Major articleTraffic flow in the operating room: An explorative and descriptive study on air quality during orthopedic trauma implant surgery
Section snippets
Setting
The study was performed at a Swedish university hospital that performs approximately 9,000 surgical procedures annually. Data was collected in 3 parallel ORs of equal size (39 m2), each equipped with an upward air-displacement system supplying cool air (2-3°C below room temperature) above the floor in each of the 4 corners of the room. By thermal convection, the air is evacuated via 4 exhaust fans installed in the ceiling. Each OR is supposed to be maintained at positive air pressure by
Results
Air sampling was performed during 30 orthopedic operations in a total of 120 air sampling intervals. The distributions of surgical procedures were 73 plates and screws (60.8%), 26 intramedullary nails (21.7%), and 21 hemiarthroplasties (17.5%). The variations in CFU/m3 values were found between operations rather than during operations (P = .001). In 52 of 91 samples, the CFU/m3 values exceeded the recommended level of <10 CFU/m3. In 14 of 24 operations, the mean values exceeded 10 CFU/m3; in 5
Discussion
In orthopedic surgery, large-scale efforts and research activities have focused on infection control, mainly in relation to elective primary joint replacement surgery. The findings of the present study show that the recommended limit of >10 CFU/m3 was exceeded in 57% of the samples analyzed. Patients with orthopedic trauma carry an extra burden of preoperative soft tissue and skeletal damage, and have minimal opportunities to be optimized in relation to comorbidities that are known to be major
Conclusion
This study has clearly linked elevated airborne bacterial counts in the surgical area to door openings in conventionally ventilated ORs, thereby providing the scientific evidence needed to initiate interventions aimed at preventing SSI by reducing traffic flow in the OR. In addition, analyzing the reasons for door openings seems to be of great importance to the success of any intervention implemented.
Acknowledgment
The authors thank the OR staff and orthopedic surgeons for their participation in this study, and L.O. Persson for statistical advice.
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Author contributions: A.E.A., I.B., B.E., J.K., and K.N. designed the study; A.E.A. performed data collection and coordination; A.E.A. and I.B. analyzed data; and A.E.A., I.B., B.E., J.K., and K.N. wrote the manuscript.
Conflict of interest: None to report.