The beneficial effect of air cleanliness with ISO 14644-1 class 7 for surgical intervention in a neonatal intensive care unit

Abstract

Whether critically ill neonates needing a surgical intervention should be transferred to an operating room (OR) or receive the intervention in a neonatal intensive care unit (NICU) is controversial. In this study, we report our experience in performing surgical procedures in a NICU including air cleanliness.This was a retrospective study performed at a metropolitan hospital. The charts of all neonates undergoing surgical procedures in the NICU and OR were retrospectively reviewed from January 2007 to June 2017. Data on baseline characteristics, procedure and duration of surgery, ventilator use, hypothermia, instrument dislocations, surgery-related infections and complications, and outcomes were analyzed.Ninety-two neonates were enrolled in this study, including 44 in the NICU group and 48 in the OR group. The air cleanliness was International Organization for Standardization (ISO) 14644-1 class 7 in the NICU and class 5-6 in the OR. The NICU group had a younger gestational age and lower birth body weight than the OR group. The OR group had a higher incidence of hypothermia than in the NICU group (56.3% vs 9.1%, P < .001). However, there were no significant differences in surgical site related infections or mortality between the 2 groups.This study suggests that performing surgical procedures in a NICU with air cleanliness class 7 is as safe as in an OR, as least in part, when performing patent ductus arteriosus ligation and exploratory laparotomy.

Prevention of hypothermia in newborn submitted to surgical procedures: an integrative review

“…After searching in database and according to established selection criteria, this integrative review included four articles (11,(24)(25)(26) , which are presented in Chart 1. These were distributed in PubMed (2; 50%), followed by Embase (1; 25%) and MEDLINE (1; 25%) databases, published in the last 50 years, totaling as a sample 268 NBs submitted to surgical procedures.…”

“…The studies used methodologies with quantitative approaches, and the language of all articles was English, and the publications in medicine (24)(25)(26) and nursing (11) .…”

“…The strategies, outcome and recommendations for hypothermia reduction presented in the selected articles are described in Chart 3. The main strategy in the prevention of hypothermia in surgical NB presented in the studies was thermal environment control in which surgery is performed (11,(24)(25)(26) .…”

“…Other strategies for prevention of hypothermia in surgical procedures are also identified, namely: use of thermal mattress, chemical or heated blankets (11,(24)(25) ; caps, overalls, and blankets (11,(24)(25) ; use of a previously heated incubator or heated cradle (11,(24)(25)(26) ; infusion of heated fluids (11,(24)(25)(26) ; monitoring of body temperature in the axillary, nasopharyngeal, esophageal or rectal regions (11,24) ; perioperative temperature measurement routines (11,24) ; coverage of abdominal organs with wet and heated surgical compresses (25) ; establishment of relative air humidification (24,26) ; air conditioning cleaning quality (26) and heat lamps (11) .…”

Bioaerosols in orthopedic surgical procedures and implications for clinical practice in the times of COVID-19: A systematic review and meta-analysis

“…57 Operating rooms are expected to comply with Class 5 (TPC < 10 5 per cubic meter) or Class 6 (TPC < 10 6 per cubic meter) cleanroom standards. 58 If we considered the pooled estimate of total particle counts (6 × 10 6 per cubic meters) from our meta-analysis, it would be in compliance with an ISO Class 9 (TPC < 35.2 × 10 6 per cubic meter) cleanroom.…”