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Egerci OF, Yapar A, Dogruoz F, Selcuk H, Kose O. Preventive strategies to reduce the rate of periprosthetic infections in total joint arthroplasty; a comprehensive review. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05301-w. [PMID: 38635048 DOI: 10.1007/s00402-024-05301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
The increasing frequency of total hip (THA) and knee arthroplasties (TKA) is marred by the rise in periprosthetic joint infections (PJIs) and surgical site infections (SSIs), with PJIs incurring costs over $1.62 billion as of 2020 and individual case management averaging $90,000. SSIs additionally burden the U.S. healthcare economy with billions in expenses annually. PJI prevalence in primary THA and TKA ranges from 0.5% to 2.4%, spiking to 20% in revisions and representing 25% of TKA revision causes. Projections estimate up to 270,000 annual PJI cases by 2030. Often caused by gram-positive bacteria, particularly methicillin-resistant staphylococci, these infections demand preventive measures. This review dissects PJI prevention across preoperative, intraoperative, and perioperative phases, aligning with evidence-based CDC and WHO guidelines. Preoperative measures include managing diabetes, obesity, tobacco use, Staphylococcus aureus screening and nasal decolonization, nutritional optimization, and management of inflammatory arthropathies. Intraoperatively, antibiotic prophylaxis, skin preparation, operative room environmental controls, surgical technique precision, and irrigation options are scrutinized. Perioperative concerns focus on anticoagulation, blood management, and infection risk mitigation. Integrating these strategies promotes a patient-centric care model, aiming to reduce PJI incidence, improve patient outcomes, and increase care cost-effectiveness in joint arthroplasty.
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Affiliation(s)
- Omer Faruk Egerci
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Aliekber Yapar
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Fırat Dogruoz
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Huseyin Selcuk
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey.
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Mihandoust S, Joseph A, Colman N. Identifying Built Environment Risk Factors to Provider Workflow and Patient Safety Using Simulation-Based Evaluation of a Pediatric ICU Room. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:92-111. [PMID: 37702324 DOI: 10.1177/19375867231194329] [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: 09/14/2023]
Abstract
OBJECTIVE This study aimed to identify latent conditions in a pediatric intensive care unit (PICU) by analyzing characteristics of flow disruptions (FD) during a simulation of a three-phased scenario. BACKGROUND The built environment of healthcare facilities contributes to FD that can lead to clinical errors and patient harm. In the facility design process, there is an opportunity to identify built environment features that cause FD and pose safety risks. Simulation-based evaluation of proposed designs may help in identifying and mitigating safety concerns before construction and occupancy. METHODOLOGY During design development for a new 400-bed children's hospital, a series of simulations were conducted using physical mock-ups in a large warehouse. A three-phased scenario, (1) admission and intubation, (2) cardiac arrest, and (3) bedside surgery involving a cannulation to extracorporeal membrane oxygenation, was conducted in a PICU room mock-up. Each scenario was video recorded from four angles. The videos were systematically coded to identify FD. RESULTS Analysis identified FDs in three ICU zones: respiratory therapists (RT) zone, nurse zone, and head of the patient. Challenges in these zones were related to spatial constraints in the RT zone and head of the bed, equipment positioning in the RT zone and nurse zone, and impeded visibility related to the location of the boom monitor in the nurse zone. CONCLUSION Simulation-based evaluation of prototypes of patient care spaces can help identify characteristics of minor and major FD related to the built environment and can provide valuable information to inform the iterative design process.
