IMPACT OF OPERATING THEATRE DOOR OPENING FREQUENCY ON AIR QUALITY AND SURGICAL SITE INFECTION RATES IN ELECTIVE ORTHOPEDIC SURGERIES AT A TERTIARY CARE HOSPITAL

Abstract

Background: Frequent operating theatre door openings can disrupt positive-pressure ventilation, increase airborne particulate and microbial contamination, and compromise the sterile environment, potentially increasing the risk of surgical site infections (SSIs) during orthopedic procedures. Objective: To determine the impact of operating theatre door opening frequency on air quality and surgical site infection rates in elective orthopedic surgeries at a tertiary care hospital. Methods: A prospective observational study was conducted among 125 patients undergoing elective orthopedic surgeries using consecutive sampling. Door opening frequency was recorded throughout each procedure, while air quality was assessed by measuring airborne particulate counts and microbial colony-forming units (CFU/m³). Patients were followed for 30 days postoperatively for SSI according to CDC criteria. Results: A total of 125 patients undergoing elective orthopedic surgeries were included. The mean age was 46.8 ± 14.2 years, with 72 (57.6%) males and 53 (42.4%) females. The mean operating theatre door opening frequency was 18.9 ± 6.7 per procedure. Airborne particulate counts increased from 248 ± 39 to 486 ± 74 particles/m³, while microbial contamination increased from 12.8 ± 3.6 to 25.4 ± 5.2 CFU/m³ with frequent door openings (p < 0.001). Overall, 11 (8.8%) patients developed surgical site infections, with a higher incidence in surgeries involving >15 door openings (12.7% vs. 3.7%; p = 0.039). Door opening frequency showed significant positive correlations with airborne particulate counts (r = 0.71) and microbial contamination (r = 0.68) (both p < 0.001). Procedures with >20 door openings had 3.42-fold higher odds of SSI (AOR = 3.42; p = 0.023). Conclusion: Frequent operating theatre door openings significantly deteriorate air quality and increase the risk of surgical site infections in elective orthopedic surgeries. Reducing unnecessary door openings may improve operating room sterility and enhance patient safety.