Ultraviolet Lighting During Orthopaedic Surgery and the Rate of Infection

Ritter, Merrill A.; Olberding, Emily M.; Malinzak, Robert A.

doi:10.2106/jbjs.f.01037

Cited by 69 publications

(37 citation statements)

References 13 publications

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“…For example at a fluence of 207-nm light that produce four logs of MRSA cell kill, there is much less than one decade of cell kill in human cells (as discussed above, we chose four logs of bacterial kill for this comparison because studies of wound irradiation with conventional UV germicidal lamps suggest that this level of bacterial reduction will produce significant decreases in SSI rates [8]). In contrast with the results for 207-nm light, while conventional germicidal lamps efficiently kill MRSA, conventional germicidal lamps are almost as efficient at killing human cells.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…One approach which in principle overcomes the problem of drug resistance is the use of germicidal UV lamps [8], [9], because UV light is generally equi-effective at inactivating drug-resistant bacteria compared with wild-type strains [10], [11]. In fact studies of surgical wound irradiation with conventional germicidal UV lamps have shown great promise, with UV fluences corresponding to 4 to 5 logs of MRSA cell kill resulting in significant decreases in SSI rates [8]. However UV radiations in the wavelength range emitted by a germicidal lamp are a human health hazard, causing roughly equal levels of biological damage in human cells as well as bacteria [12]–[14], and are clearly linked with skin cancer [15], [16] and cataract induction [17], [18].…”

Section: Introductionmentioning

confidence: 99%

“…However UV radiations in the wavelength range emitted by a germicidal lamp are a human health hazard, causing roughly equal levels of biological damage in human cells as well as bacteria [12]–[14], and are clearly linked with skin cancer [15], [16] and cataract induction [17], [18]. These health hazard to human skin and eyes necessitate the use of cumbersome protective clothing, hoods and eye shields for the surgical staff and the patient [8], [19], and this has prevented widespread use of the UV wound irradiation technique during surgery.…”

Section: Introductionmentioning

confidence: 99%

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207-nm UV Light - A Promising Tool for Safe Low-Cost Reduction of Surgical Site Infections. I: In Vitro Studies

et al. 2013

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Background0.5% to 10% of clean surgeries result in surgical-site infections, and attempts to reduce this rate have had limited success. Germicidal UV lamps, with a broad wavelength spectrum from 200 to 400 nm are an effective bactericidal option against drug-resistant and drug-sensitive bacteria, but represent a health hazard to patient and staff. By contrast, because of its limited penetration, ∼200 nm far-UVC light is predicted to be effective in killing bacteria, but without the human health hazards to skin and eyes associated with conventional germicidal UV exposure.AimsThe aim of this work was to test the biophysically-based hypothesis that ∼200 nm UV light is significantly cytotoxic to bacteria, but minimally cytotoxic or mutagenic to human cells either isolated or within tissues.MethodsA Kr-Br excimer lamp was used, which produces 207-nm UV light, with a filter to remove higher-wavelength components. Comparisons were made with results from a conventional broad spectrum 254-nm UV germicidal lamp. First, cell inactivation vs. UV fluence data were generated for methicillin-resistant S. aureus (MRSA) bacteria and also for normal human fibroblasts. Second, yields of the main UV-associated pre-mutagenic DNA lesions (cyclobutane pyrimidine dimers and 6-4 photoproducts) were measured, for both UV radiations incident on 3-D human skin tissue.ResultsWe found that 207-nm UV light kills MRSA efficiently but, unlike conventional germicidal UV lamps, produces little cell killing in human cells. In a 3-D human skin model, 207-nm UV light produced almost no pre-mutagenic UV-associated DNA lesions, in contrast to significant yields induced by a conventional germicidal UV lamp.ConclusionsAs predicted based on biophysical considerations, 207-nm light kills bacteria efficiently but does not appear to be significantly cytotoxic or mutagenic to human cells. Used appropriately, 207-nm light may have the potential for safely and inexpensively reducing surgical-site infection rates, including those of drug-resistant origin.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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207-nm UV Light - A Promising Tool for Safe Low-Cost Reduction of Surgical Site Infections. I: In Vitro Studies

et al. 2013

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“…The use of ultraviolet lighting was found to be correlated with reduced rates of PJI, however, the exposure hazards were 6 to 28 times greater than the recommended limits which also effects the orthopedic operating room personnel [92, 93]. Because of these safety concerns, there are recommendations against the routine use of UV lights in the OR [94-96].…”

Section: The Operation Daymentioning

confidence: 99%

The Prevention of Periprosthetic Joint Infections

Küçükdurmaz

Parvızı

2016

TOORTHJ

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Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) adversely affects patient quality of life and health status, and places a huge financial burden on the health care. The first step in combating this complication is prevention, which may include implementation of strategies during the preoperative, intraoperative, or postoperative period. Optimization of the patient with appreciation of the modifiable and non-modifiable factors is crucial. Preoperative optimization involves medical optimization of patients with comorbidities such as diabetes, anemia, malnutrition and other conditions that may predispose the patient to PJI. Among the intraoperative strategies, administration of appropriate and timely antibiotics, blood conservation, gentle soft tissue handling, and expeditious surgery in an ultra clean operating room are among the most effective strategies. During the postoperative period, all efforts should be made to minimize ingress or proliferation of bacteria at the site of the index arthroplasty from draining the wound and hematoma formation. Although the important role of some preventative measures is known, further research is needed to evaluate the role of unproven measures that are currently employed and to devise further strategies for prevention of this feared complication.

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Can light‐based approaches overcome antimicrobial resistance?

Hamblin

Abrahamse

2018

Drug Development Research

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The relentless rise of antibiotic resistance is considered one of the most serious problems facing mankind. This mini-review will cover three cutting-edge approaches that use light-based techniques to kill antibiotic-resistant microbial species, and treat localized infections. First, we will discuss antimicrobial photodynamic inactivation using rationally designed photosensitizes combined with visible light, with the added possibility of strong potentiation by inorganic salts such as potassium iodide. Second, the use of blue and violet light alone that activates endogenous photoactive porphyrins within the microbial cells. Third, it is used for "safe UVC" at wavelengths between 200 nm and 230 nm that can kill microbial cells without damaging host mammalian cells. We have gained evidence that all these approaches can kill multidrug resistant bacteria in vitro, and they do not induce themselves any resistance, and moreover can treat animal models of localized infections caused by resistant species that can be monitored by noninvasive bioluminescence imaging. Light-based antimicrobial approaches are becoming a growing translational part of anti-infective treatments in the current age of resistance.

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Ultraviolet Lighting During Orthopaedic Surgery and the Rate of Infection

Abstract: When appropriate safety precautions are taken, ultraviolet lighting appears to be an effective way to lower the risk of infection in the operating room during total joint replacement surgery.

Cited by 69 publications

References 13 publications

207-nm UV Light - A Promising Tool for Safe Low-Cost Reduction of Surgical Site Infections. I: In Vitro Studies

207-nm UV Light - A Promising Tool for Safe Low-Cost Reduction of Surgical Site Infections. I: In Vitro Studies

The Prevention of Periprosthetic Joint Infections

Can light‐based approaches overcome antimicrobial resistance?

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