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Affiliation(s)
- Sahar Mihandoust
- College of Architecture, Arts and Humanities, Clemson University, SC, USA
| | - Anjali Joseph
- College of Architecture, Arts and Humanities, Clemson University, SC, USA
| | - Nora Colman
- Division of Pediatric Critical Care, Department of Pediatrics, Children's Healthcare of Atlanta, GA, USA
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Nooh A, Tanzer M, Alzeedi M, Lavoie-Turcotte T, Hart A. Traffic Cameras-An Effective and Sustainable Method of Reducing Traffic and Airborne Particles During Arthroplasty Surgery. J Arthroplasty 2024; 39:255-260. [PMID: 37295618 DOI: 10.1016/j.arth.2023.05.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Traffic in the operating room (OR) create turbulence and contaminates air by bacterial shedding. Therefore, we examined: (1) if the number and duration of door openings were associated with increased particles during arthroplasty surgery; (2) if traffic cameras installed in the operating room were an effective intervention to decrease traffic and particles during arthroplasty surgery; and (3) the effectiveness of traffic camera over time. METHODS Fifty cases were included between November 3, 2021, and June 22, 2022, with 25 cases in each group. Two particle counters were used to count particles sized 0.5 to 10 µm. One counter was positioned within the sterile field, and another between the OR doors. Two door counters were mounted to count door openings. For the intervention, traffic cameras were mounted facing each door and took snapshots with door openings. RESULTS The number of door openings/minute was 30% less in the Intervention group (P < .001). The Intervention group had significantly lower particles by 26 to 43% in the operative field (0.5 μm, P = .01; 0.7 μm, P = .008; 1 μm, P = .007; 2.5 μm, P = .006; 5 μm, P = .01; and 10 μm, P = .01). The particles between the OR doors were decreased by 2 to 42% in the Intervention group and the difference was significant for (0.5 μm, P = 0.03; 0.7 μm, P = .02; and 1 μm, P = .03). The decrease in door openings and particles were sustained over the study period. CONCLUSION The use of traffic cameras was an effective and sustainable method to limit OR traffic and door openings, which resulted in a reduction in particles in the operating room.
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Affiliation(s)
- Anas Nooh
- Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada; Department of Orthopaedic Surgery, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Michael Tanzer
- Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
| | - Muadh Alzeedi
- Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Adam Hart
- Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
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MohammadiGorji S, Joseph A, Mihandoust S, Ahmadshahi S, Allison D, Catchpole K, Neyens D, Abernathy JH. Anesthesia Workspaces for Safe Medication Practices: Design Guidelines. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:64-83. [PMID: 37553817 DOI: 10.1177/19375867231190646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND Studies show that workspace for the anesthesia providers is prone to interruptions and distractions. Anesthesia providers experience difficulties while performing critical medication tasks such as medication preparation and administration due to poor ergonomics and configurations of workspace, equipment clutter, and limited space which ultimately may impact patient safety, length of surgery, and cost of care delivery. Therefore, improving design of anesthesia workspace for supporting safe and efficient medication practices is paramount. OBJECTIVES The objective of this study was to develop a set of evidence-based design guidelines focusing on design of anesthesia workspace to support safer anesthesia medication tasks in operating rooms (ORs). METHODS Data collection was based on literature review, observation, and coding of more than 30 prerecorded videos of outpatient surgical procedures to identify challenges experienced by anesthesia providers while performing medication tasks. Guidelines were then reviewed and validated using short survey. RESULTS Findings are summarized into seven evidence-based design guidelines, including (1) locate critical tasks within a primary field of vision, (2) eliminate travel into and through the anesthesia zone (for other staff), (3) identify and demarcate a distinct anesthesia zone with adequate space for the anesthesia provider, (4) optimize the ability to reposition/reconfigure the anesthesia workspace, (5) minimize clutter from equipment, (6) provide adequate and appropriately positioned surfaces for medication preparation and administration, and (7) optimize task and surface lighting. CONCLUSION This study finds many areas for improving design of ORs. Improvements of anesthesia work area will call for contribution and cooperation of entire surgical team.
