Role of Body Exhaust System in Reducing Peri-Prosthetic Joint Infection, Literature Review

Ghazavi, Mohammad

doi:10.17795/soj-8568

Cited by 2 publications

(1 citation statement)

References 12 publications

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“…7,8 Moreover, some studies have suggested that SHS only protects surgeons and other scrubbed personnel from potential fluid and bloodborne transmissions, 9 but does not reduce the incidence of surgical field contaminations. [10][11][12][13][14] As a result, the effectiveness of SHS in reducing the risk of surgeon-derived contamination and PJI has been questioned.…”

Section: Introductionmentioning

confidence: 99%

The effect of the surgical helmet system on intraoperative contamination in arthroplasty surgery

Chen,

Chan,

Yan

et al. 2023

Bone Jt Open

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AimsThe surgical helmet system (SHS) was developed to reduce the risk of periprosthetic joint infection (PJI), but the evidence is contradictory, with some studies suggesting an increased risk of PJI due to potential leakage through the glove-gown interface (GGI) caused by its positive pressure. We assumed that SHS and glove exchange had an impact on the leakage via GGI.MethodsThere were 404 arthroplasty simulations with fluorescent gel, in which SHS was used (H+) or not (H-), and GGI was sealed (S+) or not (S-), divided into four groups: H+S+, H+S-, H-S+, and H-S-, varying by exposure duration (15 to 60 minutes) and frequency of glove exchanges (0 to 6 times). The intensity of fluorescent leakage through GGI was quantified automatically with an image analysis software. The effect of the above factors on fluorescent leakage via GGI were compared and analyzed.ResultsThe leakage intensity increased with exposure duration and frequency of glove exchanges in all groups. When SHS was used and GGI was not sealed (H+S-), the leakage intensity via GGI had the fastest increase, consistently higher than other groups (H+S+, H-S+ and H-S-) after 30 minutes (p < 0.05) and when there were more than four instances of glove exchange (p < 0.05). Additionally, the leakage was strongly correlated with the duration of exposure (rs = 0.8379; p < 0.050) and the frequency of glove exchange (rs = 0.8198; p < 0.050) in H+S-. The correlations with duration and frequency turned weak when SHS was not used (H-) or GGI was sealed off (S+).ConclusionDue to personal protection, SHS is recommended in arthroplasties. Meanwhile, it is strongly recommended to seal the GGI of the inner gloves and exchange the outer gloves hourly to reduce the risk of contamination from SHS.Cite this article: Bone Jt Open 2023;4(11):859–864.

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Section: Introductionmentioning

confidence: 99%

The effect of the surgical helmet system on intraoperative contamination in arthroplasty surgery

Chen,

Chan,

Yan

et al. 2023

Bone Jt Open

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Intraoperative ‘space suits’ do not reduce periprosthetic joint infections in shoulder arthroplasty

Stoneham,

Poon,

Hirner

et al. 2024

Bone Jt Open

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AimsBody exhaust suits or surgical helmet systems (colloquially, ‘space suits’) are frequently used in many forms of arthroplasty, with the aim of providing personal protection to surgeons and, perhaps, reducing periprosthetic joint infections, although this has not consistently been borne out in systematic reviews and registry studies. To date, no large-scale study has investigated whether this is applicable to shoulder arthroplasty. We used the New Zealand Joint Registry to assess whether the use of surgical helmet systems was associated with lower all-cause revision or revision for deep infection in primary shoulder arthroplasties.MethodsWe analyzed 16,000 shoulder arthroplasties (hemiarthroplasties, anatomical, and reverse geometry prostheses) recorded on the New Zealand Joint Registry from its inception in 2000 to the present day. We assessed patient factors including age, BMI, sex, and American Society of Anesthesiologists (ASA) grade, as well as whether or not the operation took place in a laminar flow operating theatre.ResultsA total of 2,728 operations (17%) took place using surgical helmet systems. Patient cohorts were broadly similar in terms of indication for surgery (osteoarthritis, rheumatoid arthritis, fractures) and medical comorbidities (age and sex). There were 842 revisions (5% of cases) with just 98 for deep infection (0.6% of all cases or 11.6% of the revisions). There were no differences in all-cause revisions or revision for deep infection between the surgical helmet systems and conventional gowns (p = 0.893 and p = 0.911, respectively).ConclusionWe found no evidence that wearing a surgical helmet system reduces the incidence of periprosthetic joint infection in any kind of primary shoulder arthroplasty. We acknowledge the limitations of this registry study and accept that there may be other benefits in terms of personal protection, comfort, or visibility. However, given their financial and ecological footprint, they should be used judiciously in shoulder surgery.Cite this article: Bone Jt Open 2024;5(10):894–897.

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Role of Body Exhaust System in Reducing Peri-Prosthetic Joint Infection, Literature Review

Cited by 2 publications

References 12 publications

The effect of the surgical helmet system on intraoperative contamination in arthroplasty surgery

The effect of the surgical helmet system on intraoperative contamination in arthroplasty surgery

Intraoperative ‘space suits’ do not reduce periprosthetic joint infections in shoulder arthroplasty

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