Laminar airflow ventilation systems in orthopaedic operating room do not prevent surgical site infections: a systematic review and meta-analysis

Abstract

Background Laminar airflow (LAF) technologies minimize infectious microorganisms to enhance air quality and surgical site infections (SSIs). LAF lowers SSIs in some clinical studies but not others. This study analyzes laminar airflow ventilation's capacity to reduce orthopaedic surgery-related SSIs. Methods The PRISMA-compliant keywords were utilized to conduct a search for pertinent articles in various databases including PubMed, MEDLINE, CENTRAL, Web of Sciences, and the Cochrane databases. Observational studies, including retrospective, prospective, and cohort designs, satisfy the PICOS criteria for research methodology. The assessment of quality was conducted utilizing the Robvis software, while the meta-analysis was performed using the RevMan application. The study’s results were assessed based on effect sizes of odds ratio (OR) and risk ratio (RR). Results From 2000 to 2022, 10 randomized controlled clinical trials with 10,06,587 orthopaedic surgery patients met the inclusion criteria. The primary outcomes were: (1) Risk of SSI, (2) Bacterial count in sampled air and (3) Reduction in SSIs. The overall pooled OR of all included studies was 1.70 (95% CI 1.10–2.64), and the overall pooled RR was 1.27 (95% CI 1.02–1.59) with p < 0.05. LAF is ineffective at preventing SSIs in orthopaedic procedures due to its high-risk ratio and odds ratio. Conclusions The present meta-analysis has determined that the implementation of LAF systems does not result in a significant reduction in the incidence of surgical site infections (SSIs), bacterial count in the air, or SSIs occurrence in orthopaedic operating rooms. Consequently, the installation of said equipment in operating rooms has been found to be both expensive and inefficient.

Enhancing Surgical Safety: Microbiological Air Control in Operating Theatres at University Medical Centre Maribor

“…In our operating theatres, they enable an ultra-clean zone around the operating area. They utilise integrated microbial sedimentation plates that create a continuous flow of microorganism-free air by reducing infectious microbes, improving air quality in critical areas [36,37]. In the operating theatres of the University Medical Centre Maribor, there are some basic requirements for air conditioning systems, including the possibility of regulating temperature and humidity.…”

“…Secondly, the frequency of sampling should be determined based on the acuity of surgical procedures, patient risk factors and regulatory requirements. Compliance with relevant standards and guidelines, e.g., from regulatory bodies or professional organisations, is essential to ensure the validity and comparability of air sampling data [1,36]. With more frequent sampling, results could be different and the TVC could be higher, especially during the active phase of the day.…”