IN OR OUT? Minimize foot traffic to decrease your risk of SSIs, suggests a new study.

Is your OR foot traffic jeopardizing patient safety? It could, says a new study that found a connection between surgical site infections and how often the OR door is opened during a procedure.

When the safety team at Peace Arch Hospital in White Rock, British Columbia, Canada, noticed there was too much foot traffic in and out of the OR during total joint replacement procedures, they implemented several solutions to reduce it. But the initiatives not only reduced the number of door openings — they also appeared to decrease their surgical site infection rate.

OR staff at Peace Arch launched a program 2 years ago to improve patient and staff safety, according to the study presented at the American College of Surgeons National Surgical Quality Improvement Program Conference. As part of the hospital's program, the safety team asked OR nurses and surgeons to share what they thought caused patients harm, and how they thought the hospital could help prevent those problems.

One common answer? Too much foot traffic in the OR.

Around the same time, the hospital staff also learned that they had an excessively high rate of wound infections from orthopedic procedures like knee and hip joint replacements. To see if the 2 were connected, the safety team conducted a study over 2 days where they counted the number of door openings during 9 total joint replacement operations and 1 revision operation.

During these audits, the researchers counted between 42 and 70 door openings per operation from incision time to joint capsule closing time, according to the study. The reasons staff left the room varied, from taking breaks to retrieving charts, instruments and other supplies for the procedure.

To reduce the number of door openings, the patient safety team implemented several new initiatives, including stopping all traffic in and out of the OR during total joint capsule opening and closure, communicating more by phone and increasing the use of templates to identify implant size before each operation, according to the study. The team also placed signs on the doors reminding staff to minimize traffic and to record why they were entering the OR during the procedure.

After implementing these changes, the hospital continued to conduct traffic audits every 6 months. These follow-up audits showed a significant reduction in OR foot traffic, with door openings decreasing from 42 to 70 per case to an average of 3.2 door openings per case. During this time, the hospital also saw a reduction in its orthopedic SSI rate from 2.8% to 2.1%, which the study suggests is related to the decrease in OR traffic.

The team says it will continue to perform traffic audits every 6 months and that it is hoping to expand these practices to other service lines, including general surgery, urology, and gynecology.

"The idea is to be very mindful to make minimal traffic an everyday practice, and it is very close to that now," says lead study author Susann Camus, MA, MPH.

Kendal Gapinski