S12
Oral Abstracts / American Journal of Infection Control 43 (2015) S3-S17
CONCLUSIONS: Organizations should carefully consider how
to implement infection prevention recommendations from
external agencies in order to create policies that satisfy those
recommendations and simultaneously meet the needs of
patients, families, and staff. Communicating changes in isolation
policies throughout a large enterprise presents specific chal-
lenges.
unanticipated circumstances are a fact of life in academic hos-
pitals, medical institutions must develop best practices that
maximize patient safety without compromising the pedagogic
mission.
Presentation Number 025
Construction and Implementation of an
Operating Room Management Plan for
the Prevention of Perioperative
Hypothermia
OR Issues & Environmental
Contamination
Presentation Number 024
Stephanie Stroever MPH, CIC, Infection Preventionist, Infection
Prevention & Management Associates; Kasi Hayes MSN, RN,
Director of Quality & Patient Safety Officer, Victory Medical Center
Craig Ranch; Jerri Lynn Hice RN, ADN, Director of Perioperative
Services, Victory Medical Center Craig Ranch; Grace Baldauf RN,
BSN, Registered Nurse, Victory Medical Center Craig Ranch; Cathy
Woodard RN, MSN, MHA, ACHNE, Chief Clinical Officer, Victory
Medical Center Craig Ranch; Roger Martin, Director of Facilities,
Victory Medical Center Craig Ranch
Breath of Fresh Air: An Observational
Study of Factors That Compromise
Operating Room Air Quality
Isabella Guajardo BA, Research Coordinator, University of
California, San Francisco; Jonathan Teter MS, NREMT, Project
Administrator, Epidemiology and Infection Prevention, Johns
Hopkins Medicine; Tamrah Al-Rammah MD, Research Fellow,
Johns Hopkins Medicine; Gedge Rosson MD, Director of Breast
Reconstruction, Associate Professor of Plastic and Reconstructive
Surgery, Johns Hopkins Medicine; Michele Manahan MD,
Assistant Professor of Plastic and Reconstructive Surgery, Johns
Hopkins Medicine
BACKGROUND: Perioperative hypothermia (PH) is a complication
in surgical patients that can lead to an increased risk of post-
operative infection due to vasoconstriction and impaired im-
munity. There are several risk factors that place patients at a
higher risk for PH, including a cold surgical environment. The
Texas Administrative Code (TAC) has defined ventilation re-
quirements for operating suites. However, the TAC notes the
likelihood of surgeon preferences and allows variance given
multidisciplinary agreement. We undertook to develop a risk
assessment and management plan for PH and evaluated it for
effectiveness.
BACKGROUND: Understanding what leads to high airborne par-
ticulate levels in the operating room (OR) is crucial for improving
patient safety and surgical outcomes. This study examined whether
the number of times OR doors are opened affects airborne partic-
ulate counts.
METHODS: Particulate levels and observations were recorded
from
a
single location in
a
modern, positive pressure OR
METHODS: This multidisciplinary workgroup met February-July
2014. We first identified the most common surgical procedures via
volume trending reports. We then used literature to determine the
most common co-morbidities in patients undergoing those specific
surgeries, cross referenced with those that place patients at higher
risk of PH. The risk assessment was then constructed for various
temperature ranges (see figure), and risk assigned according to
probability, patient effect and our preparedness to re-establish
normothermia.
approximately every five minutes during eight surgical pro-
cedures over five days. Observations recorded: which OR door
was opened (whether to the sterile core or to the outer corridor);
the number of times the door was opened; the job title of the
person opening it; and the reason for opening it. Baseline data
was collected in the morning before any activity. Reference
samples were taken in the OR, sterile core, outer corridor and
surgical wing front desk.
RESULTS: One or more OR doors were open during 48% of all
readings (333/697). Overall airborne particulate count increased
when either door was open (p<0.1950). For particles larger than 0.5
microns, there was a significant increase in particulate counts when
either door was open (p<0.0001). Particulate levels were higher
during cases than between cases (p<0.0286). The most common
reasons for opening either door were for case equipment (29%, 95%
CI [25%, 34%]), status updates (12%) and work-related conversations
RESULTS: We determined that patients who undergo bariatric,
spine, pediatric and total joint procedures are at a high risk of PH in
operating rooms with temperatures less than 62F. As a result, a new
process was created that required intraoperative warming of all
patients in this risk category, as well as frequent, documented
temperature checks, and possible room temperature adjustment.
A brief evaluation of the new process demonstrated a lack of sig-
nificant temperature changes between patients in the higher and
lower risk categories.
(
8%).
CONCLUSIONS: Each time an OR door is opened, the number of
airborne particulates increases: this increases the risk of airborne
particulates entering the sterile field. This data supports in-
terventions aimed at increasing the use of intercoms/viewing
monitors, equipment bundling, kit review, and maximizing
teamwork. These strategies will minimize unnecessary door
openings and help prevent surgical site infections. Although
CONCLUSIONS: Though surgeons have varying temperature
preferences for operating rooms, it is important to protect our
patients from the complications associated with PH, while
remaining flexible. The risk assessment allowed us to customize
our processes to best accomplish this task. We have seen success
in the prevention of perioperative hypothermia among our
patients.
APIC 42nd Annual Educational Conference & International Meeting j Nashville, TN j June 27-29, 2015
Haque, Mohd. Rezaul
