 36, 31008 Pamplona, Navarra, Spain;
| | - Daniel Pérez-Prieto
- Orthopedic Surgery and Traumatology Department, Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Cataluña, Spain; (S.P.); (J.C.M.)
- Hospital Universitari Dexeus- Grupo Quirónsalud, Carrer de Sabino Arana, 5, 19, 08028 Barcelona, Cataluña, Spain
| | - Simone Perelli
- Orthopedic Surgery and Traumatology Department, Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Cataluña, Spain; (S.P.); (J.C.M.)
- Hospital Universitari Dexeus- Grupo Quirónsalud, Carrer de Sabino Arana, 5, 19, 08028 Barcelona, Cataluña, Spain
| | - Joan Carles Monllau
- Orthopedic Surgery and Traumatology Department, Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Cataluña, Spain; (S.P.); (J.C.M.)
- Hospital Universitari Dexeus- Grupo Quirónsalud, Carrer de Sabino Arana, 5, 19, 08028 Barcelona, Cataluña, Spain
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15
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Assessing Risks Awareness in Operating Rooms among Post-Graduate Students: A Pilot Study. SUSTAINABILITY 2021. [DOI: 10.3390/su13073860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: In this study, we promote a global approach to occupational risk perception in order to improve occupational health and safety training programs. The study investigates the occupational risk perception of operating room healthcare workers using an Analytic Hierarchy Process approach. Methods: A pilot study was carried out through a cross-sectional survey in a university hospital in Southern Italy. An ad hoc questionnaire was administered to enrolled medical post-graduate students working in the operating room. Results: Fifty medical specialists from seven fields (anaesthetists, digestive system surgeons, general surgeons, maxillofacial surgeons, thoracic surgeons, urologists, and gynaecologists) were questioned about perceived occupational risk by themselves. Biological, ionizing radiation, and chemical risks were the most commonly perceived in order of priority (w = 0.300, 0.219, 0.210). Concerning the biological risk, gynaecologists unexpected perceived this risk as less critical (w = 0.2820) than anaesthesiologists (w = 0.3354), which have the lowest perception of the risk of ionizing radiation (w = 0.1657). Conclusions: Prioritization methods could improve risk perception in healthcare settings and help detect training needs and perform sustainable training programs.
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16
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Current concepts in the prevention, diagnosis and treatment of fracture-related infection (FRI). EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:957-966. [PMID: 33778904 DOI: 10.1007/s00590-021-02956-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/21/2021] [Indexed: 12/24/2022]
Abstract
Fracture-related infection (FRI) is one of the most challenging complications following operative management of fractures. It can have profound implications for the patient, can be associated with considerable morbidity and often lead to impaired outcomes. There are significant healthcare-related costs. In recent years, there has been significant progress towards developing preventative strategies. Furthermore, diagnostic algorithms and management protocols have recently been reported. Lack of a strong evidence base has previously hindered efforts to implement these and develop established standards of care. There are multiple aspects of care that need to be considered and a multi-disciplinary approach is recommended. In this narrative review, we present the most up-to-date recommendations in the prevention, diagnosis and management of FRI.
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Kim JH, Um R, Liu J, Patel J, Curry E, Aghabaglou F, Mahapatra S, Ainechi A, Tsehay Y, Ehresman J, Hwang B, Tyler B, Iyer R, Theodore N, Manbachi A. Development of a Smart Hospital Assistant: Integrating Artificial Intelligence and a Voice-User Interface for Improved Surgical Outcomes. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2021; 11601:116010U. [PMID: 35341075 PMCID: PMC8957208 DOI: 10.1117/12.2580995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Patient safety and efficiency are top priorities in any surgical procedure. One effective way to achieve these objectives is to automate the logistical and routine tasks that occur in the operating suite. Inspired by smart assistant technology already widely used in the consumer sector, we engineered the Smart Hospital Assistant (SHA), a smart, voice-controlled virtual assistant that handles natural speech recognition while executing non-surgical functions to aid any surgery. In simulated procedures, the SHA reduced operating time, optimized surgical staff resources, and reduced the number of major touch-points that can lead to surgical site infections. The SHA holds promise not only for use in the operating theater, but also in understaffed healthcare environments where automation can improve healthcare delivery.
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Affiliation(s)
- Jeong Hun Kim
- Dept. of Electrical and Computer Engineering, Johns Hopkins University, Baltimore MD
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Richard Um
- Dept. of Biomedical Engineering, Johns Hopkins University, Baltimore MD
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Jonathan Liu
- Dept. of Biomedical Engineering, Johns Hopkins University, Baltimore MD
| | - Japesh Patel
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Eli Curry
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | | | | | - Ana Ainechi
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Yohannes Tsehay
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Jeff Ehresman
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Brian Hwang
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Betty Tyler
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Rajiv Iyer
- Dept. of Orthopedic Surgery, Columbia University Irving Medical Center, New York City NY
| | - Nicholas Theodore
- Dept. of Biomedical Engineering, Johns Hopkins University, Baltimore MD
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
| | - Amir Manbachi
- Dept. of Biomedical Engineering, Johns Hopkins University, Baltimore MD
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore MD
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18
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Lansing SS, Moley JP, McGrath MS, Stoodley P, Chaudhari AMW, Quatman CE. High Number of Door Openings Increases the Bacterial Load of the Operating Room. Surg Infect (Larchmt) 2020; 22:684-689. [PMID: 33370210 DOI: 10.1089/sur.2020.361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Operating room (OR) traffic and door openings have emerged as potential modifiable risk factors for the development of surgical site infections. Methods: This study compared the microbial load of a Control OR without traffic versus a Simulated OR with the traffic in a typical orthopedic surgery case. Air particle counts and colony forming units (CFUs) were measured. A novel iOS app was developed to provide real-time door counts. Results: There were 1,862 particles >5.0 mcm in the Simulated OR compared with 56 in the Control OR. The CFUs from plates in the Simulated OR ranged from 4-22 (on brain heart infusion [BHI] agar), 2-266 (on mannitol salt agar [MSA]), and 1-19 (on Pseudomonas isolation agar [PIA]), while all plates in the Control OR grew 0-1 CFUs. Conclusions: High number of door openings leads to more airborne bacteria in the OR and viable bacterial on OR surfaces. The increased bacterial load throughout the OR was independent of distance from the door.
