Do surgeons and surgical facilities disturb the clean air distribution close to a surgical patient in an orthopedic operating room with laminar airflow?

Cao, Guangyu; Storås, Madeleine Charlotte Aviles; Aganović, Amar; Stenstad, Liv-Inger; Skogås, Jan Gunnar

doi:10.1016/j.ajic.2018.03.019

Cited by 45 publications

(22 citation statements)

References 29 publications

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“…It has been showed in this study that the thermal plume from a human with a static to moderate activity can reach velocities up to 0.4 m/s, if the human body has a standing position (surgeon), and up to 0.2 m/s seen above the head of the human body if standing in a lying down position on a bed(patient), both with the bodies uncovered. Bringing into discussion that in this range of values (0.2÷0.4 m/s) is supplied the air from a UAF diffuser in a OR, we can see that studying this field can lead to actions meant to improve the air distribution [12].…”

Section: Discussionmentioning

confidence: 94%

Experimental and numerical investigation on the convective thermal plume around the head of the standing and lying hu-man body

et al. 2019

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This paper presents a study for two thermal plumes generated by two humanoid thermal manikins, one standing and one lying down. The research was approached from a numerical and experimental perspective. The numerical model represents an operating room (OR) with two surgeons, a patient and a unidirectional air flow (UAF) diffuser. The experimental study was made in a climatic chamber, having a similar air distribution system, using particle image velocimetry (PIV) and infrared thermography (IR) measurements. The purpose of the study was to characterize the thermal plumes of the two manikins by numerical and experimental studies. The results obtained from these different approaches were compared with each other and with the ones from the literature in order to validate our numerical models.

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Section: Discussionmentioning

confidence: 94%

Experimental and numerical investigation on the convective thermal plume around the head of the standing and lying hu-man body

et al. 2019

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“…Other studies showed significantly higher severe SSI rates following knee prosthesis and significantly higher SSI rates following hip prosthesis under laminar airflow conditions (Brandt et al, 2008). Recent studies show that there are several factors that affect the performance of LAF in operating rooms, including the presence of surgical facilities and a few transient phenomena, e.g., turbulent airflows, movement of surgeons, and cauterization of surgical wounds, which may cause significant changes air distribution pattern (Aganovic et al, 2017;Cao et al, 2018;. The recently published WHO guideline suggested that LAF systems should not be used to reduce the risk of SSI for patients undergoing total arthroplasty surgery (based on conditional recommendation, low to very low quality of evidence)) (WHO 2016).…”

Section: ! !mentioning

confidence: 99%

“…26). Laminar airflow system in operating rooms (a) Schematic outline of airflow from a LAF unit in an operating room (b)A photo of the operating room with LAF and other medical equipment (Cao et al, 2018).…”

Section: Performancementioning

confidence: 99%

A review of advanced air distribution methods - theory, practice, limitations and solutions

Yang

Melikov

Kabanshi

et al. 2019

Energy and Buildings

181

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Ventilation and air distribution methods are important for indoor thermal environments and air quality. Effective distribution of airflow for indoor built environments with the aim of simultaneously offsetting thermal and ventilation loads in an energy efficient manner has been the research focus in the past several decades. Based on airflow characteristics, ventilation methods can be categorized as fully mixed or non-uniform. Non-uniform methods can be further divided into piston, stratified and task zone ventilation. In this paper, the theory, performance, practical applications, limitations and solutions pertaining to ventilation and air distribution methods are critically reviewed. Since many ventilation methods are buoyancy driving that confines their use for heating mode, some methods suitable for heating are discussed. Furthermore, measuring and evaluating methods for ventilation and air distribution are also discussed to give a comprehensive framework of the review.

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“…In addition to the numerous studies conducted on ventilation efficiency, OT performance is often evaluated in terms of microbiological and inert contamination of air and surfaces [ 44 , 45 ] according to the guidelines and to the limit values used in cleanroom environments for pharmaceutical production. These environments conform to Good Manufacturing Practice Guidelines (GMPs) and ISO 14644:1 standards or national guidelines [ 46 , 47 , 48 ] and they are classified “at-rest” and “in operation” occupancy states.…”

Section: Introductionmentioning

confidence: 99%

Operating Theatre Ventilation Systems and Their Performance in Contamination Control: “At Rest” and “In Operation” Particle and Microbial Measurements Made in an Italian Large and Multi-Year Inspection Campaign

Romano

Milani

Ricci³

et al. 2020

IJERPH

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In Operating Theatres (OT), the ventilation system plays an important role in controlling airborne contamination and reducing the risks of Surgical Site Infections (SSIs). The air cleanliness is really crucial in this field and different measurements are used in order to characterize the situation in terms of both airborne microbiological pollutants and particle size and concentration. Although the ventilation systems and airborne contamination are strictly linked, different air diffusion schemes (in particular, the Partial Unidirectional Airflow, P-UDAF, and the Mixing Airflow, MAF) and various design parameters are used, and there is still no consensus on real performance and optimum solutions. This study presents measurements procedures and results obtained during Inspection and Periodic Performance Testing (1228 observations) in a large sample of Italian OTs (175 OTs in 31 Italian hospitals) in their operative life (period from 2010 to 2018). The inspections were made after a cleaning procedure, both in “at-rest” conditions and “in operation” state. Inert and microbial contamination data (in air and on surfaces) are analyzed and commented according to four relevant air diffusion schemes and design classes. Related data on Recovery Time (RT) and personnel presence were picked up and are commented. The results confirm that the ventilation systems are able to maintain the targeted performance levels in the OT operative life. However, they attest that significant differences in real OT contamination control capabilities do exist and could be ascribed to various design choices and to different operation and maintenance practices. The study shows and confirms that the air diffusion scheme and the design airflow rate are critical factors. Beside large variations in measurements, the performance values, in terms of control of airborne particle and microbial contamination (in air and on surfaces), for P-UDAF systems are better than those that were assessed for the MAF air diffusion solution. The average performances do increase with increasing airflows, and the results offer a better insight on this relationship leading to some possible optimization.

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Do surgeons and surgical facilities disturb the clean air distribution close to a surgical patient in an orthopedic operating room with laminar airflow?

Cited by 45 publications

References 29 publications

Experimental and numerical investigation on the convective thermal plume around the head of the standing and lying hu-man body

Experimental and numerical investigation on the convective thermal plume around the head of the standing and lying hu-man body

A review of advanced air distribution methods - theory, practice, limitations and solutions

Operating Theatre Ventilation Systems and Their Performance in Contamination Control: “At Rest” and “In Operation” Particle and Microbial Measurements Made in an Italian Large and Multi-Year Inspection Campaign

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