Laminar airflow and the prevention of surgical site infection. More harm than good?

McHugh, Seamus; Hill, Arnold D.; Humphreys, Hilary

doi:10.1016/j.surge.2014.10.003

Cited by 68 publications

(45 citation statements)

References 29 publications

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“…The evidence is more limited for other procedures, but it seems that LAF does not reduce the risk of overall SSI after abdominal and open vascular surgery as well. The findings of our meta-analysis are consistent with the results of previous literature reviews, 18,47,48 adding many more studies to the body of evidence. This meta-analysis had some limitations.…”

Section: Discussionsupporting

confidence: 91%

Effect of laminar airflow ventilation on surgical site infections: a systematic review and meta-analysis

Bischoff

Kubilay

Allegranzi

et al. 2017

The Lancet Infectious Diseases

161

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Background: The role of the operating room's (OR) ventilation system in the prevention of surgical site infection (SSI) is widely discussed and the existing guidelines do not reflect the current evidence. In this context, laminar airflow (LAF) ventilation was compared with conventional ventilation to assess their effectiveness in reducing the risk of SSI.Methods: Medline, EMBASE, Cochrane Central Register of Controlled Trials and WHO regional medical databases were searched from 1990 to 31 January 2014. The search was updated for Medline for the time period between 1 February 2014 and 27 May 2016. GRADE methodology was used to assess the quality of the retrieved evidence. Meta-analyses of available comparisons were performed using RevMan 5.3. Findings: The search identified 1947 records of which 12 observational studies were identified comparing LAF ventilation with conventional turbulent ventilation in orthopedic, abdominal, and vascular surgery. The meta-analysis of eight cohort studies showed no difference in risk for deep SSIs following total hip arthroplasty (THA, 330 146 procedures; odds ratio (OR) 1·29, 95% CI 0·98-1·71, p=0·07; I²=83%). For total knee arthroplasty (TKA, 134 368 procedures) the meta-analysis of six cohort studies showed no difference in risk for deep SSIs (OR 1·08, 95% CI 0·77-1·52, p=0·65; I²=71%). For abdominal and open vascular surgery the metaanalysis of three cohort studies found no difference in risk for overall SSI (OR 0·75, 95% CI 0·43-1·33, p=0·33; I²=95%) Interpretation: The available evidence shows no benefit for LAF compared with conventional turbulent OR ventilation in reducing the risk of SSI in THA, TKA and abdominal surgery. Decision makers, medical and administrative, should not choose to install and use LAF equipped ORs as a preventive measure to reduce the risk of SSI. AbstractBackground: The role of the operating room's (OR) ventilation system in the prevention of surgical site infection (SSI) is widely discussed and the existing guidelines do not reflect the current evidence. In this context, laminar airflow (LAF) ventilation was compared with conventional ventilation to assess their effectiveness in reducing the risk of SSI.

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Section: Discussionsupporting

confidence: 91%

Effect of laminar airflow ventilation on surgical site infections: a systematic review and meta-analysis

Bischoff

Kubilay

Allegranzi

et al. 2017

The Lancet Infectious Diseases

161

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“…Having a laminar system operating at a continuous flow helps to prevent operative and post-operative wound infections. However, recent publications have questioned whether laminar airflow ventilation confers any significant benefit and have indicated that the system may indeed be harmful [28]. As shown in our study, the use of a laminar airflow operating room was identified as a risk factor for intraoperative hypothermia.…”

Section: Discussionsupporting

confidence: 49%

Risk factors for hypothermia in patients under general anesthesia: Is there a drawback of laminar airflow operating rooms? A prospective cohort study

Yang

Huang

Zhou

et al. 2015

International Journal of Surgery

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“…Strategies relying on a decreased bacterial load and creating a bacteria-free environment around an implant during the perioperative period are widely implemented in clinical practice [44,45]. There is sufficient evidence supporting systemic [46] and in some cases local antibiotic prophylaxis [47].…”

Section: Rationale and Basic Concepts Of Pji Preventionmentioning

confidence: 99%

Silver Nanocoating Technology in the Prevention of Prosthetic Joint Infection

et al. 2016

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Prosthetic joint infection (PJI) is a feared complication of total joint arthroplasty associated with increased morbidity and mortality. There is a growing body of evidence that bacterial colonization and biofilm formation are critical pathogenic events in PJI. Thus, the choice of biomaterials for implanted prostheses and their surface modifications may significantly influence the development of PJI. Currently, silver nanoparticle (AgNP) technology is receiving much interest in the field of orthopaedics for its antimicrobial properties and a strong anti-biofilm potential. The great advantage of AgNP surface modification is a minimal release of active substances into the surrounding tissue and a long period of effectiveness. As a result, a controlled release of AgNPs could ensure antibacterial protection throughout the life of the implant. Moreover, the antibacterial effect of AgNPs may be strengthened in combination with conventional antibiotics and other antimicrobial agents. Here, our main attention is devoted to general guidelines for the design of antibacterial biomaterials protected by AgNPs, its benefits, side effects and future perspectives in PJI prevention.

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Laminar airflow and the prevention of surgical site infection. More harm than good?

Cited by 68 publications

References 29 publications

Effect of laminar airflow ventilation on surgical site infections: a systematic review and meta-analysis

Effect of laminar airflow ventilation on surgical site infections: a systematic review and meta-analysis

Risk factors for hypothermia in patients under general anesthesia: Is there a drawback of laminar airflow operating rooms? A prospective cohort study

Silver Nanocoating Technology in the Prevention of Prosthetic Joint Infection

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