Osborn Nathaniel S, Hoehmann Christopher L, McCormack Richard, Owens Jonathan
Department of Orthopedic Surgery, Nassau University Medical Center, East Meadow, New York.
JB JS Open Access. 2020 Jul 9;5(3). doi: 10.2106/JBJS.OA.20.00015. eCollection 2020 Jul-Sep.
Periprosthetic joint infection remains a devastating complication of total joint arthroplasty (TJA). The literature suggests that unnecessary operating room (OR) traffic increases the risk of surgical site infection by increasing bacterial load in the OR. We attempted to determine whether the posting of "restricted access" signs on the outside and inside of OR doors during primary TJA procedures would result in a reduction of OR door openings.
This prospectively designed, 2-phase study investigated the number of door openings per case for primary TJA. An independent observer collected data for each TJA case; the OR staff were blinded to the data collection to avoid bias. The first phase of this study recorded OR traffic without the use of "restricted access" signs. In the second, interventional phase of the study, OR traffic was monitored with the concomitant application of "restricted access" signs on the doors. The number of openings per case, from the time of incision to the time of dressing application, was collected.
The average number of openings per case during the first phase was 75, with 0.59 door openings per minute. The average number of openings per case during the second phase was 40, with 0.28 door openings per minute. Therefore, a 47% reduction in openings per case and a 53% reduction in the number of openings per minute during primary TJA cases were observed.
We demonstrated that the simple addition of "restricted access" signs on the outside and inside of OR doors produced a significant reduction (p < 0.001) in OR traffic during primary TJA.
Posting signs can decrease door openings, potentially decreasing infection.
人工关节周围感染仍然是全关节置换术（TJA）的一种毁灭性并发症。文献表明，不必要的手术室（OR）人员流动会因增加手术室内的细菌载量而增加手术部位感染的风险。我们试图确定在初次TJA手术期间在手术室门的外侧和内侧张贴“限制进入”标志是否会减少手术室门的开启次数。
这项前瞻性设计的两阶段研究调查了初次TJA手术中每个病例的门开启次数。一名独立观察者收集每个TJA病例的数据；手术室工作人员对数据收集不知情，以避免偏差。本研究的第一阶段记录了不使用“限制进入”标志时的手术室人员流动情况。在研究的第二个干预阶段，在门上同时张贴“限制进入”标志的情况下监测手术室人员流动。收集从切开到敷料应用期间每个病例的开启次数。
第一阶段每个病例的平均开启次数为75次，每分钟0.59次门开启。第二阶段每个病例的平均开启次数为40次，每分钟0.28次门开启。因此，在初次TJA病例中，每个病例的开启次数减少了47%，每分钟的开启次数减少了53%。
我们证明，在手术室门的外侧和内侧简单张贴“限制进入”标志可使初次TJA手术期间的手术室人员流动显著减少（p < 0.001）。
张贴标志可减少门的开启次数，可能降低感染率。
