The importance of airborne bacterial contamination of wounds

Whyte, W.; Hodgson, R.; Tinkler, J.

doi:10.1016/0195-6701(82)90004-4

Cited by 238 publications

(108 citation statements)

References 9 publications

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“…Wound contamination at the time of the procedure is thought to be a cause of early postoperative infections [10,13,17,18]. Recent studies have shown increased wound contamination and infection rates with the use of modern surgical helmet systems compared with conventional gowns, and it has been hypothesized that the positive pressure within a surgical helmet system may potentially underlie the higher rates of wound contamination and infection [7,11,12,18].…”

Section: Discussionmentioning

confidence: 99%

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The Gown-glove Interface Is a Source of Contamination: A Comparative Study

Fraser

Young

Valentine

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background The original Charnley-type negative-pressure body exhaust suit reduced infection rates in randomized trials of total joint arthroplasty (TJA) decades ago. However, modern positive-pressure surgical helmet systems have not shown similar benefit, and several recent studies have raised the question of whether these gowning systems result in increased wound contamination and infections. The gown-glove interface may be one source of particle contamination.Questions/purposes The purpose of this study was to compare particle contamination at the gown-glove interface in several modern surgical helmet systems and conventional surgical gowns. Methods A 5-lm fluorescent powder was evenly applied to both hands to the level of the wrist flexion crease. After gowning in the standard fashion, the acting surgeon performed a 20-minute simulated TJA protocol. Each of the five gowning systems was run through five trials. The amount of gown contamination at the gown-glove interface then was measured by three observers under ultraviolet light using a grading scale from 0 (no contamination) to 4 (gross contamination). Statistical analysis was carried out with Minitab 15. Friedman's test was used to compare the levels of contamination across trials for each gown and the Mann-Whitney test was used post hoc to perform a pairwise comparison of each gown. Results All gown-glove interfaces showed some contamination. Friedman's test showed that there was a significant difference in contamination between gowns (p = 0.029). The Stryker T5 Zipper Toga system showed more contamination than the other gowns. The median contamination score and range for each gowning setup was 1.8 (range, 1-4; conventional Kimberly-Clark MicroCool gown without helmet), 4 (range, 3-4; Stryker T5 Zipper Toga), 3.6 (range, 0-4; Stryker helmet with conventional gown), 1.6 (range, 0-2; Stryker Flyte Toga), and 3.0 (range, 2-3; DePuy Toga). A Mann-Whitney test found no difference among any of the gowns except for the Stryker T5 Zipper Toga, which showed more contamination

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Section: Discussionmentioning

confidence: 99%

“…Microbial-laden particles shed from the operating room staff were considered to be a major source of these early postoperative infections [13,17]. This led to the introduction of ultraclean air operating rooms and body exhaust suits.…”

Section: Introductionmentioning

confidence: 99%

The Gown-glove Interface Is a Source of Contamination: A Comparative Study

Fraser

Young

Valentine

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…These routine contacts are potential sources of wound contamination and subsequent PJI if the PPS is deemed to be unsterile. One study suggests operative personnel were the source of contamination in 98% of cases with 30% reaching the wound through the air and 70% directly from hands or instruments [23]. In our study, all areas of the hood, except the face bar, were contaminated in over 20% of the samples collected, resulting in numerous opportunities to directly introduce pathogens into the operative field.…”

Section: Discussionmentioning

confidence: 89%

Sterility of the Personal Protection System in Total Joint Arthroplasty

Kearns

Witmer

Makda

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Bacteria shed by operating room personnel is a source of wound contamination and postoperative infections. The personal protection system (PPS) was designed to decrease airborne bacteria and intraoperative contamination in total joint arthroplasty. Questions/purposes We determined the microbial contamination rate of the PPS and incidence of contamination with key pathogens, Staphylococcus aureus and coagulasenegative staphylococci. Patients and Methods We prospectively evaluated PPS contamination in 61 primary THAs and 41 TKAs. The PPS were assumed to be sterile before opening the packs. The initial culture was taken immediately after the hood was placed over the helmet. Four cultures were collected at the conclusion of the procedure. Plates were examined and colonies were classified according to Gram stain results and biochemical tests. S. aureus was classified as methicillin-resistant or -susceptible. Results At time zero, 22 of 102 cultures isolated an organism, accounting for a contamination rate of 22%. The bacterial contamination rate of the PPS at the conclusion of the procedure was 47% (48 of 102). The relative percentage of the various organisms found was coagulase-negative staphylococci 50%, Micrococcus sp. 20%, methicillin-susceptible S. aureus 11%, and methicillinresistant S. aureus (MRSA) 1%. Conclusions The external surface of the PPS cannot be assumed to be sterile after its removal from the original packaging. Of all the PPS studied, the potential pathogens coagulase-negative staphylococcus, S. aureus, and MRSA were found in 43%. This study supports the need to change gloves if the PPS is touched or adjusted during the procedure.

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“…Hoffman et al 1 pointed out that the air change rate in preparation rooms used for laying-up sterile instruments should be around 37 ACH; a greater air change rate than in theatres. 2 Up until now, it is not clear whether the performance in terms of air quality achieved in the laying-up zone of a UDHF system equals or exceeds that of a UDDF system during the laying-up of instruments in a separate preparation room. The objective of this experimental comparative study is to answer the following research question: "what is the difference in contamination (presence of particles and micro-organisms) of the clean area within which laying up takes place when a UDHF system is used versus when a UDDF system is used?…”

Section: Introductionmentioning

confidence: 99%

“…15 These skin particles measuring 10-25 μm and roughly 1 μm thick [2] especially have a lot of staphylococci many people are carriers of. 16,17,18,19 This group of microorganisms is responsible for post-operative wound infections especially in implantation surgery.…”

mentioning

confidence: 99%

Laying-up of sterile instruments in the operating theatre: equal or superior protection by using a horizontal unidirectional air flow system

Traversari¹,

Goedhart²,

Dusseldorp³

et al. 2013

Journal of Hospital Infection

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SummaryBackground: A system for the preparation of sterilized instruments with unidirectional horizontal air flow (UDHF) has several advantages over a unidirectional down-flow system (UDDF). The advantages are based on the installation of the system being more flexible and easier to use, no cooling of the air flow being necessary and less air being needed for circulation, resulting in reduced energy use.

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The importance of airborne bacterial contamination of wounds

Cited by 238 publications

References 9 publications

The Gown-glove Interface Is a Source of Contamination: A Comparative Study

The Gown-glove Interface Is a Source of Contamination: A Comparative Study

Sterility of the Personal Protection System in Total Joint Arthroplasty

Laying-up of sterile instruments in the operating theatre: equal or superior protection by using a horizontal unidirectional air flow system

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