Changes in orthopaedic operating theatre practice, monitored using settle plates

Area of Science:

• Orthopedic Surgery
• Infection Control
• Environmental Monitoring

Background:

• Sir John Charnley demonstrated ultraclean air reduces deep infection rates in joint replacement surgery.
• While early trials showed effectiveness, registry data have yielded inconsistent benefits.
• This study aimed to assess theatre air quality in the context of treating rheumatoid arthritis patients.

Purpose of the Study:

• To evaluate the impact of body exhaust systems on airborne bacterial load in a joint replacement theatre.
• To determine if contemporary practices can achieve ultraclean air standards comparable to historical benchmarks.

Main Methods:

• Air quality was monitored using settle plates in a joint replacement theatre over two phases.
• Phase 1: Standard procedure without body exhaust systems.
• Phase 2: All staff utilized body exhaust systems, with attention to surgical light and trolley positioning.

Main Results:

• Phase 1 yielded 0.24 colonies/plate/hour, aligning with Charnley trial findings.
• Phase 2 demonstrated a significant reduction to 0.03 colonies/plate/hour (p<0.001).
• A tendency for colonies to appear on trolley edges was observed under controlled conditions.

Conclusions:

• Contemporary surgical environments can achieve ultraclean air status.
• The use of body exhaust systems by all team members is key to significantly reducing bacterial counts.
• This method offers a viable strategy for minimizing deep infection risk in joint replacement surgery.