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Affiliation(s)
- Shan S Lansing
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - James P Moley
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Mary S McGrath
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Paul Stoodley
- The Ohio State University Department of Microbial Infection and Immunity, Columbus, Ohio, USA.,The Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio, USA.,National Centre for Advanced Tribiology and Southampton (nCATS) and National Biofilm Innovation Centre (NBIC), Mechanical Engineering, University of Southampton, Southampton, UK
| | - Ajit M W Chaudhari
- The Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio, USA.,School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Carmen E Quatman
- The Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio, USA
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19
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Simulating the effects of operating room staff movement and door opening policies on microbial load. Infect Control Hosp Epidemiol 2020; 42:1071-1075. [PMID: 33342455 DOI: 10.1017/ice.2020.1359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To identify factors that increase the microbial load in the operating room (OR) and recommend solutions to minimize the effect of these factors. DESIGN Observation and sampling study. SETTING Academic health center, public hospitals. METHODS We analyzed 4 videotaped orthopedic surgeries (15 hours in total) for door openings and staff movement. The data were translated into a script denoting a representative frequency and location of movements for each OR team member. These activities were then simulated for 30 minutes per trial in a functional operating room by the researchers re-enacting OR staff-member roles, while collecting bacteria and fungi using settle plates. To test the hypotheses on the influence of activity on microbial load, an experimental design was created in which each factor was tested at higher (and lower) than normal activity settings for a 30-minute period. These trials were conducted in 2 phases. RESULTS The frequency of door opening did not independently affect the microbial load in the OR. However, a longer duration and greater width of door opening led to increased microbial load in the OR. Increased staff movement also increased the microbial load. There was a significantly higher microbial load on the floor than at waist level. CONCLUSIONS Movement of staff and the duration and width of door opening definitely affects the OR microbial load. However, further investigation is needed to determine how the number of staff affects the microbial load and how to reduce the microbial load at the surgical table.
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20
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Moslem AR, Rezaei H, Yektay S, Miri M. Comparing BTEX concentration related to surgical smoke in different operating rooms. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2020; 203:111027. [PMID: 32888595 DOI: 10.1016/j.ecoenv.2020.111027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/03/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
The available evidence on the indoor air quality of operating rooms (ORs) in the Low- and Middle-income Countries (LMICs) is very scarce. Moreover, there is no study on the comparing the concentration of indoor air pollutants in different ORs. Therefore, this study aimed to measure and compare the benzene, toluene, ethylbenzene and xylene (BTEX) concentrations in the air of different ORs in hospitals of Sabzevar, Iran. Moreover, carcinogenic and non-carcinogenic risk of exposure to these pollutants were assessed using Monte Carlo simulations technique. This cross-sectional study was based on volatile organic compounds (VOCs) passive sampling of eight ORs including General surgery, Curettage, Eye surgery, Neurosurgery, Orthopedic, Laparoscopic, Cesarean and Ear, nose, throat (ENT) in two monthly campaigns from November 2019 to February 2020. One-way ANOVA and Post-hoc analyses were used to compare the concentration of BTEX compounds in different ORs. The overall mean (standard deviation (SD)) of benzene, toluene, ethylbenzene, xylene and total BTEX concentrations were 10.0 (1.8), 7.2 (1.9), 1.8 (0.6), 0.4 (0.2) and 19.4 (4.1) μg/m3. The Curettage OR had the highest (12.93 μg/m3) and ENT OR had the lowest (7.42 μg/m3) benzene concentrations. The highest concentrations of toluene, ethylbenzene and total BTEX were observed in General surgery OR. The cancer risks of exposure to benzene in all ORs were higher than the acceptable range recommended by Unite State Environmental Protection Agency (USEPA, 1 × 106). However, the hazard quotient (HQ) values for all ORs were at safe level (HQ < 1). Overall, our study suggested that the concentrations of BTEX compounds were significantly difference in different ORs and benzene had a carcinogenic risk for personnel and surgical staff in different ORs.
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Affiliation(s)
- Ali Reza Moslem
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Hossein Rezaei
- Student Research Committee, Department of Environmental Health, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Sima Yektay
- Student Research Committee, Department of Environmental Health, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mohammad Miri
- Non-communicable Diseases Research Center, Department of Environmental Health, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran.
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21
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Roth JA, Juchler F, Dangel M, Eckstein FS, Battegay M, Widmer AF. Frequent Door Openings During Cardiac Surgery Are Associated With Increased Risk for Surgical Site Infection: A Prospective Observational Study. Clin Infect Dis 2020; 69:290-294. [PMID: 30321301 DOI: 10.1093/cid/ciy879] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/09/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Preliminary studies that analyzed surrogate markers have suggested that operating room (OR) door openings may be a risk factor for surgical site infection (SSI). We therefore aimed to estimate the effect of OR door openings on SSI risk in patients undergoing cardiac surgery. METHODS This prospective, observational study involved consecutive patients undergoing cardiac surgery in 2 prespecified ORs equipped with automatic door-counting devices from June 2016 to October 2017. Occurrence of an SSI within 30 days after cardiac surgery was our primary outcome measure. Respective outcome data were obtained from a national SSI surveillance cohort. We analyzed the relationship between mean OR door opening frequencies and SSI risk by use of uni- and multivariable Cox regression models. RESULTS A total of 301 594 OR door openings were recorded during the study period, with 87 676 eligible door openings being logged between incision and skin closure. There were 688 patients included in the study, of whom 24 (3.5%) developed an SSI within 30 days after surgery. In uni- and multivariable analysis, an increased mean door opening frequency during cardiac surgery was associated with higher risk for consecutive SSI (adjusted hazard ratio per 5-unit increment, 1.49; 95% confidence interval, 1.11-2.00; P = .008). The observed effect was driven by internal OR door openings toward the clean instrument preparation room. CONCLUSIONS Frequent door openings during cardiac surgery were independently associated with an increased risk for SSI. This finding warrants further study to establish a potentially causal relationship between OR door openings and the occurrence of SSI.
