68 - Operating Room Traffic Patterns and Surgical Site Infections
Description: Problem/PurposeOpening operating room (OR) doors increases the risk for surgical site infection (SSI). This study aimed to further explore the role of the circulating nurse in minimizing risk for SSI in their patients through novel exploration of staff sequencing patterns. Literature ReviewSSIs are high hospital priorities as these infections are both costly to the hospital and threatening to patients’ long-term health. Researchers recently found a correlation between both number of persons in the operating and number of door swings to levels of bacterial colony forming units (CFUs), noting a 2.5% increase in CFUs/m3 per person in the OR and a 0.25% increase per door swing. Given nurses’ responsibility for 25-40% of traffic, the OR nurse has a high responsibility to manipulate the environment to reduce traffic for optimal patient safety. Research Question/Hypothesis This study examined OR staff entry and exit during surgical procedures to discover any identifiable patterns to staff traffic flow in the OR. Researchers considered variables including type of total joint arthroplasty (TJA), role of persons entering through and reason for passage, timing during surgical event, and trends over time. Conceptual Framework:Johnson’s Health Behaviour theory has been applied to nursing care and infection prevention and serves as a framework to support this work.MethodologyThis observational study maintained a dedicated researcher in the OR during TJA for data collection from room opening to dressing application. Nurse researchers and a statistician performed data analysis using SASv9.4 to identify points of possible staff pattern sequencing (Sequential Data Analysis). A total of 2,204 data points from 29 cases were analyzed to identify elementary staff roles and reasons for traffic through the OR. Following simple analysis, the researchers analyzed various tools for identification of staff traffic patterns and cluster rates. Data AnalysisDespite the surgical case having predictable events and needs, researchers concluded that there is no discernable pattern to inter-staff movement during TJA. This study revealed new knowledge in staff sequence patterning in the operating room. Conclusions/DiscussionThe findings imply that OR staff are primarily moving independently of other staffing needs, with poor collaboration. Despite guidance from the AORN in the 2019 Guidelines, current active participation in traffic reduction methods appear to be minimal. Perioperative Nursing ImplicationsBecause the circulating nurse has such a high responsibility for traffic through the OR, targeted education for RNs could assist staff in creating new patterns of purposeful, minimal movement in and out of the OR that would decrease environmental infection risk.