Teter Jonathan, Guajardo Isabella, Al-Rammah Tamrah, Rosson Gedge, Perl Trish M, Manahan Michele
Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Am J Infect Control. 2017 May 1;45(5):477-482. doi: 10.1016/j.ajic.2016.12.018. Epub 2017 Feb 13.
The role of the operating room (OR) environment has been thought to contribute to surgical site infection rates. The quality of OR air, disruption of airflow, and other factors may increase contamination risks. We measured air particulate counts (APCs) to determine if they increased in relation to traffic, door opening, and other common activities.
During 1 week, we recorded APCs in 5-minute intervals and movement of health care workers. Trained observers recorded information about traffic, door openings, job title of the opener, and the reason for opening.
At least 1 OR door was open during 47% of all readings. There were 13.4 door openings per hour during cases. Door opening rates ranged from 0.19-0.28 per minute. During this time, a total of 660 air measurements were obtained. The mean APCs were 9,238 particles (95% confidence interval [CI], 5,494- 12,982) at baseline and 14,292 particles (95% CI, 12,382-16,201) during surgery. Overall APCs increased 13% when either door was opened (P < .15). Larger particles that correlated to bacterial size were elevated significantly (P < .001) on door opening.
We observed numerous instances of verbal communication and equipment movement. Improving efficiency of communication and equipment can aid in reduction of traffic. Further study is needed to examine links between microbiologic sampling, outcome data, and particulate matter to enable study of risk factors and effects of personnel movement.
手术室环境被认为会影响手术部位感染率。手术室空气质量、气流紊乱及其他因素可能增加污染风险。我们测量了空气微粒计数（APC），以确定其是否会因人员走动、开门及其他常见活动而增加。
在1周时间内，我们每隔5分钟记录一次APC及医护人员的活动情况。经过培训的观察员记录有关人员走动、开门情况、开门者的职称及开门原因等信息。
在所有读数中，至少有一扇手术室门处于打开状态的情况占47%。手术过程中每小时有13.4次开门情况。开门率为每分钟0.19 - 0.28次。在此期间，共进行了660次空气测量。基线时APC的平均值为9238个微粒（95%置信区间[CI]，5494 - 12982），手术期间为14292个微粒（95%CI，12382 - 16201）。任何一扇门打开时，总体APC增加13%（P < 0.15）。与细菌大小相关的较大微粒在开门时显著升高（P < 0.001）。
我们观察到了大量言语交流和设备移动的情况。提高沟通和设备使用效率有助于减少人员走动。需要进一步研究以检验微生物采样、结果数据和颗粒物之间的联系，从而能够研究人员移动的风险因素及其影响。