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Affiliation(s)
- Jan A Roth
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Bern, Switzerland.,University of Basel, Bern, Switzerland.,Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Bern, Switzerland
| | - Fabrice Juchler
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Bern, Switzerland.,University of Basel, Bern, Switzerland
| | - Marc Dangel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Bern, Switzerland.,University of Basel, Bern, Switzerland
| | - Friedrich S Eckstein
- University of Basel, Bern, Switzerland.,Department of Cardiac Surgery, University Hospital Basel, Bern, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Bern, Switzerland.,University of Basel, Bern, Switzerland
| | - Andreas F Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Bern, Switzerland.,University of Basel, Bern, Switzerland.,Swissnoso, National Center for Infection Prevention, Bern, Switzerland
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22
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Birgand G, Haudebourg T, Grammatico-Guillon L, Moret L, Gouin F, Mauduit N, Leux C, Le Manach Y, Tavernier E, Giraudeau B, Lepelletier D, Lucet JC. Intraoperative Door Openings and Surgical Site Infection: A Causal Association? Clin Infect Dis 2020; 71:469-470. [PMID: 31563935 DOI: 10.1093/cid/ciz954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Gabriel Birgand
- Centre d'Appui à la Prévention des Infections Associées aux Soins (CPias), Pays de la Loire, Nantes University Hospital, Nantes, France.,Health Protection Research Unit, Imperial College London, London, United Kingdom
| | - Thomas Haudebourg
- Centre d'Appui à la Prévention des Infections Associées aux Soins (CPias), Pays de la Loire, Nantes University Hospital, Nantes, France
| | - Leslie Grammatico-Guillon
- Service de Santé Publique, Unité Régionale d'Epidémiologie Hospitalière, CHU, Université de Tours, Tours, France
| | - Leila Moret
- Service de Santé Publique, Nantes University Hospital, Nantes, France
| | - François Gouin
- Service de Chirurgie Orthopédique, Nantes University Hospital, Nantes, France
| | - Nicolas Mauduit
- Service d'Information Médicale, Nantes University Hospital, Nantes, France
| | - Christophe Leux
- Service d'Information Médicale, Nantes University Hospital, Nantes, France
| | - Yannick Le Manach
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, Ontario, Canada
| | | | - Bruno Giraudeau
- INSERM CIC 1415, CHRU de Tours, Tours, France.,Université de Tours, Université de Nantes, INSERM SPHERE U1246, Tours, France
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23
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Ogihara S, Yamazaki T, Shiibashi M, Maruyama T, Chikuda H, Miyoshi K, Inanami H, Oshima Y, Azuma S, Kawamura N, Yamakawa K, Hara N, Morii J, Okazaki R, Takeshita Y, Sato K, Tanaka S, Saita K. Risk Factor Analysis of Deep Surgical Site Infection After Posterior Instrumented Fusion Surgery for Spinal Trauma: A Multicenter Observational Study. World Neurosurg 2020; 134:e524-e529. [DOI: 10.1016/j.wneu.2019.10.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 11/25/2022]
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24
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Lo Giudice D, Trimarchi G, La Fauci V, Squeri R, Calimeri S. Hospital infection control and behaviour of operating room staff. Cent Eur J Public Health 2020; 27:292-295. [PMID: 31951688 DOI: 10.21101/cejph.a4932] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Surgical site infections (SSIs) are a frequent complication of surgical procedures and one of the most common forms of hospital acquired infection (HAI). National/international guidelines and recommendations have been issued for prevention. The objective of this study was to observe the behaviour of healthcare workers engaged in surgical procedures and hence assess compliance with SSI guidelines. METHODS An observational descriptive study was conducted at a University hospital in southern Italy. A specifically designed form was used to record the actions of the surgical team during randomly selected surgical operations. Observations comprised the use of surgical attire, the frequency of doors opening and the number of staff in the operating room. RESULTS A total of 308 operating room personnel was observed during 402 surgical procedures: 127 surgeons (41%), 39 anaesthesiologists (13%), 62 nurses (20%) and 80 students in training (26%). 96% of the surgical team wore scrubs, 93% of health workers wore a mask and of these 78% wore it correctly in order to completely cover the nose, mouth and beard (when present), 99% wore a cap (only in 48% was the hair completely covered), 50% of the operators wore gloves, 95% wore shoes dedicated to the operating theater and 23% also wore shoe covers, 56% wore gowns, and 22% had eye protection. Furthermore, the average number of health personnel in the operating theater was 8, the doors remained closed in 261 (65%) surgical operations. CONCLUSION As the results indicated a low adherence to international guidelines among the personnel, it is suggested that training courses should be provided to increase staff awareness on prevention and management of HAI.
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Affiliation(s)
- Daniela Lo Giudice
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giuseppe Trimarchi
- SIR - Faculty of Medicine and Surgery, University of Messina, Messina, Italy
| | - Vincenza La Fauci
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Raffaele Squeri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Sebastiano Calimeri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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Pasquarella C, Balocco C, Colucci ME, Saccani E, Paroni S, Albertini L, Vitali P, Albertini R. The Influence of Surgical Staff Behavior on Air Quality in a Conventionally Ventilated Operating Theatre during a Simulated Arthroplasty: A Case Study at the University Hospital of Parma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E452. [PMID: 31936699 PMCID: PMC7013425 DOI: 10.3390/ijerph17020452] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/28/2022]
Abstract
Surgical staff behavior in operating theatres is one of the factors associated with indoor air quality and surgical site infection risk. The aim of this study was to apply an approach including microbiological, particle, and microclimate parameters during two simulated surgical hip arthroplasties to evaluate the influence of staff behavior on indoor air quality. During the first hip arthroplasty, the surgical team behaved correctly, but in the second operation, behavioral recommendations were not respected. Microbiological contamination was evaluated by active and passive methods. The air velocity, humidity, temperature, and CO2 concentration were also monitored. The highest levels of microbial and particle contamination, as well as the highest variation in the microclimate parameter, were recorded during the surgical operation where the surgical team behaved "incorrectly". Turbulent air flow ventilation systems appeared more efficient than in the past and very low air microbial contamination was reached when behavior was correct. Therefore, adherence to behavioral recommendations in operating theatres is essential to not undermine the effectiveness of the heating, ventilation, and air conditioning systems and employed resources.
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Affiliation(s)
- Cesira Pasquarella
- Department of Medicine and Surgery, University of Parma, via Volturno, 39, 43125 Parma, Italy; (M.E.C.); (E.S.); (S.P.); (R.A.)
| | - Carla Balocco
- Department of Industrial Engineering, University of Florence, via S. Marta 3, 50139 Firenze, Italy;
| | - Maria Eugenia Colucci
- Department of Medicine and Surgery, University of Parma, via Volturno, 39, 43125 Parma, Italy; (M.E.C.); (E.S.); (S.P.); (R.A.)
| | - Elisa Saccani
- Department of Medicine and Surgery, University of Parma, via Volturno, 39, 43125 Parma, Italy; (M.E.C.); (E.S.); (S.P.); (R.A.)
| | - Samuel Paroni
- Department of Medicine and Surgery, University of Parma, via Volturno, 39, 43125 Parma, Italy; (M.E.C.); (E.S.); (S.P.); (R.A.)
| | | | - Pietro Vitali
- Hygiene Unit, University Hospital of Parma, Parma, via Gramsci 14, 43126 Parma, Italy;
| | - Roberto Albertini
- Department of Medicine and Surgery, University of Parma, via Volturno, 39, 43125 Parma, Italy; (M.E.C.); (E.S.); (S.P.); (R.A.)
