title: Traffic in the operating room during joint replacement is a multidisciplinary problem.
abstract: BACKGROUND
  Door openings disrupt the laminar air flow and increase the bacterial count in the operating room (OR). We aimed to define the incidence of door openings in the OR during primary total joint arthroplasty (TJA) surgeries and determine whether measures were needed and/or possible to reduce OR staff traffic.
  
  
  METHODS
  We recorded the number of door openings during 100 primary elective TJA surgeries; the OR personnel were unaware of the observer's intention. Operating time was divided into the preincision period, defined as the time from the opening of surgical trays to skin incision, and the postincision period, defined as time from incision to dressing application.
  
  
  RESULTS
  The mean number of door openings during primary TJA was 71.1 (range 35-176) with a mean operative time of 111.9 (range 53-220) minutes, for an average of 0.64 (range 0.36-1.05) door openings/min. Nursing staff were responsible for 52.2% of total door openings, followed by anesthesia staff at 23.9% and orthopedic staff at 12.7%. In the preincision period, we observed an average of 0.84 door openings/ min, with nursing and orthopedic personnel responsible for most of the door openings. The postincision period yielded an average of 0.54 door openings/min, with nursing and anesthesia personnel being responsible for most of the door openings.
  
  
  CONCLUSIONS
  There is a high incidence of door openings during TJA. Because we observed a range in the number of door openings per surgery, we believe it is possible to reduce this number during TJA.
authors.affiliation: From the Department of Orthopedic Surgery, CHU de Québec, Hôpital de l'Enfant-Jésus, Québec, Que. (Bédard, Pelet); and the Faculty of Medicine, Université Laval, Québec, Que. (Bédard, Pelletier-Roy, Angers-Goulet, Leblanc, Pelet).
authors.forename: Martin
authors.initials: M
authors.lastname: Bédard
authors.affiliation: From the Department of Orthopedic Surgery, CHU de Québec, Hôpital de l'Enfant-Jésus, Québec, Que. (Bédard, Pelet); and the Faculty of Medicine, Université Laval, Québec, Que. (Bédard, Pelletier-Roy, Angers-Goulet, Leblanc, Pelet).
authors.forename: Rémi
authors.initials: R
authors.lastname: Pelletier-Roy
authors.affiliation: From the Department of Orthopedic Surgery, CHU de Québec, Hôpital de l'Enfant-Jésus, Québec, Que. (Bédard, Pelet); and the Faculty of Medicine, Université Laval, Québec, Que. (Bédard, Pelletier-Roy, Angers-Goulet, Leblanc, Pelet).
authors.forename: Mathieu
authors.initials: M
authors.lastname: Angers-Goulet
authors.affiliation: From the Department of Orthopedic Surgery, CHU de Québec, Hôpital de l'Enfant-Jésus, Québec, Que. (Bédard, Pelet); and the Faculty of Medicine, Université Laval, Québec, Que. (Bédard, Pelletier-Roy, Angers-Goulet, Leblanc, Pelet).
authors.forename: Pierre-Alexandre
authors.initials: PA
authors.lastname: Leblanc
authors.affiliation: From the Department of Orthopedic Surgery, CHU de Québec, Hôpital de l'Enfant-Jésus, Québec, Que. (Bédard, Pelet); and the Faculty of Medicine, Université Laval, Québec, Que. (Bédard, Pelletier-Roy, Angers-Goulet, Leblanc, Pelet).
authors.forename: Stéphane
authors.initials: S
authors.lastname: Pelet
mesh_terms: D019643:Arthroplasty, Replacement / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D009873:Operating Rooms / Q000592:standards* / Q000706:statistics & numerical data; D013997:Time Factors