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Affiliation(s)
- Soheyla MohammadiGorji
- Interior Design, FINA, College of Health & Social Sciences, San Francisco State University, CA, USA
| | - Anjali Joseph
- Center for Health Facilities Design and Testing, School of Architecture, College of Architecture, Arts and Humanities, Clemson University, SC, USA
| | - Sahar Mihandoust
- Center for Health Facilities Design and Testing, School of Architecture, College of Architecture, Arts and Humanities, Clemson University, SC, USA
| | - Seyedmohammad Ahmadshahi
- Center for Health Facilities Design and Testing, School of Architecture, College of Architecture, Arts and Humanities, Clemson University, SC, USA
| | - David Allison
- Center for Health Facilities Design and Testing, School of Architecture, College of Architecture, Arts and Humanities, Clemson University, SC, USA
| | - Ken Catchpole
- Center for Health Facilities Design and Testing, School of Architecture, College of Architecture, Arts and Humanities, Clemson University, SC, USA
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - David Neyens
- Department of Industrial Engineering, College of Engineering, Computing and Applied Sciences, Clemson University, SC, USA
| | - James H Abernathy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
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Humphreys H, Bak A, Ridgway E, Wilson APR, Vos MC, Woodhead K, Haill C, Xuereb D, Walker JM, Bostock J, Marsden GL, Pinkney T, Kumar R, Hoffman PN. Rituals and behaviours in the operating theatre - joint guidelines of the Healthcare Infection Society and the European Society of Clinical Microbiology and Infectious Diseases. J Hosp Infect 2023; 140:165.e1-165.e28. [PMID: 37454912 DOI: 10.1016/j.jhin.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/05/2023] [Accepted: 06/11/2023] [Indexed: 07/18/2023]
Affiliation(s)
- H Humphreys
- Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland; Healthcare Infection Society, London, UK; ESCMID Study Group for Nosocomial Infection, Basel, Switzerland.
| | - A Bak
- Healthcare Infection Society, London, UK
| | - E Ridgway
- Healthcare Infection Society, London, UK
| | - A P R Wilson
- Healthcare Infection Society, London, UK; University College London Hospitals, London, UK
| | - M C Vos
- ESCMID Study Group for Nosocomial Infection, Basel, Switzerland; Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - K Woodhead
- Association for Perioperative Practice, Harrogate, UK; Royal College of Nursing, London, UK
| | - C Haill
- Healthcare Infection Society, London, UK
| | - D Xuereb
- Infection Prevention Society, Seafield, UK
| | - J M Walker
- Healthcare Infection Society, London, UK; NHS Grampian, Greater Aberdeen, UK
| | - J Bostock
- Lay Member for Healthcare Infection Society, London, UK
| | - G L Marsden
- Healthcare Infection Society, London, UK; Royal College of General Practitioners, London, UK
| | - T Pinkney
- University of Birmingham, Birmingham, UK
| | - R Kumar
- Lay Member for Healthcare Infection Society, London, UK
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Chellam Singh B, Arulappan J. Operating Room Nurses' Understanding of Their Roles and Responsibilities for Patient Care and Safety Measures in Intraoperative Practice. SAGE Open Nurs 2023; 9:23779608231186247. [PMID: 37465651 PMCID: PMC10350747 DOI: 10.1177/23779608231186247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction Surgical care has been a vital part of healthcare services worldwide. Several patient safety measures have been adopted universally in the operating room (OR) before, during, and following surgical procedures. Despite this, errors or near misses still occur. Nurses in the OR have a pivotal role in the identification of factors that may impact patient safety and quality of care. Therefore, exploring the OR nurses' understanding of their roles and responsibilities for patient care and safety in the intraoperative practice, which could lead to optimal patient safety, is essential. Objective This study explored the understanding of OR nurses regarding their roles and responsibilities for patient care and safety measures in the intraoperative practice. Methods The study was conducted in one of the tertiary care hospitals in the United Arab Emirates. Qualitative, descriptive, exploratory research design was utilized. The data were collected using semi-structured face to face interviews. Purposive sampling included eight nurses. Data analysis was performed following Colaizzi's seven-step strategy. Results Seven emerging themes were identified. The main themes are: patient safety, preoperative preparation, standardization of practice, time management, staffing appropriateness, staff education and communication, and support to the patient in the OR. Conclusion OR nurse leaders may take into consideration the current findings as a reference for quality improvement projects in the hospital, considering the specific characteristics of each local setting. Although the participants consider that the environment is safe and the quality of care is high in the study setting, there is still room for improvement on workflows and processes. OR workflow should be improved especially by addressing the potential patient safety issues.
