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Bolten A, Kringos DS, Spijkerman IJB, Sperna Weiland NH. The carbon footprint of the operating room related to infection prevention measures: a scoping review. J Hosp Infect 2022; 128:64-73. [PMID: 35850380 DOI: 10.1016/j.jhin.2022.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Infection prevention measures are widely used in operating rooms (ORs). However, the extent to which they are at odds with ambitions to reduce the health sector's carbon footprint remains unclear. AIM To synthesize the evidence base for the carbon footprint of commonly used infection prevention measures in the OR, namely medical devices and instruments, surgical attire and air treatment systems. METHODS A scoping review of the international scientific literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search was performed in PubMed and Google Scholar. Articles published between 2010 and June 2021 on infection prevention measures, their impact on the health sector's carbon footprint, and risk for surgical site infections (SSIs) were included. FINDINGS Although hospitals strive to reduce their carbon footprint, many infection prevention measures result in increased emissions. Evidence suggests that the use of disposable items instead of reusable items generally increases the carbon footprint, depending on sources of electricity. Controversy exists regarding the correlation between air treatment systems, contamination and the incidence of SSIs. The literature indicates that new air treatment systems consume more energy and do not necessarily reduce SSIs compared with conventional systems. CONCLUSION Infection prevention measures in ORs can be at odds with sustainability. The use of new air treatment systems and disposable items generally leads to significant greenhouse gas emissions, and does not necessarily reduce the incidence of SSIs. Alternative infection prevention measures with less environmental impact are available. Implementation could be facilitated by embracing environmental impact as an additional dimension of quality of care, which should change current risk-based approaches for the prevention of SSIs.
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Affiliation(s)
- A Bolten
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - D S Kringos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - I J B Spijkerman
- Department of Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - N H Sperna Weiland
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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2
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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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3
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Guo XM, Runge M, Miller D, Aaby D, Milad M. A bundled intervention lowers surgical site infection in hysterectomy for benign and malignant indications. Int J Gynaecol Obstet 2020; 150:392-397. [DOI: 10.1002/ijgo.13257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/22/2020] [Accepted: 06/01/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Xiaoyue Mona Guo
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Megan Runge
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Deborah Miller
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - David Aaby
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Magdy Milad
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
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Langvatn H, Schrama J, Cao G, Hallan G, Furnes O, Lingaas E, Walenkamp G, Engesæter L, Dale H. Operating room ventilation and the risk of revision due to infection after total hip arthroplasty: assessment of validated data in the Norwegian Arthroplasty Register. J Hosp Infect 2020; 105:216-224. [DOI: 10.1016/j.jhin.2020.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/06/2020] [Indexed: 01/25/2023]
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5
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Baldini A, Blevins K, Del Gaizo D, Enke O, Goswami K, Griffin W, Indelli PF, Jennison T, Kenanidis E, Manner P, Patel R, Puhto T, Sancheti P, Sharma R, Sharma R, Shetty R, Sorial R, Talati N, Tarity TD, Tetsworth K, Topalis C, Tsiridis E, W-Dahl A, Wilson M. General Assembly, Prevention, Operating Room - Personnel: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S97-S104. [PMID: 30360975 PMCID: PMC7111314 DOI: 10.1016/j.arth.2018.09.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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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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7
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Burlingame BL. Clinical Issues—September 2018. AORN J 2018; 108:311-319. [DOI: 10.1002/aorn.12362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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8
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Yao R, Tan T, Tee JW, Street J. Prophylaxis of surgical site infection in adult spine surgery: A systematic review. J Clin Neurosci 2018; 52:5-25. [DOI: 10.1016/j.jocn.2018.03.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 03/12/2018] [Indexed: 01/27/2023]
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9
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Langsteiner A, Loncaric I, Henkel-Odwody AM, Tichy A, Licka TF. Initial adhesion of methicillin-sensitive and methicillin-resistant Staphylococcus aureus strains to untreated and electropolished surgical steel drill bits. Res Vet Sci 2017; 114:474-481. [PMID: 28946121 DOI: 10.1016/j.rvsc.2017.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 05/22/2017] [Accepted: 09/14/2017] [Indexed: 11/26/2022]