- Clinical Immunology Unit, University Hospital of Parma, Parma, via Gramsci 14, 43126 Parma, Italy
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A comprehensive unit-based safety program for the reduction of surgical site infections in plastic surgery and hand surgery. Infect Control Hosp Epidemiol 2019; 40:1367-1373. [PMID: 31607274 DOI: 10.1017/ice.2019.279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To reduce surgical site infection (SSI) incidence in plastic surgery and hand surgery. DESIGN Uncontrolled before-and-after study. SETTING Department of plastic surgery and hand surgery of a tertiary-care teaching hospital. PATIENTS Patients undergoing surgery between January 2016 and April 2018. INTERVENTION A comprehensive unit-based safety program (CUSP) consisting of a bundle of evidence-based SSI prevention strategies and a change in safety culture was fully implemented after a 14-month baseline surveillance and implementation period. SSI surveillance was performed over an intervention period of another 14 months, and differences in SSI rates between the 2 periods were calculated. Adherence with bundle components and risk factors for SSI were further evaluated in a case-cohort analysis. RESULTS Of 3,321 patients, 63 (1.9%) developed an SSI, 38 of 1,722 (2.2%) in the baseline group and 25 of 1,599 (1.6%) in the intervention group (P = .20). The CUSP was associated with an adjusted relative SSI risk reduction of 41% (95% confidence interval [CI], 0.4%-65%; P = .048) in multivariable analysis, whereas the need for revision surgery increased SSI risk (odds ratio [OR], 2.63; 95% CI, 1.31-5.30; P = .007). During the intervention period, the proportion of checklists completed was 62.4%, and no difference in adherence with bundle components between patients with and without SSI was observed. CONCLUSIONS This CUSP helped reduce SSI in a surgical specialty with a low baseline SSI incidence, even though adherence with checklist completion was moderate and the main modifiable risk factors remained unchanged over time. Programs that include safety culture change may more effectively promote SSI reduction than prevention bundles alone.
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Rubeli SL, D’Alonzo D, Mueller B, Bartlomé N, Fankhauser H, Bucheli E, Conen A, Fandino J, Fux CA. Implementation of an infection prevention bundle is associated with reduced surgical site infections in cranial neurosurgery. Neurosurg Focus 2019; 47:E3. [DOI: 10.3171/2019.5.focus19272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 05/13/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe objective of this study was to quantify surgical site infection (SSI) rates after cranial neurosurgery in a tertiary care hospital, identify risk factors for SSI, and evaluate the impact of standardized surveillance and an infection prevention bundle (IPB).METHODSThe authors compared SSI rates during 7 months before and after the intervention. The IPB included standardized patient preparation, perioperative antibiotic/antiseptic use, barrier precautions, coaching of surgeons, and the implementation of a specialized technical operation assistant team.RESULTSThree hundred twenty-two unselected consecutive patients were evaluated before the IPB, and 296 were evaluated after implementation. Infection rates after 1 year decreased from 7.8% (25/322) to 3.7% (11/296, p = 0.03) with similar mortality rates (14.7% vs 13.8%, p = 0.8). The isolated bacteria included Staphylococcus aureus (42%), Cutibacterium acnes (22%), and coagulase-negative staphylococci (14%). Organ/space infections dominated with 67%, and mostly consisted of subdural empyema and meningitis/ventriculitis. Among the 36 SSIs, 13 (36%) occurred during hospitalization, and 29 (81%) within the first 3 months of follow-up. In multivariable analysis including established risk factors described in the literature, non-CNS neoplasia (odds ratio [OR] 3.82, 95% confidence interval [CI] 1.39–10.53), postoperative bleeding (OR 4.09, 1.44–11.62), operations performed by or under supervision of a senior faculty surgeon (OR 0.38, 0.17–0.84), and operations performed after the implementation of standardized surveillance and an IPB (OR 0.38, 0.17–0.85) significantly influenced the infection rate.CONCLUSIONSThe introduction of an IPB combined with routine surveillance and personal feedback was associated with a 53% reduced infection rate. The lower infection rates of senior faculty and the strong association between postoperative bleeding and infection underline the importance of both surgical experience as well as thorough supervision and coaching of younger surgeons.
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Affiliation(s)
| | | | - Beate Mueller
- Departments of 1Infectious Diseases and Hospital Hygiene,
| | | | | | - Evelin Bucheli
- Departments of 1Infectious Diseases and Hospital Hygiene,
| | - Anna Conen
- Departments of 1Infectious Diseases and Hospital Hygiene,
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Bazzi M, Bergbom I, Hellström M, Fridh I, Ahlberg K, Lundgren SM. Team composition and staff roles in a hybrid operating room: A prospective study using video observations. Nurs Open 2019; 6:1245-1253. [PMID: 31367451 PMCID: PMC6650673 DOI: 10.1002/nop2.327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/03/2019] [Accepted: 05/21/2019] [Indexed: 11/24/2022] Open
Abstract
AIM The aim of the study was to evaluate team composition and staff roles in a hybrid operating room during endovascular aortic repairs. DESIGN Quantitative descriptive design. METHODS Nine endovascular aortic repairs procedures were video-recorded between December 2014 and September 2015. The data analysis involved examining the work process, number of people in the room and categories of staff and their involvement in the procedure. RESULTS The procedures were divided into four phases. The hybrid operating room was most crowded in phase 3 when the skin wound was open. Some staff categories were in the room for the entire procedure even if they were not actively involved. The largest number of people simultaneously in the room was 14.
