Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-22T15:48:01.744Z Has data issue: false hasContentIssue false

Association of Airborne Microorganisms in the Operating Room With Implant Infections: A Randomized Controlled Trial

Published online by Cambridge University Press:  26 October 2016

Rabih O. Darouiche*
Affiliation:
Departments of Medicine, Surgery, and Physical Medicine and Rehabilitation, Michael E. DeBakey Veterans Affairs Medical Center (VAMC), and Infectious Disease Service, Baylor College of Medicine, Houston, Texas
David M. Green
Affiliation:
Section of Orthopedic Surgery, Michael E. DeBakey VAMC, Houston, Texas
Melvyn A. Harrington
Affiliation:
Baylor College of Medicine Medical Center, Houston, Texas
Bruce L. Ehni
Affiliation:
Section of Neurosurgery, Michael E. DeBakey VAMC, Houston, Texas
Panagiotis Kougias
Affiliation:
Section of Vascular Surgery, Michael E. DeBakey VAMC, Houston, Texas
Carlos F. Bechara
Affiliation:
Houston Methodist Cardiovascular Surgery Associates, Houston, Texas
Daniel P. O’Connor
Affiliation:
University of Houston, Houston, Texas
*
Address correspondence to Rabih O. Darouiche, MD, Departments of Medicine, Surgery, and Physical Medicine and Rehabilitation, Michael E. DeBakey VAMC, Bldg 100, Rm 4B-370, 2002 Holcombe Blvd, Houston, TX 77030 ([email protected]).

Abstract

OBJECTIVE

To evaluate the association of airborne colony-forming units (CFU) at incision sites during implantation of prostheses with the incidence of either incisional or prosthesis-related surgical site infections.

DESIGN

Randomized, controlled trial.

SETTING

Primary, public institution.

PATIENTS

Three hundred patients undergoing total hip arthroplasty, instrumented spinal procedures, or vascular bypass graft implantation.

METHODS

Patients were randomly assigned in a 1:1 ratio to either the intervention group or the control group. A novel device (Air Barrier System), previously shown to reduce airborne CFU at incision sites, was utilized in the intervention group. Procedures assigned to the control group were performed without the device, under routine operating room atmospheric conditions. Patients were followed up for 12 months to determine whether airborne CFU levels at the incision sites predicted the incidence of incisional or prosthesis-related infection.

RESULTS

Data were available for 294 patients, 148 in the intervention group and 146 in the control group. CFU density at the incision site was significantly lower in the intervention group than in the control group (P<.001). The density of airborne CFU at the incision site during the procedures was significantly related to the incidence of implant infection (P=.021). Airborne CFU densities were 4 times greater in procedures with implant infection versus no implant infection. All 4 of the observed prosthesis infections occurred in the control group.

CONCLUSION

Reduction of airborne CFU specifically at the incision site during operations may be an effective strategy to reduce prosthesis-related infections. Trial Registration: clinicaltrials.gov Identifier: NCT01610271

Infect Control Hosp Epidemiol 2016;1–8

Type
Original Articles
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Kurtz, SM, Lau, E, Watson, H, Schmier, JK, Parvizi, J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012;27:6165.CrossRefGoogle ScholarPubMed
2. Edmiston, CE Jr, Sinski, S, Seabrook, GR, Simons, D, Goheen, MP. Airborne particulates in the OR environment. AORN J 1999;69:11691179.Google Scholar
3. Stocks, GW, Self, SD, Thompson, B, Adame, XA, O’Connor, DP. Predicting bacterial populations based on airborne particulates: a study performed in nonlaminar flow operating rooms during joint arthroplasty surgery. Am J Infect Control 2010;38:199204.CrossRefGoogle ScholarPubMed
4. Wan, GH, Chung, FF, Tang, CS. Long-term surveillance of air quality in medical center operating rooms. Am J Infect Control 2011;39:302308.CrossRefGoogle ScholarPubMed
5. Hamilton, H, Jamieson, J. Deep infection in total hip arthroplasty. Can J Surg 2008;51:111117.Google ScholarPubMed
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;4:111131.CrossRefGoogle ScholarPubMed
7. Ritter, MA. Operating room environment. Clin Orthop Relat Res 1999;369:103109.Google Scholar
8. Andersson, AE, Bergh, I, Karlsson, J, Eriksson, BI, Nilsson, K. Traffic flow in the operating room: an explorative and descriptive study on air quality during orthopedic trauma implant surgery. Am J Infect Control 2012;40:750755.CrossRefGoogle Scholar
9. Edmiston, CE Jr., Seabrook, GR, Cambria, RA, et al. Molecular epidemiology of microbial contamination in the operating room environment: is there a risk for infection? Surgery 2005;138:573579.Google Scholar
10. Smith, EB, Raphael, IJ, Maltenfort, MG, Honsawek, S, Dolan, K, Younkins, EA. The effect of laminar air flow and door openings on operating room contamination. J Arthroplasty 2013;28:14821485.Google Scholar
11. Evans, RP. Current concepts for clean air and total joint arthroplasty: laminar airflow and ultraviolet radiation: a systematic review. Clin Orthop Relat Res 2011;469:945953.CrossRefGoogle ScholarPubMed
12. 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;62:174180.Google Scholar
13. Burke, JF. Identification of the sources of staphylococci contaminating the surgical wound during operation. Ann Surg 1963;158:898904.CrossRefGoogle ScholarPubMed
14. Duhaime, AC, Bonner, K, McGowan, KL, Schut, L, Sutton, LN, Plotkin, S. Distribution of bacteria in the operating room environment and its relation to ventricular shunt infections: a prospective study. Childs Nerv Syst 1991;7:211214.Google Scholar
15. 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;52:142.Google ScholarPubMed
16. 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;20:250278.Google Scholar
17. Firth, D. Bias reduction of maximum likelihood estimates. Biometrika 1993;80:2738.CrossRefGoogle Scholar
18. Heinze, G, Schemper, M. A solution to the problem of separation in logistic regression. Stat Med 2002;21:24092419.Google Scholar
19. Long, JS. Regression Models for Categorical and Limited Dependent Variables. Thousand Oaks, CA: Sage; 1997:242247.Google Scholar
20. Stocks, GW, O’Connor, DP, Self, SD, Marcek, GA, Thompson, BL. Directed air flow to reduce airborne particulate and bacterial contamination in the surgical field during total hip arthroplasty. J Arthroplasty 2011;26:771776.Google Scholar
21. Panahi, P, Stroh, M, Casper, DS, Parvizi, J, Austin, MS. Operating room traffic is a major concern during total joint arthroplasty. Clin Orthop Relat Res 2012;470:26902694.Google Scholar
22. Darouiche, RO, Wall, MJ Jr, Itani, KM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010;362:1826.CrossRefGoogle ScholarPubMed
23. Morrison, TN, Chen, AF, Taneja, M, Kucukdurmaz, F, Rothman, RH, Parvizi, J. Single vs repeat surgical skin preparations for reducing surgical site infection after total joint arthroplasty: a prospective, randomized, double-blinded study. J Arthroplasty 2016;31:12891294.CrossRefGoogle ScholarPubMed
24. Andersson, AE, Petzold, M, Bergh, I, Karlsson, J, Eriksson, BI, Nilsson, K. Comparison between mixed and laminar airflow systems in operating rooms and the influence of human factors: experiences from a Swedish orthopedic center. Am J Infect Control 2014;42:665669.Google Scholar
25. Ayliffe, GA. Role of the environment of the operating suite in surgical wound infection. Rev Infect Dis 1991;13:S800S804.Google Scholar
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;28:222226.Google Scholar