Operating theatre ventilation systems and microbial air contamination in total joint replacement surgery: results of the GISIO-ISChIA study

Agodi, Antonella; Auxilia, F.; Barchitta, Martina; Cristina, Maria Luisa; D'Alessandro, D; Mura, I; Nobile, M.; Pasquarella, Cesira; Avondo, Sergio; Bellocchi, Patrizia; Canino, Rosario; Capozzi, C; Casarin, Renata Picanço; Cavasin, Massimo; Contegiacomo, Pietro; Deriu, M.; Evola, Francesco Roberto; Farsetti, Pasquale; Grandi, Annise; Guareschi, Danilo; Longhitano, Anna Maria; Longo, G.; Malatesta, Renzo; Marenghi, P; Marras, Francesco; Maso, Alessandra; Mattaliano, Anna Rita; Montella, Maria Teresa; Moscato, Umberto; Navone, Paola; Romeo, Maria Antonietta; Rossi, Flora; Ruffino, Maria Antonella; Santangelo, Carmela; Sartini, Marina; Sessa, Giuseppe; Tardivo, Stefano; Leali, P. Tranquilli; Torregrossa, Maria Valeria; Vitali, Pietro

doi:10.1016/j.jhin.2015.02.014

Cited by 51 publications

(59 citation statements)

References 15 publications

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“…Number of door openings and OR foot traffic have previously been shown to affect airborne particles and bacteria . Therefore, the number of door openings during sampling time and the number of OR staff were also recorded and included in the multivariate analyses.…”

Section: Methodsmentioning

confidence: 99%

In‐Room Ultraviolet Air Filtration Units Reduce Airborne Particles During Total Joint Arthroplasty

Anis

Curtis

Klika

et al. 2019

Journal Orthopaedic Research

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Reducing airborne bioburden in total joint arthroplasty (TJA) is of critical importance. The efficacy of crystalline ultraviolet-C (C-UVC) filtration in reducing bioburden in a dynamic operating room (OR) environment has not been evaluated. We assessed whether C-UVC filtration reduced (i) total particle counts (TPC); (ii) viable particle counts (VPC); and (iii) colony-forming units (CFUs). Fifty primary TJA cases were performed in a positive-pressure OR; 25 cases with the C-UVC unit and 25 cases without. The air was sampled by a particle counter and an impact air sampler to measure particle counts and CFUs, respectively. To compare TPC, VPC, and CFU/m 3 between groups, independent t tests and multivariate regression, adjusted for number of OR staff and door openings, were performed. The C-UVC group had significantly lower TPC (2.6 × 10 6 vs. 4.7 × 10 6 particles, p = 0.001) and VPC (18,605 vs. 27,516 particles, p = 0.001). There were fewer CFUs in the C-UVC group (10.9 CFU/m 3 vs. 13.7 CFU/m 3 , p = 0.163). Multivariate analysis identified C-UVC filtration as a significant predictor of decreased TPC (β = −0.44, p = 0.002) and VPC (β = −0.47, p = 0.001) after accounting for door openings and number of OR staff. The reduction in CFUs was not significant on multivariate analysis. In this prospective pilot study, a C-UVC air disinfection and recirculation unit led to a significant reduction in both TPC and VPC and a non-significant reduction in CFU. Statement of clinical significance: Further studies are needed to investigate the effects of C-UVC filtration units on surgical-site infection rates.

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Section: Methodsmentioning

confidence: 99%

In‐Room Ultraviolet Air Filtration Units Reduce Airborne Particles During Total Joint Arthroplasty

Anis

Curtis

Klika

et al. 2019

Journal Orthopaedic Research

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“…4 The results confirm the findings of previous studies suggesting that door openings may affect the air sterility of the OR. [15][16][17][18][19][20] Door movements are known to alter the efficacy of ventilation systems by a disruption of the positive pressures 5 , and the air flow. 21 Our data suggest that controlling the movements of staff members inside the OR may be more efficient than restricting their number to prevent the air particles contamination.…”

Section: Discussionmentioning

confidence: 99%

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

Birgand

Azevedo

Rukly

et al. 2019

Infect. Control Hosp. Epidemiol.