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Affiliation(s)
- May Bazzi
- Institute of Health and Care SciencesSahlgrenska Academy at Gothenburg UniversityGothenburgSweden
| | - Ingegerd Bergbom
- Institute of Health and Care SciencesSahlgrenska Academy at Gothenburg UniversityGothenburgSweden
| | - Mikael Hellström
- Department of Radiology, Sahlgrenska University Hospital and Sahlgrenska AcademyGothenburg UniversityGothenburgSweden
| | - Isabell Fridh
- Faculty of Caring Sciences, Work Life & Social WelfareUniversity of BoråsBoråsSweden
| | - Karin Ahlberg
- Institute of Health and Care SciencesSahlgrenska Academy at Gothenburg UniversityGothenburgSweden
| | - Solveig M. Lundgren
- Institute of Health and Care SciencesSahlgrenska Academy at Gothenburg UniversityGothenburgSweden
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Birgand G, Haudebourg T, Grammatico-Guillon L, Ferrand L, Moret L, Gouin F, Mauduit N, Leux C, Le Manach Y, Lepelletier D, Tavernier E, Lucet JC, Giraudeau B. Improvement in staff behavior during surgical procedures to prevent post-operative complications (ARIBO 2): study protocol for a cluster randomised trial. Trials 2019; 20:275. [PMID: 31109343 PMCID: PMC6528209 DOI: 10.1186/s13063-019-3370-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/16/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Inappropriate staff behaviour during surgical procedures may disrupt the surgical performance and compromise patient safety. We developed an innovative monitoring and feedback system combined with an adaptive approach to optimise staff behaviour intraoperatively and prevent post-operative complications (POC) in orthopaedic surgery. METHODS/DESIGN This protocol describes a parallel-group, cluster randomised, controlled trial with orthopaedic centre as the unit of randomisation. The intervention period will last 6 months and will be based on the monitoring of two surrogates of staff behaviour: the frequency of doors opening and the level of noise. Both will be collected from incision to wound closure, using wireless sensors and sonometers, and recorded and analysed on a dedicated platform (Livepulse®). Staff from centres randomised to the intervention arm will be informed in real time on their own data through an interactive dashboard available in each operating room (OR), and a posteriori for hip and knee replacement POC. Aggregated data from all centres will also be displayed for benchmarking. A lean method will be applied in each centre by a local multidisciplinary team to analyse baseline situations, determine the target condition, analyse the root cause(s), and take countermeasures. The education and awareness of participants on the impact of their behaviour on patient safety will assist the quality improvement process. The control centres will be blinded to monitoring data and quality improvement approaches. The primary outcome will be any POC occurring during the 30 days post operation. We will evaluate this outcome using local and national routinely collected data from hospital discharge and disease databases. Thirty orthopaedic centres will be randomised for a total of 9945 hip and knee replacement surgical procedures. DISCUSSION The field of human factors and behaviour in the OR seems to offer potential room for improvement. An intervention providing goal-setting, monitoring, feedback and action planning may reduce the traffic flow and interruptions/distractions of the surgical team during procedures, preventing subsequent POCs. The results of this trial will provide important data on the impact of OR staff behaviour on patient safety, and promote best practice during surgical procedures. TRIAL REGISTRATION ClinicalTrials.gov, NCT03158181 .
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Affiliation(s)
- Gabriel Birgand
- CPias Pays de la Loire, Nantes University Hospital, CHU - Le Tourville, 5, rue du Pr Yves Boquien, 44093, Nantes, cedex, France. .,Health Protection Research Unit, Imperial College London, London, UK.
| | - Thomas Haudebourg
- CPias Pays de la Loire, Nantes University Hospital, CHU - Le Tourville, 5, rue du Pr Yves Boquien, 44093, Nantes, cedex, France
| | - Leslie Grammatico-Guillon
- Service de Santé Publique, Unité Régionale d'épidémiologie Hospitalière, CHU, Université de Tours, Tours, France
| | - Léa Ferrand
- Direction de la Recherche Clinique, Nantes University Hospital, Nantes, France
| | - Leila Moret
- Service de Santé Publique, Nantes University Hospital, Nantes, France
| | - François Gouin
- Service de Chirurgie Orthopédique, Nantes University Hospital, Nantes, France
| | - Nicolas Mauduit
- Service D'information Médicale, Nantes University Hospital, Nantes, France
| | - Christophe Leux
- Service D'information Médicale, Nantes University Hospital, Nantes, France
| | - Yannick Le Manach
- Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada
| | | | - Elsa Tavernier
- INSERM CIC 1415, CHRU de Tours, Tours, France.,Université de Tours, Université de Nantes, INSERM SPHERE U1246, Tours, France
| | - Jean-Christophe Lucet
- Unité d'hygiène et de lutte Contre L'infection Nosocomiale (UHLIN), AP-HP, Paris, France
| | - Bruno Giraudeau
- INSERM CIC 1415, CHRU de Tours, Tours, France.,Université de Tours, Université de Nantes, INSERM SPHERE U1246, Tours, France
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Azevedo-Coste C, Pissard-Gibollet R, Toupet G, Fleury É, Lucet JC, Birgand G. Tracking Clinical Staff Behaviors in an Operating Room. SENSORS 2019; 19:s19102287. [PMID: 31108975 PMCID: PMC6567358 DOI: 10.3390/s19102287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/07/2019] [Accepted: 05/13/2019] [Indexed: 11/24/2022]
Abstract
Inadequate staff behaviors in an operating room (OR) may lead to environmental contamination and increase the risk of surgical site infection. In order to assess this statement objectively, we have developed an approach to analyze OR staff behaviors using a motion tracking system. The present article introduces a solution for the assessment of individual displacements in the OR by: (1) detecting human presence and quantifying movements using a motion capture (MOCAP) system and (2) observing doors’ movements by means of a wireless network of inertial sensors fixed on the doors and synchronized with the MOCAP system. The system was used in eight health care facilities sites during 30 cardiac and orthopedic surgery interventions. A total of 119 h of data were recorded and analyzed. Three hundred thirty four individual displacements were reconstructed. On average, only 10.6% individual positions could not be reconstructed and were considered undetermined, i.e., the presence in the room of the corresponding staff member could not be determined. The article presents the hardware and software developed together with the obtained reconstruction performances.
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Affiliation(s)
- Christine Azevedo-Coste
- Institut National de Recherche en Informatique et en Automatique (INRIA), Université de Montpellier, 34095 Montpellier, France.
| | - Roger Pissard-Gibollet
- Institut National de Recherche en Informatique et en Automatique (INRIA), Grenoble Rhône-Alpes, 38330 Montbonnot, France.
| | - Gaelle Toupet
- APHP Bichat University Hospital, Infection Control Unit, 75018 Paris, France.
| | - Éric Fleury
- Institut National de Recherche en Informatique et en Automatique (INRIA), Grenoble Rhône-Alpes, 38330 Montbonnot, France.
| | - Jean-Christophe Lucet
- APHP Bichat University Hospital, Infection Control Unit, 75018 Paris, France.
- Institute for Medical Research (INSERM), Infection Antimicrobials Modelling Evolution laboratory (IAME UMR 1137), 75018 Paris, France.
- Universities Paris Diderot, Infection Antimicrobials Modelling Evolution laboratory (IAME UMR 1137), Sorbonne Paris Cité, 75018 Paris, France.
| | - Gabriel Birgand
- APHP Bichat University Hospital, Infection Control Unit, 75018 Paris, France.
- Institute for Medical Research (INSERM), Infection Antimicrobials Modelling Evolution laboratory (IAME UMR 1137), 75018 Paris, France.
- Universities Paris Diderot, Infection Antimicrobials Modelling Evolution laboratory (IAME UMR 1137), Sorbonne Paris Cité, 75018 Paris, France.
