CNRS, SIGMA Clermont, ICCF, CHU de Clermont-Ferrand, université Clermont Auvergne, 63000 Clermont-Ferrand, France.
CNRS, SIGMA Clermont, ICCF, CHU de Clermont-Ferrand, université Clermont Auvergne, 63000 Clermont-Ferrand, France.
Orthop Traumatol Surg Res. 2024 Sep;110(5):103843. doi: 10.1016/j.otsr.2024.103843. Epub 2024 Feb 21.
Infections following orthopedic surgery are rare but difficult to treat. Among the prevention measures reviewed during the Musculoskeletal Infection Society's (MSIS) 2023 international consensus meeting, the only strategy to obtain 100% agreement was the control of traffic in and out of the operating room (OR). Although this recommendation makes good sense, to our knowledge, it has not been previously investigated in a comparative study. We, therefore, conducted a prospective, observational, before-and-after study of the implementation of an informational sign designed to limit traffic in and out of the OR to (1) determine its impact on door openings and the number of people present during orthopedic surgery and (2) assess the risk of surgical site infection after the institution of this sign.
This type of sign reduces the number of door openings.
This prospective, observational study included all patients operated on in one of our ORs over a 6-week period. The number of entrances and exits from the OR and how long the doors were kept open were recorded during the entire study period. After 3 weeks, an informational sign was posted on the OR doors warning people that unnecessary traffic in and out of the OR increases the risk of infection. During this period, we also recorded the type of procedure, operative time, the number of people in the OR at the time of the incision, and the number of entrances and exits. Patients underwent a follow-up at 2 years to check for postoperative infection. The primary endpoint was the number of OR door openings, and the secondary endpoint was the number of infections at 2 years postoperatively.
The 2 groups (before and after the implementation of the sign) were homogeneous. The average total number of door openings for all ORs was 28.9±19.6 [2-90]. In the no sign group, it was 33.3±20.9 [3-90], and in the sign group, it was 21.0±14.7 [2-50] (p=0.011). The maximum number of people in the OR at one time was 8.32±1.84 [4-12] in the no sign group and 8.44±1.98 [5-12] in the sign group (p=0.8). There were 3 postoperative infections at the 2-year follow-up, all occurring in the no sign group. The infection rate was 6.4% (3/47) in the no sign group versus 0% (0/25) in the sign group (p=0.197).
Our prospective study demonstrated a simple strategy to reduce the number of entrances and exits, the number of people in the OR, and potentially the risk of surgery-related infection. Another larger-scale study is needed to assess the exact impact of this type of sign, particularly on the risk of infection.
III; prospective non-randomized comparative study.
骨科手术后感染虽少见，但却难以治疗。在矫形感染学会（MSIS）2023 年国际共识会议上审查的预防措施中，唯一获得 100% 一致认可的策略是控制手术室（OR）的进出流量。尽管这一建议有充分的道理，但据我们所知，此前尚未在比较研究中进行过调查。因此，我们进行了一项前瞻性、观察性、前后对照研究，以评估设计用于限制 OR 进出流量的信息标志的实施情况：（1）确定其对开门次数和骨科手术期间在场人数的影响；（2）评估该标志实施后手术部位感染的风险。
这种类型的标志可减少开门次数。
本前瞻性、观察性研究纳入了在我们的一个 OR 中进行手术的所有患者，为期 6 周。在整个研究期间记录 OR 的进出次数以及门敞开的时间。3 周后，在 OR 门上张贴了一个信息标志，警告人们不必要的 OR 进出会增加感染风险。在此期间，我们还记录了手术类型、手术时间、切口时 OR 内的人数以及进出次数。患者在术后 2 年时进行随访，以检查术后感染情况。主要终点是 OR 开门次数，次要终点是术后 2 年时的感染数量。
两组（标志实施前后）具有同质性。所有 OR 的平均总开门次数为 28.9±19.6 [2-90]。无标志组为 33.3±20.9 [3-90]，标志组为 21.0±14.7 [2-50]（p=0.011）。同一时间 OR 内人数最多为 8.32±1.84 [4-12]，无标志组为 8.44±1.98 [5-12]（p=0.8）。术后 2 年随访时发生 3 例感染，均发生在无标志组。无标志组的感染率为 6.4%（3/47），标志组为 0%（0/25）（p=0.197）。
我们的前瞻性研究证明了一种简单的策略，可减少进入和离开手术室的次数、手术室人数，并可能降低与手术相关的感染风险。需要进行另一项更大规模的研究来评估此类标志的准确影响，特别是对感染风险的影响。
III；前瞻性非随机对照研究。
