Decreasing Operating Room (OR) Traffic to Improve Patient Safety in an Academic Medical Center

Abstract

Background : OR traffic can contribute to the risk of developing a surgical site infection (SSI) as there is a link between elevated airborne particle counts and door openings. There is growing evidence that traffic patterns, including the number and movement of surgical team members should be carefully monitored during surgery especially for longer duration procedures. In this project, we propose to conduct a needs assessment and develop interventions based on findings to reduce door openings. Methods : The team utilized the Institute for Healthcare Improvement: Plan-Do-Study-ACT (PDSA) approach. The project involved a needs assessment, direct observations during cases, analysis and presentation of data, literature review, and leadership education. A needs assessment consisting of twenty-six surgery observations across five different service lines in seven different OR departments was completed with results on over 1666 door openings. Observations for the entire surgery were obtained and categorized as pre-incision versus post-incision. Reasons for door openings along with healthcare worker title and entry door access was collected. Data trends for each OR department were summarized separately. Results : Overall, across all the OR's, data revealed a high number of door openings. Most staff door openings involved non-scrubbed personnel movement and the most frequent reason was retrieval of supplies. All but one of the OR's had most door openings in the post-incision phase. Primary implementation strategies included 1) educating peri-operative leadership on the implications of OR traffic 2) updating surgeon preference cards and evaluating impact 3) restricting vendor traffic and 4) involving front line staff to launch an improvement campaign. Conclusions : The needs assessment demonstrates that a traffic campaign and further education is needed across all peri-operative areas. Peri-operative areas are sustaining the project with a campaign, staff surveys, education and further data collection.