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Affiliation(s)
- Bisma Chellam Singh
- Staff Nurse, Head and Neck Operation Theater, Manchester Royal Infirmary Hospital, Manchester, UK
| | - Judie Arulappan
- Department of Maternal and Child health, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
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Taaffe K, Ferrand YB, Khoshkenar A, Fredendall L, San D, Rosopa P, Joseph A. Operating room design using agent-based simulation to reduce room obstructions. Health Care Manag Sci 2022:10.1007/s10729-022-09622-3. [PMID: 36529790 PMCID: PMC10369668 DOI: 10.1007/s10729-022-09622-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 11/09/2022] [Indexed: 12/23/2022]
Abstract
This study seeks to improve the safety of clinical care provided in operating rooms (OR) by examining how characteristics of both the physical environment and the procedure affect surgical team movement and contacts. We video recorded staff movements during a set of surgical procedures. Then we divided the OR into multiple zones and analyzed the frequency and duration of movement from origin to destination through zones. This data was abstracted into a generalized, agent-based, discrete event simulation model to study how OR size and OR equipment layout affected surgical staff movement and total number of surgical team contacts during a procedure. A full factorial experiment with seven input factors - OR size, OR shape, operating table orientation, circulating nurse (CN) workstation location, team size, number of doors, and procedure type - was conducted. Results were analyzed using multiple linear regression with surgical team contacts as the dependent variable. The OR size, the CN workstation location, and team size significantly affected surgical team contacts. Also, two- and three-way interactions between staff, procedure type, table orientation, and CN workstation location significantly affected contacts. We discuss implications of these findings for OR managers and for future research about designing future ORs.
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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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Cahn J. Planning and Designing Perioperative Areas. AORN J 2022; 116:261-269. [PMID: 36005878 DOI: 10.1002/aorn.13777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/07/2022]
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Buckner L, Lacy J, Young K, Dishman D. Decreasing Foot Traffic in the Orthopedic Operating Room: A Narrative Review of the Literature. J Patient Saf 2022; 18:e414-e423. [PMID: 33871413 DOI: 10.1097/pts.0000000000000833] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Surgical site infections (SSIs) are implicated in poor outcomes in orthopedic surgical patients. Decreasing foot traffic in orthopedic surgical suites is correlated with the reduction of SSI risk. This review aims to understand the background and significance of the problem, isolate factors contributing to the movement in and out of operating rooms, and identify interventions that decrease traffic in procedure areas. METHODS A comprehensive search was completed using the databases Embase and Medline (Ovid). A PICOT question was used in the literature search to evaluate the efficacy of a standardized guideline on operating room door opening frequency. The Mixed Methods Appraisal Tool was used to appraise the literature critically, and conventional content analysis methodology identified themes within the publications. RESULTS The literature search yielded 18 articles providing 3 different themes of evidence: airborne bacterial counts and their association with foot traffic; specific personnel, namely, nurses demonstrating the greatest amount of foot traffic; and interventions aimed at minimizing this foot traffic. CONCLUSIONS Implementing multiple evidence-based interventions can decrease foot traffic and reduce the risk of SSIs in orthopedic patients. Further studies are needed to directly link airborne bacterial counts to SSIs, increase the level of evidence, and isolate interventions.
