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Chow O, Hu H, Lajevardi SS, Deva AK, Atkinson RL. Preventing Bacterial Contamination of Breast Implants Using Infection Mitigation Techniques: An In Vitro Study. Aesthet Surg J 2024; 44:605-611. [PMID: 38290053 DOI: 10.1093/asj/sjae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Bacterial contamination of implants has been linked to biofilm formation and subsequent infection, capsular contracture, and breast implant-associated anaplastic large cell lymphoma. Reducing contamination during implant insertion should therefore reduce biofilm formation disease sequelae. OBJECTIVES The aim of this study was to compare levels of contamination between preventative techniques. METHODS A model to simulate the passage of implants through a skin incision was designed that utilized a sterile textured polyvinyl plastic sheet contaminated with Staphylococcus epidermidis. In the first stage of the polyvinyl contamination model, implants were subject to infection-mitigation techniques and passed through the incision, then placed onto horse blood agar plates and incubated for 24 hours. In the second stage of the study the same contamination was applied to human abdominal wall specimens. A 5 cm incision was made through skin and fat, then implants were passed through and levels of contamination were measured as described. RESULTS Smooth implants grew a mean of 95 colony-forming units (CFUs; approximately 1 CFU/cm2) and textured implants grew 86 CFUs (also approximately 1 CFU/cm2). CFU counts were analyzed by the Mann-Whitney U-test which showed no significant difference between implant types (P < .05); independent-sample t-tests showed a significant difference. The dependent-variable techniques were then compared as groups by one-way analysis of variance, which also showed a significant reduction compared with the control group (P < .01). CONCLUSIONS This in vitro study has shown the effectiveness of antiseptic rinse and skin/implant barrier techniques for reducing bacterial contamination of breast implants at the time of insertion.
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Morris J, Hoggett L, Rogers S, Ranson J, Sloan A. Variation of Practice in Prophylactic Protocol to Reduce Prosthetic Joint Infection in Primary Hip and Knee Arthroplasty: A National Survey in the United Kingdom. Hip Pelvis 2023; 35:228-232. [PMID: 38125266 PMCID: PMC10728051 DOI: 10.5371/hp.2023.35.4.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose Prosthetic joint infection (PJI) has an enormous physiological and psychological burden on patients. Surgeons rightly wish to minimise this risk. It has been shown that a standardised, evidence-based approach to perioperative care leads to better patient outcomes. A review of current practice was conducted using a cross-sectional survey among surgeons at multiple centers nationwide. Materials and Methods An 11-question electronic survey was circulated to hip and knee arthroplasty consultants nationally via the BOA (British Orthopaedic Association) e-newsletter. Results The respondents included 56 consultants working across 19 different trusts. Thirty-four (60.7%) screen patients for asymptomatic bacteriuria (ASB) preoperatively, with 19 (55.9%) would treating with antibiotics. Fifty-six (100%) screen for methicillin-resistant Staphylococcus aureus and treat if positive. Only 15 (26.8%) screen for methicillin-sensitive S. aureus (MSSA) or empirically eradicate. Zero (0%) routinely catheterise patients perioperatively. Forty-one (73.2%) would give intramuscular or intravenous gentamicin for a perioperative catheterisation. All surgeons use laminar flow theatres. Twenty-six (46.4%) use only an impervious gown, 6 (10.7%) exhaust pipes, and 24 (42.3%) surgical helmet system. Five different antimicrobial prophylaxis regimens are used 9 (16.1%) cefuroxime, 2 (3.6%) flucloxacillin, 19 (33.9%) flucloxacillin and gentamicin, 10 (17.9%) teicoplanin, 16 (28.6%) teicoplanin and gentamicin. Twenty-two (39.3%) routinely give further doses. Conclusion ASB screening, treatment and intramuscular gentamicin for perioperative catheterisation is routinely practiced despite no supporting evidence base. MSSA screening and treatment is underutilised. Multiple antibiotic regimens exist despite little variation in organisms in PJI. Practice varies between surgeons and centers, we should all be practicing evidence-based medicine.
