Laminar flow does not affect risk of prosthetic joint infection after primary total knee replacement in Asian patients

Teo, Bryon Jun Xiong; Woo, Yew Lok; Phua, Jonathan Kia-Sheng; Chong, Hwei Chi; Yeo, William; Tan, Andrew Hwee Chye

doi:10.1016/j.jhin.2019.12.014

Cited by 9 publications

(8 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A large registry-based study found an effect for high-volume, unidirectional, vertical flow ventilation compared with other devices [113]. In contrast, a large study in an Asian population showed no effect on PJI rate after TKA when directly comparing surgeries performed in a laminar airflow operating room to those performed in a room without laminar airflow [114]. In addition, the true cost-effectiveness of ultra-clean air ventilation or laminar airflow systems is not clear [115,116].…”

Section: Operating Room-technical Parameters Trafficmentioning

confidence: 99%

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Gallo

Nieslanikova

2020

JCM

View full text Add to dashboard Cite

A projected increased use of total joint arthroplasties will naturally result in a related increase in the number of prosthetic joint infections (PJIs). Suppression of the local peri-implant immune response counters efforts to eradicate bacteria, allowing the formation of biofilms and compromising preventive measures taken in the operating room. For these reasons, the prevention of PJI should focus concurrently on the following targets: (i) identifying at-risk patients; (ii) reducing “bacterial load” perioperatively; (iii) creating an antibacterial/antibiofilm environment at the site of surgery; and (iv) stimulating the local immune response. Despite considerable recent progress made in experimental and clinical research, a large discrepancy persists between proposed and clinically implemented preventative strategies. The ultimate anti-infective strategy lies in an optimal combination of all preventative approaches into a single “clinical pack”, applied rigorously in all settings involving prosthetic joint implantation. In addition, “anti-infective” implants might be a choice in patients who have an increased risk for PJI. However, further progress in the prevention of PJI is not imaginable without a close commitment to using quality improvement tools in combination with continual data mining, reflecting the efficacy of the preventative strategy in a particular clinical setting.

show abstract

Section: Operating Room-technical Parameters Trafficmentioning

confidence: 99%

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Gallo

Nieslanikova

2020

JCM

View full text Add to dashboard Cite

show abstract

Section: Resultsmentioning

confidence: 97%

“…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%

“…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%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

“…We read with interest the article written by Teo et al entitled 'Laminar flow does not affect risk of prosthetic joint infection after primary knee replacement in Asian patients' 1 . We compliment the authors on their article and their contribution to the ongoing debate in this journal about the effectiveness of ultraclean air systems in reducing joint infections after total joint arthroplasty.…”

Section: Sirmentioning

confidence: 99%

Criticisms of Teo et al.'s study of ultraclean air systems in operating theatres

Whyte

Lytsy

2020

Journal of Hospital Infection

View full text Add to dashboard Cite

Laminar flow does not affect risk of prosthetic joint infection after primary total knee replacement in Asian patients

Cited by 9 publications

References 19 publications

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

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

Criticisms of Teo et al.'s study of ultraclean air systems in operating theatres

Contact Info

Product

Resources

About