Sitting in the back of an operating room (OR) at the Nassau University Medical Center in East Meadow, New York recently, an observer unobtrusively noted the number of times a door was opened for each total joint arthroplasty (TJA)—75 times per case!. The results, “Operating Room Traffic in Total Joint Arthroplasty,” were published in the July-September 2020 edition of JBJS: Open Access.
Co-author Nathaniel S. Osborn, D.O. told OTW, “We were seeing a high rate of OR traffic during our total joint arthroplasty cases and there was significant concern that such traffic could lead to an increased rate of infection.”
“The observer was not scrubbed in to the case, and was present before, after, and during the entirety of the procedure,” wrote the authors. “Specifically, the observer recorded the time from the first incision to the application of dressings as the ‘total time’ of surgery and documented the raw number of door openings for each case. The observer did not document which OR personnel contributed to door openings. To minimize the opportunity for measurement bias, OR personnel were blinded in that they did not know data were being recorded.”
In phase 1 of the study, 25 cases were analyzed, with 1,888 door openings (an average of 75 door openings per case). In phase 2, the intervention, 25 cases were analyzed, with 1,002 door openings (an average of 40 door openings per case). The researchers found a significant difference between the two phases in the average number of door openings per minute.
“I’d say the biggest surprise was just how often the doors to an OR are open during an arthroplasty case,” stated Dr. Osborn to OTW. “We were recording triple digit door openings for routine primary total joints.”
“Ultimately, the most critical finding to this study is that a simple and easy solution of just posting signs on the inside and the outside of the OR doors can dramatically decrease the traffic during these cases. It seems reasonable that every hospital or surgery center performing arthroplasty cases should implement Restricted Access signs if they haven’t already.”
“Moving forward, a large prospective study should be done to determine if increased OR traffic leads to an increased risk of periprosthetic joint infections. Furthermore, similar studies to our design could be performed to determine if staff education, and supply logistics also effect OR traffic.”
