Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates

Lidwell, O. M.; Lowbury, E. J. L.; Whyte, W.; Blowers, Robert; Stanley, Susan J.; Lowe, Derek

doi:10.1016/0195-6701(83)90041-5

Cited by 239 publications

(123 citation statements)

References 11 publications

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“…Most studies on the interaction of the prosthesis with infecting organisms have shown that bacteria readily attach to devices during implantation (Lidwell et al 1983). The main sources of contamination are the patient's skin and airborne particles from theater personnel (Pittet and Ducel 1994).…”

mentioning

confidence: 99%

The role of small-colony variants in failure to diagnose and treat biofilm infections in orthopedics

et al. 2007

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mentioning

confidence: 99%

The role of small-colony variants in failure to diagnose and treat biofilm infections in orthopedics

et al. 2007

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“…It is generally impossible to decide whether the microbial contamination responsible for infection of an implanted device has occurred during or after its insertion, although it appears likely that either possibility may account for some prosthetic infections (Downes, 1977;Lidwell et al, 1983). These two possible modes of infection have implications for operative techniques and for surgical prophylaxis and treatment of subsequent infections.…”

Section: Discussionmentioning

confidence: 99%

Protein-Mediated Adhesion of Staphylococcus Aureus to Silicone Implant Polymer

Barrett

1985

Journal of Medical Microbiology

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SUMMARY. Investigation was made of the role of protein A and clumping factor in the adhesion of Staphylococcus aureus to the silicone polymer used for manufacture of cerebrospinal fluid shunting systems. The two proteins were judged to contribute non-specifically to adhesion. S. aureus was also shown to be capable of hydrophobic binding, but this was found to be distinct from the demonstrated protein-mediated adhesion. INTRODUCTIONAs is the case with other surgically implanted materials, the useful life of cerebrospinal fluid (CSF) shunting systems is often limited by infection of the device. Staphylococci are the bacteria most commonly responsible for these infections. Staphylococcus epidermidis has been responsible for > 50% of reported CSF shunt infections. Several workers have studied the mechanisms whereby this otherwise rarely pathogenic micro-organism is able to colonise synthetic materials; carbohydrate-based and protease-sensitive mechanisms of adhesion have been noted, and the role of hydrophobic binding has also been investigated (Christensen et aZ., 1982; Hogt et aZ., 1983). S. aureus has been reported from a smaller number of CSF shunt infections (c. 20%) and, perhaps in consequence, its adhesive mechanisms have received less attention. The observation of a trypsin-sensitive mode of attachment to CSF shunt polymer (Barrett, 1983) prompted the present investigation of the adhesive role of two specific S. aureus surface proteins (protein A and clumping factor). The ability of S. aureus to undergo hydrophobic attachment was also studied. MATERIALS AND METHODSSubstrates. The substrate for adhesion was polydimethyl and methylvinyl-siloxane (CleanGrade Elastomer MDX4-45 15, Dow Corning, Barry, South Glamorgan). To provide a sufficient surface area for adhesion measurement, this was reduced from the tubular form used for CSF shunts by crushing in liquid nitrogen.The ability to undergo hydrophobic interactions was assessed with Agarose beads either in the native state, or bearing octyl, decyl, or phenyl hydrocarbon groups (Sepharose, Pharmacia Limited, Milton Keynes, Northants).Adhesion measurement. Bacteria used in these experiments were grown on nutrient agar

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“…This leads to the question whether air or surface counts or both should be used to evaluate operating room hygiene. Air counts have been used by most workers (Lidwell et al 1983) but Taylor and Bannister (1993) suggested that sedimentation plates may offer a better assessment of bacterial fall-out into a surgical wound. From our study we can only conclude that there is no obvious correlation between air counts and sedimentation of bacteria.…”

Section: Discussionmentioning

confidence: 99%

“…In a large multicenter study of hip and knee replacements, a linear correlation was defined between bacterial counts in the operating room air and the postoperative deep infection rate (Lidwell et al 1983). In order to reduce bacterial air contamination in operating rooms, vertical or horizontal Laminar Air Flow (LAF) systems equipped with High Efficiency Particulate Air (HEPA) filters producing ultraclean air ( 4 0 cfu/ m3 air) were introduced in the 1960s (Charnley 1964).…”

Section: Barbro E E Friberg' Sven Friberg' and Lars G Burman2mentioning

confidence: 99%

Zoned vertical ultraclean operating room ventilation: A novel concept making long side walls unnecessary

Friberg

Burman

1996

Acta Orthopaedica Scandinavica

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Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates

Cited by 239 publications

References 11 publications

The role of small-colony variants in failure to diagnose and treat biofilm infections in orthopedics

The role of small-colony variants in failure to diagnose and treat biofilm infections in orthopedics

Protein-Mediated Adhesion of Staphylococcus Aureus to Silicone Implant Polymer

Zoned vertical ultraclean operating room ventilation: A novel concept making long side walls unnecessary

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