Effect of laminar airflow ventilation on surgical site infections: a systematic review and meta-analysis

Abstract

Background: The role of the operating room's (OR) ventilation system in the prevention of surgical site infection (SSI) is widely discussed and the existing guidelines do not reflect the current evidence. In this context, laminar airflow (LAF) ventilation was compared with conventional ventilation to assess their effectiveness in reducing the risk of SSI.Methods: Medline, EMBASE, Cochrane Central Register of Controlled Trials and WHO regional medical databases were searched from 1990 to 31 January 2014. The search was updated for Medline for the time period between 1 February 2014 and 27 May 2016. GRADE methodology was used to assess the quality of the retrieved evidence. Meta-analyses of available comparisons were performed using RevMan 5.3. Findings: The search identified 1947 records of which 12 observational studies were identified comparing LAF ventilation with conventional turbulent ventilation in orthopedic, abdominal, and vascular surgery. The meta-analysis of eight cohort studies showed no difference in risk for deep SSIs following total hip arthroplasty (THA, 330 146 procedures; odds ratio (OR) 1·29, 95% CI 0·98-1·71, p=0·07; I²=83%). For total knee arthroplasty (TKA, 134 368 procedures) the meta-analysis of six cohort studies showed no difference in risk for deep SSIs (OR 1·08, 95% CI 0·77-1·52, p=0·65; I²=71%). For abdominal and open vascular surgery the metaanalysis of three cohort studies found no difference in risk for overall SSI (OR 0·75, 95% CI 0·43-1·33, p=0·33; I²=95%) Interpretation: The available evidence shows no benefit for LAF compared with conventional turbulent OR ventilation in reducing the risk of SSI in THA, TKA and abdominal surgery. Decision makers, medical and administrative, should not choose to install and use LAF equipped ORs as a preventive measure to reduce the risk of SSI. AbstractBackground: The role of the operating room's (OR) ventilation system in the prevention of surgical site infection (SSI) is widely discussed and the existing guidelines do not reflect the current evidence. In this context, laminar airflow (LAF) ventilation was compared with conventional ventilation to assess their effectiveness in reducing the risk of SSI.

Motion-capture system to assess intraoperative staff movements and door openings: Impact on surrogates of the infectious risk in surgery

“…A recent meta-analysis concluded that LAF may not be efficient in reducing the risk of SSIs in total hip and knee arthroplasties, and abdominal surgery. 25 After adjustment, our results showed a significant and independent increase air microbial contamination in OR with conventional airflow system in comparison to LAF. Moreover, the airborne particle concentration was consistently lower at incision in ORs with LAF vs conventional airflow and decreased faster during the procedures (Appendix Figure A2).…”

What’s New in Musculoskeletal Infection: Update on Biofilms

“…The use of surgical helmet systems, even with tape around the surgical gown cuffs, was not found to reduce the rate of wound contamination during surgery 27 . Similarly, laminar airflow ventilation demonstrated no associated reduction in SSI risk compared with modern operating room ventilation (positive pressure and high-volume and HEPA [high-efficiency particulate air] filtration that can lead to turbulent flow) 28 . In a different high-quality study, a reduction in airborne microorganisms using a device that delivers filtered airflow over the surgical wound reduced the rate of implant infections 29 .…”

Prävention postoperativer Wundinfektionen

“…In neueren retrospektiven kontrollierten Studien konnte kein protektiver Einfluss von LAF bzw. TAV im Vergleich zu turbulenter Mischlüftung (TML) gezeigt werden [157,[364][365][366][367][368]. Alle einschlägigen aktuellen Studien sind durch Limitationen gekennzeichnet: Zum Teil ist unbekannt, in welchem Ausmaß sich sterile Flächen außerhalb des TAV-Schutzbereichs befanden; orthopädische Spätinfek-tionen sind nicht erfasst [369,370].…”