Current Concepts for Clean Air and Total Joint Arthroplasty: Laminar Airflow and Ultraviolet Radiation: A Systematic Review

Evans, Richard P.

doi:10.1007/s11999-010-1688-7

Cited by 113 publications

(76 citation statements)

References 25 publications

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“…The opening of the operating room door disrupts the laminar airflow, allowing pathogens to enter the space surrounding the site of the operation [4,9,11,17]. These pathogens have the potential to lead to increased rates of infection.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical time, perioperative antibiotic prophylaxis, preparation and draping techniques, ultraviolet light, and laminar airflow have all been investigated [4-6, 8, 14]. A systematic review by Evans [4] demonstrated the effectiveness of the One of the authors (JP) is a consultant for Stryker Orthopaedics (Mahwah, NJ, USA) and has intellectual properties on SmarTech (Philadelphia, PA, USA) All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device.…”

Section: Introductionmentioning

confidence: 99%

“…In rooms equipped with laminar airflow, the opening and closing of the operating room door disrupts the airflow in close proximity to the patient. This disruption reportedly allows microbes to enter the airspace above the surgical site, possibly contributing to an increased risk of infection [4,9,11,17]. It has been reported that increased OR traffic was one factor that adds to the increased incidence of PJI in revision as compared to primary TJA [12].…”

Section: Introductionmentioning

confidence: 99%

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Operating Room Traffic is a Major Concern During Total Joint Arthroplasty

Panahi

Casper

et al. 2012

Clinical Orthopaedics &Amp; Related Research

150

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Background Periprosthetic joint infection (PJI) is a challenging complication associated with total joint arthroplasty (TJA). Traffic in the operating room (OR) increases bacterial counts in the OR, and may lead to increased rates of infection. Question/purposes Our purposes were to (1) define the incidence of door opening during primary and revision TJA, providing a comparison between the two types of procedures, and (2) identify the causes of door opening in order to develop a strategy to reduce traffic in the operating room. Methods An observer collected data during 80 primary and 36 revision TJAs. Surgeries were performed under vertical, laminar flow. Operating room personnel were unaware of the observer, thus removing bias from traffic. The observer documented the number, reason, and personnel involved in the event of a door opening from time of tray opening to closure of the surgical site.Results The average operating time for primary and revision procedures was 92 and 161 minutes, respectively. Average door openings were 60 in primary cases and 135 in revisions, yielding per minute rates of 0.65 and 0.84, respectively. The circulating nurse and surgical implant representatives constituted the majority of OR traffic. Conclusions Traffic in the OR is a major concern during TJA. Revision cases demonstrated a particularly high rate of traffic. Implementation of strategies, such as storage of instruments and components in the operating room and education of OR personnel, is required to reduce door openings in the OR.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Operating Room Traffic is a Major Concern During Total Joint Arthroplasty

Panahi

Casper

et al. 2012

Clinical Orthopaedics &Amp; Related Research

150

View full text Add to dashboard Cite

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“…Within these methods, laminar airflow, positive air pressure, and body exhaust suits have been proven to be effective [2,9,18,22,27,28]; however, these steps cannot reduce infections from the patient's skin flora [12]. To reduce these infections, the Centers for Disease Control and Prevention has recommended bathing with an antiseptic agent the night before the index procedure [23].…”

Section: Introductionmentioning

confidence: 99%

Does Preadmission Cutaneous Chlorhexidine Preparation Reduce Surgical Site Infections After Total Hip Arthroplasty?

Kapadia

Jauregui

Murray

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Periprosthetic hip infections are among the most catastrophic complications after total hip arthroplasty (THA). We had previously proven that the use of chlorhexidine cloths before surgery may help decrease these infections; hence, we increased the size of the previously reported cohort. Questions/purposes (1) Does a preadmission chlorhexidine cloth skin preparation protocol decrease the risk of surgical site infection in patients undergoing THA? (2) When stratified using the National Healthcare Safety Network (NHSN) risk categories, which categories are associated with risk reduction from the preadmission chlorhexidine preparation protocol? Methods Between 2007 and 2013, a group of 998 patients used chlorhexidine cloths before surgery, whereas a group of 2846 patients did not use them and underwent standard perioperative disinfection only. Patient records were reviewed to determine the development of periprosthetic infection in both groups of patients. Results Patients without the preoperative chlorhexidine gluconate disinfection protocol had a higher risk of infections (infections with protocol: six of 995 [0.6%]; infections in control: 46 of 2846 [1.62%]; relative risk: 2.68 [95% confidence interval {CI}, 1.15-0.26]; p = 0.0226). When stratified based on risk category, no differences were detected; preadmission chlorhexidine preparation was not associated with reduced infection risk for low, medium, and high NHSN risk categories (p = 0.386, 0.153, and 0.196, respectively). Conclusions The results of our study suggest that this cloth application appears to reduce the risk of infection in patients undergoing THA. When stratified by risk categories, we found no difference in the infection rate, but these findings were underpowered. Although future multicenter randomized trials will need to confirm these preliminary findings, the intervention is inexpensive and is unlikely to be risky and so might be considered on the basis of this retrospective, comparative study. Level of Evidence Level III, therapeutic study.

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“…Patient factors such as malnutrition [18], diabetes [59], and obesity [39] have been associated with increased rates of infection secondary to poor wound healing, and interventions such as diet and lifestyle modification may reduce infections. Multiple methods have been instituted to reduce the incidence of SSIs in orthopaedic patients, including instituting laminar air flow in the operating room [14], administering perioperative antibiotic prophylaxis [8], and using antiseptic surgical skin preparation scrubs and solutions [38]. Another method for reducing MSSA/MRSA infections is the preoperative detection of S. aureus colonization and subsequent decolonization with intranasal mupirocin and chlorhexidine body scrubs [42].…”

Section: Introductionmentioning

confidence: 99%