Clean air at operation and subsequent sepsis in the joint

Area of Science:

• Orthopedic Surgery
• Infectious Disease Control
• Hospital Engineering

Background:

• High rates of surgical sepsis were observed following early arthroplasty procedures.
• A resurgence in understanding airborne bacteria's role in surgical site infections occurred.
• Engineering advancements enabled the creation of significantly cleaner surgical environments.

Purpose of the Study:

• To investigate the impact of reduced airborne contamination on sepsis rates in arthroplasty.
• To compare the effectiveness of ultraclean air versus prophylactic antibiotics in preventing joint sepsis.
• To evaluate the combined effect of ultraclean air and antibiotics on infection rates.

Main Methods:

• Implementing advanced ventilation and specialized clothing systems to minimize airborne contaminants.
• Conducting a ten-year study to systematically reduce airborne contamination by over 100-fold.
• Analyzing data from randomized studies comparing ultraclean air operating rooms with standard ventilation plus prophylactic antibiotics.

Main Results:

• A tenfold reduction in sepsis rates was achieved through significant reduction of airborne contamination, without antibiotics.
• Recent studies confirm that ultraclean air reduces sepsis rates considerably.
• Prophylactic antibiotics with normal ventilation achieve similarly low sepsis rates.
• Both methods are independently effective, and combined, reduce joint sepsis after total arthroplasty to a few per 1000.

Conclusions:

• Minimizing airborne bacteria in the operating room is crucial for reducing sepsis after total arthroplasty.
• Both ultraclean air technology and prophylactic antibiotics are effective strategies for infection control.
• The combination of ultraclean air and prophylactic antibiotics offers the most significant reduction in post-arthroplasty joint sepsis.