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Arthroplasty Central Discuss How many people in the OR? Does it matter? in the General Discussion forums; Karin (Nairek) brought up an interesting point the other day as she explained her agonizing pre-op process. One point she ...

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Old 02-04-2009, 12:56 PM
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Lightbulb How many people in the OR? Does it matter?

Karin (Nairek) brought up an interesting point the other day as she explained her agonizing pre-op process. One point she addressed reminded me of a discussion I had with a hip arthroplasty patient, Jeff, who has posted here a few times. Jeff was explaining (lamenting) about the number of people who can end up in the operating rooms; sales reps, students and other non-doctors. His main beef was this it represented an infection risk to the patient.

I wondered about that for a long time, and then had a chat about it with a general surgeon to better understand some of the complexities with OR process. None of us want to go into surgery with the feeling that we’ll be under general anesthesia, spread naked in the da Vinci position and have a crowd of people over us while we get opened!

Out of the list of possible OR “traffic” risks to patients, here are just a few:

1. Measurement of Foot Traffic in the Operating Room: Implications for Infection Control

Surgical site infections cause significant morbidity and mortality in the postoperative period. Opening of the operating room door disrupts its filtered atmosphere, increasing contamination above the wound. We conducted a study of traffic in the operating room as a risk for infections. This is an observational study of recorded behaviors in the operating room. Data collected included number of people entering/exiting, the role of these individuals, and the cause for the event. A total of 3071 door openings were recorded in 28 cases. Traffic varied from 19 to 50 events per hour across specialties. The pre-incision period represented 30% to 50% of all events. Information requests accounted for the majority of events. Door openings increase in direct proportion to case length, but have an exponential relationship with the number of persons in the operating room. There is a high rate of traffic across all specialties, compromising the sterile environment of the operating room. (Am J Med Qual. 2009;24:45-52)

2. The practices of the medical personnel and the masks they wear. In some cases, docs may not wear the masks during parts of a procedure (as seen on a recent ADR procedure). Also, one critique from a doctor is that the masks themselves lose their effectiveness over time; e.g. in a very long surgical procedure. These filtering capabilities may have changed in the last few years, as technology has improved the mask materials.

3. Patient information: Joint infection (article specific to hips and knees, but still applies to spinal arthroplasty)

Risk factors — Although it is not possible to predict which patients will develop an infection after artificial joint placement, some patients may be more at risk than others. Some of the risk factors include:
  1. An infected wound (not necessarily the wound over the artificial joint)
  2. Previous surgery on the joint
  3. Rheumatoid arthritis or other bodywide illness
  4. Other infections around the time of surgery
  5. Prior infection of the joint or adjacent bone
  6. Prolonged time in the operating room during the joint replacement
  7. Higher number of operating room personnel during the joint replacement
  8. Bleeding or blood clot formation after joint replacement surgery
  9. Advanced age
Look, this is complex stuff for sure. But it may help patients think about the kind of questions they should be asking. Talk to your doctor, and ask some tough questions like: How many people will be in the operating room? Are you working with your usual staff? What else do I have to know about OR personnel who will be present?

You get the point. Hope this helps….
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Old 05-21-2010, 03:37 PM
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Default Article Attached

One of the authors was kind enough to share the article I mentioned in the previous post. Please read it carefully.
Attached Files
File Type: pdf OR Traffic and Infection Control.pdf (356.1 KB, 2 views)
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"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
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