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Affiliation(s)
- James Morris
- Department of Trauma and Orthopaedic Surgery, Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom
| | - Lee Hoggett
- Department of Trauma and Orthopaedic Surgery, Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom
| | - Sophie Rogers
- Department of Trauma and Orthopaedic Surgery, Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom
| | - John Ranson
- Department of Trauma and Orthopaedic Surgery, Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom
| | - Andrew Sloan
- Department of Trauma and Orthopaedic Surgery, Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom
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Ouyang X, Wang Q, Li X, Zhang T, Rastogi S. Laminar airflow ventilation systems in orthopaedic operating room do not prevent surgical site infections: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:572. [PMID: 37543643 PMCID: PMC10403924 DOI: 10.1186/s13018-023-03992-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/09/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Laminar airflow (LAF) technologies minimize infectious microorganisms to enhance air quality and surgical site infections (SSIs). LAF lowers SSIs in some clinical studies but not others. This study analyzes laminar airflow ventilation's capacity to reduce orthopaedic surgery-related SSIs. METHODS The PRISMA-compliant keywords were utilized to conduct a search for pertinent articles in various databases including PubMed, MEDLINE, CENTRAL, Web of Sciences, and the Cochrane databases. Observational studies, including retrospective, prospective, and cohort designs, satisfy the PICOS criteria for research methodology. The assessment of quality was conducted utilizing the Robvis software, while the meta-analysis was performed using the RevMan application. The study's results were assessed based on effect sizes of odds ratio (OR) and risk ratio (RR). RESULTS From 2000 to 2022, 10 randomized controlled clinical trials with 10,06,587 orthopaedic surgery patients met the inclusion criteria. The primary outcomes were: (1) Risk of SSI, (2) Bacterial count in sampled air and (3) Reduction in SSIs. The overall pooled OR of all included studies was 1.70 (95% CI 1.10-2.64), and the overall pooled RR was 1.27 (95% CI 1.02-1.59) with p < 0.05. LAF is ineffective at preventing SSIs in orthopaedic procedures due to its high-risk ratio and odds ratio. CONCLUSIONS The present meta-analysis has determined that the implementation of LAF systems does not result in a significant reduction in the incidence of surgical site infections (SSIs), bacterial count in the air, or SSIs occurrence in orthopaedic operating rooms. Consequently, the installation of said equipment in operating rooms has been found to be both expensive and inefficient.
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Affiliation(s)
- Xueqian Ouyang
- Anesthesia operating room, Xianyang Central Hospital, 712000, Xianyang, People's Republic of China
| | - Qiaolin Wang
- Department of Internal Medicine Ward I, Yantai Qishan Hospital, Yantai, 264001, Shandong Province, People's Republic of China
| | - Xiaohua Li
- Vasculocardiology Department, Xianyang Central Hospital, Xianyang, 712000, People's Republic of China
| | - Ting Zhang
- Anesthesia operating room, Northwest Women's and Children's Hospital, 710061, Xi'an, People's Republic of China.
| | - Sanjay Rastogi
- ESIC Model Hospital, ESIC, Pir Ajan Fakir Rd, Guwahati, 781021, Assam, India
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Troeman DPR, Kluytmans JAJW. "From Nares to Wound: Exploring the mechanisms for Staphylococcal surgical site infections, implications for infection prevention". ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e130. [PMID: 37592968 PMCID: PMC10428146 DOI: 10.1017/ash.2023.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 08/19/2023]
Abstract
Surgical site infections (SSIs) are important healthcare-associated infections, leading to increased morbidity and mortality, healthcare costs, and prolonged hospital stays. Staphylococcus aureus is an important and common microbial cause of SSI. Nasal carriage of S. aureus has been shown to be an important determinant for the development of SSI, and interventions aimed at eradicating preoperative nasal carriage are associated with a reduced risk of infection. Yet, it is not entirely clear how the nasally residing S. aureus causes SSI at distant body sites. In this commentary, we describe our view on how S. aureus can be transported from the nares to the incision site during surgery. In addition, we shed light on the implications of our view for infection prevention research.
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Affiliation(s)
- Darren P. R. Troeman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan A. J. W. Kluytmans
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Castel-Oñate A, Marín-Peña O, Martínez Pastor J, Guerra Farfán E, Cordero Ampuero J. Proyecto PREVENCOT: ¿Seguimos las recomendaciones internacionales para la prevención de la infección del sitio quirúrgico en cirugía ortopédica programada? Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:306-314. [DOI: 10.1016/j.recot.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/04/2021] [Accepted: 10/17/2021] [Indexed: 11/30/2022] Open
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Castel-Oñate A, Marín-Peña O, Martínez Pastor J, Guerra Farfán E, Cordero Ampuero J. [Translated article] PREVENCOT project: Do we follow international guidelines to prevent surgical site infection in orthopaedic elective surgery? Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Rezzadeh K, Parikh H, Guanche I, Debbi E, Rajaee S, Schwarzkopf R, Paiement G. Clean or Dirty? A Systematic Review of Splash Basin Use and Its Infectious Potential in Orthopaedic Surgery. THE IOWA ORTHOPAEDIC JOURNAL 2022; 42:82-89. [PMID: 36601221 PMCID: PMC9769359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Splash basins are used in orthopaedic surgery cases to wash and hold instrumentsintraoperatively. This systematic review aims to summarize information on contamination of splash basins intraoperatively. Methods A systematic review was conducted using the following search terms: "splash basin" or "splash bucket." Two authors independently reviewed the literature. Studies were included if they reported on intraoperative splash basin contamination rates. Studies were excluded if they were not relevant to orthopaedic surgery, non-English articles, or repeat studies yielded by different online databases. Results There were seven studies included in this review. The median contamination rate of sterile water or physiologic saline splash basins was 23.9% [range: 2%-74%]. The addition of surgical antiseptics to sterile water splash basins was associated with 0% contamination rates in two studies. The most frequent splash basin contaminants identified in bacterial culture were coagulase negative staphylococcus (50%) and staphylococcus aureus (10%). Conclusion The splash basin appears to be a frequent source of contamination in the operating room. Many studies suggest abandoning splash basin use altogether, although the efficacy of alternative methods such as cleaning instruments with lap pads in avoiding contamination of the sterile field has not been studied. Further investigation into surgical teams' use of the splash basin and the contents of the splash basin as they relate to contamination rates may help advance our understanding of optimal use of this surgical tool. Shorter case durations and dilute surgical antiseptics in splash basins appear associated with lower splash basin contamination risk. Level of Evidence: V.
