Infection Antimicrobials Modelling Evolution (IAME),French Institute for Medical Research (INSERM),Paris,France.
Laboratoire d'Informatique de Robotique et de Microélectronique de Montpellier (LIRMM),INRIA Research Center,MontpellierFrance.
Infect Control Hosp Epidemiol. 2019 May;40(5):566-573. doi: 10.1017/ice.2019.35. Epub 2019 Mar 12.
We longitudinally observed and assessed the impact of the operating room (OR) staff movements and door openings on surrogates of the exogenous infectious risk using a new technology system.
This multicenter observational study included 13 ORs from 10 hospitals, performing planned cardiac and orthopedic surgery (total hip or knee replacement). Door openings during the surgical procedure were obtained from data collected by inertial sensors fixed on the doors. Intraoperative staff movements were captured by a network of 8 infrared cameras. For each surgical procedure, 3 microbiological air counts, longitudinal particles counts, and 1 bacteriological sample of the wound before skin closure were performed. Statistics were performed using a linear mixed model for longitudinal data.
We included 34 orthopedic and 25 cardiac procedures. The median frequency of door openings from incision to closure was independently associated with an increased log10 0.3 µm particle (ß, 0.03; standard deviation [SD], 0.01; P = .01) and air microbial count (ß, 0.07; SD, 0.03; P = .03) but was not significantly correlated with the wound contamination before closure (r = 0.13; P = .32). The number of persons (ß, -0.08; SD, 0.03; P < .01), and the cumulated movements by the surgical team (ß, 0.0004; SD, 0.0005; P < .01) were associated with log10 0.3 µm particle counts.
This study has demonstrated a previously missing association between intraoperative staff movements and surrogates of the exogenous risk of surgical site infection. Restriction of staff movements and door openings should be considered for the control of the intraoperative exogenous infectious risk.
我们使用新技术系统纵向观察和评估手术室（OR）工作人员的移动和开门对替代外源性感染风险的影响。
这项多中心观察性研究包括来自 10 家医院的 13 个 OR，进行计划中的心脏和骨科手术（全髋关节或膝关节置换）。手术过程中的开门数据来自固定在门上的惯性传感器收集的数据。术中工作人员的移动情况由 8 个红外摄像机网络捕捉。对于每个手术程序，在皮肤关闭前进行 3 次微生物空气计数、纵向颗粒计数和 1 次伤口细菌学样本。使用线性混合模型对纵向数据进行统计分析。
我们纳入了 34 例骨科和 25 例心脏手术。从切口到关闭过程中开门的中位数频率与增加的对数 0.3 µm 颗粒（β，0.03；标准差 [SD]，0.01；P =.01）和空气微生物计数（β，0.07；SD，0.03；P =.03）独立相关，但与关闭前伤口污染无显著相关性（r = 0.13；P =.32）。人数（β，-0.08；SD，0.03；P <.01）和手术团队的累积运动（β，0.0004；SD，0.0005；P <.01）与对数 0.3 µm 颗粒计数相关。
这项研究表明，术中工作人员的移动与手术部位感染外源性风险的替代指标之间存在以前未被发现的关联。应考虑限制工作人员的移动和开门，以控制术中外源性感染风险。
