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Airborne contamination in orthopedic surgery. Evaluation of laminar air flow system and aspiration suit
Abstract:
The question arises whether, on the basis of our studies, the laminar flow system and aspiration suit should be considered as useful and effective components of the overall proctocol to prevent postoperative surgical infections. Our observations do not permit a definitive answer. This would obviously depend on the demonstration of a reduction of the incidence of postoperative infection by means of a large controlled study. The infection rate encountered in this study can not be used to draw any conclusion as to the efficacy of the laminar flow systems, since there are too many uncontrollable variables which may be influential in causing a post operative wound infection. Published reports and present data seem to indicate that the airborne route of transmission is of little significance in modern surgery and that the amount of wound contamination is not necessarily a reflection of airborne contamination. Thus, the use of the laminar air flow system and aspiration suits, which are clearly designed to prevent wound infection by the airborne route, does not seem to be justified on this basis at the present time. On the other hand, the use of laminar air flow system and/or aspiration suit by necessity imposes a strict discipline in those operating rooms, where multiple personnel are routinely involved; i.e., they reduced the number of personnel in contact with patient, reduce the traffic about the surgical patient, etc., which may have significant benefits towards the control of surgical wound infections. This enforced discipline may very well account for the significant decrease in the number of positive intraoperative wound cultures in this study when laminar air flow systems and/or aspiration suits were in use.
Insights
Laminar flow systems and aspiration suits may not prevent surgical infections via airborne transmission. However, they enforce operating room discipline, potentially reducing infection rates by limiting personnel and traffic.
Area of Science:
- Surgical Infection Prevention
- Operating Room Protocols
- Infection Control
Background:
- Postoperative surgical infections remain a significant concern.
- The efficacy of laminar airflow systems and aspiration suits in preventing these infections is debated.
- Current data suggests airborne transmission may play a minor role in wound contamination.
Purpose of the Study:
- To evaluate the effectiveness of laminar airflow systems and aspiration suits in reducing postoperative surgical infections.
- To determine if these systems justify their use based on infection prevention.
- To explore indirect benefits of these systems on operating room practices.
Main Methods:
- Observational study assessing infection rates with and without laminar airflow systems/aspiration suits.
- Analysis of intraoperative wound cultures.
- Consideration of uncontrollable variables influencing infection rates.
Main Results:
- The study could not definitively conclude on the efficacy of laminar airflow systems and aspiration suits for preventing airborne transmission of infections.
- Published data indicates airborne transmission is of minimal significance in modern surgery.
- A significant decrease in positive intraoperative wound cultures was observed when these systems were in use, possibly due to enforced discipline.
Conclusions:
- The use of laminar airflow systems and aspiration suits is not currently justified based on preventing airborne transmission of surgical site infections.
- These systems enforce strict operating room discipline, reducing personnel and traffic, which may contribute to lower infection rates.
- Further large-scale controlled studies are needed to definitively establish the role of these systems in preventing postoperative surgical infections.