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Affiliation(s)
- Kevin Rezzadeh
- Department of Orthopaedics, Division of Arthroplasty, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Harin Parikh
- Department of Orthopaedics, Division of Arthroplasty, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Isabella Guanche
- Department of Orthopaedics, Division of Arthroplasty, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Eytan Debbi
- Department of Orthopaedics, Division of Arthroplasty, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Sean Rajaee
- Department of Orthopaedics, Division of Arthroplasty, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Ran Schwarzkopf
- Department of Orthopaedics, Division of Arthroplasty, NYU Langone Medical Center, New York, New York, USA
| | - Guy Paiement
- Department of Orthopaedics, Division of Arthroplasty, Cedars Sinai Medical Center, Los Angeles, California, USA
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Bartek B, Winkler T, Garbe A, Schelberger T, Perka C, Jung T. Bacterial contamination of irrigation fluid and suture material during ACL reconstruction and meniscus surgery : Low infection rate despite increasing contamination over surgery time. Knee Surg Sports Traumatol Arthrosc 2022; 30:246-252. [PMID: 33566145 PMCID: PMC8800874 DOI: 10.1007/s00167-021-06481-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 01/25/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE During knee arthroscopy, irrigation fluid from the surgical site accumulates in the sterile reservoir. Whether these fluid collections and also suture material used during the arthroscopic surgical processes show bacterial contamination over time during surgery remains unclear. The purpose of this study was to determine this contamination rate and to analyze its possible influence on postoperative infection. MATERIALS AND METHODS In this study, 155 patients were included. Fifty-eight underwent reconstruction of the anterior cruciate ligament (ACL), 63 meniscal surgery and 34 patients combined ACL reconstruction and meniscus repair. We collected pooled samples of irrigation fluid from the reservoir on the sterile drape every 15 min during the surgery. In addition, we evaluated suture material of ACL graft and meniscus repair for bacterial contamination. Samples were sent for microbiological analysis, incubation time was 14 days. All patients were seen in the outpatient department 6, 12 weeks and 12 months postoperatively and examined for clinical signs of infection. RESULTS A strong statistical correlation (R2 = 0.81, p = 0.015) was found between an advanced duration of surgery and the number of positive microbiological findings in the accumulated fluid. Suture and fixation material showed a contamination rate of 28.4% (29 cases). Despite the high contamination rate, only one infection was found in the follow-up examinations, caused by Staphylococcus lugdunensis. CONCLUSION Since bacterial contamination of accumulated fluid increases over time the contact with the fluid reservoirs should be avoided. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Benjamin Bartek
- Center for Musculoskeletal Surgery, Charitéplatz 1, 10117, Berlin, Germany.
| | - Tobias Winkler
- Center for Musculoskeletal Surgery, Charitéplatz 1, 10117, Berlin, Germany
- Julius Wolff Institute, Berlin, Germany
- Berlin-Institute of Health Center for Regenerative Therapies, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anja Garbe
- Center for Musculoskeletal Surgery, Charitéplatz 1, 10117, Berlin, Germany
| | - Tarek Schelberger
- Center for Musculoskeletal Surgery, Charitéplatz 1, 10117, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charitéplatz 1, 10117, Berlin, Germany
| | - Tobias Jung
- Center for Musculoskeletal Surgery, Charitéplatz 1, 10117, Berlin, Germany
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Barber MD, Young O, Kulkarni D, Young I, Saleem TB, Fernandez T, Revie E, Dixon JM. No evidence of benefit for laminar flow in theatre for sling-assisted, implant-based breast reconstruction. Surgeon 2021; 19:e112-e116. [DOI: 10.1016/j.surge.2020.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/18/2020] [Accepted: 08/27/2020] [Indexed: 01/25/2023]
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Jaly I, Iyengar KP, Bahl S, Jain V, Vaishya R. COVID-19 Pandemic and Debates on the Design of Operating Theatre Ventilation Systems in Healthcare Facilities. JOURNAL OF INDUSTRIAL INTEGRATION AND MANAGEMENT 2021. [DOI: 10.1142/s2424862221500093] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
COVID-19 pandemic had a significant impact on providing Trauma and Orthopedic surgery around the world. The orthopedic community had to reconfigure emergency and urgent trauma services safely but also support strategies to prevent person-to-person coronavirus transmission. Various organizations including British Orthopedic Association (BOA), American Academy of Orthopedic Surgeons (AAOS) and Public Health England (PHE) have provided guidelines for conducting safe essential surgery in operating theatres. One of the areas that have not been debated enough is the type of ventilation systems that should be used in operating theatres during this global pandemic. We review the current evidence in the literature particularly in the challenges faced by health care professionals in current COVID-19 pandemic in deciding and implementing an effective operating theatre ventilation system protecting both our patients and operating room personnel.
