The operating room and the ultraviolet environment

Clean surgical wounds may be contaminated from three separate sources: endogenously from the patient himself; exogenously from direct contamination by unsterile instruments, drapes, gowns, hands, or gloves; and by bacteria settling from that final common pathway, the air over the operative field. The advent of total joint replacement precipitated a renewed consciousness in the orthopedic community of the disastrous consequences a wound infection can have upon the orthopedic patient. Deep infection around a total joint replacement can convert a procedure with a 95 percent probability of success to a total disaster, leaving the patient worse than prior to operation. Most orthopedists use at least two accepted methods of preventing deep wound infection in the postoperative period: the application of topical antibiotics during surgery, and the intravenous infusion of systemic antibiotics during and after surgery for a brief period. In addition, many orthopedic surgeons are operating in clean air rooms with body exhaust systems; others are operating in an ultraviolet environment. Orthopedic surgery in the ultraviolet environment has been used at the brigham hospitals since 1973. The infection rate has dropped from 3.8 percent to 1.04 percent in a series of 2000 patients. However, inconveniences and hazards have been experienced in the use of ultraviolet radiation in the operating room.