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Motion-capture system to assess intraoperative staff movements and door openings: Impact on surrogates of the infectious risk in surgery. Infect Control Hosp Epidemiol 2019; 40:566-573. [PMID: 30857569 DOI: 10.1017/ice.2019.35] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We longitudinally observed and assessed the impact of the operating room (OR) staff movements and door openings on surrogates of the exogenous infectious risk using a new technology system. DESIGN AND SETTING This multicenter observational study included 13 ORs from 10 hospitals, performing planned cardiac and orthopedic surgery (total hip or knee replacement). Door openings during the surgical procedure were obtained from data collected by inertial sensors fixed on the doors. Intraoperative staff movements were captured by a network of 8 infrared cameras. For each surgical procedure, 3 microbiological air counts, longitudinal particles counts, and 1 bacteriological sample of the wound before skin closure were performed. Statistics were performed using a linear mixed model for longitudinal data. RESULTS We included 34 orthopedic and 25 cardiac procedures. The median frequency of door openings from incision to closure was independently associated with an increased log10 0.3 µm particle (ß, 0.03; standard deviation [SD], 0.01; P = .01) and air microbial count (ß, 0.07; SD, 0.03; P = .03) but was not significantly correlated with the wound contamination before closure (r = 0.13; P = .32). The number of persons (ß, -0.08; SD, 0.03; P < .01), and the cumulated movements by the surgical team (ß, 0.0004; SD, 0.0005; P < .01) were associated with log10 0.3 µm particle counts. CONCLUSIONS This study has demonstrated a previously missing association between intraoperative staff movements and surrogates of the exogenous risk of surgical site infection. Restriction of staff movements and door openings should be considered for the control of the intraoperative exogenous infectious risk.
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Alizo G, Onayemi A, Sciarretta JD, Davis JM. Operating Room Foot Traffic: A Risk Factor for Surgical Site Infections. Surg Infect (Larchmt) 2019; 20:146-150. [DOI: 10.1089/sur.2018.248] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Georgina Alizo
- Grand Strand Medical Center, Myrtle Beach, South Carolina
| | - Ayolola Onayemi
- Palisades Medical Center, Hackensack University Medical Center, North Bergen, New Jersey
| | | | - John Mihran Davis
- Palisades Medical Center, Hackensack University Medical Center, North Bergen, New Jersey
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DiBartola AC, Barron C, Smith S, Quatman-Yates C, Chaudhari AMW, Scharschmidt TJ, Moffatt-Bruce SD, Quatman CE. Decreasing Room Traffic in Orthopedic Surgery: A Quality Improvement Initiative. Am J Med Qual 2019; 34:561-568. [PMID: 30654622 DOI: 10.1177/1062860618821180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Operating room (OR) traffic and door openings increase potential for air contamination in the OR and create distractions for surgical teams. A multidisciplinary intervention was developed among OR staff, surgical staff, vendors, radiology, and anesthesia and approved by the hospital system's patient and quality safety department for implementation. Interventions included education, OR signage, and team-based accountability and behavioral interventions. After interventions were implemented, a second prospective, observational data collection was performed and compared to preintervention OR traffic. A total of 35 cases were observed over the 3-month period in the preintervention group; 42 cases were observed in the postintervention group. Average door openings per minute decreased by 22% (P = .0011) after intervention. All surgical groups excluding anesthesia had significant reductions in OR traffic following the intervention. Behavioral interventions that focus on education, awareness, and efficiency strategies can decrease overall OR traffic for orthopedic cases.
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Affiliation(s)
| | | | - Scott Smith
- The Ohio State University College of Medicine, Columbus, OH
| | | | | | - Thomas J Scharschmidt
- The Ohio State University, Wexner Medical Center, Columbus, OH.,The Ohio State University College of Medicine, Columbus, OH
| | - Susan D Moffatt-Bruce
- The Ohio State University, Wexner Medical Center, Columbus, OH.,The Ohio State University College of Medicine, Columbus, OH
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da Silva LL, Almeida AGCDS, Possari JF, Poveda VDB. Forced Air Warming System: Evaluation of Internal System Contamination. Surg Infect (Larchmt) 2019; 20:215-218. [PMID: 30653405 DOI: 10.1089/sur.2018.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Despite the indisputable need to prevent peri-operative hypothermia, some evidence in the literature questions the possible role of forced air warming systems as a risk factor for the occurrence of surgical site infection. The objective of the study is to evaluate the micro-biologic safety of a forced air warming systems (FAW) in relation to the risk of emission of micro-organisms in the surgical environment. METHODS A quantitative, descriptive-exploratory laboratory study performed in a large hospital. An evaluation of possible internal contamination was performed by collecting air from the hose onto plates containing Trypticase Soy Agar. The experiment was performed in triplicate two months after replacing the filter and again after six months using a random sample of 50% of the FAW in use, which corresponded to 13 FAW and a total of 75 samples. RESULTS Among the 39 samples analyzed in the first stage, only nine (23.1%) plates presented microbial growth of one or two colonies, while only six (16.7%) plates of the 36 evaluated samples in the second phase had growth of one or two colonies. CONCLUSIONS This study showed small microbial growth of culture after 48 hours after filter replacement. New investigations that correlate the findings of micro-biology analysis and the occurrence of surgical site infection should be conducted.
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Scholz R, Hönning A, Seifert J, Spranger N, Stengel D. Effectiveness of architectural separation of septic and aseptic operating theatres for improving process quality and patient outcomes: a systematic review. Syst Rev 2019; 8:16. [PMID: 30626433 PMCID: PMC6325836 DOI: 10.1186/s13643-018-0937-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Architectural division of aseptic and septic operating theatres is a distinct structural feature of surgical departments in Germany. Internationally, hygienists and microbiologists mainly recommend functional separation (i.e. aseptic procedures first) without calling for separate operating floors and rooms. However, patients with severe musculoskeletal infections (e.g. joint empyema, spondylodiscitis, deep implant-associated infections) may benefit from the permanent availability of septic operating capacities without delay caused by an ongoing aseptic surgical program. A systematic literature review on the influence of a structural separation of septic and aseptic operating theatres on process and/or outcome quality has not yet been conducted. METHODS Systematic literature search in PubMed MEDLINE, Ovid Embase, CINAHL and the Cochrane Library, screening of referenced citations, and assessment of grey literature. RESULTS A total of 572 articles were found through the systematic literature search. No head-to-head studies (neither randomised, quasi-randomised nor observational) were identified which examined the impact of structural separation of septic and aseptic operating theatres on process and/or outcome quality. CONCLUSIONS This review did not identify evidence in favour nor against architectural separation of septic or aseptic operating theatre. Specifically, there is no evidence of a harmful effect of architectural separation. Unless prospective studies, ideally randomised trials, will be available, it is unjustified to call for abolishing established hospital structures. Future investigations must address patient-centered endpoints, surgical site infections, process quality and hospital economy. SYSTEMATIC REVIEW REGISTRATION PROSPERO (International prospective register of systematic reviews): CRD42018086568.
