Main Operating Room Versus Field Sterility in Hand Surgery: A Review of the Evidence

Area of Science:

• Orthopedic Surgery
• Infection Control
• Evidence-Based Medicine

Background:

• Current operating room sterility guidelines often lack evidence-based support.
• Practices are frequently based on assumptions rather than data on infection rates.
• Evidence-based sterility focuses on practices that impact infection rates, not just bacterial counts.

Purpose of the Study:

• To present updated evidence on sterility practices in hand surgery.
• To evaluate the safety and efficacy of performing hand surgery outside the main operating room.
• To challenge traditional, non-evidence-based sterility guidelines.

Main Methods:

• Review of evidence not included in prior 2019 publication on evidence-based sterility in hand surgery.
• Balancing scientific evidence with expert opinion and common sense.
• Analysis of infection rates for hand surgery performed with field sterility in minor procedure rooms versus main operating rooms.

Main Results:

• A significant increase in hand surgeries performed with field sterility outside main operating rooms.
• Evidence indicates no higher infection rates for hand operations conducted with field sterility in minor procedure rooms.
• Traditional main operating room practices are not always necessary for reducing postoperative infection risk.

Conclusions:

• Healthcare providers should support relocating hand surgery to minor procedure rooms.
• The costs, waste, and inconvenience of main operating room use are often unjustified for many hand surgeries.
• Evidence supports the use of field sterility in minor procedure rooms for hand surgery, challenging established protocols.