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Motion-capture system to assess intraoperative staff movements and door openings: Impact on surrogates of the infectious risk in surgery

Published online by Cambridge University Press:  12 March 2019

Gabriel Birgand*
Affiliation:
Infection Antimicrobials Modelling Evolution (IAME), French Institute for Medical Research (INSERM), Paris, France Infection Antimicrobials Modelling Evolution (IAME), University Paris Diderot, Paris, France Infection Control Unit, Hôpital Bichat, l’Assistance publique - Hôpitaux de Paris (AP-HP), Paris, France
Christine Azevedo
Affiliation:
Laboratoire d’Informatique de Robotique et de Microélectronique de Montpellier (LIRMM), INRIA Research Center, MontpellierFrance Institut National de Recherche en Informatique et en Automatique, Montbonnot, France
Stephane Rukly
Affiliation:
Infection Antimicrobials Modelling Evolution (IAME), French Institute for Medical Research (INSERM), Paris, France
Roger Pissard-Gibollet
Affiliation:
Institut National de Recherche en Informatique et en Automatique, Montbonnot, France
Gaëlle Toupet
Affiliation:
Infection Control Unit, Hôpital Bichat, l’Assistance publique - Hôpitaux de Paris (AP-HP), Paris, France
Jean-François Timsit
Affiliation:
Infection Antimicrobials Modelling Evolution (IAME), French Institute for Medical Research (INSERM), Paris, France Infection Antimicrobials Modelling Evolution (IAME), University Paris Diderot, Paris, France Medical Intensive Care Unit, Hôpital Bichat, l’Assistance publique - Hôpitaux de Paris (AP-HP), Paris, France
Jean-Christophe Lucet
Affiliation:
Infection Antimicrobials Modelling Evolution (IAME), French Institute for Medical Research (INSERM), Paris, France Infection Antimicrobials Modelling Evolution (IAME), University Paris Diderot, Paris, France Infection Control Unit, Hôpital Bichat, l’Assistance publique - Hôpitaux de Paris (AP-HP), Paris, France
the ARIBO Study Group
Affiliation:
Infection Antimicrobials Modelling Evolution (IAME), French Institute for Medical Research (INSERM), Paris, France Infection Antimicrobials Modelling Evolution (IAME), University Paris Diderot, Paris, France Infection Control Unit, Hôpital Bichat, l’Assistance publique - Hôpitaux de Paris (AP-HP), Paris, France Laboratoire d’Informatique de Robotique et de Microélectronique de Montpellier (LIRMM), INRIA Research Center, MontpellierFrance Institut National de Recherche en Informatique et en Automatique, Montbonnot, France Medical Intensive Care Unit, Hôpital Bichat, l’Assistance publique - Hôpitaux de Paris (AP-HP), Paris, France
*
Author for correspondence: Gabriel Birgand, Email: gbirgand@gmail.com

Abstract

Objectives:

We longitudinally observed and assessed the impact of the operating room (OR) staff movements and door openings on surrogates of the exogenous infectious risk using a new technology system.

Design and setting:

This multicenter observational study included 13 ORs from 10 hospitals, performing planned cardiac and orthopedic surgery (total hip or knee replacement). Door openings during the surgical procedure were obtained from data collected by inertial sensors fixed on the doors. Intraoperative staff movements were captured by a network of 8 infrared cameras. For each surgical procedure, 3 microbiological air counts, longitudinal particles counts, and 1 bacteriological sample of the wound before skin closure were performed. Statistics were performed using a linear mixed model for longitudinal data.

Results:

We included 34 orthopedic and 25 cardiac procedures. The median frequency of door openings from incision to closure was independently associated with an increased log10 0.3 µm particle (ß, 0.03; standard deviation [SD], 0.01; P = .01) and air microbial count (ß, 0.07; SD, 0.03; P = .03) but was not significantly correlated with the wound contamination before closure (r = 0.13; P = .32). The number of persons (ß, −0.08; SD, 0.03; P < .01), and the cumulated movements by the surgical team (ß, 0.0004; SD, 0.0005; P < .01) were associated with log10 0.3 µm particle counts.

Conclusions:

This study has demonstrated a previously missing association between intraoperative staff movements and surrogates of the exogenous risk of surgical site infection. Restriction of staff movements and door openings should be considered for the control of the intraoperative exogenous infectious risk.

Type
Original Article
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

a

Members of the Applied Robotics for Installation and Base Operations (ARIBO) study group: Pierre Squara, Corinne de Diesbach, Alain Brusset, Marie-Françoise Vogel, François Gouin, Sophie Touchais, Jacqueline Lepennec, Gérard BABATASI, Emmanuel de ThomasSon, Mathieu Debauchez, Christian Mazel, Pascal Bizot, Philippe Rosset, Patrick Nataf, Philippe Massin, Agnès Jue-Denis, Gilles Antoniotti, Philippe Souchoix, Xavier Richomme, Marie-Noëlle Deschamps, Didier Lepelletier, Florence Legallou, Nathalie Ferronnière, Audrey Mouet, Xavier Lecoutour, Véronique Aguelon, Claire LESTEVEN, Carole PORNET, Jean Baptiste Stern, Jacques-Yves Nizou, Yves-Marie Vandamme, Maurice Tanguy, Marie-Laure Joly-Guillou, Nathalie van der Mée - Marquet, Aurélie Thomas-Hervieux

Previous presentation: These data were presented in part at the 26th European Congress of Clinical Microbiology and Infectious Diseases on April 10, 2016, in Copenhagen, Denmark.

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