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Affiliation(s)
- Ibrahim Jaly
- Department of Trauma and Orthopaedics, Southport and Ormskirk NHS Trust, Southport PR8 6PN United Kingdom
| | - Karthikeyan P Iyengar
- Department of Trauma and Orthopaedics, Southport and Ormskirk NHS Trust, Southport PR8 6PN United Kingdom
| | - Shashi Bahl
- Department of Mechanical Engineering, I.K. Gujral Punjab Technical University, Hoshiarpur Campus, Hoshiarpur 146001, India
| | - Vijay Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar, Lohia Hospital, New Delhi 110001, India
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi 110076, India
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Abstract
INTRODUCTION Owing to the COVID-19 pandemic, there has been significant disruption to all surgical specialties. In the UK, units have cancelled elective surgery and a decrease in aerosol generating procedures (AGPs) was favoured. Centres around the world advocate the use of negative pressure environments for AGPs in reducing the spread of infectious airborne particles. We present an overview of operating theatre ventilation systems and the respective evidence with relation to surgical site infection (SSI) and airborne pathogen transmission in light of COVID-19. METHODS A literature search was conducted using the PubMed, Cochrane Library and MEDLINE databases. Search terms included "COVID-19", "theatre ventilation", "laminar", "turbulent" and "negative pressure". FINDINGS Evidence for laminar flow ventilation in reducing the rate of SSI in orthopaedic surgery is widely documented. There is little evidence to support its use in general surgery. Following previous viral outbreaks, some centres have introduced negative pressure ventilation in an attempt to decrease exposure of airborne pathogens to staff and surrounding areas. This has again been suggested during the COVID-19 pandemic. A limited number of studies show some positive results for the use of negative pressure ventilation systems and reduction in spread of pathogens; however, cost, accessibility and duration of conversion remain an unexplored issue. Overall, there is insufficient evidence to advocate large scale conversion at this time. Nevertheless, it may be useful for each centre to have its own negative pressure room available for AGPs and high risk patients.
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Affiliation(s)
- C Theodorou
- St Helens and Knowsley Teaching Hospitals NHS Trust, UK
| | - G S Simpson
- St Helens and Knowsley Teaching Hospitals NHS Trust, UK
| | - C J Walsh
- Wirral University Teaching Hospital NHS Foundation Trust, UK
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Zhou M, Zou J. A dynamical overview of droplets in the transmission of respiratory infectious diseases. PHYSICS OF FLUIDS (WOODBURY, N.Y. : 1994) 2021; 33:031301. [PMID: 33897237 PMCID: PMC8061903 DOI: 10.1063/5.0039487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/29/2020] [Indexed: 05/04/2023]
Abstract
The outbreak of the coronavirus disease has drawn public attention to the transmission of infectious pathogens, and as major carriers of those pathogens, respiratory droplets play an important role in the process of transmission. This Review describes respiratory droplets from a physical and mechanical perspective, especially their correlation with the transmission of infectious pathogens. It covers the important aspects of (i) the generation and expulsion of droplets during respiratory activities, (ii) the transport and evolution of respiratory droplets in the ambient environment, and (iii) the inhalation and deposition of droplets in the human respiratory tract. State-of-the-art experimental, computational, and theoretical models and results are presented, and the corresponding knowledge gaps are identified. This Review stresses the multidisciplinary nature of its subject and appeals for collaboration among different fields to fight the present pandemic.
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Affiliation(s)
- Maoying Zhou
- School of Mechanical Engineering, Hangzhou Dianzi
University, Hangzhou, Zhejiang 310027, China
| | - Jun Zou
- State Key Laboratory of Fluid Power and Mechatronic Systems,
Zhejiang University, Hangzhou, Zhejiang 310027,
China
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Kirschbaum S, Hommel H, Strache P, Horn R, Falk R, Perka C. Laminar air flow reduces particle load in TKA-even outside the LAF panel: a prospective, randomized cohort study. Knee Surg Sports Traumatol Arthrosc 2021; 29:3641-3647. [PMID: 33165633 PMCID: PMC7649711 DOI: 10.1007/s00167-020-06344-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/20/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Released particles are a major risk of airborne contamination during surgery. The present prospective study investigated the quantitative and qualitative particle load in the operating room (OR) depending on location, time of surgery and use of laminar air flow (LAF) system. METHODS The particle load/m3 was measured during the implantation of 12 total knee arthroplasties (6 × LAF, 6 × Non-LAF) by using the Met One HHPC 6 + device (Beckmann Coulter GmbH, Germany). Measurement was based on the absorption and scattering of (laser) light by particles and was performed at three different time-points [empty OR, setting up, ongoing operation) at 3 fixed measurement points [OR table (central LAF area), anaesthesia tower (marginal LAF area), surgical image amplifier (outside LAF area)]. RESULTS Independent of time and location, all measurements showed