Traffic flow in the operating room: An explorative and descriptive study on air quality during orthopedic trauma implant surgery

Annette Erichsen Andersson RN, Ingrid Bergh RN, PhDc, Jón Karlsson MD, PhDd, Bengt I. Eriksson MD, PhD, Kerstin Nilsson RN, PhD

ABSTRACT

Background: Understanding the protective potential of operating room (OR) ventilation under different conditions is crucial to optimizing the surgical environment. This study investigated the air quality, expressed as colony-forming units (CFU)/m3, during orthopedic trauma surgery in a displacement- ventilated OR; explored how traffic flow and the number of persons present in the OR affects the air contamination rate in the vicinity of surgical wounds; and identified reasons for door openings in the OR. Methods: Data collection, consisting of active air sampling and observations, was performed during 30 orthopedic procedures.

Results: In 52 of the 91 air samples collected (57%), the CFU/m3 values exceeded the recommended level of <10 CFU/m3. In addition, the data showed a strongly positive correlation between the total CFU/m3 per operation and total traffic flow per operation (r 1⁄4 0.74; P 1⁄4 .001; n 1⁄4 24), after controlling for duration of surgery. A weaker, yet still positive correlation between CFU/m3 and the number of persons present in the OR (r 1⁄4 0.22; P 1⁄4 .04; n 1⁄4 82) was also found. Traffic flow, number of persons present, and duration of surgery explained 68% of the variance in total CFU/m3 (P 1⁄4 .001).

Conclusions: Traffic flow has a strong negative impact on the OR environment. The results of this study support interventions aimed at preventing surgical site infections by reducing traffic flow in the OR.