Operating Room Traffic is a Major Concern During Total Joint Arthroplasty

TLDR

Periprosthetic joint infection is a challenging complication of total joint arthroplasty. The study aimed to quantify door‑opening incidence and causes during primary and revision total joint arthroplasty and to develop strategies to reduce operating‑room traffic. Observations were recorded during surgeries performed under vertical laminar flow, with staff blinded to the observer, documenting door openings, reasons, personnel, and operative times. Primary and revision total joint arthroplasty had average door openings of 60 and 135, respectively, with higher per‑minute rates in revisions; circulating nurses and implant representatives were the main contributors, underscoring traffic as a major concern, especially in revision cases.

Abstract

Periprosthetic joint infection (PJI) is a challenging complication associated with total joint arthroplasty(TJA). Traffic in the operating room (OR) increases bacterial counts in the OR, andmay lead to increased rates of infection.Our purposes were to (1) define the incidence of door opening during primary and revision TJA,providing a comparison between the two types of procedures,and (2) identify the causes of door opening in order to develop a strategy to reduce traffic in the operating room.An observer collected data during 80 primary and 36 revision TJAs. Surgeries were performed under vertical, laminar flow. Operating room personnel were unaware of the observer, thus removing bias from traffic. The observer documented the number, reason, and personnel involved in the event of a door opening from time of tray opening to closure of the surgical site.The average operating time for primary and revision procedures was 92 and 161 minutes, respectively. Average door openings were 60 in primary cases and 135 in revisions, yielding per minute rates of 0.65 and 0.84, respectively. The circulating nurse and surgical implant representatives constituted the majority of OR traffic.Traffic in the OR is a major concern during TJA. Revision cases demonstrated a particularly high rate of traffic. Implementation of strategies, such as storage of instruments and components in the operating room and education of OR personnel, is required to reduce door openings in the OR.