2.  Operating room (OR) foot traffic refers to the number of people in and out of the OR suite and the number of door openings during a surgical procedure  An increase in OR foot traffic can increase a patient’s risk of developing a surgical site infection

3.  Surgical site infections are one of the most common hospital acquired infections  Prosthetic joint infections are the second most common complication of total joint replacements (Teixeira & Johnson, 2007).  Developing a SSI leads to increased morbidity and mortality, prolonged hospitalization, reduced quality of life, and healthcare costs.

4.  High volume of unnecessary foot traffic during total joint procedures  Orthopedic supplies are limited causing people to enter rooms looking for supplies  People enter room for breaks, lunches, walkthroughs and socialization  RN leaves room frequently due to incorrect surgeon preference cards

5.  Lynch et al., (2007), and Anderson et al., (2012) found multiple door openings disturb the positive pressure airflow in the room and an increase in personnel introduce bacterial contaminants into the air  54% of door openings were for informational requests

6. Proper air handling is the single most important environmental factor in the prevention of surgical site infections (Lindsay, Bigsby, & Bannister, 2011). Reducing a patients risk of developing a surgical site infection is evidenced by limiting OR traffic in the surgical suite by changing the practice behaviors of staff and implementing solutions within the OR environment.

7.  Implement a Code of Traffic guideline to decrease the number of OR foot traffic occurrences in and out of total joint rooms  Raise staff’s awareness on improving practice behaviors

8.  After 90 days:  Implement a Code of Traffic guideline  Decrease the amount of personnel in a total joint room by three people  Decrease door openings by 20%  All orthopedic supplies will be present in each room for first case of the day

9.  Orthopedic surgeons’ preference cards will be updated by 70%  Staff will utilize signs on doors and telephones outside each room  Implement a Velcro communication tool for nurses breaks and lunches  Educate staff on AORN Standards and Recommendations on Traffic Flow

10. . Unfreezing: Identify problem, letting go of old patterns and behaviors Moving: Putting change into practice Leadership empowerment Refreezing: Incorporating new behaviors for permanent change in practice Driving forcesResistive forces

11.  Letting go of old habits and behaviors  Identify problem: a change will occur  In-service for education, research findings, planning, and feedback  Change agents and team leaders  Collect quantitative pre-data using OR surveillance tool  Staff survey

12.  Putting change into practice  Leadership Empowerment  Motivation; hold everyone accountable  Strengthen driving and weaken resistant forces  In-service and feedback  Collect data

13.  New behaviors become permanent practice  Code of traffic guideline  Open communication, maintenance and ongoing education

14.  OR surveillance tool, Likert survey  Frequency and rate of door openings and personnel will be recorded in frequency distribution tables  Pie chart will identify reasons why staff enter or exit room

15.  Employees who “manage up” will hold each other accountable by discouraging negative practice behaviors and ensuring everyone is adhering to the change initiative (Smith, 2010).  Preventing infection is the responsibility and duty of the entire surgical team

16.  Anderson, A., Bergh, I., Karlsson, J., Eriksson, B., & Nilsson, K. (2012). Traffic Flow in the operating room: An explorative and descriptive study on air quality during orthopedic trauma implant surgery. American Journal of Infection Control, 40(8), 750-755. http://dx.doi.org/10.1016/j.ajic.2011.09.015 http://dx.doi.org/10.1016/j.ajic.2011.09.015  Lindsay, W., Bigsby, E., & Bannister, G. (2011). Prevention of infection in orthopaedic joint replacement. Journal of Perioperative Practice, 21(6), 206-209. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21823311 http://www.ncbi.nlm.nih.gov/pubmed/21823311  Lynch, R., Englesbe, M., Srurm, L., Bitar, A., Budhiraj, K., Kolia, S.,... Campbell, D. (2009). Measurement of Foot Traffic in the Operating Room: Implications for Infection Control. American Journal of Medical Quality, 24(45), 45- 52. http://dx.doi.org/: 10.1177/1062860608326419

17.  Smith, S. (2010, May). “Managing Up” Can Improve Teamwork in the OR. AORN Journal, 91(5), 576-582. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2045099 9  Teixeira, L., & Johnson, J. (2007). Prosthetic joint infection: When to suspect it, how to manage it. Geriatrics, 62(12), 18-22. Retrieved from http://web.ebscohost.com/ehost/pdfviewer/p dfviewer?vid=19&sid=ec79b05e-4e2b-4643- acc8-722506f3ab92%40sessionmgr112&hid=22