Operating room traffic is a major concern during total joint arthroplasty

Area of Science:

• Orthopedic Surgery
• Infection Control
• Surgical Safety

Background:

• Periprosthetic joint infection (PJI) is a significant complication following total joint arthroplasty (TJA).
• Increased operating room (OR) traffic, evidenced by door openings, correlates with higher bacterial counts and infection risk.
• Understanding the dynamics of OR traffic is crucial for mitigating PJI rates.

Purpose of the Study:

• To quantify the incidence of OR door openings during primary and revision TJA.
• To compare door opening frequency between primary and revision TJA procedures.
• To identify the primary causes of OR door openings to inform strategies for traffic reduction.

Main Methods:

• An observational study was conducted during 80 primary and 36 revision TJA procedures.
• Data on door openings (number, reason, personnel involved) were collected by an unaware observer to minimize bias.
• Surgeries were performed under controlled vertical, laminar flow conditions.

Main Results:

• Revision TJA procedures had a higher average rate of door openings per minute (0.84) compared to primary TJA (0.65).
• The average operating time was significantly longer for revision (161 minutes) versus primary (92 minutes) TJA.
• Circulating nurses and surgical implant representatives were the most frequent personnel associated with OR door openings.

Conclusions:

• Operating room traffic is a substantial concern in TJA, particularly in revision cases.
• Implementing strategies like in-OR storage of supplies and personnel education is essential to decrease door openings.
• Reducing OR traffic is a key step in minimizing the risk of PJI after TJA.