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(c) Gehrke, T; Parvizi, J. (2013)

Proceedings of the international Consensus Meeting on Periprostethic Joint Infection, The Bone & Joint Journal, Vol. 95-B, No 11,

Orthopaedic experts agree that ultraclean air is important as a means to lower the risk for surgical site infections.

(b) Lidwell, O. M. (1988)

Air, antibiotics and sepsis in replacement joints. Journal of Hospital Infection, 11, 18-40.

In 1973 the Medical Research Council together with the Department of Health and Social Security in the United Kingdom carried out an investigation on the relationship between the reduction of air contamination and the incidence rate of joint sepsis. 19 hospitals in Europe took part in the multicenter investigation and more than 8 000 operations were performed. The results strongly suggest that sepsis in the joint is the result of bacteria introduced into the wound at the time of surgery although an infection might not occur instantly. The study attributes the observed reduction of joint sepsis to ultra clean air ventilation systems, occlusive clothing and the use of antibiotics.

(a) Charnley, J. (1972)

Postoperative Infection after Total Hip Replacement with Special Reference to Air Contamination in the Operating Room. Clinical Orthopaedics and Related Research, 87, 167-187.

Sir John Charnley, recognized as one of the main contributors to the surgical method for hip replacement also contributed to decreasing the rate of postoperative infections. In 1972 Charnley summarized the results from 5 800 total hip replacements and found that the infection rate fell from about 7-9% in 1960 to below 1% in 1970. The reduction was a result of taking measures to reduce sources of exogenous infection in the operating room, i.e. the usage of clean air technology and body exhaust suits. The use of prophylactic antibiotics was in this study purposely avoided.

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