Does laminar flow reduce the risk of early surgical site infection in hip fracture patients?

Tameez-ud-din, Ahsan; Foden, Phil; Mathew, Mo

doi:10.1016/j.jor.2019.08.026

Cited by 2 publications

(4 citation statements)

References 6 publications

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“…The obtained results were also in accordance with evidence in the literature, demonstrating that air flow patterns and air velocity and temperature distributions were disrupted by the amount, behavior, and upright and bending positions of surgical staff [20,48].…”

Section: Discussionsupporting

confidence: 90%

The Influence of Surgical Staff Behavior on Air Quality in a Conventionally Ventilated Operating Theatre during a Simulated Arthroplasty: A Case Study at the University Hospital of Parma

Pasquarella

Balocco

Colucci

et al. 2020

IJERPH

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Surgical staff behavior in operating theatres is one of the factors associated with indoor air quality and surgical site infection risk. The aim of this study was to apply an approach including microbiological, particle, and microclimate parameters during two simulated surgical hip arthroplasties to evaluate the influence of staff behavior on indoor air quality. During the first hip arthroplasty, the surgical team behaved correctly, but in the second operation, behavioral recommendations were not respected. Microbiological contamination was evaluated by active and passive methods. The air velocity, humidity, temperature, and CO2 concentration were also monitored. The highest levels of microbial and particle contamination, as well as the highest variation in the microclimate parameter, were recorded during the surgical operation where the surgical team behaved “incorrectly”. Turbulent air flow ventilation systems appeared more efficient than in the past and very low air microbial contamination was reached when behavior was correct. Therefore, adherence to behavioral recommendations in operating theatres is essential to not undermine the effectiveness of the heating, ventilation, and air conditioning systems and employed resources.

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Section: Discussionsupporting

confidence: 90%

The Influence of Surgical Staff Behavior on Air Quality in a Conventionally Ventilated Operating Theatre during a Simulated Arthroplasty: A Case Study at the University Hospital of Parma

Pasquarella

Balocco

Colucci

et al. 2020

IJERPH

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Section: Resultsmentioning

confidence: 97%

“…Overall, 46 empirical studies of OR ventilation were captured in this systematic review. 7,22,75-84,33,85-94,46,95-104,48,105-110,52-54,66,70 Twenty-four of these studies investigated LAF with 22 comparing LAF to another type of ventilation system 33,48,[82][83][84][85][86][87][88][89][90][91]54,92,93,[75][76][77][78][79][80][81] and two investigating the configuration and system settings of LAF canopies. 52,104 One of the later articles sought to compare the performance of a newly installed LAF system with a LAF system that was overdue for an air filter change.…”

Section: Empirical Studiesmentioning

confidence: 99%

“…Of the ten studies that explored SSI rates, five failed to find a statistically significant difference between LAF and another ventilation system, 83,84,86,89,90 two found higher incidence rates of SSIs under LAF conditions, 85,93 and three found that surgeries performed in LAF-equipped operating theaters have lowered risk or rate of SSIs. 87,91,92 Interestingly, seven of the ten studies investigated the outcomes of general orthopedic surgeries, 83,85,86,89,90,92,93 while the other three studies investigated orthopedic trauma surgeries, 84 gastric surgeries, 87 and vascular surgeries. 91 The two studies that found a positive correlation between the use of LAF and SSIs were both restricted to total knee and total hip arthroplasties (TKAs; THAs), and both defined the outcome of the study as the number of patients requiring a revision surgery due to the development of a deep infection.…”

Section: Empirical Studiesmentioning

confidence: 99%

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Influence of the Built Environment on Airflow, Contamination, and Infection in the Operating Room: A Systematic Literature Review

Klimkiewicz

Gallagher

Lambrou

et al. 2022

Preprint

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BackgroundHealthcare-associated infections (HAIs) constitute a significant financial strain on healthcare systems across the world, with surgical site infections (SSIs) being the costliest form. Despite the existence of diverse sources of infection in the operating room (OR), current literature focuses on human and procedural sources of contamination that could lead to an infection. Comparatively, the OR built environment is understudied as a potential disease transmission interface between the environment, patients, and surgical staff. This systematic literature review aims to investigate how the physical characteristics and components of the built environment impact airflow, infection risk, aerosols, particle counts, contamination, and pathogens in operating rooms.Methods and FindingsLiterature searches were conducted in the PubMed and Web of Science Core Collection databases on December 21, 2020, ultimately retrieving 2,965 articles after duplicates were removed. During abstract screening, all abstracts were independently reviewed by two authors and conflicts were resolved by a third author. All articles published since January 1, 2010, that reported primary data investigating an aspect of the built environment inside an OR in relation to airflow, contamination, and/or infection for which the full text in English was available were included. This resulted in the inclusion of 138 articles, which includes studies conducted in ORs during active surgeries, computer modeling studies, and simulations in which a real OR was used for a mock surgical procedure. Six major built environment categories were identified based on the collected literature: OR layout, disinfection systems, surgical lights, doors, ventilation, and portable airflow devices. A survey created on Qualtrics software was used to record the aspect of the built environment and the outcome of each study, as well as the relationship between the two.ConclusionsWhile OR ventilation has been studied extensively, the OR built environment as a whole is understudied in relation to airflow, contamination, and infection. The current literature is inconsistent in both its findings and subsequent recommendations, making it difficult to inform hospital design in the context of SSIs. No articles were identified that discussed respiratory infection transmission in the OR, and very few addressed healthcare worker (HCW) safety in relation to the OR built environment. The significant discrepancies in the literature identified in this review highlight the need for future studies that assess the quality and bias of these studies before firm recommendations can be made. Future work should also focus on addressing the lack information regarding respiratory infection transmission in the OR, especially in the context of HCW safety.

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Does laminar flow reduce the risk of early surgical site infection in hip fracture patients?

Cited by 2 publications

References 6 publications

The Influence of Surgical Staff Behavior on Air Quality in a Conventionally Ventilated Operating Theatre during a Simulated Arthroplasty: A Case Study at the University Hospital of Parma

The Influence of Surgical Staff Behavior on Air Quality in a Conventionally Ventilated Operating Theatre during a Simulated Arthroplasty: A Case Study at the University Hospital of Parma

Influence of the Built Environment on Airflow, Contamination, and Infection in the Operating Room: A Systematic Literature Review

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