The Barrow Randomized Operating Room Traffic (BRITE) Trial: An Observational Study on the Effect of Operating Room Traffic on Infection Rates.

S urgical site infections (SSIs) account for 14% to 20% of all nosocomial infections. They have been shown to increase a patient’s risk of death 2to 11-fold, and they cost our nation an estimated $3.5 to $10 billion annually. Neurosurgical SSIs are of particular concern, because the potential consequences of SSIs in the central nervous system are dire. SSIs are known to be multifactorial, with a large number of both fixed and modifiable risk factors present in the preoperative, intraoperative, and postoperative periods. Among the modifiable intraoperative risk factors, cleanliness of the operating room (OR) environment is often targeted in SSI prevention strategies. Observational studies have shown that OR bacterial air counts are directly related to OR activity. As such, several national organizations, including the Centers for Disease Control and Prevention (CDC), the Joint Commission, and the Association of Operative Registered Nurses, have published recommendations for reducing SSIs that include calls to restrict OR traffic to essential personnel only. In the 15 years since publication of these recommendations, numerous studies have been published that attempt to correlate OR traffic with SSI risk. The level of evidence in these studies is low, with major methodological flaws and heterogeneous methods making it difficult to interpret what effect, if any, reducing OR traffic has on SSI rate. The purpose of this study was to provide high-quality evidence regarding the effect of OR traffic on SSI risk.