Abstract
Electropolishing of stainless steel has been thoroughly investigated as a prophylactic measure to prevent bacterial colonization of orthopaedic implants and infection. Initial bacterial adhesion onto surgical drill bits as a possible factor for orthopaedic surgical site infections has not yet been documented. The present study investigated the influence of electropolishing on initial staphylococcal adhesion onto AISI 440A stainless steel drill bits. Specifically, one methicillin-susceptible standard laboratory Staphylococcus aureus type strain (DSM 20231T), one methicillin-resistant S. aureus reference strain (DSM 46320) and one methicillin-resistant clinical isolate from an infected orthopaedic implant were used. After standard sterilization, drill bits were immersed in the respective bacterial suspension; bacteria adherent to surface were harvested by vortexing the drill bits in phosphate-buffered saline and viable counts of bacteria transferred from the suspension were made (transferred to log10 for further analysis). Electropolishing significantly reduced adhesion of the clinical S. aureus strain and the S. aureus DSM 20231T. However, electropolishing significantly increased adhesion of the S. aureus DSM 46320. These results show that electropolishing significantly influences initial adhesion of S. aureus strains to surgical drill bits and that the nature of this influence depends on the S. aureus strain examined. For a general recommendation of electropolishing drill bits and guidelines for their handling during surgery, further studies with more strains isolated from infected wounds are suggested.
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Affiliation(s)
- Annemarie Langsteiner
- Department for Companion Animals and Horses, Equine University Clinic, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria
| | - Igor Loncaric
- Department for Pathobiology, Institute of Microbiology, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria.
| | - Anna-Maria Henkel-Odwody
- Department for Companion Animals and Horses, Equine University Clinic, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria
| | - Alexander Tichy
- Department of Biomedical Sciences, Bioinformatics and Biostatistics Platform, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria.
| | - Theresia F Licka
- Department for Companion Animals and Horses, Equine University Clinic, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria; Department of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, EH25 9RG Edinburgh, United Kingdom.
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Teter J, Guajardo I, Al-Rammah T, Rosson G, Perl TM, Manahan M. Assessment of operating room airflow using air particle counts and direct observation of door openings. Am J Infect Control 2017; 45:477-482. [PMID: 28209451 DOI: 10.1016/j.ajic.2016.12.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/23/2016] [Accepted: 12/23/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The role of the operating room (OR) environment has been thought to contribute to surgical site infection rates. The quality of OR air, disruption of airflow, and other factors may increase contamination risks. We measured air particulate counts (APCs) to determine if they increased in relation to traffic, door opening, and other common activities. METHODS During 1 week, we recorded APCs in 5-minute intervals and movement of health care workers. Trained observers recorded information about traffic, door openings, job title of the opener, and the reason for opening. RESULTS At least 1 OR door was open during 47% of all readings. There were 13.4 door openings per hour during cases. Door opening rates ranged from 0.19-0.28 per minute. During this time, a total of 660 air measurements were obtained. The mean APCs were 9,238 particles (95% confidence interval [CI], 5,494- 12,982) at baseline and 14,292 particles (95% CI, 12,382-16,201) during surgery. Overall APCs increased 13% when either door was opened (P < .15). Larger particles that correlated to bacterial size were elevated significantly (P < .001) on door opening. CONCLUSIONS We observed numerous instances of verbal communication and equipment movement. Improving efficiency of communication and equipment can aid in reduction of traffic. Further study is needed to examine links between microbiologic sampling, outcome data, and particulate matter to enable study of risk factors and effects of personnel movement.
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Affiliation(s)
- Jonathan Teter
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Isabella Guajardo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tamrah Al-Rammah
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gedge Rosson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Trish M Perl
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins University, School of Public Health, Baltimore, MD
| | - Michele Manahan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
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Barbadoro P, Bruschi R, Martini E, Savini S, Gioia M, Stoico R, Di Tondo E, D'Errico M, Prospero E. Impact of laminar air flow on operating room contamination, and surgical wound infection rates in clean and contaminated surgery. Eur J Surg Oncol 2016; 42:1756-1758. [DOI: 10.1016/j.ejso.2016.06.409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022] Open
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