a significantly higher particle load in the Non-LAF group (p < 0.01). With ongoing surgical procedure both groups showed increasing particle load. While there was a major increase of fine particles (size < 1 µm) with advancing activity in the LAF group, the Non-LAF group showed higher particle gain with increasing particle size. The lowest particle load in the LAF group was measured at the operating column, increasing with greater distance from the operating table. The Non-LAF group presented a significantly higher particle load than the LAF group at all locations. CONCLUSION The use of a LAF system significantly reduces the particle load and therefore potential bacterial contamination regardless of the time or place of measurement and therefore seems to be a useful tool for infection prevention. As LAF leads to a significant decrease of respirable particles, it appears to be a protective factor for the health of the surgical team regardless of its use in infection prevention. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Stephanie Kirschbaum
- Centre for Musculoskeletal Surgery, Charité - University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Hagen Hommel
- Clinic for Orthopaedics, Sports Medicine and Rehabilitation, KH-MOL GmBH, Sonnenburger Weg 3, 16269, Wriezen, Germany
- Academic Teaching Hospital of the Medical School of Brandenburg Theodor Fontane, Fehrbelliner Strase 38, 16816, Neuruppin, Germany
| | - Peggy Strache
- Clinic for Orthopaedics, Sports Medicine and Rehabilitation, KH-MOL GmBH, Sonnenburger Weg 3, 16269, Wriezen, Germany
| | - Roland Horn
- Clinic for Orthopaedics, Sports Medicine and Rehabilitation, KH-MOL GmBH, Sonnenburger Weg 3, 16269, Wriezen, Germany
| | - Roman Falk
- Clinic for Orthopaedics, Sports Medicine and Rehabilitation, KH-MOL GmBH, Sonnenburger Weg 3, 16269, Wriezen, Germany
| | - Carsten Perka
- Centre for Musculoskeletal Surgery, Charité - University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Challenges to Implementing Total Joint Replacement Programs in Developing Countries. Orthop Clin North Am 2020; 51:131-139. [PMID: 32138851 DOI: 10.1016/j.ocl.2019.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In this review article, the authors present the many challenges that orthopedic surgeons in developing countries face when implementing arthroplasty programs. The issues of cost, sterility, and patient demographics are specifically addressed. Despite the many challenges, developing countries are beginning to offer hip and knee reconstructive surgery to respond to the increasing demand for such elective operations as the prevalence of osteoarthritis continues to increase. The authors shed light on these nascent arthroplasty programs.
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Safety of Pleuroscopy Performed in Negative Pressure Bronchoscopy Rooms. J Bronchology Interv Pulmonol 2019; 26:250-253. [DOI: 10.1097/lbr.0000000000000557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Roach J, Gaastra B, Bulters D, Shtaya A. Safety, Accuracy, and Cost Effectiveness of Bedside Bolt External Ventricular Drains (EVDs) in Comparison with Tunneled EVDs Inserted in Theaters. World Neurosurg 2019; 125:e473-e478. [PMID: 30735879 DOI: 10.1016/j.wneu.2019.01.106] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES External ventricular drain (EVD) placement is required frequently in neurosurgical patients to divert cerebrospinal fluid and monitor intracranial pressure. The usual practice is the tunneled EVD technique performed in operating theaters. EVD insertion through a bolt in intensive care also is described. We employ both practices in our institute. Herein, we compare the indications, accuracy, safety, and costs of the 2 techniques. METHODS This was a retrospective cohort study of a prospectively maintained EVD database of all patients undergoing first frontal EVD placement between January 2010 and December 2015. Those patients with preceding cerebrospinal fluid infection were excluded. We compared bolt EVD with tunneled EVD techniques in terms of accuracy of EVD tip location by analyzing computed tomography scans to grade catheter tip location as optimal (ipsilateral frontal horn) or otherwise suboptimal, and complications that include infection and revision rates. RESULTS In total, 579 eligible patients aged 3 months to 84 years were identified; 430 had tunneled EVDs and 149 bolt EVDs. The most frequent diagnosis was intracranial hemorrhage (73% bolt vs. 50.4% tunneled group; P < 0.001). Other diagnoses included tumor (4.7% bolt vs. 19.1% tunneled; P < 0.001) and traumatic brain injury (17.5% bolt vs. 17.4% tunneled). In the bolt EVD group 66.4% of EVD tips were optimal, compared with 61.0% in the tunneled group (P = 0.33). Infection was confirmed in 15 (10.0%) bolt EVDs compared with 61 (14.2%) tunneled EVDs (P = 0.2). Each bolt EVD kit costs £260, whereas placing a tunneled one in the theater costs £1316. CONCLUSIONS Bedside bolt EVD placement is safe, accurate, and cost effective in selective patients with hemorrhage-related hydrocephalus.
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Affiliation(s)
- Joy Roach
- Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom
| | - Benjamin Gaastra
- Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom
| | - Diederik Bulters
- Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom
| | - Anan Shtaya
- Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom; Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London and St. George's University Hospital NHS Trust, London, United Kingdom.
