Can clothing systems and human activity in operating rooms with mixed flow ventilation systems help achieve the ultraclean air requirement (≤10 CFU/m3) during orthopaedic surgeries?

OBJECTIVES: The level of airborne microbial contamination in operating rooms (ORs) is an important indicator of indoor air quality and ensures a clean surgical environment. The main objective of this study was to clarify the possibility of achieving the requirement for an ultraclean operating room (≤ 10 CFU/m3) with mixed flow ventilation based on clothing and human activity. METHODS: Experimental measurements during mock surgeries were conducted in an actual OR with mixed flow ventilation in the Emergency, Heart and Lung Centre at St. Olavs Hospital in Trondheim. The bacterial concentration close to the surgical site was measured during five mock-up surgeries. All five mock-up surgeries followed real surgical procedures which could represent similar conditions in the OR. RESULTS: The experiment results verified that the average CFU/m3 of three of the five mock-up surgeries was 8.5, which was below or equal to the ultraclean requirement, while the other two mock-up surgeries did not meet the ultraclean requirement. Surgical activity together with the type of clothing worn by surgical staff in ORs seem to be the most significant reason for the high CFU level during surgery. CONCLUSIONS: It is possible to achieve the ultraclean air requirement (≤ 10 CFU/m3) during a surgical process with proper clothing and low surgical activity in ORs. This study clarifies the effect of clothing and human activity on the CFU level in the surgical micro-environment in ORs, and contributes to developing new products for the surgical team.

Operating room ventilation and the risk of revision due to infection after total hip arthroplasty: assessment of validated data in the Norwegian Arthroplasty Register.

BACKGROUND: The air in the operating room is considered a risk factor for surgical site infection (SSI) due to airborne bacteria shed from the surgical staff or from patients themselves. AIM: To assess the influence of validated operating room (OR) ventilation data on the risk of revision surgery due to deep infection after primary total hip arthroplasty (THA) reported to the Norwegian Arthroplasty Register (NAR). METHODS: Forty orthopaedic units reporting THAs to the NAR during the period 2005-2015 were included. The true type of OR ventilation in all hospitals at the time of primary THA was confirmed in a previous study. Unidirectional airflow (UDF) systems were subdivided into: small, low-volume, unidirectional vertical flow (lvUDVF) systems; large, high-volume, unidirectional vertical flow (hvUDVF) systems; and unidirectional horizontal flow (UDHF) systems. These three ventilation groups were compared with conventional, turbulent, mixing ventilation (CV). The association between the end-point, time to revision due to infection, and OR ventilation was estimated by calculating relative risks (RRs) in a multivariate Cox regression model, with adjustments for several patient- and surgery-related covariates. FINDINGS: A total of 51,292 primary THAs were eligible for assessment. Of these, 575 had been revised due to infection. A similar risk of revision due to infection after THA performed was found in ORs with lvUDVF and UDHF compared to CV. THAs performed in ORs with hvUDVF had lower risk of revision due to infection compared to CV (RR = 0.8; 95% CI: 0.6-0.9; P = 0.01). CONCLUSION: THAs performed in ORs with hvUDVF systems had lower risk of revision due to infection compared to THAs performed in ORs with CV systems. The perception that all UDF systems are similar and possibly harmful seems erroneous.

Bacterial findings in infected hip joint replacements in patients with rheumatoid arthritis and osteoarthritis: a study of 318 revisions for infection reported to the norwegian arthroplasty register.

High rates of Staphylococcus aureus are reported in prosthetic joint infection (PJI) in rheumatoid arthritis (RA). RA patients are considered to have a high risk of infection with bacteria of potentially oral or dental origin. One thousand four hundred forty-three revisions for infection were reported to the Norwegian Arthroplasty Register (NAR) from 1987 to 2007. For this study 269 infection episodes in 255 OA patients served as control group. In the NAR we identified 49 infection episodes in 37 RA patients from 1987 to 2009. The RA patients were, on average, 10 years younger than the OA patients and there were more females (70% versus 54%). We found no differences in the bacterial findings in RA and OA. A tendency towards a higher frequency of Staphylococcus aureus (18% versus 11%) causing PJI was found in the RA patients compared to OA. There were no bacteria of potential odontogenic origin found in the RA patients, while we found 4% in OA. The bacteria identified in revisions for infection in THRs in patients with RA did not significantly differ from those in OA. Bacteria of oral or dental origin were not found in infected hip joint replacements in RA.