Having additional OR personnel during the intraoperative period is not associated with an increased risk for surgical site infections (SSIs), according to a recent retrospective case control trial.
Surgical site infections are a significant source of patient morbidity and medical costs; prior studies have suggested that intraoperative traffic and the number of OR personnel might be risk factors for SSIs, according to Brendan T. Wanta, MD, lead study author and Critical Care Fellow at Mayo Clinic in Rochester, Minn.
“To date, several risk factors have been identified for surgical site infections. These include environmental factors, patient factors, and behavioral factors in the operating room,” Dr. Wanta said. “All the guidelines that we have today target these factors. The most interesting to us are the environmental factors as we know that these are modifiable and easy to change.”
The researchers analyzed the Mayo Clinic Division of Infection Control SSI database and patient intraoperative records to identify type 1 wounds from five surgical specialties (orthopedic, general, spine, vascular and neurologic). Type 1 was defined as a clean, uncontaminated wound that developed a superficial SSI. The procedures included in the study were conducted between January 2003 and December 2012. The investigators identified 722 cases and matched them to 2,389 non-SSI controls based on age, sex, procedure, date of surgery and American Society of Anesthesiologists physical status. The main measure was whether the number of OR personnel is associated with an increased odd of postoperative wound infections.
They found that a greater number of intraoperative providers is “not a strong risk factor for SSI” (OR [odds ratio] = 1.06; 95% CI, 1.03-1.09; P<0.0001). The findings suggested the same after correcting for multiple factors such as operative duration and patient factors (e.g., BMI, diabetes and vascular disease) (OR=1.05; 95% CI, 0.98-1.12; P=0.18). Orthopedic surgery had the highest number of SSI cases (49.2%), followed by general (18.9%), neurosurgery (12%), spine (11.8%) and vascular (8%).
“What we did find that was interesting is that peripheral vascular disease and diabetes mellitus were both significantly associated with the risk of surgical site infection after correcting for all of the other factors,” Dr. Wanta said. The findings were presented at the most recent New York State Society of Anesthesiologists PostGraduate Assembly in Anesthesiology (poster P-9113).
The researchers then separated all personnel into three groups to determine if a provider’s role affects SSI rates.
“We had our surgical scrubbed group, which included the surgeon, residents, fellows, surgical assistants and scrub technicians. We had the non-scrubbed category, which included the circulating nurses, recorders and any other personnel that was recorded in our data mart that was not in the scrub field,” Dr. Wanta said. “Then our anesthesia providers, including anesthesiologists, anesthesia residents and our registered nurse anesthetists.”
There were no differences among the groups, the researchers noted. Dr. Wanta said these findings are in contrast to some previous studies and guidelines, and that more research is needed.
“In the future, we’re going to look at larger numbers of patient data to see if we can identify other factors because this is something that is easily modifiable,” he said.