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17
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Atkins GJ, Alberdi MT, Beswick A, Blaha JD, Bingham J, Cashman J, Chen AF, Cooper AM, Cotacio GL, Fraguas T, Gambhir A, Gromov K, Guerra E, Hooper G, Khlopas A, Kieser D, Klaber I, Kyte R, Levine B, Mont MA, Nikolaou V, Nuñez J, Overgaard S, Parvizi J, Saxena A, Sayago G, Shahcheraghi H, Sodhi N, Solomon LB, Starczak Y, Tan TL, Tarabichi M, Olivan RT, Virolainen P, Wyatt M. General Assembly, Prevention, Surgical Site Preparation: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S85-S92. [PMID: 30348579 DOI: 10.1016/j.arth.2018.09.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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18
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Aalirezaie A, Akkaya M, Barnes CL, Bengoa F, Bozkurt M, Cichos KH, Ghanem E, Darouiche RO, Dzerins A, Gursoy S, Illiger S, Karam JA, Klaber I, Komnos G, Lohmann C, Merida E, Mitt P, Nelson C, Paner N, Perez-Atanasio JM, Reed M, Sangster M, Schweitzer D, Simsek ME, Smith BM, Stocks G, Studers P, Talevski D, Teuber J, Travers C, Vince K, Wolf M, Yamada K, Vince K. General Assembly, Prevention, Operating Room Environment: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S105-S115. [PMID: 30348570 DOI: 10.1016/j.arth.2018.09.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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19
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Davies PS, Graham SM, Maqungo S, Harrison WJ. Total joint replacement in sub-Saharan Africa: a systematic review. Trop Doct 2019; 49:120-128. [PMID: 30636518 PMCID: PMC6535807 DOI: 10.1177/0049475518822239] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Outcomes of arthroplasty in sub-Saharan Africa are not widely reported. To our knowledge, this systematic review is the first to explore this topic. Scopus, EMBASE, Medline and PubMed databases were searched, utilising MeSH headings and Boolean search strategies. All papers from South Africa were excluded. Twelve papers reporting 606 total hip replacements (THRs) and 763 total knee replacements (TKRs) were included. Avascular necrosis was the most common indication for THR, whereas osteoarthritis was the main indication for TKR. HIV prevalence of up to 33% was seen. Improvements were seen in patient-reported outcome measures in both THR and TKR. The dislocation rate in THR was 1.6%. The deep infection rate was 1.6% for TKRs and 0.5% for THRs. Positive results were reported, with comparable complications to high-income countries. However, there is likely to be significant reporting bias and the introduction of mandatory registries would enable more accurate monitoring across the region.
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Affiliation(s)
- Peter Se Davies
- 1 Registrar, Department of Trauma and Orthopaedics, Ninewells Hospital and Medical School, Dundee, UK
| | - Simon M Graham
- 2 Limb Reconstruction and Orthopaedic Trauma Fellow, Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa.,3 Welcome Trust Clinical Research Fellow, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Sithombo Maqungo
- 4 Consultant Surgeon and Professor, Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - William J Harrison
- 5 Consultant Surgeon and Professor, Department of Trauma and Orthopaedics, Countess of Chester Hospital, Chester, UK
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20
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Ai ZT, Melikov AK. Airborne spread of expiratory droplet nuclei between the occupants of indoor environments: A review. INDOOR AIR 2018; 28:500-524. [PMID: 29683213 DOI: 10.1111/ina.12465] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 04/13/2018] [Indexed: 05/04/2023]
Abstract
This article reviews past studies of airborne transmission between occupants in indoor environments, focusing on the spread of expiratory droplet nuclei from mouth/nose to mouth/nose for non-specific diseases. Special attention is paid to summarizing what is known about the influential factors, the inappropriate simplifications of the thermofluid boundary conditions of thermal manikins, the challenges facing the available experimental techniques, and the limitations of available evaluation methods. Secondary issues are highlighted, and some new ways to improve our understanding of airborne transmission indoors are provided. The characteristics of airborne spread of expiratory droplet nuclei between occupants, which are influenced correlatively by both environmental and personal factors, were widely revealed under steady-state conditions. Owing to the different boundary conditions used, some inconsistent findings on specific influential factors have been published. The available instrumentation was too slow to provide accurate concentration profiles for time-dependent evaluations of events with obvious time characteristics, while computational fluid dynamics (CFD) studies were mainly performed in the framework of inherently steady Reynolds-averaged Navier-Stokes modeling. Future research needs in 3 areas are identified: the importance of the direction of indoor airflow patterns, the dynamics of airborne transmission, and the application of CFD simulations.
