Airborne contamination and surgical site infection: Could a thirty-year-old idea help solve the problem?

Surgical site infection (SSI) is a most serious postoperative complication, associated with increased morbidity and mortality, as well as extended therapy and elevated healthcare costs. In open clean surgery, e.g. orthopedic and cardiothoracic operations, the risk of SSI is strongly correlated with the amount of airborne bacteria being present in the operating room and the surgical field. The source of these bacteria is the surgical team itself, as we all emit thousands of bacteria-carrying skin particles every minute into the air. Although the risk of airborne contamination has decreased over the years, thanks to modern surgical clothing and advanced operating room ventilation, airborne bacteria are still detected and cause SSI. However, during the past thirty years there has been a simple and potentially effective preventive method waiting to be noticed. In 1986 Hall, Mackintosh and Hoffman found in a controlled experimental study that the application of regular unperfumed skin lotion to a person's body reduced the emission of airborne bacteria-carrying particles by approximately 90%. Moreover, the effect lasted at least 4 hours, which corresponds to a major surgical procedure. Thus, in the light of those results the present paper puts forth the hypothesis that this method can decrease the incidence of airborne bacterial contamination and SSI in open clean surgery. The paper also discusses the rationale and advantages of the method, and questions why it has escaped scientific attention for so long. In healthcare, difficult problems rarely have a simple and cheap solution. However, the use of ordinary skin lotion in open surgery may just be one, as it could potentially help prevent surgical site infection, and thereby increase patient safety and reduce healthcare costs.