Abstract
Introduction: Many of the guidelines that are generally accepted as main operating room best practices are not evidence based. They are based on the concept that if some sterility is good, more must be better. They are not derived from evidence-based sterility. Evidence-based sterility is the study of which of our various sterility practices increase or decrease our infection rates, as opposed to guidelines based on how many bacteria are in the operating room. Methods: This article adds the most important evidence we could find that is not included in the first paper on evidence-based sterility in hand surgery published in 2019. In this review, we also balance the evidence with common sense opinion. Results: The 21st century has seen a rapid rise in the number and reports of hand surgery procedures performed with field sterility outside the main operating room. There is now an abundance of good evidence to support that the rate of infection is not higher when many hand operations are performed with field sterility in minor procedure rooms. Conclusion: Moving hand surgery out of the main operating room to minor procedure rooms should be supported by healthcare providers. The higher cost, increased solid waste, and inconvenience of main operating room surgery are not justifiable for many procedures because it does not reduce the risk of postoperative infection.