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Unfolding the risk: a pilot study of airborne contamination in the operating room during total joint arthroplasty
David A Ibrahim1, Andrew Frey2, Joshua U Hancock3
1Adult Reconstruction, Florida Orthopaedic Institute, 909 N. Dale Mabry Hwy., Tampa, FL, 33609, USA.
Background:
As known microbial reservoirs, hospital linens thrown in the operating room (OR) can impact sterility in total joint arthroplasty, where a reduced inoculum may result in periprosthetic joint infection. Herein, we examine the effects of hospital blankets dropped or thrown in the OR on airborne bioburden and contamination.
Methods:
A standardized, staged pilot study was developed employing different blanket handling practices in the OR. Airborne bioburden was compared between each of these common scenarios. Settling plates (n = 48) at varying distances from the disturbances were used to detect aerosolized organisms. Test conditions were conducted in the morning and afternoon to assess temporal changes in microbial flora.
Results:
Of the 17 (35.4%) microorganism-positive plates, 7 (41.2%) were observed on control and 10 (58.8%) on days with dropped or thrown blankets. Positions near the airflow disturbance were 3× more likely to become contaminated compared to far positions (p = 0.03). Blankets dropped and thrown resulted in 18% more microorganisms compared to control (p = 0.59). Temporally, 58.8% (10/17) of the positive plates were observed following afternoon cases (p = 0.59). All microorganisms were gram positive, of which 93.3% were human colonizers, with Staphylococcus spp. being most common.
Conclusions:
This pilot study demonstrated that closer proximity to airflow disruptions negatively impacts sterility, while later time of day and dropped or thrown objects may contribute to contamination. The presented methodologies provide guidance for future studies, and the findings can help curtail OR practices by offering insights into the effects of airflow disruptions beyond the sterile field.
Insights
Dropping or throwing hospital blankets in the operating room (OR) increases airborne microbes, posing a risk to sterility in procedures like total joint arthroplasty. Proximity to disturbances significantly impacts contamination levels, highlighting the need for careful OR practices.
Area of Science:
- Healthcare-associated infections
- Operating room sterility
- Microbial contamination
Background:
- Hospital linens, including blankets, are potential reservoirs for microorganisms in the operating room (OR).
- Improper handling of linens can lead to microbial contamination, potentially impacting sterile procedures like total joint arthroplasty.
- Understanding the impact of blanket handling on airborne bioburden is crucial for preventing periprosthetic joint infections.
Purpose of the Study:
- To investigate the effect of dropping or throwing hospital blankets in the OR on airborne microbial contamination.
- To compare airborne bioburden associated with different blanket handling practices.
- To assess the influence of proximity to disturbances and time of day on microbial contamination.
Main Methods:
- A pilot study using standardized blanket handling scenarios in the OR.
- Deployment of settling plates at varying distances from blanket disturbances to quantify airborne organisms.
- Comparison of microbial contamination between control (normal handling) and experimental (dropped/thrown blankets) conditions.
- Assessment of temporal microbial changes by conducting tests in morning and afternoon sessions.
Main Results:
- Microorganism-positive plates were higher on days with dropped or thrown blankets (58.8%) compared to control (41.2%).
- Contamination was significantly more likely at positions closer to airflow disturbances (3x higher, p=0.03).
- Gram-positive bacteria, primarily human colonizers like Staphylococcus spp., were the predominant microorganisms detected.
Conclusions:
- Closer proximity to airflow disruptions, such as dropped or thrown blankets, negatively impacts OR sterility.
- Later time of day and specific blanket handling practices may contribute to increased microbial contamination.
- Findings provide insights for modifying OR practices to minimize airborne contamination and enhance patient safety.
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