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.

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.

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.

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.

To analyze influential infectious diseases, antimicrobial stewardship, infection control, or medical microbiology blogs and bloggers

World wide web

We conducted a systematic search for blogs in accordance with the PRISMA guidelines in September 2015.

A snowball sampling approach was applied to identify blogs using various search engines. Blogs were eligible if they (1) focused on infectious diseases, antimicrobial stewardship, infection control, or medical microbiology; (2) were intended for health professionals; and (3) were written in English and (4) were updated regularly. We mapped blog and blogger characteristics and used an innovative tool to assess the architecture and content of the included blogs. The motivations and perceptions of bloggers and readers were also assessed.

A total of 88 blogs were identified. Moreover, 28 blogs (32%) focused on infectious diseases, 46 (52%) focused on medical microbiology, and 14 (16%) focused on infection control or antimicrobial stewardship. Bloggers were mainly male with medical doctorates and/or PhDs; 32 bloggers (36%) posted at least weekly; and 51 (58%) had a research purpose. The aims were considered clear for 23 blogs (26%), and the field covered was considered broad for 25 blogs (28%). Presentation was considered good for 22 blogs (25%), 51 blogs (58%) were easy to read, and 46 blogs (52%) included expert interpretation. Among the top 10 blogs, 3 focused on infectious diseases, 6 focused on medical microbiology, and 2 focused on infection control (2 were equally ranked). The bloggers we questioned were motivated to share their independent expertise and opinions. Readers appreciated the concise messages on scientific topics and practical updates.

This study describes high-level blogs in the fields of infectious diseases, infection control, and medical microbiology. Our findings suggest ways in which bloggers should build/orientate blogs for readers, and we have highlighted current gaps in blog topics such as antimicrobial stewardship.

Infect. Control Hosp. Epidemiol 2017;38:832–839

The best strategy for controlling extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) transmission in intensive care units (ICUs) remains elusive.

We developed a stochastic transmission model to quantify the effectiveness of interventions aimed at reducing the spread of ESBL-PE in an ICU.

We modeled the evolution of an outbreak caused by the admission of a single carrier in a 10-bed ICU free of ESBL-PE. Using data obtained from recent muticenter studies, we studied 26 strategies combining different levels of the following 3 interventions: (1) increasing healthcare worker compliance with hand hygiene before and after contact with a patient; (2) cohorting; (3) reducing antibiotic prevalence at admission with or without reducing antibiotherapy duration.

Improving hand hygiene compliance from 55% before patient contact and 60% after patient contact to 80% before and 80% after patient contact reduced the nosocomial incidence rate of ESBL-PE colonization by 91% at 90 days. Adding cohorting to hand hygiene improvement intervention decreased the proportion of ESBL-PE acquisitions by an additional 7%. Antibiotic restriction had the lowest impact on the epidemic. When combined with other interventions, it only marginally improved effectiveness, despite strong hypotheses regarding antibiotic impact on transmission.

Our results suggest that hand hygiene is the most effective intervention to control ESBL-PE transmission in an ICU.

Infect. Control Hosp. Epidemiol. 2016;37(3):272–280

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