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Affiliation(s)
- Romy Scholz
- Centre for Clinical Research, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Alexander Hönning
- Centre for Clinical Research, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Julia Seifert
- Department of Trauma and Orthopaedic Surgery, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Nikolai Spranger
- Department of Trauma and Orthopaedic Surgery, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Dirk Stengel
- Centre for Clinical Research, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
- Department of Trauma and Orthopaedic Surgery, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
- Hospital Group of the Statutory Accident Insurance, Berlin, Germany
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Brown C, Owen SLF. An exploration on the relationship between traffic flow and the rate of surgical site infections: A literature review. J Perioper Pract 2018; 29:135-139. [PMID: 30565521 DOI: 10.1177/1750458918815550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Surgical site infections are the second most frequent type of health-care associated infections in Europe and America. Public Health England's data on 139,691 operations at 209 hospitals reported 1,635 surgical site infections between April 2012 and March 2017. Patients with a surgical site infection are twice as likely to die, five times more likely to be readmitted after discharge and are likely to have a prolonged hospitalization. Therefore, it is still a significant issue that professionals need to help reduce. This literature review looks at ventilation within theatres and how traffic flow can affect the air flow and if it can increase the incidence rates of surgical site infections. Recommendations of strategies are made to help reduce traffic flow within operating theatres.
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Affiliation(s)
- Claire Brown
- 1 Operating Department Practitioner, Gloucester Royal Hospital, Gloucester
| | - Sara L F Owen
- 2 Department of Allied Health and Professional Development, Oxford Brookes University, Oxford
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Staple versus suture closure for ankle fracture fixation: Retrospective chart review for safety and outcomes. Foot (Edinb) 2018; 37:71-76. [PMID: 30326415 DOI: 10.1016/j.foot.2018.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/25/2018] [Accepted: 08/17/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION/AIM Recent comparisons of suture versus metal staple skin closure on the rates of wound complications in orthopaedic surgeries have yielded conflicting results. Several studies have since started to approach this question based on anatomic location, comparing suture versus staple closure in total hip and knee arthroplasty and acetabulum fracture surgery. Ankle fractures are one of the most commonly treated fractures by orthopaedic surgeons with unique challenges to skin closure due to the lack of subcutaneous support. However, to date there are no studies comparing superficial skin closure methods specifically in ankle surgery. The objective of this study was to evaluate the safety of staple versus suture closure for open fixation of acute traumatic ankle fractures. METHODS The medical records of patients treated at one institution by a single surgeon with open surgical fixation of an acute traumatic ankle fracture between 2011 and 2017 were retrospectively reviewed. Patients with less than 6 months of follow-up, polytrauma patients, diabetic patients, and patients with more than 3 medical comorbidities were excluded. Skin closure technique was determined by the presence or absence of metallic staples on postoperative imaging. Demographic variables, surgical characteristics, and postoperative outcomes up to one year were compared between patients who received superficial skin closure using staple versus suture techniques. Statistical analysis was performed using chi-squared tests and Fisher's exact tests, with p=0.05 used to denote statistical significance. RESULTS This study included 94 patients aged 18 to 75: two groups of 47 patients (Staple group and Suture group) that were demographically similar at baseline. Overweight and obese patients constituted the majority of the sample, 34% and 46% of patients, respectively. Current tobacco use was reported by 45% of patients. Fractures tended to be right-sided (63%), low energy (64%), and closed (98%), and the most common fracture types were bimalleolar (30%), lateral malleolar (24%), and pilon (19%) fractures. Ten patients (10.6%) developed local wound related complications within 4 months postoperatively, including five incidences of wound dehiscence, four superficial wound infections, and one deep infection. Eight patients (8.5%) required revision surgery due to wound related complications. There was no difference in the incidence of surgical site infections (p=0.361), local wound related complications (p=0.316), or revision surgeries (p=0.267) between wound closure techniques. Suture group patients required more staff in the operating room compared with staple group patients (p=0.001). CONCLUSION These results suggest that staples are a safe alternative to sutures for superficial skin closure in healthy, non-diabetic patients following open surgical fixation of acute traumatic ankle fractures. However, this retrospective, single-institution study was limited by the low number of available patients relative to the rare outcomes of interest. Larger, prospective studies are needed to validate the accuracy and generalizability of these results.
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Armellino D, Dowling O, Newman SB, Schwarz RB, Jacobs M, Cifu-Tursellino K, Di Capua JF. Remote Video Auditing to Verify OR Cleaning: A Quality Improvement Project. AORN J 2018; 108:634-642. [PMID: 30480793 DOI: 10.1002/aorn.12426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
There are many sources of contamination in the perioperative environment. Patient experience can be negatively affected by the presence of environmental contamination, especially if it is the cause of a surgical site infection. Perioperative and environmental services staff members and leaders are tasked with ensuring a clean and safe environment for their patients while maintaining an awareness of time and budgetary constraints. In addition, leaders are responsible for the competency of their staff members and must address performance issues when needed. New technological advances designed to streamline monitoring and reporting processes related to OR cleanliness are available for use. This article describes the quality improvement project that one multifacility organization completed related to the use of remote video auditing and the positive effect it had on the organization's environmental contamination.
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The Influence of Traffic, Area Location, and Other Factors on Operating Room Microbial Load. Infect Control Hosp Epidemiol 2018; 39:391-397. [DOI: 10.1017/ice.2017.323] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVETo 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.DESIGNObservation and sampling study.SETTINGAcademic health center, public hospital.METHODSWe 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.RESULTSThe 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.CONCLUSIONSMovement 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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Surveillance of Environmental and Procedural Measures of Infection Control in the Operating Theatre Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 15:ijerph15010046. [PMID: 29283367 PMCID: PMC5800145 DOI: 10.3390/ijerph15010046] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/19/2017] [Accepted: 12/27/2017] [Indexed: 12/22/2022]
Abstract
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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Stauning MT, Bediako-Bowan A, Andersen LP, Opintan JA, Labi AK, Kurtzhals JAL, Bjerrum S. Traffic flow and microbial air contamination in operating rooms at a major teaching hospital in Ghana. J Hosp Infect 2017; 99:263-270. [PMID: 29253624 DOI: 10.1016/j.jhin.2017.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Current literature examining the relationship between door-opening rate, number of people present, and microbial air contamination in the operating room is limited. Studies are especially needed from low- and middle-income countries, where the risk of surgical site infections is high. AIM To assess microbial air contamination in operating rooms at a Ghanaian teaching hospital and the association with door-openings and number of people present. Moreover, we aimed to document reasons for door-opening. METHODS We conducted active air-sampling using an MAS 100® portable impactor during 124 clean or clean-contaminated elective surgical procedures. The number of people present, door-opening rate and the reasons for each door-opening were recorded by direct observation using pretested structured observation forms. FINDINGS During surgery, the mean number of colony-forming units (cfu) was 328 cfu/m3 air, and 429 (84%) of 510 samples exceeded a recommended level of 180 cfu/m3. Of 6717 door-openings recorded, 77% were considered unnecessary. Levels of cfu/m3 were strongly correlated with the number of people present (P = 0.001) and with the number of door-openings/h (P = 0.02). In empty operating rooms, the mean cfu count was 39 cfu/m3 after 1 h of uninterrupted ventilation and 52 (51%) of 102 samples exceeded a recommended level of 35 cfu/m3. CONCLUSION The study revealed high values of intraoperative airborne cfu exceeding recommended levels. Minimizing the number of door-openings and people present during surgery could be an effective strategy to reduce microbial air contamination in low- and middle-income settings.
