“The main measures to prevent SSI are antibiotics, the use of suitable ventilation, surgical clothing, staff numbers and behaviour”
(f) 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.
(e) Wang. C (2019)
Mixing ventilation cannot reliably maintain an ultraclean environment and therefore is generally not recommended for infection-prone surgeries.
(d) Buhl, S., Eschenbecher, N., Hentschel, S. & Bulitta, C.(2016)
In this study clothing and three types of ventilation systems have been investigated and their ability to reduce airborne bacterial counts in the operating room was assessed. The clothing evaluated were German and Swedish operating gowns. The main difference was that the Swedish clothing had tightened cuffs and a closed neck region to avoid unintentional spreading of particles. The results in the study favored the Swedish clothing regarding cfu-levels. The ventilation systems tested were temperature controlled ventilation, laminar airflow and turbulent mixed ventilation. The temperature controlled system provided the lowest overall mean value for the three different measurement sites.
(c) Sadrizadeh, S., Tammelin, A., Ekolind, P. & Holmberg, S. (2014)
The number of surgical personnel and their positions influence the ventilation airflow and thereby the concentration and distribution of colony forming units in an operating room. The influence on airborne bacteria distribution within the critical surgical zone was investigated using a numerical model and the results imply increasing concentrations of colony forming units when the number of staff was increased. From the results, it can also be concluded that the number of staff located in the critical surgical zone should be kept to a minimum since the concentration increase with decreasing distance.
(b) Burman, L. G. (2006)
The report from Swedish National Board of Health and Welfare informs that deep postoperative infection is a consequence of bacterial contamination during surgery. This is believed to apply for other postoperative wound infections as well. The number of bacteria carrying particles in the operating room air depends on the number of people, their activity and routines, clothing and the type of ventilation used. To limit the rate of postoperative infections actions regarding these are important apart from the use of prophylactic antibiotics, good hygiene, and a suitable design of the operating room that minimizes unnecessary traffic and allows for proper transportation of the patient, staff and goods in and out of the operating room.
(a) Lidwell, O. M., Lowbury, E. J., Whyte, W., Blowers, R., Stanley, S.J. & Lowe, D. (1982)
Lidwell’s previously mentioned randomized study, see 1b, involved 8,000 patients undergoing knee or hip replacement surgery. All patients were then followed up for 2 to 3 years for evidence of post-operative wound sepsis. The reduction of joint sepsis rates was attributed to air cleanliness, special operating suits and the use of antibiotic prophylaxis which reduced the sepsis rate independently. More specifically, the use of antibiotics resulted in a four-fold reduction of the incidence rate. The use of occlusive clothing halved the rate further and so did the use of ultra clean air.
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