Frequent Door Openings During Cardiac Surgery are Associated with Increased Risk for Surgical Site Infection: A Prospective Observational Study

Clin Infect Dis 2018: (Journal)

Roth J. A., Juchler F., Dangel M., Eckstein F. S., Battegay M., Widmer A. F.

Background: Preliminary studies analyzing surrogate markers have suggested that operating room (OR) door openings may be a risk factor for surgical site infection (SSI). We therefore aimed to estimate the effect of OR door openings on SSI risk in patients receiving a cardiac surgery. Methods: This prospective observational study involved consecutive patients receiving a cardiac surgery in two pre-specified ORs equipped with automatic door counting devices from June 2016 to October 2017. Occurrence of a SSI within 30 days after cardiac surgery was our primary outcome measure. Respective outcome data was obtained from a national SSI surveillance cohort. We analyzed the relationship between mean OR door opening frequencies and SSI risk by use of uni- and multivariable Cox regression models. Results: 301 594 OR door openings were recorded during the study period with 87 676 eligible door openings being logged between incision and skin closure. 688 patients were included, of whom 24 (3.5%) developed an SSI within 30 days after surgery. In uni- and multivariable analysis, an increased mean door opening frequency during cardiac surgery was associated with higher risk for consecutive SSI (adjusted hazard ratio per five-unit increment, 1.49; 95% confidence interval, 1.11-2.00; P=.008); the observed effect was driven by internal OR door openings towards the clean instrument preparation room. Conclusions: Frequent door openings during cardiac surgery were independently associated with an increased risk for surgical site infection: This finding warrants further study to establish a potentially causal relationship between OR door openings and the occurrence of SSI.

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