Door opening

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anbuitachi

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At my institution for cardiac and joint cases, once sterile equipments are open you must enter /exit thru back door not front door. Nurses and sometimes surgeons FLIP out if you enter thru the front door. As far as I know there's a study that shows frequent door opening may defeat positive pressure benefit of OR. I didn't see any studies showing increased infections. Is it like this everywhere? Anyone know of better studies? Seems insane to change so many practices just based on one questionable study.
 
I am aware of this trend, mentality, and supposed "study", I have never seen outcomes relating to it. However, I did not experience anyone caring about this outside of the NYC area. Also, two major heart centers I worked at did not have an alternate entrance/exit to the OR, so I can definitely say some places don't seem to even think of this as a theoretical concern.

I will also say anecdotally, the same surgeons and nurses I had seen yell at people, I also witnessed them eating in the OR, wearing non-hospital scrubs in the OR, and standing over the patient with an untied mask and the chest open...so yeah.
 
The main argument centers around hospitals that have a sterile core. Like if your ORs all connect to a core equipment area where ppl are supposed to wear hat or masks etc. So in theory you aren't allowing the miasma of the common folk in if you use that entrance.

I also LOVE your post if you did what I think you did.
 
Frequent Door Openings During Cardiac Surgery Are Associated With Increased Risk for Surgical Site Infection: A Prospective Observational Study
"""
Conclusions
Frequent door openings during cardiac surgery were independently associated with an increased risk for SSI. This finding warrants further study to establish a potentially causal relationship between OR door openings and the occurrence of SSI.
"""

I think the real problem isn't the door opening but that door opening is a surrogate marker for how bad **** is getting.
Do I have all the equipment I need?
Are the staff running around between things or finding things?
Do I need extra product?
 
Orin said:
Frequent Door Openings During Cardiac Surgery Are Associated With Increased Risk for Surgical Site Infection: A Prospective Observational Study
"""
Conclusions
Frequent door openings during cardiac surgery were independently associated with an increased risk for SSI. This finding warrants further study to establish a potentially causal relationship between OR door openings and the occurrence of SSI.
"""

I think the real problem isn't the door opening but that door opening is a surrogate marker for how bad **** is getting.
Do I have all the equipment I need?
Are the staff running around between things or finding things?
Do I need extra product?
Click to expand...

Agree. And perhaps who is going in and out? If the surgeon is breaking scrubs many times and going back in maybe that increase chances of infection as opposed to a med student opening a door for whatever reason

And do they really think the sterile Core air is more sterile than Or area ? It's not like cars or people on jeans are running around infront of front door.
 
Here's a story from my all too fun practice:

During setup for a spine surgery it was noted by staff that a hair from a previous patient was present in the Gardner Wells tongs bin s/p sterilization. The surgeon argued that the hair (again, from another patient) was "sterilized" and that we should proceed.

Note that these cases always have the external OR door taped shut to prevent alleged increased infection risk, and this surgeon goes nuts if anyone breaks through...

PS - the OR charge nurse had none of this "sterile" hair business and swiped the bin from him. My OR nursing staff really is top notch and they always do the right thing.

The case was delayed a good 30 min - and rightfully so.
 
Back door. Hairs. Tongs...

This thread reminds me of

 
kidthor said:
Here's a story from my all too fun practice:

During setup for a spine surgery it was noted by staff that a hair from a previous patient was present in the Gardner Wells tongs bin s/p sterilization. The surgeon argued that the hair (again, from another patient) was "sterilized" and that we should proceed.

Note that these cases always have the external OR door taped shut to prevent alleged increased infection risk, and this surgeon goes nuts if anyone breaks through...

PS - the OR charge nurse had none of this "sterile" hair business and swiped the bin from him. My OR nursing staff really is top notch and they always do the right thing.

The case was delayed a good 30 min - and rightfully so.
Click to expand...

you didn't think the hair was sterile?
 
kidthor said:
In the sense that another patient's body matter in an OR is never sterile - no, it was not sterile.

But, haters gonna hate.
Click to expand...

But, hair is already devitalized tissue. The high temps of the sterilizer should kill a overwhelming significant amount of microbes.
 
I was doing an implant and a fly buzzed past me. Patient did fine.
 
There is a friendly neighborhood cat that always hangs out in the outside atrium at one of our hospitals.

Legend has it he made his way into the hospital and snuck back into the ORs one time.

They now have high frequency sound units at all the entrances to keep him from sneaking through open doors.

Sammie the Cat
 
Best part of that door study:

"Internal" doors connect to the clean instrument room with fancy laminar airflow.

"External" doors connect to the hallway.

Results (after data massaging that was previously not significant):

In univariable analysis, an increased mean opening frequency of all OR doors combined was associated with higher risk for SSI (HR per 5-unit increment, 1.47; 95% confidence interval [CI], 1.11–1.95; P = .007; Figure 3); the observed effect was driven by internal OR door openings (HR per 5-unit increment, 2.00; 95% CI, 1.24–3.20; P = .005).

"There was no evidence for an association between mean opening frequencies of external OR doors and risk for SSI (HR per 5-unit increment, 1.27; 95% CI, 0.83–1.90; P = .28)."

