Contamination Relative to the Activation Timing of Filtered-Exhaust Helmets

Abstract

Background Filtered-exhaust helmet systems are commonplace during total joint arthroplasty, but their ability to limit intraoperative contamination has been questioned. We hypothesized that activation of the airflow system after complete gowning would lead to decreased contamination of the surgical environment. Methods Using a fluorescent particle model, the maximal particle spread from a filtered-exhaust helmet and contamination of the surgical environment based on timing of airflow activation through simulated surgical gowning procedures were evaluated. Results Helmet airflow analysis revealed particle spread greater than 5 feet in all trials. Activation before gowning resulted in a significantly greater contamination in the control group compared with the experimental group (P = .014). Conclusions We recommend complete surgical gowning before activation of the airflow system.

Examination of Surgical Helmet and Surgical Hood Application Methods in Reducing Contamination in Arthroplasty Surgery

“…In particular, early activation of surgical helmet has been associated with major contamination for both the surgeon and the scrub nurse. This is consistent with a study performed by Hanselman et al [7]. Although another study did not demonstrate bacterial contamination of the surgical hood immediately after it was applied, there was no mention in this article about the timing of fan activation [8].…”

“…Despite this, surgical helmets have remained commonly used as personal protective equipment (PPE). Activation of the surgical helmet fan after the surgeon is completely gowned and gloved may reduce the risk of contamination [7].…”

The Orthopaedic Trauma Service and COVID-19: Practice Considerations to Optimize Outcomes and Limit Exposure

“…23 Specifically, if using a surgical hood, it is imperative to not connect the hood to the battery, turning the system on, until after fully gowned to limit surrounding air flow and potential spread of the virus if in a contaminated environment. 30 Given the concern for continued availability of PPE, considerations and recommendations have been made on the reuse of N95 respirators. In several of the author's institutions, the N95 respirators are only being used for SARS-CoV-2 positive patients or by members of the operative team for high risk, aerosolizing procedures in SARS-CoV-2 unknown patients.…”

CORR Insights®: Surgeon Personal Protection: An Underappreciated Benefit of Positive-pressure Exhaust Suits

“…Large-scale prospective comparisons of conventional gown-and-mask, body exhaust suits, and positive-pressure exhaust suit systems on comparable patient populations using modern infection prevention methods (prophylactic antibiotics, standardized skin preparation, use of hemostatic agents, timely surgical procedures), uniform definitions of deep infection, and a reasonable period of postoperative surveillance are ultimately needed to determine what impact surgeon clothing has on post-arthroplasty infection rates. Furthermore, more clarification through fundamental studies are needed to determine if details such as when the exhaust fan is turned on when donning a positive-pressure exhaust suit [9] and if taping down the cuffglove interface [8] can adequately reduce bacterial transmission from the surgeon to the surgical wound. Results from these smaller studies should then influence how positive-pressure exhaust suit systems are utilized in the larger prospective work.…”