The Effect of Door Opening on Positive Pressure and Airflow in Operating Rooms

Mitchell C. Weiser, Shai Shemesh, Darwin D. Chen, Michael J. Bronson, Calin S. Moucha

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

INTRODUCTION: Door openings and increased foot traffic in operating rooms (ORs) during total joint arthroplasty are thought to increase the risk of surgical site infection.

METHODS: Digital manometers were used to collect pressure data during off-hours at the thresholds of both the outer door (ie, the door to the common OR hallway) and the inner substerile door, which opens to the substerile hallway, of six empty ORs used for total joint arthroplasty. Airflow patterns were visualized with smoke studies to determine whether outside air entered the ORs during single or multiple door openings. Data were analyzed using the Student t-test and one-way analysis of variance.

RESULTS: Positive pressure was not defeated during any door-opening event. The average time for recovery of the initial pressurization in the OR regardless of the door used was between 14 and 15 seconds (P = 0.462). No differences in the degree of room depressurization were noted between entry of personnel through the outer door, passing of a surgical tray through the outer door, and entry of personnel through the inner door (P = 0.312). Smoke studies confirmed that no contaminated outside air entered the OR with single door opening. Outside air entered the OR if two doors were open simultaneously.

CONCLUSION: Single door opening does not defeat OR positive pressure, but simultaneous opening of two doors allows contaminated air to flow into the OR. OR traffic should continue to be limited during surgical procedures. OR personnel should be educated about the danger to the sterile field that can result from simultaneous door openings and should be discouraged from such activity.

Original languageEnglish (US)
Pages (from-to)e105-e113
JournalThe Journal of the American Academy of Orthopaedic Surgeons
Volume26
Issue number5
DOIs
StatePublished - Mar 1 2018

Fingerprint

Operating Rooms
Pressure
Air
Smoke
Arthroplasty
Joints
Surgical Wound Infection
Foot
Analysis of Variance
Students

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

The Effect of Door Opening on Positive Pressure and Airflow in Operating Rooms. / Weiser, Mitchell C.; Shemesh, Shai; Chen, Darwin D.; Bronson, Michael J.; Moucha, Calin S.

In: The Journal of the American Academy of Orthopaedic Surgeons, Vol. 26, No. 5, 01.03.2018, p. e105-e113.

Research output: Contribution to journalArticle

Weiser, Mitchell C. ; Shemesh, Shai ; Chen, Darwin D. ; Bronson, Michael J. ; Moucha, Calin S. / The Effect of Door Opening on Positive Pressure and Airflow in Operating Rooms. In: The Journal of the American Academy of Orthopaedic Surgeons. 2018 ; Vol. 26, No. 5. pp. e105-e113.
@article{006243e69b5743a9890aef97e7e5ff03,
title = "The Effect of Door Opening on Positive Pressure and Airflow in Operating Rooms",
abstract = "INTRODUCTION: Door openings and increased foot traffic in operating rooms (ORs) during total joint arthroplasty are thought to increase the risk of surgical site infection.METHODS: Digital manometers were used to collect pressure data during off-hours at the thresholds of both the outer door (ie, the door to the common OR hallway) and the inner substerile door, which opens to the substerile hallway, of six empty ORs used for total joint arthroplasty. Airflow patterns were visualized with smoke studies to determine whether outside air entered the ORs during single or multiple door openings. Data were analyzed using the Student t-test and one-way analysis of variance.RESULTS: Positive pressure was not defeated during any door-opening event. The average time for recovery of the initial pressurization in the OR regardless of the door used was between 14 and 15 seconds (P = 0.462). No differences in the degree of room depressurization were noted between entry of personnel through the outer door, passing of a surgical tray through the outer door, and entry of personnel through the inner door (P = 0.312). Smoke studies confirmed that no contaminated outside air entered the OR with single door opening. Outside air entered the OR if two doors were open simultaneously.CONCLUSION: Single door opening does not defeat OR positive pressure, but simultaneous opening of two doors allows contaminated air to flow into the OR. OR traffic should continue to be limited during surgical procedures. OR personnel should be educated about the danger to the sterile field that can result from simultaneous door openings and should be discouraged from such activity.",
author = "Weiser, {Mitchell C.} and Shai Shemesh and Chen, {Darwin D.} and Bronson, {Michael J.} and Moucha, {Calin S.}",
year = "2018",
month = "3",
day = "1",
doi = "10.5435/JAAOS-D-16-00891",
language = "English (US)",
volume = "26",
pages = "e105--e113",
journal = "The Journal of the American Academy of Orthopaedic Surgeons",
issn = "1067-151X",
publisher = "American Association of Orthopaedic Surgeons",
number = "5",

