As a perioperative nurse, have you ever wondered how excessive foot traffic within the surgical suite affects surgical site infections (SSIs)? A study at Johns Hopkins revealed that one-third of observed procedures had enough door openings during the surgeries to potentially defeat the safety effects of systems meant to keep contaminated air out of sterile ORs. Our role is to facilitate a safe OR and prevent postoperative complications, with nursing interventions. This means that considerable efforts should be made to prevent exposure of patients to personnel and to achieve positive room pressure to keep airborne contaminants out.
Closing the Door on Infection
Foot traffic into and out of the operating room during surgery can undermine these efforts. Heating, ventilating, and cooling systems are designed to maintain elevated air pressure in the operating room relative to the adjacent hallways and rooms (positive pressure). When an operating room door is opened, positive pressure forces air out of the room, preventing airborne contaminants from entering. But a high level of OR foot traffic may adversely affect this sterility, since the foot traffic volume is directly related to higher bacterial counts in the operating room.1,2
AORN’s “Recommended practices for traffic patterns in the surgical suite” is designed to reduce the amount of airborne contamination during surgery. Specifically, AORN recommends that movement of staff members should be kept to a minimum while a surgical procedure is in progress. This includes minimizing the number of people in the OR, movement, and talking during surgery and maintaing that OR doors be closed except during movements of staff member or equipment.3
Going Back to Basics
But in spite of advances in practice, we might be losing the battle because our energy is spent trying to develop new strategies instead of implementing existing ones. We cannot overlook the value and importance of actions that should be routine in every practice setting, and we cannot be focused so intensely on high levels of prevention that we overlook the value of basic practices. Following the principles of aseptic technique, limiting traffic and closing doors in ORs, wearing PPE—such as masks and gloves—correctly, following standard precautions, and using antibiotics appropriately are examples of practices that require consistent behaviors by all team members and control in perioperative settings. Focusing on simple practices such as these can reduce risk to ourselves and our patients.
Solutions Don’t Have to be Complicated
A safety team at a Canadian hospital recently determined that they had far too much traffic passing through their OR. After studying the number of door openings and reasons for comings and goings, the team implemented some key changes, including:
- Communicating more by phone;
- Posting a sign on the OR door to remind staff to minimize traffic; and
- Asking staff to record why they are entering the OR during an operation.
The first post-implementation audit six months later revealed a significant reduction in OR traffic, dropping the incidence of door openings from 42 to 70 per procedure down to just 3.2 door openings. This drop is also considered to have played a part in their decreased orthopedic SSIs, which has fallen from 2.8 percent to 2.1 percent since implementing the traffic control.
Solutions to OR traffic congestion don’t have to be complicated. Sometimes the simplest reminder—like a simple door sign—can go a long way.
Is your OR a busy intersection? What practices have you found reduce the traffic?
- Andersson AE, Bergh I, Karlsson J, Eriksson BI, 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(8):750–755. doi:10.1016/j.ajic.2011.09.015 [CrossRef]
- Scaltriti S, Cencetti S, Rovesti S, Marchesi I, Bargellini A, Borella P. Risk factors for particulate and microbial contamination of air in operating theatres. J Hosp Infect. 2007; 66(4):320–326. doi:10.1016/j.jhin.2007.05.019 [CrossRef]
- “Recommended practices for traffic patterns in the perioperative practice setting,” in AORN Standards, Recommended Practices, and Guidelines (Denver: Association of Operating Room Nurses, Inc, 1998) 313-315.