The Effect of Heated CO2 Insufflation in Minimising Surgical Wound Contamination During Open Surgery

Abstract

The primary source of infections in open surgeries has been found to be bacteria and viruses carried into the surgical wound on the surfaces of skin particles shed by patients and surgical staff. In open cardiac surgeries, insufflation of the wound with carbon dioxide is used to limit the quantity of air able to enter into the heart, avoiding air embolisms when the heart is restarted. This surgical technique has been evaluated as a method of limiting the number of skin particles able to enter into the wound, using computational fluid dynamics (CFD) simulations and experimental testing. Spherical particles of 5.0 and 13.5 μm in diameter were used to simulate skin particles falling above a wound, travelling in air ventilation velocities of either 0.2 or 0.4 m/s, and with or without CO insufflation. The CFD simulations with CO included a diffuser placed in the wound and supplied with CO at a rate of 10 L/min. Experimental testing was completed under similar conditions. The results of CFD simulations and experimental testing showed CO insufflation can significantly limit the number of particles able to enter into the wound.

Polymeric Microfiltration Membranes Modification by Supercritical Solvent Impregnation—Potential Application in Open Surgical Wound Ventilation

“…As a result, the CFU number decreased from an average value of 7.75 (without de-airing) to 2.75. This finding is consistent with the results of Persson and van der Linden [ 16 ] and Baumann and Cater [ 18 ], who showed that de-airing with carbon dioxide might prevent direct airborne contamination during cardiac surgery. Further experiments in our study demonstrated that using carvacrol-loaded membranes instead of neat polyamide membranes made it possible to decrease the contamination level by another 27% (decrease in the average CFU level from 2.75 to 2).…”

“…According to the literature, the most often applied flow rates in open surgical wound ventilation in Japan range from 2 to 5 L/min [ 15 ]. Other studies have indicated flow rates of interest as 2–10 L/min [ 14 ], 5 and 10 L/min [ 16 ], 5 L/min [ 17 ], and 10 L/min [ 18 ]. We selected a 5 L/min flow rate of carbon dioxide through the membrane for our experiments.…”

“…Insufflation of carbon dioxide in the thoracic cavity during open-heart surgery has been used to prevent arterial air metabolism since the 1950s [ 14 ]. Scientists, surgeons, and clinical engineers have made efforts to better understand the de-airing process and develop convenient devices ever since [ 14 , 15 , 16 , 17 , 18 ]. It has also been shown that carbon dioxide insufflation during open thoracic cavity surgeries might be used to reduce exogenous perioperative tissue contamination and occurrence of surgical site infections that are most commonly caused by Staphylococcus aureus [ 16 , 17 , 18 ].…”

“…Scientists, surgeons, and clinical engineers have made efforts to better understand the de-airing process and develop convenient devices ever since [ 14 , 15 , 16 , 17 , 18 ]. It has also been shown that carbon dioxide insufflation during open thoracic cavity surgeries might be used to reduce exogenous perioperative tissue contamination and occurrence of surgical site infections that are most commonly caused by Staphylococcus aureus [ 16 , 17 , 18 ]. A source of perioperative exogenous contamination can be an active person present in the operating room as each individual emits thousands of bacteria-carrying particles every minute [ 16 ].…”

“…Persson et al [ 17 ] further proposed antiseptic open surgical wound ventilation using carbon dioxide carrying gasified ethanol, demonstrating its efficiency in contamination prevention. Baumann and Cater [ 18 ] also showed that insufflation with warm carbon dioxide significantly reduced open wound contamination compared to the procedure without insufflation.…”