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Affiliation(s)
- Laura Buckner
- From the University of Texas Health Science Center at Houston, Houston, Texas
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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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Impact of Surgical Table Orientation on Flow Disruptions and Movement Patterns during Pediatric Outpatient Surgeries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158114. [PMID: 34360407 PMCID: PMC8345741 DOI: 10.3390/ijerph18158114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 01/21/2023]
Abstract
(1) Background: The surgical table within a typical ambulatory surgery operating room is frequently rotated and placed in different orientations to facilitate surgery or in response to surgeon preferences. However, different surgical table orientations can impact access to different work zones, areas and equipment in the OR, potentially impacting workflow of surgical team members and creating patient safety risks; (2) Methods: This quantitative observational study used a convenience sample of 38 video recordings of the intraoperative phase of pediatric outpatient surgeries to study the impacts of surgical table orientation on flow disruptions (FDs), number of contacts between team members and distance traveled; (3) Results: This study found that the orientation of the surgical table significantly influenced staff workflow and movement in the OR with an angled surgical table orientation being least disruptive to surgical work. The anesthesia provider, scrub nurse and circulating nurse experienced more FDs compared to the surgeon; (4) Conclusions: The orientation of the surgical table matters, and clinicians and architects must consider different design and operational strategies to support optimal table orientation in the OR.
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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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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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Zeidan A, Abdelgelil HT, Edwin E, Alqarni D. Apple Siri as communication conduit during COVID-19: between inside and outside the OR. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:274-275. [PMID: 35516820 PMCID: PMC8936690 DOI: 10.1136/bmjstel-2020-000740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/18/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Ahed Zeidan
- Anaesthesia, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | | | - Edward Edwin
- Anaesthesia, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Dhafer Alqarni
- Anaesthesia, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
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Postoperative Antibiotic Prophylaxis in Reduction Mammaplasty: A Randomized Controlled Trial. Plast Reconstr Surg 2020; 145:1022e-1028e. [DOI: 10.1097/prs.0000000000006809] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Heffernan DS, Evans HL, Huston JM, Claridge JA, Blake DP, May AK, Beilman GS, Barie PS, Kaplan LJ. Surgical Infection Society Guidance for Operative and Peri-Operative Care of Adult Patients Infected by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Surg Infect (Larchmt) 2020; 21:301-308. [DOI: 10.1089/sur.2020.101] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Daithi S. Heffernan
- Department of Surgery, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
- Division of Trauma and Surgical Critical Care, Department of Surgery, Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Heather L. Evans
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jared M. Huston
- Departments of Surgery and Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Jeffrey A. Claridge
- Division of Trauma, Critical Care, Burns & Acute Care Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - David P. Blake
- Department of Surgery, Division of Trauma/Surgical Critical Care, Inova Medical Group, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Department of Surgery, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, Maryland, USA
| | - Addison K. May
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Greg S. Beilman
- Division of General Surgery/Critical Care Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Philip S. Barie
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
- Division of Medical Ethics, Weill Cornell Medicine, New York, New York, USA
| | - Lewis J. Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Society of Critical Care Medicine, Mount Prospect, Illinois, USA
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Stryja J, Sandy-Hodgetts K, Collier M, Moser C, Ousey K, Probst S, Wilson J, Xuereb D. PREVENTION AND MANAGEMENT ACROSS HEALTH-CARE SECTORS. J Wound Care 2020; 29:S1-S72. [DOI: 10.12968/jowc.2020.29.sup2b.s1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jan Stryja
- Vascular Surgeon, Centre of vascular and miniinvasive surgery, Hospital Podlesi, Trinec, The Czech Republic. Salvatella Ltd., Centre of non-healing wounds treatment, Podiatric outpatients’ department, Trinec, The Czech Republic
| | - Kylie Sandy-Hodgetts
- Senior Research Fellow – Senior Lecturer, Faculty of Medicine, School of Biomedical Sciences, University of Western Australia, Director, Skin Integrity Clinical Trials Unit, University of Western Australia
| | - Mark Collier