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Objectives:We longitudinally observed and assessed the impact of the operating room (OR) staff movements and door openings on surrogates of the exogenous infectious risk using a new technology system.Design and setting:This multicenter observational study included 13 ORs from 10 hospitals, performing planned cardiac and orthopedic surgery (total hip or knee replacement). Door openings during the surgical procedure were obtained from data collected by inertial sensors fixed on the doors. Intraoperative staff movements were captured by a network of 8 infrared cameras. For each surgical procedure, 3 microbiological air counts, longitudinal particles counts, and 1 bacteriological sample of the wound before skin closure were performed. Statistics were performed using a linear mixed model for longitudinal data.Results:We included 34 orthopedic and 25 cardiac procedures. The median frequency of door openings from incision to closure was independently associated with an increased log10 0.3 µm particle (ß, 0.03; standard deviation [SD], 0.01; P = .01) and air microbial count (ß, 0.07; SD, 0.03; P = .03) but was not significantly correlated with the wound contamination before closure (r = 0.13; P = .32). The number of persons (ß, −0.08; SD, 0.03; P < .01), and the cumulated movements by the surgical team (ß, 0.0004; SD, 0.0005; P < .01) were associated with log10 0.3 µm particle counts.Conclusions:This study has demonstrated a previously missing association between intraoperative staff movements and surrogates of the exogenous risk of surgical site infection. Restriction of staff movements and door openings should be considered for the control of the intraoperative exogenous infectious risk.

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“…Correlation between active and passive sampling was also described during a study comparing different ventilation regimes in OTs. 12 Using a Surface Air System sampler (SAS, International Pbi, Milan, Italy) operating at 180 L/min and settle plates, both with tryptic soy agar, the study showed that unidirectional airflows within OTs did not guarantee low counts of airborne bacteria. The study also confirmed that an increased number of people and door openings in an OT influenced an increase in bacterial count.…”

Section: Healthcare-specific Field Studiesmentioning

confidence: 96%

“…More recently an investigation into contamination in modern operating theatres (OTs) with turbulent airflows suggested that the IMA value could lead to an underestimation of the risk. 12 In a study which compared air and surface sampling for Aspergillus sp. using contact plates within a hospital ward, a significant difference between the collection of airborne and surface spores was noted, with aspergillus accounting for >25% of the fungi isolated in the air but <2% of fungi isolated from surfaces.…”

Section: Principles Of Bioaerosol Collectionmentioning

confidence: 99%

Bioaerosol sampling: sampling mechanisms, bioefficiency and field studies

Haig

Mackay

Walker

et al. 2016

Journal of Hospital Infection

151

118

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Investigations into the suspected airborne transmission of pathogens in healthcare environments have posed a challenge to researchers for more than a century. With each pathogen demonstrating a unique response to environmental conditions and the mechanical stresses it experiences, the choice of sampling device is not obvious. Our aim was to review bioaerosol sampling, sampling equipment, and methodology. A comprehensive literature search was performed, using electronic databases to retrieve English language papers on bioaerosol sampling. The review describes the mechanisms of popular bioaerosol sampling devices such as impingers, cyclones, impactors, and filters, explaining both their strengths and weaknesses, and the consequences for microbial bioefficiency. Numerous successful studies are described that point to best practice in bioaerosol sampling, from the use of small personal samplers to monitor workers' pathogen exposure through to large static samplers collecting airborne microbes in various healthcare settings. Of primary importance is the requirement that studies should commence by determining the bioefficiency of the chosen sampler and the pathogen under investigation within laboratory conditions. From such foundations, sampling for bioaerosol material in the complexity of the field holds greater certainty of successful capture of low-concentration airborne pathogens. From the laboratory to use in the field, this review enables the investigator to make informed decisions about the choice of bioaerosol sampler and its application.

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Operating theatre ventilation systems and microbial air contamination in total joint replacement surgery: results of the GISIO-ISChIA study

Abstract: These findings challenge the belief that unidirectional systems always provide acceptable airborne bacterial counts.

Cited by 51 publications

References 15 publications

In‐Room Ultraviolet Air Filtration Units Reduce Airborne Particles During Total Joint Arthroplasty

In‐Room Ultraviolet Air Filtration Units Reduce Airborne Particles During Total Joint Arthroplasty

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

Bioaerosol sampling: sampling mechanisms, bioefficiency and field studies

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