A systems analysis approach to postoperative wound infections
Morris L. V. French, Ph.D.
Merrill A. Ritter, M.D.
Jack B. Hart, Ph.D.
Harold E. Eitzen, Ph.D.
Many factors have been implicated as exogenous sources of bacteria influential in postoperative wound infections. Can we evaluate all of these during actual operating room procedures and if so, can we determine which ones are of major importance?
Methods and procedures
In order to evaluate the relative importance of these environmental factors we first divided them into indirect and direct wound contact sources.
The indirect sources are: (1) number of personnel in the operating room, (2) number of scrubbed personnel, (3) number of personnel wearing caps, (4) number of personnel wearing hoods, (5) cloth gowns and drapes, (6) disposable gowns and drapes, (7) use of the expired air exhaust system, (8) length of the surgical procedure, (9) number of door openings, (10) change in room temperature, and (11) operating room floor microbial levels. For each clean orthopaedic case, recordings were made of the above items, location of the operating table in the room, equipment, personnel, sampling sites of the air, wound (as mentioned in Phase I), gowns, floor, and whether the laminar air flow was on or off.
Nasal flora cultures of all patients and personnel were obtained by rotating a swab moistened in Dey/Engley (D/E) broth about the nares twice.1 Gowns were sampled before and after each surgical operation by Rodac impression plates over the sternum.2
The floor about the operating room table was sampled by five Rodac plates containing D/E agar before and after surgery and after cleaning. The cleaning procedure involved pouring approximately 1 gallon of a. . .