OR traffic, workflow disruptions drive infection risk

Editor's Note

Unnecessary traffic, workflow interruptions, and lapses in protocol in the OR increase the risk of surgical site infections (SSIs), according to an April 23 article in Infection Control Today.

While sterile technique, antibiotic use, and instrument cleanliness remain front-line defenses against infection, authors Katharine J. Hoffman, MPH, CIC, and Daisy Robles, BSN, RN, CIC, LSSYB, stress that less obvious factors—such as staff movement, personal protective equipment (PPE) compliance, hand hygiene, and equipment staging—also play a critical role in patient safety. For example, every time an OR door opens, it disrupts the positive pressure system designed to keep contaminants out, significantly raising particle counts and the likelihood of infection. They also cite a study finding OR traffic interruptions resulted in 29 times higher airborne particle counts compared to a controlled environment. 

Beyond air pressure concerns, the article points out the risks associated with surgical attire and personal protective equipment (PPE). Staff who don surgical clothing at home or fail to properly cover hair and facial hair can inadvertently bring external contaminants into the OR. Proper use of masks and other PPE is essential not only for sterile field staff but for anyone entering the suite, as asymptomatic carriers can transmit harmful pathogens without realizing it.

Hand hygiene also remains a persistent vulnerability, the authors write. Failing to clean hands before handling supplies or equipment can transfer pathogens directly to sterile areas. Likewise, moving equipment into the OR mid-procedure—especially if its cleanliness is uncertain—increases the risk of contamination. To counteract this, they recommend thorough preparation and staging of all equipment before the start of surgery to avoid disruptive, infection-prone workflow interruptions.

The full report offers additional  detail on these as well as other risks, such as overreliance on immediate-use steam sterilization and OR traffic and noise distracting surgical teams.