AJIC: American Journal of Infection Control
Volume 38, Issue 3 , Pages 199-204 , April 2010

Predicting bacterial populations based on airborne particulates: A study performed in nonlaminar flow operating rooms during joint arthroplasty surgery

  • Gregory W. Stocks, MD

      Affiliations

    • Fondren Orthopedic Group, Houston, TX
    • Corresponding Author InformationAddress correspondence to Gregory W. Stocks, MD, Fondren Orthopedic Group, 7401 S Main Street, Houston, TX 77030-4509.
    • ,
  • Sean D. Self

      Affiliations

    • Nimbic Systems, Inc, Houston, TX
    • ,
  • Brandon Thompson

      Affiliations

    • Fondren Orthopedic Group, Houston, TX
    • ,
  • Xavier A. Adame

      Affiliations

    • ISO Software Consultants, Houston, TX
    • ,
  • Daniel P. O'Connor, PhD

      Affiliations

    • Laboratory of Integrated Physiology, University of Houston, Houston, TX

References 

  1. National Nosocomial Infections Surveillance System . National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32:470–485
  2. Klevens RM, Edwards JR, Richards CL, Horan TC, Gaynes RP, Pollock DA, et al. Estimating health care–associated infections and deaths in US hospitals, 2002. Public Health Rep. 2007;122:160–166
  3. Chu VH, Crosslin DR, Friedman JY, Reed SD, Cabell CH, Griffiths RI, et al. Staphylococcus aureus bacteremia in patients with prosthetic devices: costs and outcomes. Am J Med. 2005;118:1416;e19-1416.e24
  4. Perencevich EN, Sands KE, Cosgrove SE, Guadagnoli E, Meara E, Platt R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis. 2003;9:196–203
  5. Gosden PE, MacGowan AP, Bannister GC. Importance of air quality and related factors in the prevention of infection in orthopaedic implant surgery. J Hosp Infect. 1998;39:173–180
  6. Lidwell OM, Lowbury EJ, Whyte W, Blowers R, Stanley SJ, Lowe D. Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates. J Hosp Infect. 1983;4:111–131
  7. Lidwell OM, Elson RA, Lowbury EJ, Whyte W, Blowers R, Stanley SJ, et al. Ultraclean air and antibiotics for prevention of postoperative infection. A multicenter study of 8052 joint replacement operations. Acta Orthop Scand. 1987;58:4–13
  8. Friberg B, Friberg S, Burman LG. Inconsistent correlation between aerobic bacterial surface and air counts in operating rooms with ultra clean laminar air flows: proposal of a new bacteriological standard for surface contamination. J Hosp Infect. 1999;42:287–293
  9. Friberg B, Friberg S, Ostensson R, Burman LG. Surgical area contamination. Comparable bacterial counts using disposable head and mask and helmet aspirator system, but dramatic increase upon omission of headgear: an experimental study in horizontal laminar air flow. J Hosp Infect. 2001;47:110–115
  10. Friberg B, Friberg S, Burman LG. Correlation between surface and air counts of particles carrying aerobic bacteria in operating rooms with turbulent ventilation: an experimental study. J Hosp Infect. 1999;42:61–68
  11. Knobben BA, van Horn JR, van der Mei HC, Busscher HJ. Evaluation of measures to decrease intra-operative bacterial contamination in orthopaedic implant surgery. J Hosp Infect. 2006;62:174–180
  12. Whyte W, Hodgson R, Tinkler J. The importance of airborne bacterial contamination of wounds. J Hosp Infect. Jun 1982;3:123–135
  13. Landrin A, Bissery A, Kac G. Monitoring air sampling in operating theatres: can particle counting replace microbiological sampling?. J Hosp Infect. 2005;61:27–29
  14. Seal DV, Clark RP. Electronic particle counting for evaluating the quality of air in operating theatres: a potential basis for standards?. J Appl Bacteriol. 1990;68:225–230
  15. Barbeau J, Tanguay R, Faucher E, Avezard C, Trudel L, Cote L, et al. Multiparametric analysis of waterline contamination in dental units. Appl Environ Microbiol. 1996;62:3954–3959
  16. West BT, Welch KB, Galecki AT. Random coefficient models for longitudinal data. In: Linear mixed models: a practical guide using statistical software. Boca Raton, FL: Chapman & Hall/CRC; 2006;p. 219–272
  17. Edmiston CE, Seabrook GR, Cambria RA, Brown KR, Lewis BD, Sommers JR, et al. Molecular epidemiology of microbial contamination in the operating room environment: is there a risk for infection?. Surgery. 2005;138:573–579
  18. Lidwell OM, Lowbury EJ, Whyte W, Blowers R, Stanley SJ, Lowe D. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. Br Med J (Clin Res Ed). 1982;285:10–14
  19. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20:250–278
  20. Whyte W, Hambraeus A, Laurell G, Hoborn J. The relative importance of the routes and sources of wound contamination during general surgery, II: airborne. J Hosp Infect. 1992;22:41–54
  21. Clarke MT, Lee PT, Roberts CP, Gray J, Keene GS, Rushton N. Contamination of primary total hip replacements in standard and ultra-clean operating theaters detected by the polymerase chain reaction. Acta Orthop Scand. 2004;75:544–548
  22. Ritter MA. Surgical wound environment. Clin Orthop Relat Res. 1984;190:11–13
  23. Howard JL, Hanssen AD. Principles of a clean operating room environment. J Arthroplasty. 2007;22:6–11
  24. Ritter MA, Olberding EM, Malinzak RA. Ultraviolet lighting during orthopaedic surgery and the rate of infection. J Bone Joint Surg Am. 2007;89:1935–1940
  25. Brandt C, Hott U, Sohr D, Daschner F, Gastmeier P, Ruden H. Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery. Ann Surg. 2008;248:695–700
  26. Miner AL, Losina E, Katz JN, Fossel AH, Platt R. Deep infection after total knee replacement: impact of laminar airflow systems and body exhaust suits in the modern operating room. Infect Control Hosp Epidemiol. 2007;28:222–226
  27. Nelson CL. Prevention of sepsis. Clin Orthop Relat Res. 1987;222:66–72
  28. Davies RR, Noble WC. Dispersal of bacteria on desquamated skin. Lancet 22. 1962;2:1295–1297
  29. Walter CW, Kundsin RB. The airborne component of wound contamination and infection. Arch Surg. 1973;107:588–595
  30. Ritter MA, Eitzen H, French ML, Hart JB. The operating room environment as affected by people and the surgical face mask. Clin Orthop Relat Res. 1975;111:147–150
  31. Sehulster L, Chinn RY. Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep. 2003;52:1–42
  32. Der Tavitian J, Ong SM, Taub NA, Taylor GJ. Body-exhaust suit versus occlusive clothing: a randomised, prospective trial using air and wound bacterial counts. J Bone Joint Surg Br. 2003;85:490–494

 Conflicts of interest: None to report.

PII: S0196-6553(09)00830-X

doi: 10.1016/j.ajic.2009.07.006

AJIC: American Journal of Infection Control
Volume 38, Issue 3 , Pages 199-204 , April 2010

Article Tools

* Image Usage & Resolution