POSTOPERATIVE INFECTION IN A DOUBLE-OCCUPANCY OPERATING-ROOM - A PROSPECTIVE-STUDY OF 2458 PROCEDURES ON THE EXTREMITIES

The purposes of this study were: to determine the rate of infection as sociated with elective outpatient operations on an extremity, performe d in a double-occupancy operating room (one operating room designed to accommodate two separate operating teams), and to determine which fac tors influenced this rate, We evaluated the records of 2458 consecutiv e patients who had had such a procedure, performed by one of nine surg eons during a two and one-half-year period, and in whom the operative wound had been classified as clean (without a drain) or clean-contamin ated (with a drain), The information regarding the factors associated with the operation and the operating-room environment was recorded for each patient at the time of the operation, Each wound was inspected p eriodically in the attending surgeon's office for at least thirty days postoperatively, Using definitions established by the Centers for Dis ease Control, the attending surgeon determined the presence of infecti on primarily by judging whether there was purulent drainage or whether erythema or swelling at the operative site was beyond that expected f rom the procedure. Of the 2458 patients, thirty-seven (1.5 per cent; 9 5 per cent confidence interval, 1.1 to 2.1 per cent) had infection of the operative wound, Only eight patients (0.3 per cent) had deep infec tion, with seven of the infections necessitating a reoperation, Infect ion developed in thirty of the 2311 clean wounds, a rate of 1.3 per ce nt (95 per cent confidence interval, 0.9 to 1.8 per cent), and in seve n of the 147 clean-contaminated wounds, a rate of 4.8 per cent (95 per cent confidence interval, 2.3 to 9.5 per cent) (p = 0.001), No cross- contamination occurred between patients who had infection, The rate of infection was not related to the number of:patients who were operated on in the same room at the same time, Logistic regression analysis, u sed to account for confounding factors, demonstrated a significant ass ociation between the classification of the wound (use of a drain) and a higher rate of infection (p = 0.006) as well as between the instilla tion of a topical steroid solution and a lower rate of infection (p = 0.04), It also demonstrated a significant difference, with respect to the rate of infection, among individual surgeons (p = 0.02).