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Influence of Staff Behavior on Infectious Risk in Operating Rooms: What Is the Evidence?

Published online by Cambridge University Press:  05 January 2015

Gabriel Birgand*
French Institute of Health and Medical Research (INSERM), Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, F-75018 Paris, France Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France Assistance publique–Hôpitaux de Paris (AP-HP), Hôpital Bichat, Infection Control Unit, F-75018 Paris, France
Philippe Saliou
Brest Teaching Hospital, Infection Control Unit, Brest, France
Jean-Christophe Lucet
French Institute of Health and Medical Research (INSERM), Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, F-75018 Paris, France Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France Assistance publique–Hôpitaux de Paris (AP-HP), Hôpital Bichat, Infection Control Unit, F-75018 Paris, France
Address correspondence to Gabriel Birgand, Infection Control Unit, Bichat-Claude Bernard Teaching Hospital, AP-HP, 46 rue Henri Huchard 75018 Paris (



A systematic literature review was performed to assess the impact of surgical-staff behaviors on the risk of surgical site infections. Published data are limited, heterogeneous, and weakened by several methodological flaws, underlying the need for more studies with accurate tools.


To assess the current literature regarding the impact of surgical-staff behaviors on the risk of surgical-site infection (SSI).


Systematic literature review.


We searched the Medline, EMBASE, Ovid, Web of Science, and Cochrane databases for original articles about the impact of intraoperative behaviors on the risk of SSI published in English before September 2013.


We retrieved 27 original articles reporting data on number of people in the operating room (n=14), door openings (n=14; number [n=6], frequency [n=7], reasons [n=4], or duration [n=3]), surgical-team discipline (evidence of distraction; n=4), compliance with traffic measures (n=6), or simulated behaviors (n=3). Most (59%) articles were published in 2009–2013. End points were the 30-day SSI rate (n=8), air-particle count (n=2), or microbiological air counts (n=6); 11 studies were only descriptive. Number of people in the operating room and SSI rate or airborne contaminants (particle/bacteria) were correlated in 2 studies. Door openings and airborne bacteria counts were correlated in 2 observational studies and 1 experimental study. Two cohort studies showed a significant association between surgeon interruptions/distraction or noise and SSI rate. The level of evidence was low in all studies.


Published data about the impact of operating-room behaviors on the risk of infection are limited and heterogeneous. All studies exhibit major methodological flaws. More studies with accurate tools should be performed to address the influence of operating room behaviors on the infectious risk.

Infect Control Hosp Epidemiol 2015;36(1): 93–106

Review Article
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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