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Affiliation(s)
- Z T Ai
- Department of Civil Engineering, International Centre for Indoor Environment and Energy, Technical University of Denmark, Copenhagen, Denmark
| | - A K Melikov
- Department of Civil Engineering, International Centre for Indoor Environment and Energy, Technical University of Denmark, Copenhagen, Denmark
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21
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Chen KK, Elbuluk AM, Vigdorchik JM, Long WJ, Schwarzkopf R. The effect of wound dressings on infection following total joint arthroplasty. Arthroplast Today 2018; 4:125-129. [PMID: 29560407 PMCID: PMC5859663 DOI: 10.1016/j.artd.2017.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/08/2017] [Accepted: 03/08/2017] [Indexed: 11/24/2022] Open
Abstract
Background The use of perioperative surgical wound dressings is an important factor in the mitigation of infection following total joint arthroplasty (TJA). Few studies have been published comparing wound dressings and infection rates after TJA. Methods MEDLINE, PubMed, and EMBASE were searched for studies published between 2006 and 2016 reporting infection rates in patients using various wound dressings after undergoing TJA. All studies comparing Hydrofibre dressings to Standard dressings or Absorbent dressings were included in this meta-analysis. Studies looking at TJA secondary to trauma were excluded. Two individuals independently extracted data, and study results were divided based on type of treatment. The primary outcome was to compare the infection rate of Hydrofibre dressings to that of both Standard Dressings and Absorbent dressings. Results Of a total of 3721 participants, 1483 were treated with Standard dressings (non-impregnated gauze), 1911 with Hydrofibre dressings, and 327 with Absorbent dressings. The risk ratio for infection comparing Standard with Hydrofibre was 4.16 (95% confidence interval, 1.71-10.16) as compared to 2.60 (95% confidence interval, 0.66-10.27) when comparing Absorbent with Hydrofibre dressings. Conclusions Our analysis suggests that Hydrofibre dressings may be significantly better than Standard and Absorbent dressings with respect to reducing infection. However, given the observed heterogeneity and small number of studies included, more comparative studies are needed to definitively recommend superiority among dressings following TJA. Level of Evidence Level 1.
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Affiliation(s)
- Kevin K Chen
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, NY, USA
| | - Ameer M Elbuluk
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, NY, USA
| | - Jonathan M Vigdorchik
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, NY, USA
| | - William J Long
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, NY, USA
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22
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Refaie R, Rushton P, McGovern P, Thompson D, Serrano-Pedraza I, Rankin KS, Reed M. The effect of operating lights on laminar flow. Bone Joint J 2017; 99-B:1061-1066. [DOI: 10.1302/0301-620x.99b8.bjj-2016-0581.r2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 03/14/2017] [Indexed: 01/28/2023]
Abstract
Aims The interaction between surgical lighting and laminar airflow is poorly understood. We undertook an experiment to identify any effect contemporary surgical lights have on laminar flow and recommend practical strategies to limit any negative effects. Materials and Methods Neutrally buoyant bubbles were introduced into the surgical field of a simulated setup for a routine total knee arthroplasty in a laminar flow theatre. Patterns of airflow were observed and the number of bubbles remaining above the surgical field over time identified. Five different lighting configurations were assessed. Data were analysed using simple linear regression after logarithmic transformation. Results In the absence of surgical lights, laminar airflow was observed, bubbles were cleared rapidly and did not accumulate. If lights were placed above the surgical field laminar airflow was abolished and bubbles rose from the surgical field to the lights then circulated back to the surgical field. The value of the decay parameter (slope) of the two setups differed significantly; no light (b = -1.589) versus one light (b = -0.1273, p < 0.001). Two lights touching (b = -0.1191) above the surgical field had a similar effect to that of a single light (p = 0. 2719). Two lights positioned by arms outstretched had a similar effect (b = -0.1204) to two lights touching (p = 0.998) and one light (p = 0.444). When lights were separated widely (160 cm), laminar airflow was observed but the rate of clearance of the bubbles remained slower (b = -1.1165) than with no lights present (p = 0.004). Conclusion Surgical lights have a significantly negative effect on laminar airflow. Lights should be positioned as far away as practicable from the surgical field to limit this effect. Cite this article: Bone Joint J 2017;99-B:1061–6.
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Affiliation(s)
- R. Refaie
- Northumbria Healthcare NHS Foundation
Trust, Woodhorn Ln, Ashington, Northumberland
NE63 9JJ, UK
| | - P. Rushton
- Northumbria Healthcare NHS Foundation
Trust, Woodhorn Ln, Ashington, Northumberland
NE63 9JJ, UK
| | - P. McGovern
- Northumbria Healthcare NHS Foundation
Trust, Woodhorn Ln, Ashington, Northumberland
NE63 9JJ, UK
| | - D. Thompson
- Northumbria Healthcare NHS Foundation
Trust, Woodhorn Ln, Ashington, Northumberland
NE63 9JJ, UK
| | | | - K. S. Rankin
- Freeman Hospital, High
Heaton, Newcastle Upon Tyne NE7 7DN, UK
| | - M. Reed
- Northumbria Healthcare NHS Foundation
Trust, Woodhorn Ln, Ashington, Northumberland
NE63 9JJ, UK
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23
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Chirca I, Marculescu C. Prevention of Infection in Orthopedic Prosthetic Surgery. Infect Dis Clin North Am 2017; 31:253-263. [PMID: 28292539 DOI: 10.1016/j.idc.2017.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Total joint arthroplasty is a generally safe orthopedic procedure; however, infection is a potentially devastating complication. Multiple risk factors have been identified for development of prosthetic joint infections. Identification of patients at risk and preoperative correction of known risk factors, such as smoking, diabetes mellitus, anemia, malnutrition, and decolonization of Staphylococcus carriers, represent well-established actions to decrease the infection risk. Careful operative technique, proper draping and skin preparation, and appropriate selection and dosing of antimicrobials for perioperative prophylaxis are also very important in prevention of infection.
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Affiliation(s)
- Ioana Chirca
- Department of infectious Diseases, University Hospital, 1350 Walton Way, Augusta, GA 30909, USA
| | - Camelia Marculescu
- Division of Infectious Diseases, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA.
