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The Influence of Traffic, Area Location, and Other Factors on Operating Room Microbial Load

Published online by Cambridge University Press:  15 February 2018

Kevin Taaffe*
Affiliation:
Department of Industrial Engineering, Clemson University, Clemson, South Carolina
Brandon Lee
Affiliation:
Department of Management, Clemson University, Clemson, South Carolina
Yann Ferrand
Affiliation:
Department of Management, Clemson University, Clemson, South Carolina
Lawrence Fredendall
Affiliation:
Department of Management, Clemson University, Clemson, South Carolina
Dee San
Affiliation:
Medical University of South Carolina, Charleston, South Carolina
Cassandra Salgado
Affiliation:
Medicine and Public Health, Medical University of South Carolina, Charleston, South Carolina
Dotan Shvorin
Affiliation:
Department of Industrial Engineering, Clemson University, Clemson, South Carolina
Amin Khoshkenar
Affiliation:
Department of Industrial Engineering, Clemson University, Clemson, South Carolina
Scott Reeves
Affiliation:
Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina
the Realizing Improved Patient Care through Human-Centered Design in the Operating Room (RIPCHD.OR) Study Group
Affiliation:
Center for Health Facilities Design and Testing, A SmartState South Carolina Center of Economic Excellence at Clemson University, Clemson, South Carolina
*
Address correspondence to Kevin Taaffe, PhD, 269 Freeman Hall, Department of Industrial Engineering, Clemson University, Clemson, SC, 29634 (taaffe@clemson.edu).

Abstract

OBJECTIVE

To determine how the movement of patients, equipment, materials, staff, and door openings within the operating room (OR) affect microbial loads at various locations within the OR.

DESIGN

Observation and sampling study.

SETTING

Academic health center, public hospital.

METHODS

We first analyzed 27 videotaped procedures to determine the areas in the OR with high and low numbers of people in transit. We then placed air samplers and settle plates in representative locations during 21 procedures in 4 different ORs during 2 different seasons of the year to measure microbial load in colony-forming units (CFU). The temperature and humidity, number of door openings, physical movement, and the number of people in the OR were measured for each procedure. Statistical analysis was conducted using hierarchical regression.

RESULTS

The microbial load was affected by the time of year that the samples were taken. Both microbial load measured by the air samplers and by settle plates in 1 area of the OR was correlated with the physical movement of people in the same area but not with the number of door openings and the number of people in the OR.

CONCLUSIONS

Movement in the OR is correlated with the microbial load. Establishing operational guidelines or developing OR layouts that focus on minimizing movement by incorporating desirable internal storage points and workstations can potentially reduce microbial load, thereby potentially reducing surgical site infection risk.

