title: Cardiac surgical theatre traffic: time for traffic calming measures?
abstract: Surgical site infections (SSIs) remain a significant cause of postoperative complications. The risk of death from a medical error in a UK hospital remains one in 300. Increased theatre traffic has been identified as a modifiable determinant of SSI and surgical error. This cross-sectional study for the first time describes the pattern of theatre traffic in a UK cardiac centre. An electronic door counter and galaxy theatre management software (v3.4, iSOFT Banbury, UK) were used to calculate frequencies and rates of door opening during operations. Forty-six cases were analysed with 4273 door openings recorded. The median age of patients was 65 (range 43-75) with a median EuroSCORE of 5 (1-14). The mean frequency of door openings per case was 92.9 (45-205), with 19.2 (6.4-38.2) openings per hour. The theatre door was open for 10.7% of each hour of operating. Prolonged, acute and cases involving patients with higher EuroSCOREs demonstrated a trend towards increased opening. Door opening disturbs theatre airflow and results in increased air and wound contamination. It is also described as a contributor to surgical mistakes. Current levels of traffic are unacceptably high and represent a modifiable risk factor for SSI and error.
authors.affiliation: The General Infirmary at Leeds, UK. richard.young@doctors.org.uk
authors.forename: Richard S
authors.initials: RS
authors.lastname: Young
authors.forename: David J
authors.initials: DJ
authors.lastname: O'Regan
mesh_terms: D000328:Adult; D000368:Aged; D000391:Air Microbiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D004739:England; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008505:Medical Staff, Hospital / Q000458:organization & administration*; D008875:Middle Aged; D009870:Operating Room Information Systems; D009873:Operating Rooms / Q000458:organization & administration*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D000078329:Workforce