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Affiliation(s)
- M T Stauning
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Bediako-Bowan
- Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana; Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - L P Andersen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J A Opintan
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - A-K Labi
- Department of Microbiology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - J A L Kurtzhals
- Centre for Medical Parasitology, Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.
| | - S Bjerrum
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Global Health Section, Department of Public Health, University of Copenhagen, Denmark
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Minimizing Sources of Airborne, Aerosolized, and Contact Contaminants in the OR Environment. AORN J 2017; 106:494-501. [DOI: 10.1016/j.aorn.2017.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 12/17/2022]
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Wathen C, Kshettry VR, Krishnaney A, Gordon SM, Fraser T, Benzel EC, Modic MT, Butler S, Machado AG. The Association Between Operating Room Personnel and Turnover With Surgical Site Infection in More Than 12 000 Neurosurgical Cases. Neurosurgery 2017; 79:889-894. [PMID: 27465846 DOI: 10.1227/neu.0000000000001357] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Surgical site infection (SSI) contributes significantly to postoperative morbidity and mortality and greatly increases the cost of care. OBJECTIVE To identify the impact of workflow and personnel-related risk factors contributing to the incidence of SSIs in a large sample of neurological surgeries. METHODS Data were obtained using an enterprisewide electronic health record system, operating room, and anesthesia records for neurological procedures conducted between January 1, 2009, and November 30, 2012. SSI data were obtained from prospective surveillance by infection preventionists using Centers for Disease Control and Prevention definitions. A multivariate model was constructed and refined using backward elimination logistic regression methods. RESULTS The analysis included 12 528 procedures. Most cases were elective (94.5%), and the average procedure length was 4.8 hours. The average number of people present in the operating room at any time during the procedure was 10.0. The overall infection rate was 2.3%. Patient body mass index (odds ratio, 1.03; 95% confidence interval [CI], 1.01-1.04) and sex (odds ratio, 1.36; 95% CI, 1.07-1.72) as well as procedure length (odds ratio, 1.19 per additional hour; 95% CI, 1.15-1.23) and nursing staff turnovers (odds ratio, 1.095 per additional turnover; 95% CI, 1.02-1.21) were significantly correlated with the risk of SSI. CONCLUSION This study found that patient body mass index and male sex were associated with an increased risk of SSI. Operating room personnel turnover, a modifiable, work flow-related factor, was an independent variable positively correlated with SSI. This study suggests that efforts to reduce operating room turnover may be effective in preventing SSI. ABBREVIATIONS OR, operating roomSSI, surgical site infection.
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Affiliation(s)
- Connor Wathen
- ‡Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio; §Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; ¶Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; ‖Infectious Diseases Department, Medicine Institute, Cleveland Clinic, Cleveland, Ohio; #Neurological Institute, Cleveland Clinic, Cleveland, Ohio; **Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; ‡‡Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Bartek M, Verdial F, Dellinger EP. Naked Surgeons? The Debate About What to Wear in the Operating Room. Clin Infect Dis 2017; 65:1589-1592. [PMID: 28575168 PMCID: PMC5850458 DOI: 10.1093/cid/cix498] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 05/23/2017] [Indexed: 11/12/2022] Open
Abstract
There has been recent controversy regarding recommendations and regulations concerning operating room attire. We performed a nonsystematic literature search regarding operating room attire and surgical site infection (SSI) risk. Much of the literature relies on air sampling and culture of operating room equipment but does not present evidence regarding effect on SSI risk. There is no evidence regarding SSI risk related to operating room attire except for sterile gowns and the use of gloves. Naked surgeons shed fewer bacteria into the operating room environment than ones wearing scrub suits.
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Affiliation(s)
- Matthew Bartek
- Department of Surgery, University of Washington, Seattle
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Cracking the case: should orthopaedic case carts be subjected to more stringent regulations? CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prevention of fracture-related infection: a multidisciplinary care package. INTERNATIONAL ORTHOPAEDICS 2017; 41:2457-2469. [DOI: 10.1007/s00264-017-3607-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 08/08/2017] [Indexed: 01/25/2023]
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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. J Hosp Infect 2017; 96:281-285. [DOI: 10.1016/j.jhin.2017.03.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/23/2017] [Indexed: 11/23/2022]
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Operating room team member role affects room traffic in orthopaedic surgery: a prospective observational study. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ploegmakers IBM, Olde Damink SWM, Breukink SO. Alternatives to antibiotics for prevention of surgical infection. Br J Surg 2017; 104:e24-e33. [PMID: 28121034 DOI: 10.1002/bjs.10426] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/29/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Surgical-site infection (SSI) is still the second most common healthcare-associated infection, after respiratory tract infection. SSIs are associated with higher morbidity and mortality rates, and result in enormous healthcare costs. In the past decade, several guidelines have been developed that aim to reduce the incidence of SSI. Unfortunately, there is no consensus amongst the guidelines, and some are already outdated. This review discusses the recent literature regarding alternatives to antibiotics for prevention of SSI. METHODS A literature search of PubMed/MEDLINE was performed to retrieve data on the prevention of SSI. The focus was on literature published in the past decade. RESULTS Prevention of SSI can be divided into preoperative, perioperative and postoperative measures. Preoperative measures consist of showering, surgical scrubbing and cleansing of the operation area with antiseptics. Perioperative factors can be subdivided as: environmental factors, such as surgical attire; patient-related factors, such as plasma glucose control; and surgical factors, such as the duration and invasiveness of surgery. Postoperative measures consist mainly of wound care. CONCLUSION There is a general lack of evidence on the preventive effectiveness of perioperative measures to reduce the incidence of SSI. Most measures are based on common practice and perceived effectiveness. The lack of clinical evidence, together with the stability of the high incidence of SSI (10 per cent for colorectal procedures) in recent decades, highlights the need for future research.
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Affiliation(s)
- I B M Ploegmakers
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - S W M Olde Damink
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, University College London, London, UK
| | - S O Breukink
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
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