Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-25T06:20:57.707Z Has data issue: false hasContentIssue false
  • English
  • Français

Laminar Airflow Ceiling Size: No Impact on Infection Rates Following Hip and Knee Prosthesis

Published online by Cambridge University Press:  02 January 2015

Ann-Christin Breier ,
Christian Brandt ,
Dorit Sohr ,
Christine Geffers  and
Petra Gastmeier
Ann-Christin Breier
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité-University Hospital Berlin, Berlin, Germany
Christian Brandt
Affiliation:
Institute of Medical Microbiology and Infection Control, Goethe University Frankfurt/Main, Frankfurt, Germany
Dorit Sohr
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité-University Hospital Berlin, Berlin, Germany
Christine Geffers
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité-University Hospital Berlin, Berlin, Germany
Petra Gastmeier*
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité-University Hospital Berlin, Berlin, Germany
*
Institute of Hygiene and Environmental Medicine, Charité-University Hospital Berlin, Hindenburg-damm 27, 12203 Berlin, Germany ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Laminar airflow (LAF) systems are widely used, at least in orthopedic surgery. However, there is still controversial discussion about the influence of LAF on surgical site infection (SSI) rates. The size of the LAF ceiling is also often a question of debate. Our objective is to determine the effect of this technique under conditions of actual rather than ideal use.

Design.

Cohort study using multivariate analysis with generalized estimating equations method.

Setting.

Data for hip and knee prosthesis procedures from hospitals participating in the German national nosocomial infection surveillance system (KISS) from July 2004 to June 2009 were used for analysis.

Patients.

A total of 33,463 elective hip prosthesis procedures due to arthrosis (HIP-A) from 48 hospitals, 7,749 urgent hip prosthesis procedures due to fracture (HIP-F) from 41 hospitals, and 20,554 knee prosthesis (KPRO) procedures from 38 hospitals were included.

Methods.

The data were analyzed for hospitals with and without LAF in the operating rooms and by the size of the LAF ceiling. The endpoints were severe SSI rates.

Results.

The overall severe SSI rate was 0.74 per 100 procedures for HIP-A, 2.39 for HIP-F, and 0.63 for KPRO. For all 3 prosthesis types, neither LAF nor the size of the LAF ceiling was associated with lower infection risk.

Conclusions.

The data demonstrate consistency and reproducibility with the results from earlier registry studies. Neither LAF nor ceiling size had an impact on severe SSI rates.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 11 , November 2011 , pp. 1097 - 1102
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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

1.Lidwell, O, Lowbury, E, Whyte, W, Blowers, R, 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 1982;285:10–14.Google Scholar
2.Smyth, E, Humphreys, H, Stacey, A, et al. Survey of operating theatre ventilation facilities for minimally invasive surgery in Great Britain and Northern Ireland: current practice and considerations for the future. J Hosp Infect 2005;61:112–122.Google Scholar
3.Brandt, C, Hott, U, Sohr, D, Daschner, F, Gastmeier, P, Rüden, 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.CrossRefGoogle ScholarPubMed
4.Humphreys, H, Taylor, EW. Operating theatre ventilation standards and the risk of postoperative infection. J Hosp Infect 2002; 50:85–90.CrossRefGoogle ScholarPubMed
5.van Griethausen, A, Soies-van Rooijen, N, Hoogenboom-Verdegaal, A. Surveillance of wound infections and a new theatre: unexpected lack of improvement.J Hosp Infect 1996;34:99–106.Google Scholar
6.Pasquarella, C, Sansebastiano, G, Ferretti, S, et al. A mobile laminar airflow unit to reduce air bacterial contamination at surgical area in a conventionally ventilated operating theatre. J Hosp Infect 2007;66:313–319.CrossRefGoogle Scholar
7.Rodridues da Costa, A, Kothari, A, Bannister, G, Blom, A. Investigating bacterial growth in surgical theatres: establishing the effect of laminar airflow on bacterial growth on plastic, metal and wood surfaces. Ann R Coll Surg Engl 2008;90:417–419.CrossRefGoogle ScholarPubMed
8.Cacciari, P, Giannoni, R, Marcelli, E, Cercenelli, L. Cost evaluation of a ventilation system for operating theatre: an ultraclean design versus a conventional one. Ann Ig 2004;16:803–809.Google ScholarPubMed
9.Assadian, O, Kuelpmann, R, Zhumadilova, A, Kobayashi, H, Heidecke, C-D, Kramer, A. Protective effect of HEPA-filtered operating room air ventilation with or without laminar airflow on surgical site infections. Ann Surg 2009;250:659–660.CrossRefGoogle ScholarPubMed
10.Brandt, C, Rüden, H, Gastmeier, P. Protective effect of HEPA-filtered operating room air Ventilation with or without laminar airflow on surgical site infections. Ann Surg 2009;250:660.CrossRefGoogle Scholar
11.Kramer, A, Külpmann, R, Wille, F, et al. Infektiologische Bedeutung von Raumlufttechnischen Anlagen (RLTA) in Operations-und Eingriffsräumen. Zentralbl Chir 2010;135:11–17.CrossRefGoogle Scholar
12.Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of surgical site infections: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606–608.Google Scholar
13.Emori, TG, Culver, DH, Horan, TC, et al. National Nosocomial Infection Surveillance System (NNIS): description of surveillance methodology. Am J Infect Control 1991;19:19–35.Google Scholar
14.Brandt, C, Sohr, D, Behnke, M, Daschner, F, Rüden, H, Gastmeier, P. Reduction of surgical site infection rates with the help of benchmark data. Infect Control Hosp Epidemiol 2006;27: 1347–1351.Google Scholar
15.Salvati, E, Robinson, R, Zeno, S, Koslin, B, Brause, B, Wilson, PJ. Infection rates after total hip and total knee replacements performed with and without a horizontal unidirectional filtered airflow system. J Bone Joint Surg Am 1982;64:525–535.Google Scholar
16.Kurz, A, Sessler, DI, Lenhardt, R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 1996;334:1209–1215.Google Scholar
17.Melling, A, Ali, B, Scott, E, Leaper, D. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial. Lancet 2001;358:876–880.CrossRefGoogle ScholarPubMed
18.Lipsett, P. Do we really need laminar flow ventilation in the operating room to prevent surgical site infections? Ann Surg 2008;248:701–703.Google Scholar
19.Engesaeter, L, Lie, S, Espehaug, B, Furnes, O, Vollset, S, Havelin, L. Antibiotic prophylaxis in total hip arthroplasty. Acta Orthop Scand 2003;74:644–651.Google ScholarPubMed
20.Miner, A, Losina, E, Katz, J, Fossel, A, 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.CrossRefGoogle ScholarPubMed
21.Centers for Disease Control and Prevention/Healthcare Infection Control Practices Advisory Committee. Guidelines for environmental infection control in health care facilities. MMWR Morb Mortal Wkly Rep 2003;52.Google Scholar
22. gGMBH BQ. National External Quality Assessment. Düsseldorf, 2009.Google Scholar