Infect Control Hosp Epidemiol 2018;39:391–397

Type
Original Articles
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. de Lissovoy, G, Fraeman, K, Hutchins, V, Murphy, D, Song, D, Vaughn, B. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009;37:387397.Google Scholar
2. Durando, P, Bassetti, M, Orengo, G, et al. Adherence to international and national recommendations for the prevention of surgical site infections in Italy: results from an observational prospective study in elective surgery. Am J Infect Control 2012;40:969972.Google Scholar
3. Andersson, A, Bergh, I, Karlsson, J, Eriksson, B, Nilsson, K. Traffic flow in the operating room: an explorative and descriptive study on air quality during orthopedic trauma implant surgery. Am J Infect Control 2012;40:750755.Google Scholar
4. Benenson, S, Moses, A, Cohen, M, et al. A practical tool for surveillance of surgical-site infections: a 5-year experience in orthopedic surgeries. Infect Control Hosp Epidemiol 2017;38:610613.Google Scholar
5. Anthony, C, Peterson, R, Polgreen, L, Sewell, D, Polgreen, P. The seasonal variability in surgical site infections and the association with warmer weather: a population-based investigation. Infect Control Hosp Epidemiol 2017;38:809816.Google Scholar
6. Birgand, G, Saliou, P, Lucet, J. Influence of staff behavior on infectious risk in operating rooms: What is the evidence? Infect Control Hosp Epidemiol 2015;36:93106.Google Scholar
7. Friberg, B, Friberg, S, Burman, L. Correlation between surface and air counts of particles carrying aerobic bacteria in operating rooms with turbulent ventilation: an experimental study. J Hosp Infect 1999;42:6168.CrossRefGoogle ScholarPubMed
8. Tjade, O, Gabor, I. Evaluation of airborne operating room bacteria with a Biap slit sampler. J Hygiene 1980;84:3740.CrossRefGoogle ScholarPubMed
9. Castella, A, Charrier, L, Legami, V, et al. Surgical site infection surveillance: analysis of adherence to recommendations for routine infection control practices. Infect Control Hosp Epidemiol 2006;27:835840.Google Scholar
10. Ritter, M. Operating room environment. Clin Orthop Relat Res 1999;369:103109.Google Scholar
11. Yinnon, A, Wiener-Well, Y, Jerassy, Z, et al. Improving implementation of infection control guidelines to reduce nosocomial infection rates: pioneering the report card. J Hosp Infect 2012;81:169176.Google Scholar
12. Borer, A, Gilad, J, Meydan, N, et al. Impact of active monitoring of infection control practices on deep sternal infection after open heart surgery. Ann Thorac Surg 2001;72:515520.Google Scholar
13. Crolla, R, van der Laan, L, Veen, E, Hendriks, Y, van Schendel, C, Kluytmans, J. Reduction of surgical site infections after implementation of a bundle of care. PLoS One 2012;7:e44599.Google Scholar
14. Van der Slegt, J, van der Laan, L, Veen, E, Hendriks, Y, Romme, J, Kluytmans, J. Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery. PLoS One 2013;8:e71566.Google Scholar
15. Beldi, G, Bisch-Knaden, S, Banz, V, Mühlemann, K, Candinas, D. Impact of intraoperative behavior on surgical site infections. Am J Surg 2009;198:157162.Google Scholar
16. Tammelin, A, Blomfeldt, A. Comparison of two single-use scrub suits in terms of effect on air-borne bacteria in the operating room. J Hosp Infect 2017;95:324326.CrossRefGoogle ScholarPubMed
17. Mangram, A, Horan, T, Pearson, M, Silver, L, Jarvis, W. CDC guideline for prevention of surgical site infection. Infect Control Hosp Epidemiol 1999;20:247278.Google Scholar
18. Uçkay, I, Harbarth, S, Peter, R, Lew, D, Hoffmeyer, P, Pittet, D. Preventing surgical site infections. Expert Rev Anti Infect Ther 2010;8:657670.Google Scholar
19. Gosden, PE, MacGowan, AP, Bannister, GC. Importance of air quality and related factors in the prevention of infection in orthopedic implant surgery. J Hosp Infect 1998;39:173180.Google Scholar
20. Alfonso-Sanchez, J, Martinez, I, Martin-Moreno, J, et al. Analyzing the risk factors influencing surgical site infections: the site of environmental factors. Can J Surg 2017;60:155161.Google Scholar
21. Wan, G, Chung, F, Tang, C. Long-term surveillance of air quality in medical center operating rooms. Am J Infect Control 2011;39:302308.CrossRefGoogle ScholarPubMed
22. Babkin, Y, Raveh, D, Lifschitz, M, et al. Incidence and risk factors for surgical infection after total knee replacement. Scand J Infect Dis 2007;39:890895.Google Scholar
23. Armellino, D. Optimal infection control practices in the OR environment. AORN J 2016;104:516522.Google Scholar
24. Loison, G, Troughton, R, Raymond, F, et al. Dress code and traffic flow in the operating room: a multicentre study of staff discipline during surgical procedures. J Hosp Infect 2017. doi: 10.1016/j.jhin.2017.03.026.Google Scholar
25. Pasquarella, C, Pitzurra, O, Savino, A. The index of microbial air contamination. J Hosp Infect 2000;46:241256.Google Scholar
26. Wooldridge, J. Introductory Econometrics: A Modern Approach. 5th ed. Mason, OH: South-Western College Publishing; 2013.Google Scholar
27. Napoli, C, Tafuri, S, Montenegro, L, et al. Air sampling methods to evaluate microbial contamination in operating theatres: results of a comparative study in an orthopaedics department. J Hosp Infect 2012;80:128132.Google Scholar
28. Napoli, C, Marcotrigiano, V, Montagna, M. Air sampling procedures to evaluate microbial contamination: a comparison between active and passive methods in operating theatres. BMC Public Health 2012;12:594599.Google Scholar
29. Spruce, L. Surgical head coverings: a literature review. AORN J 2017;106:306316.Google Scholar