The most reasonable answer to this is: BS, after enough data massaging they finally got a significant result and it is one that is illogical.

The most generous to them answer: it's the surgical staffs fault.

Take home answer: Use the dirtiest door possible, bring in a pulled pork sandwich.
 
We studied this years ago when our joint surgeons complained about OR traffic. Roughly 75% of the door openings during the case were related to their sales reps, and the rest to a combination of OR and anesthesia staff.
 
Urzuz said:
Only in Pakistan - Cat in Operating Room : pakistan
Click to expand...

Another great part of that video is all the people wearing facemasks ... pulled down around their chins.


The developing world is ... another world. I worked in an OR last year that had two patients side by side going at once: one was a total knee arthroplasty, and the other was an I&D of an abscess. The prosthetic infection rate that they admitted to was over 20%. In the dual c-section OR the obstetrician would do one c-section, take off his gloves, spin around, put new gloves on, and do another c-section. Kept the same gown on. I bet if he wanted to he could've done all 5 or 6 that day without moving his left foot, like a pivoting basketball player.

Also, they often kept the doors open.
 
pgg said:
Another great part of that video is all the people wearing facemasks ... pulled down around their chins.


The developing world is ... another world. I worked in an OR last year that had two patients side by side going at once: one was a total knee arthroplasty, and the other was an I&D of an abscess. The prosthetic infection rate that they admitted to was over 20%. In the dual c-section OR the obstetrician would do one c-section, take off his gloves, spin around, put new gloves on, and do another c-section. Kept the same gown on. I bet if he wanted to he could've done all 5 or 6 that day without moving his left foot, like a pivoting basketball player.

Also, they often kept the doors open.
Click to expand...
Because they are still in the 19th century and Ignaz Semmelweis is a state secret.
 
pgg said:
In the dual c-section OR the obstetrician would do one c-section, take off his gloves, spin around, put new gloves on, and do another c-section.
Click to expand...

Sounds classy. I have heard tales of OR staff being given one pair of what we would consider disposable gloves for the day. They wash them off periodically, in between bloody tasks, etc.
 
anbuitachi said:
they dont have as much money
Click to expand...
Sort of.

The place I worked had enough money for state of the art ceramic artificial joint implants. And a transplant program. They had a brand new Epiq TEE machine with a 3D probe.

But they also did most everything under regional anesthesia to keep drug and supply costs down. Kidney harvest and transplant procedures done with a total anesthetic expenditure of two spinal needles and one bottle of 0.5% bupivacaine, for example. (And to think the penny pinchers here gripe about des vs iso.)

Mostly I think their habits and practices just hadn't caught up to the relatively abrupt influx of sorta random modern "stuff" ... and some of that stuff brought some very ambitious surgeons.

Organs and joints only went to cash paying patients, and they would pay for the new joint, and then pay again for the infected joint explant, and pay again for a new joint. I think the surgeons were largely happy with that arrangement, and the patients were probably counseled that infections were just normal (if they were counseled about risks at all!) and they accepted the redo procedures and extra costs with some fatalism.

Nearly all the bad outcomes I witnessed were consequences of practice and culture, not poverty. Which was actually good, as we had a better shot at altering their practice than we did at altering their economics.
 
pgg said:
Sort of.

The place I worked had enough money for state of the art ceramic artificial joint implants. And a transplant program. They had a brand new Epiq TEE machine with a 3D probe.

But they also did most everything under regional anesthesia to keep drug and supply costs down. Kidney harvest and transplant procedures done with a total anesthetic expenditure of two spinal needles and one bottle of 0.5% bupivacaine, for example. (And to think the penny pinchers here gripe about des vs iso.)

Mostly I think their habits and practices just hadn't caught up to the relatively abrupt influx of sorta random modern "stuff" ... and some of that stuff brought some very ambitious surgeons.

Organs and joints only went to cash paying patients, and they would pay for the new joint, and then pay again for the infected joint explant, and pay again for a new joint. I think the surgeons were largely happy with that arrangement, and the patients were probably counseled that infections were just normal (if they were counseled about risks at all!) and they accepted the redo procedures and extra costs with some fatalism.

Nearly all the bad outcomes I witnessed were consequences of practice and culture, not poverty. Which was actually good, as we had a better shot at altering their practice than we did at altering their economics.
Click to expand...

Oh they do kidney transplants under spinal?
 
anbuitachi said:
At my institution for cardiac and joint cases, once sterile equipments are open you must enter /exit thru back door not front door. Nurses and sometimes surgeons FLIP out if you enter thru the front door. As far as I know there's a study that shows frequent door opening may defeat positive pressure benefit of OR. I didn't see any studies showing increased infections. Is it like this everywhere? Anyone know of better studies? Seems insane to change so many practices just based on one questionable study.
Click to expand...

Forget door opening, who else has to wear these ridiculous paper jackets to protect the patient from "squames"?
 
fakin' the funk said:
Forget door opening, who else has to wear these ridiculous paper jackets to protect the patient from "squames"?
Click to expand...


Right. And how do you protect patients Friday m their own squames? All patients and staff should just strip down and full body ioban (which is also widely used even though it has no effect on SSI’s) before entering the OR.
 
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