Reduce OR Traffic, Reduce Infections

A Canadian hospital may have figured out a way to reduce orthopedic surgical site infections (SSIs)…close the door! Concerned that there was an excess of traffic in and out of the operating room (OR) during total joint replacement procedures, the safety team at Peace Arch Hospital (Fraser Health) in White Rock, British Columbia, undertook measures to correct the situation.

The results, presented at the 2016 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Conference, emanate in part from a survey of medical staff indicating that too much traffic in the OR caused harm.

Jason Forbes, M.D., a general surgeon at Peace Arch, a community hospital with 20 surgeons, said that the hospital staff also learned from its NSQIP data that they had an excessively high rate of wound infections from orthopedic operations like knee and hip joint replacements, which are frequently performed in their hospital serving an aging population. “Those SSIs were a high outlier and an area that needed urgent correction, ” said Dr. Forbes, the hospital’s NSQIP Surgeon Champion.

As indicated in the news release, researchers, led by Susann Camus, M.A., M.P.H., counted between 42 and 70 door openings per operation from incision time to joint capsule closure time. Operations averaged 75 minutes. Reasons for entering and exiting the OR during operations included retrieving charts, instruments, or equipment, and taking a break.

“Following these results, Ms. Camus said the CUSP team brainstormed ways to reduce door openings. Key changes included stopping all traffic in and out of the OR between total joint capsule opening and closure, communicating by phone, and increasing the use of templates to identify implant size prior to each operation. A sign on the OR door also reminds staff to minimize traffic and asks them to record why they are entering the OR during an operation. Ms. Camus said subsequent traffic audits taken every six months indicated a significant reduction in OR traffic from between 42 and 70 door openings to 3.2 door openings per case. This intervention may have contributed to a decrease in orthopedic SSIs from 2.8 percent to 2.1 percent since traffic control was implemented, according to study authors.”

Dr. Forbes told OTW, “There is some thought that traffic in and out of the OR can disrupt airflow and lead to infection. After a review, we found there was an unexpectedly large number of door openings during our orthopedic cases. We were able to reduce the SSI rate in our orthopedic cases at Peace Arch Hospital after implementing a ‘closed door’ OR policy.”

“I think it is important to plan ahead to ensure all the required equipment is in the OR at the start of the case to minimize traffic. I have found the time out at the start of the case to be an ideal time to ensure all the required equipment is at hand.”