885 - Feasibility of Observing Traffic Patterns (FOOT Patter) in Veterans Health Administration Operating Rooms

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Presenting Author(s)

Tola Ewers

Health Services Researcher
University of Wisconsin-Madison School of Medicine and Public Health
Madison, Wisconsin
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

BA

Babak Aryanfar

Researcher
VA Greater Los Angeles
Los Angeles, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MB

Marvin J. Bittner

Professor
Creighton University School of Medicine and VA Nebraska-Western Iowa Health Care System
Omaha, Nebraska
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EB

Erin C. Balkenende

Research Coordinator
Iowa City VA Health Care System and University of Iowa
Iowa City, IA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Suzanne F. Bradley

Professor of Internal Medicine
University of Michigan Medical School
Ann Arbor, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MB

Madisen Brown

Social Science Program Specialist
Department of Veterans Affairs
Jamaica Plain, Massachusetts
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Matthew B. Goetz

Chief, Infectious Diseases
VA Greater Los Angeles Healthcare System
Los Angeles, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KG

Kalpana Gupta

Professor of Medicine
VA Boston Healthcare System and Boston Universiy School of Medicine
West Roxbury, MA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CH

Christopher J. Hostler

Staff Physician and Assistant Professor of Medicine
Durham VA/Duke
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EP

Eli N. Perencevich

COIN Director - Physician
Iowa City VA Health Care Sysrtem and University of Iowa
Iowa City, IA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JS

Judith Strymish

Assistant Professor of Medicine
VA Boston Healthcare System
West Roxbury, Massachusetts
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
GU

Gisel Urdaneta

Research Coordinator
Miami VA Healthcare System
Miami, Florida
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Christopher J. Crnich

Associate Professor of Medicine
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Surgical site infections (SSIs) complicate nearly 6% of surgeries performed in Veterans Health Administration (VA) hospitals and occur despite adoption of practices known to reduce them. SSIs are associated with prolonged hospitalization and an increased risk of readmission, reoperation and mortality. Operating room (OR) door openings may increase SSI through disruption of desired OR air flow patterns and increased wound microbe counts. Our study objectives were to: 1) develop a methodological approach for collecting data on entry/exit traffic patterns in VA ORs and 2) characterize patterns across different surgery types.

Methods: Trained researchers from 10 VA-Centers for Disease Control and Prevention (CDC) Practice-based Research Network sites observed staff entering and exiting VA ORs. Staff were categorized and identified by role. Exits/entries were recorded on a standardized tracking sheet. Surgery type and observation duration from incision to closure were noted. Mean hourly door openings across procedure and role types were compared via a one-way ANOVA using Stata ver. 15.0.

Results: We observed 56 surgeries on 55 patients (Fig. 1). During 9,801 observation minutes, 766 staff opened doors 3,882 times. Door openings by role differed significantly (p < 0.001) with nurses, perfusionists, anesthesia and vendors having the highest mean door-opening rate. Coronary artery bypass grafts (CABGs) accounted for most door openings and significantly greater surgical duration than other procedures (p=0.012). Time-adjusted OR door opening rate was similar across procedure types at ~22-26 hourly openings (p=0.186).Figure 1. FOOT Patter results

Conclusion: The hourly rate of door openings varied notably by staff role. Our data show that measurement of OR movements is feasible although gaining access and approval to observe, achieving ideal observer positioning in complex floor plans, and potential misidentification of entering/exiting staff are challenges of direct methods. Scaling this study up may require automated processes. Studies exploring influences of traffic patterns on OR air quality metrics and impact on risk of SSI, identifying rationale and necessity for door openings and effective strategies for reducing unneeded door openings are needed.