Operating Room Door Opening Patterns in Total Hip and Knee Arthroplasties

Abstract

Background Operating room (OR) foot traffic is a contributing factor in the development of periprosthetic joint infection (PJI), following total joint arthroplasty (TJA). Operating room door openings have been shown to increase bacterial counts in the OR, contributing to the risk of PJI. Because PJI is a costly and challenging complication, understanding door opening behavior is essential to minimize potential of PJI. Methods An observational study was conducted to evaluate OR foot traffic patterns for total knee and hip arthroplasties in a non-academic facility. Sixteen surgeries by 6 different surgeons were observed, 10 inpatient total hip arthroplasties (THA) and 6 inpatient total knee arthroplasties (TKA). OR traffic was monitored and recorded by counting the number of door openings, noting the timing of door openings, detailing personnel entering/exiting, and documenting the door used and the duration of each procedure. Results The average number of door openings for all cases during the possible contamination period was 73.4, and the average case length was 147 minutes. Sixty-four percent of traffic occurred from the time sterile trays were open to the incision being made and 36% of traffic occurred from incision to wound closure. Conclusion Managing door openings in the OR is a modifiable risk factor associated with PJI. From incision to closure, nurses and medical supply representatives were the largest contributors to OR foot traffic during TJA procedures. Understanding uring TJA will allow for the implementation of effective strategies to reduce OR foot traffic.