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24
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Bischoff P, Kubilay NZ, Allegranzi B, Egger M, Gastmeier P. Effect of laminar airflow ventilation on surgical site infections: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2017; 17:553-561. [PMID: 28216243 DOI: 10.1016/s1473-3099(17)30059-2] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 11/14/2016] [Accepted: 12/13/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND The role of the operating room's ventilation system in the prevention of surgical site infections (SSIs) is widely discussed, and existing guidelines do not reflect current evidence. In this context, laminar airflow ventilation was compared with conventional ventilation to assess their effectiveness in reducing the risk of SSIs. METHODS We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and WHO regional medical databases from Jan 1, 1990, to Jan 31, 2014. We updated the search for MEDLINE for the period between Feb 1, 2014, and May 25, 2016. We included studies most relevant to our predefined question: is the use of laminar airflow in the operating room associated with the reduction of overall or deep SSI as outcomes in patients of any age undergoing surgical operations? We excluded studies not relevant to the study question, studies not in the selected languages, studies published before Jan 1, 1990, or after May 25, 2016, meeting or conference abstracts, and studies of which the full text was not available. Data were extracted by two independent investigators, with disagreements resolved through further discussion. Authors were contacted if the full-text article was not available, or if important data or information on the paper's content was absent. Studies were assessed for publication bias. Grading of recommendations assessment, development, and evaluation was used to assess the quality of the identified evidence. Meta-analyses were done with RevMan (version 5.3). FINDINGS We identified 1947 records of which 12 observational studies were comparing laminar airflow ventilation with conventional turbulent ventilation in orthopaedic, abdominal, and vascular surgery. The meta-analysis of eight cohort studies showed no difference in risk for deep SSIs following total hip arthroplasty (330 146 procedures, odds ratio [OR] 1·29, 95% CI 0·98-1·71; p=0·07, I2=83%). For total knee arthroplasty, the meta-analysis of six cohort studies showed no difference in risk for deep SSIs (134 368 procedures, OR 1·08, 95% CI 0·77-1·52; p=0·65, I2=71%). For abdominal and open vascular surgery, the meta-analysis of three cohort studies found no difference in risk for overall SSIs (63 472 procedures, OR 0·75, 95% CI 0·43-1·33; p=0·33, I2=95%). INTERPRETATION The available evidence shows no benefit for laminar airflow compared with conventional turbulent ventilation of the operating room in reducing the risk of SSIs in total hip and knee arthroplasties, and abdominal surgery. Decision makers, medical and administrative, should not regard laminar airflow as a preventive measure to reduce the risk of SSIs. Consequently, this equipment should not be installed in new operating rooms. FUNDING None.
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Affiliation(s)
- Peter Bischoff
- Institute of Hygiene and Environmental Health, Charité-University Medicine Berlin, Berlin, Germany.
| | - N Zeynep Kubilay
- World Health Organization Patient Safety Program, World Health Organization, Geneva, Switzerland
| | - Benedetta Allegranzi
- World Health Organization Patient Safety Program, World Health Organization, Geneva, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Health, Charité-University Medicine Berlin, Berlin, Germany
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25
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Yang C, Yang X, Zhao B. Person to person droplets transmission characteristics in unidirectional ventilated protective isolation room: The impact of initial droplet size. BUILDING SIMULATION 2016; 9:597-606. [PMID: 32218912 PMCID: PMC7091150 DOI: 10.1007/s12273-016-0290-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/26/2016] [Accepted: 03/23/2016] [Indexed: 05/03/2023]
Abstract
Person to person droplets/particles or contaminant cross transmission is an important issue in ventilated environment, especially in the unidirectional ventilated protective isolation room (UVPIR) where the patient's immune system is extremely low and easily infected. We simulated the dispersion process of the droplets with initial diameter of 100 μm, 10 μm and gaseous contaminant in unidirectional ventilated protective isolation room and studied the droplets dispersion and cross transmission with different sizes. The droplets with initial size of 100 μm settle out of the coughing jet quickly after coming out from mouth and cannot be carried by the coughing jet to the human thermal plume affecting (HTPA) zone of the susceptible manikin. Hence, the larger droplets disperse mainly in the HTPA zone of the source manikin, and the droplets cross transmission between source manikin and susceptible manikin is very small. The droplets with initial size of 10 μm and gaseous contaminant have similar dispersion but different removal process in the UVPIR. Part of the droplets with initial size of 10 μm and gaseous contaminant that are carried by the higher velocity coughing airflow can enter the HTPA zone of the susceptible manikin and disperse around it. The other part cannot spread to the susceptible manikin's HTPA zone and mainly spread in the source manikin's HTPA zone. The results from this study would be useful for UVPIR usage and operation in order to minimize the risk of cross infection.
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Affiliation(s)
- Caiqing Yang
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Department of Building Science, Tsinghua University, Beijing, 100084 China
- Beijing Institute of Architectural Design, Beijing, 100045 China
| | - Xudong Yang
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Department of Building Science, Tsinghua University, Beijing, 100084 China
| | - Bin Zhao
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Department of Building Science, Tsinghua University, Beijing, 100084 China
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