“Indirect contamination of the surgical wound via medical devices occurs as well as direct airborne contamination”
(d) Qiaojie Wang, MD; Chi Xu, MD; Karan Goswami, MD, MRCS; et al (2020)
This study suggests that the use of LAF in the operating room was not associated with a reduced incidence of PJI after primary total joint arthroplasty. With an appropriate perioperative protocol for infection prevention, LAF does not seem to play a protective role in PJI prevention. Patients underwent total joint arthroplasty in operating rooms equipped with either LAF or turbulent airflow.
(c) Benen, T., Wille, F. & Clausdorff, L. (2013)
One main aspect of avoiding surgical site infections is to ensure the sterility of the medical devices and instruments in the operating room and their location in the operating room is important. In this study, laminar airflow ventilation manages to maintain ultraclean air within the surgical protection zone but a 55-fold increase of the mean value of airborne colony forming units was observed outside the protected area compared to the value inside.
(b) Whyte, W., Hodgson, R. & Tinkler, J. (1982)
An investigation regarding bacterial wound contamination during hip and knee replacement surgery was conducted in an operating suite using either laminar flow or conventional ventilation. It was found that the bacterial count in the air was substantially lowered, representing a 97-fold reduction, when laminar flow ventilation was used. The average number of bacteria that was washed out after surgery was 35 times lower compared to when conventional ventilation was applied. Therefore, a minority of the bacteria that contaminated the wound are estimated to have fallen directly from the air. The rest is assumed to have been transferred to the wound indirectly by depositing on the surgeon’s hands, drapes and instruments.
(a) Edmiston, C.E., Seabrook, G.R., Cambria, R.A., Brown, K.R., Lewis, B.D., Sommers, J.R., Krepel, C.J., Wilson, P.J., Sinski, S. & Towne, J.B. (2005)
Via air currents bacteria can be deposited in the surgical wound or onto a surface that might come in contact with the wound. To investigate the potential sources of contamination during operation, air sampling was performed ranging from 0.5 to 4 m from the surgical wound during 70 vascular surgical procedures. This study documents that during operations and under optimal environment conditions, microbial populations were frequently recovered from the sampling points. This is believed to be the result of failure of the traditional surgical mask to prevent microbial shedding which is likely to be associated with an increased risk of perioperative contamination. For example, Staphylococcus aureus was recovered from 64% of air samples, 39% from within 0.5 m from the wound.
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