}

TY - JOUR

T1 - The Effect of Door Opening on Positive Pressure and Airflow in Operating Rooms

AU - Weiser, Mitchell C.

AU - Shemesh, Shai

AU - Chen, Darwin D.

AU - Bronson, Michael J.

AU - Moucha, Calin S.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - INTRODUCTION: Door openings and increased foot traffic in operating rooms (ORs) during total joint arthroplasty are thought to increase the risk of surgical site infection.METHODS: Digital manometers were used to collect pressure data during off-hours at the thresholds of both the outer door (ie, the door to the common OR hallway) and the inner substerile door, which opens to the substerile hallway, of six empty ORs used for total joint arthroplasty. Airflow patterns were visualized with smoke studies to determine whether outside air entered the ORs during single or multiple door openings. Data were analyzed using the Student t-test and one-way analysis of variance.RESULTS: Positive pressure was not defeated during any door-opening event. The average time for recovery of the initial pressurization in the OR regardless of the door used was between 14 and 15 seconds (P = 0.462). No differences in the degree of room depressurization were noted between entry of personnel through the outer door, passing of a surgical tray through the outer door, and entry of personnel through the inner door (P = 0.312). Smoke studies confirmed that no contaminated outside air entered the OR with single door opening. Outside air entered the OR if two doors were open simultaneously.CONCLUSION: Single door opening does not defeat OR positive pressure, but simultaneous opening of two doors allows contaminated air to flow into the OR. OR traffic should continue to be limited during surgical procedures. OR personnel should be educated about the danger to the sterile field that can result from simultaneous door openings and should be discouraged from such activity.

AB - INTRODUCTION: Door openings and increased foot traffic in operating rooms (ORs) during total joint arthroplasty are thought to increase the risk of surgical site infection.METHODS: Digital manometers were used to collect pressure data during off-hours at the thresholds of both the outer door (ie, the door to the common OR hallway) and the inner substerile door, which opens to the substerile hallway, of six empty ORs used for total joint arthroplasty. Airflow patterns were visualized with smoke studies to determine whether outside air entered the ORs during single or multiple door openings. Data were analyzed using the Student t-test and one-way analysis of variance.RESULTS: Positive pressure was not defeated during any door-opening event. The average time for recovery of the initial pressurization in the OR regardless of the door used was between 14 and 15 seconds (P = 0.462). No differences in the degree of room depressurization were noted between entry of personnel through the outer door, passing of a surgical tray through the outer door, and entry of personnel through the inner door (P = 0.312). Smoke studies confirmed that no contaminated outside air entered the OR with single door opening. Outside air entered the OR if two doors were open simultaneously.CONCLUSION: Single door opening does not defeat OR positive pressure, but simultaneous opening of two doors allows contaminated air to flow into the OR. OR traffic should continue to be limited during surgical procedures. OR personnel should be educated about the danger to the sterile field that can result from simultaneous door openings and should be discouraged from such activity.

UR - http://www.scopus.com/inward/record.url?scp=85052956174&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052956174&partnerID=8YFLogxK

U2 - 10.5435/JAAOS-D-16-00891

DO - 10.5435/JAAOS-D-16-00891

M3 - Article

C2 - 29419726

AN - SCOPUS:85052956174

VL - 26

SP - e105-e113

JO - The Journal of the American Academy of Orthopaedic Surgeons

JF - The Journal of the American Academy of Orthopaedic Surgeons

SN - 1067-151X

IS - 5

ER -