Reduction of OR traffic could decrease infection rate during joint replacement

Protecting against periprosthetic joint infection could be as simple as reducing operating room traffic during primary and revision total knee and total hip arthroplasty procedures, according to Philadelphia researchers.

Four observers collected the information during 80 primary and 36 revision procedures performed under vertical, laminar flow, according to the abstract. During primary joint replacement, the average operating time was 92 minutes and the operating room (OR) door opened an average of 60 times, according to the abstract. In 36 revision joint replacement procedures, each averaging 161 minutes, the OR door opened an average of 135 times.

Javad Parvizi

“Our study demonstrates that traffic in the operating room is a major problem. Considering the undisputed fact that personnel in the operating room are a major source of bacterial shedding and the direct link between OR traffic and subsequent infections, these findings are sobering and worrisome,” Javad Parvizi, MD, FRCS, co-author of the study and an Orthopedics Today editorial board member, told ORTHOPEDICS TODAY.

Prior to surgery, a sign was hung on the two entry doors warning OR staff that implants were in use and to limit traffic. The observers noted the reason, number and personnel involved with the traffic. Surgical implant representatives and circulating nurses represented the greatest amount of traffic and nearly one-quarter of traffic was due to staff getting supplies. Forty-seven percent of the traffic was unexplained.

While the study was limited to a single hospital setting, Parvizi noted the findings are not applicable to only certain institutions.

“I would caution against such assumption and challenge all surgeons to implement a strategy that aims to decrease OR traffic and potential for subsequent infections,” Parvizi said. “As a visitor of various centers and a volunteer consultant to hospitals with ‘infection problems,’ I can assure you that operating room doors are rarely guarded against unnecessary openings and entries.”

Reference:
Panahi P, Stroh M, Casper D, et al. Operating room traffic is a major concern during total joint arthroplasty. Clin Orthop Rel Res. 2012;470:2690-2694. doi:10.1007/s11999-012-2252-4.

Disclosure: Parvizi is a consultant to Zimmer, Smith and Nephew, 3M and Convatec.