- Nurse Consultant and Associate Lecturer – Tissue Viability, Independent – formerly at the United Lincolnshire Hospitals NHS Trust, c/o Pilgrim Hospital, Sibsey Road, Boston, Lincolnshire, PE21 9Q
| | - Claus Moser
- Clinical microbiologist, Rigshospitalet, Department of Clinical Microbiology, Copenhagen, Denmark
| | - Karen Ousey
- Professor of Skin Integrity, University of Huddersfield. Institute of Skin Integrity and Infection Prevention, Huddersfield, UK
| | - Sebastian Probst
- Professor of wound care, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Jennie Wilson
- Professor of Healthcare Epidemiology, University of West London, College of Nursing, Midwifery and Healthcare, London, UK
| | - Deborah Xuereb
- Senior Infection Prevention & infection Control Nurse, Mater Dei Hospital, Msida, Malta
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19
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Cook TM, Piatt CJ, Barnes S, Edmiston CE. The Impact of Supplemental Intraoperative Air Decontamination on the Outcome of Total Joint Arthroplasty: A Pilot Analysis. J Arthroplasty 2019; 34:549-553. [PMID: 30600122 DOI: 10.1016/j.arth.2018.11.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/07/2018] [Accepted: 11/29/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND During the early era of arthroplasty, the concept of ultraclean operating room (OR) was introduced based on the principle that the number of airborne particles in the OR directly influences incidence of device-related infections. The hypothesis of this pilot study was that use of an innovative UV-C air decontamination technology would lead to a reduction in the incidence of periprosthetic joint infection (PJI) following total joint arthroplasty. METHODS A retrospective, observational, surveillance study was conducted with a consecutive series of patients who underwent total joint arthroplasty (n = 496) between January 2016 and August 2017. All perioperative and postoperative care protocols were identical for both groups, only study variable was that in 231 arthroplasty patients (OR B), an innovative supplemental UV-C air decontamination technology was used, whereas in the remaining 265 patients, arthroplasty was performed with standard turbulent HVAC (OR A). RESULTS There was no significant difference between patient groups regarding age, body mass index, diabetes diagnosis, smoking status, length of surgery, or revision status. The rate of PJI was documented to be 1.9% in the turbulent air group, and no infections were documented in the cohorts operated under UV-C air decontamination, which was statistically significant (P < .044). CONCLUSION While PJI is multifactorial in nature, the present retrospective pilot study suggests that use of an intraoperative supplemental air decontamination significantly reduced the overall risk of PJI. The findings of this study are encouraging and should be examined in a larger-scale, prospective, multicenter study.
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Affiliation(s)
- Thomas M Cook
- Division of Orthopedic Surgery, Grandview Medical Center, Dayton, OH
| | - Caleb J Piatt
- Division of Orthopedic Surgery, Grandview Medical Center, Dayton, OH
| | - Sue Barnes
- Clinical Infection Prevention Consultant, San Mateo, CA
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20
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Abstract
AIMS Prosthetic joint infection (PJI) remains a serious complication that is associated with high morbidity and costs. The aim of this study was to prepare a systematic review to examine patient-related and perioperative risk factors that can be modified in an attempt to reduce the rate of PJI. MATERIALS AND METHODS A search of PubMed and MEDLINE was conducted for articles published between January 1990 and February 2018 with a combination of search terms to identify studies that dealt with modifiable risk factors for reducing the rate of PJI. An evidence-based review was performed on 12 specific risk factors: glycaemic control, obesity, malnutrition, smoking, vitamin D levels, preoperative Staphylococcus aureus screening, the management of anti-rheumatic medication, perioperative antibiotic prophylaxis, presurgical skin preparation, the operating room environment, irrigant options, and anticoagulation. RESULTS Poor glycaemic control, obesity, malnutrition, and smoking are all associated with increased rates of PJI. Vitamin D replacement has been shown in preliminary animal studies to decrease rates of PJI. Preoperative Staphylococcus aureus screening and appropriate treatment results in decreased rates of PJI. Perioperative variables, such as timely and appropriate dosage of prophylactic antibiotics, skin preparation with chlorohexidine-based solution, and irrigation with dilute betadine at the conclusion of the operation, have all been associated with reduced rates of PJI. Similarly, aggressive anticoagulation and increased operating room traffic should be avoided to help minimize risk of PJI. CONCLUSION PJI remains a serious complication of arthroplasty. Surgeons should be vigilant of the modifiable risk factors that can be addressed in an attempt to reduce the risk of PJI.
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Affiliation(s)
- V K Alamanda
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - B D Springer
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA and OrthoCarolina Hip and Knee Center, Charlotte, North Carolina, USA
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