title: Influence of staff behavior on infectious risk in operating rooms: what is the evidence?
abstract: SUMMARY A systematic literature review was performed to assess the impact of surgical-staff behaviors on the risk of surgical site infections. Published data are limited, heterogeneous, and weakened by several methodological flaws, underlying the need for more studies with accurate tools. OBJECTIVE To assess the current literature regarding the impact of surgical-staff behaviors on the risk of surgical-site infection (SSI). DESIGN Systematic literature review. METHODS We searched the Medline, EMBASE, Ovid, Web of Science, and Cochrane databases for original articles about the impact of intraoperative behaviors on the risk of SSI published in English before September 2013. RESULTS We retrieved 27 original articles reporting data on number of people in the operating room (n=14), door openings (n=14; number [n=6], frequency [n=7], reasons [n=4], or duration [n=3]), surgical-team discipline (evidence of distraction; n=4), compliance with traffic measures (n=6), or simulated behaviors (n=3). Most (59%) articles were published in 2009-2013. End points were the 30-day SSI rate (n=8), air-particle count (n=2), or microbiological air counts (n=6); 11 studies were only descriptive. Number of people in the operating room and SSI rate or airborne contaminants (particle/bacteria) were correlated in 2 studies. Door openings and airborne bacteria counts were correlated in 2 observational studies and 1 experimental study. Two cohort studies showed a significant association between surgeon interruptions/distraction or noise and SSI rate. The level of evidence was low in all studies. CONCLUSIONS Published data about the impact of operating-room behaviors on the risk of infection are limited and heterogeneous. All studies exhibit major methodological flaws. More studies with accurate tools should be performed to address the influence of operating room behaviors on the infectious risk.
authors: 1French Institute of Health and Medical Research (INSERM),Infection,Antimicrobials,Modelling,Evolution (IAME),UMR 1137,F-75018 Paris,France.
authors: Gabriel
authors: G
authors: Birgand
authors: 4Brest Teaching Hospital,Infection Control Unit,Brest,France.
authors: Philippe
authors: P
authors: Saliou
authors: 1French Institute of Health and Medical Research (INSERM),Infection,Antimicrobials,Modelling,Evolution (IAME),UMR 1137,F-75018 Paris,France.
authors: Jean-Christophe
authors: JC
authors: Lucet
mesh_terms: D000391:Air Microbiology; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D017053:Infection Control / Q000592:standards*; D009873:Operating Rooms; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*