Home E-Weekly November 21, 2017

Limit Foot Traffic in Your ORs

Published: November 20, 2017

DOOR AJAR Excessive foot traffic disrupts laminar flow and sends contaminates into the sterile field.

Installing a door alarm that sounds whenever a staff member enters the operating room helps limit the unnecessary foot traffic that increases surgical site infection risk, according to a study published in the journal Orthopedics.

One-third of OR door openings are for unessential reasons, such as social visits, according to the study's authors. They say signs that attempt to restrict OR access often go unnoticed or are ignored and locked doors create safety concerns and impede staff members who have legitimate reasons for disrupting surgery. The study's authors, who believed audial alerts would prove more effective than signs and locks, compared the number of times an OR door was opened during a series of hip and knee replacements performed with and without an alarm in place.

The alarm sounded a 2-tone chime every time the door was opened and repeated the chime every 3 seconds until the door was closed. During 50 consecutive surgeries without the alarm, the door was opened an average of 88 times per case and remained open for 14 minutes per procedure. During the 50 cases with the alarm installed, the number of door openings dropped to 69 and the door remained open for 10 minutes per surgery.

The numerous factors that impact infection rates during total joint surgery — obesity, diabetes, smoking, operative time, surgical technique — include traffic flow into and out of operating rooms. Opening the OR door disrupts the room's laminar flow, which could send bacteria into the sterile field instead of pushing it away from the patient's open wound. One study has reported that any increase in the number of door openings raises the risk of contamination in the OR by as much as 70%.

Keeping OR doors closed as much as possible during surgery is a legitimate issue with no clear solution, say the researchers, who note the warning chimes they tested proved effective until alarm fatigue set in. "Despite the limited long-term effect of this alarm, it should bring further attention to excessive operating room traffic," they write. "Continuing education and awareness may be necessary to maintain the results found in this study."

Daniel Cook

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