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Wound infections after surgery in a modern operating suite: clinical, bacteriological and epidemiological findings

Published online by Cambridge University Press:  15 May 2009

Stellan Bengtsson ,
Anna Hambraeus  and
Gunnar Laurell
Stellan Bengtsson
Affiliation:
Institute of Clinical Bacteriology, University of Uppsala, Uppsala, Sweden
Anna Hambraeus
Affiliation:
Institute of Clinical Bacteriology, University of Uppsala, Uppsala, Sweden
Gunnar Laurell
Affiliation:
Institute of Clinical Bacteriology, University of Uppsala, Uppsala, Sweden
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Summary

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A prospective study of 2983 operations in general and orthopaedic surgery during 3 years performed in four operating theatres in a modern operating suite was carried out in order to evaluate the importance of airborne infection. Weekly nose-and-throat samples were taken from the surgical staff and pre-operative samples were taken from the nose, throat, skin and perineum of the patients. The air contamination was followed by using settle plates, which showed low mean counts of total bacteria of between 9 and 15 c.f.u./m2/min, with mean counts of Staph. aureus of between 0.03 and 0.06 c.f.u./m2/min. No correlation was found between the total number of bacteria and the incidence of post-operative infections or between the amount of Staph. aureus in the air and post-operative Staph. aureus infections. It was concluded that further increases in ventilation could, at best, only marginally affect the incidence of post-operative infection.

The post-operative wound-infection rate was 9.0%. In various types of surgery, the infection rates varied from 5.3% in clean operations to 47.6% in dirty surgery. About one third of the infections were classified as moderate or severe.

Adverse patient factors, such as immunodeficiency, steroid treatment, intensive care, etc., increased the rate to 15.0%; in ‘normal’ patients it was 3.8%.

Among the bacteria isolated, gram-negative bacilli (31% of wounds), often together with other bacteria, and Staph. aureus (28%) predominated, but in 25% no specimens were taken.

Of 76 post-operative Staph. aureus infections, 32 were caused by the patients' own strains, and of the remaining 44 infections, 22, or 8% of all infections, could be traced to strains present in the air and/or the respiratory tracts of staff during the operation.

The length of pre-operative hospital stay had no influence on the carrier rate of Staph. aureus in patients. The incidence of post-operative wound infection was significantly higher in patients carrying Staph. aureus and was even higher if these bacteria were found on the skin.

Patients with wound infections stayed, on an average, 15 days longer than patients without infections. In serious infections the increase in duration of stay was > 20 days. Although infections were commoner in older patients, the average additional hospital stay of infected patients did not increase with age. If the post-operative infections studied in a concurrent retrospective study are taken into account more than 12 000 bed-days were due to post-surgical wound infections in the period studied or, in other words, some 12 beds (corresponding to 5.5% of the total) were always occupied by infected patients.

Type
Research Article
Information
Journal of Hygiene , Volume 83 , Issue 1 , August 1979 , pp. 41 - 58
Copyright
Copyright © Cambridge University Press 1979

References

Abel, E. & Allander, C. (1966). Undersökning av nytt inblåsningssystem för rena rum. VVS, no. 8.Google Scholar
Ad Hoc Committee National Research Council (1964). Postoperative wound infection. Annals of Surgery 160, Suppl. 2.Google Scholar
Altemeir, W. A. (1971). Current Infection Problems in Surgery.Proceedings of the International Conference on Nosocomial Infections.Baltimore,Waverly Press.Google Scholar
Anaerobe Laboratory Manual (1973). Virginia Polytechnic Institute, Anaerobe Laboratory, Blacksbury, Virginia, U.S.A.Google Scholar
Ayliffe, G. A. J. & Collins, B. J. (1967). Wound infections from a disperser of an unusual strain of Staphylococcus aureus. Journal of Clinical Pathology 20, 195.CrossRefGoogle ScholarPubMed
Ayliffe, G. A. J., Brightwell, K. M., Collins, B. J., Lowbury, E. J. L., Goonatilake, P. C. L. & Etheridge, R. A. (1977). Surveys of hospital infection in the Birmingham region. I. Effect of age, sex, length of stay and antibiotic use on nasal carriage of tetracycline-resistant Staphylococcus aureus and on post-operative wound infection. Journal of Hygiene 79, 299.CrossRefGoogle ScholarPubMed
Beck, W. C. (1976). The defining of biologic clean air and its clinical significance. In Proceedings of Workshop on Clean Air in Operating Rooms, p. 45. Sponsored jointly by the American Academy of Orthopedic Surgery and the National Research Council.Google Scholar
Bengtsson, S., Bergqvist, F.-O. & Schneider, W. (1975). A data system for bacteriological routine and research. Symposium on Rapid Methods and Automation in Microbiology, Vol. 2 (ed. Heden, C.-G.), p. 291. New York: Wiley.Google Scholar
Bergqvist, F. & Bengtsson, S. (1978). OP 72 – data technical aspects. Lecture notes in medical information 1, 443.CrossRefGoogle Scholar
Blair, J. E. & Williams, R. E. O. (1961). Phage typing of staphylococci. Bulletin of the World Health Organization 24, 771.Google ScholarPubMed
Blowers, R., Mason, G. H., Wallace, K. R. & Walton, M. (1955). Control of wound infection in a thoracic surgery unit. Lancet ii, 786.CrossRefGoogle Scholar
Bourdillon, R. B. & Colebrook, L. (1946). Air hygiene in dressing rooms for burns or major wounds. Lancet i, 601.CrossRefGoogle Scholar
Bruun, J. N. (1970). Postoperative wound infection. Acta medica scandinavica, Suppl. 514.Google Scholar
Bröte, L. (1976). Postoperative wound infections in general surgery. Linköping University Medical Dissertations, no. 33.Google ScholarPubMed
Calia, F., Wolinsky, E., Mortimer, E. A., Abrams, J. & Rammelkamp, C. H. (1969). Importance of the carrier state as a source of Staphylococcus aureus in wound sepsis. Journal of Hygiene 67, 49.CrossRefGoogle ScholarPubMed
Charnley, J. (1964). A clean air operating enclosure. British Journal of Surgery 51, 202.CrossRefGoogle ScholarPubMed
Charnley, J. (1972). Postoperative infection after total hip replacement with special reference to air contamination in the operating room. Clinical Orthopaedics 87, 167.CrossRefGoogle ScholarPubMed
Charnley, J. & Eftekhar, N. S. (1969). Postoperative infection in total prosthetic replacement arthroplasty of the hip joint, with special reference to the bacterial content of the air of the operating room. British Journal of Surgery 56, 641.CrossRefGoogle Scholar
Clark, R. E., Amos, W. C., Higgins, V., Bemberg, K. F. & Weldon, C. S. (1976). Infection control in cardiac surgery. Surgery 79, 89.Google ScholarPubMed
Finland, M., Marget, W. & Bartman, K. (1971). Bacterial infections. Changes in their causative agents trends and possible basis. Bayer Symposium III. New York: Springer Verlag.Google Scholar
Hambraeus, A., Bengtsson, S. & Laurell, G. (1977). Bacterial contamination in a modern operating suite. 1. Effect of ventilation on airborne bacteria and transfer of airborne particles. Journal of Hygiene 79, 121.CrossRefGoogle Scholar
Hambraeus, A., Bengtsson, S. & Laurell, G. (1978a). Bacterial contamination in a modern operating suite. 2. Effect of a zoning system on contamination of floors and other surfaces. Journal of Hygiene 80, 57.CrossRefGoogle Scholar
Hambraeus, A., Bengtsson, S. & Laurell, G. (1978b). Bacterial contamination in a modern operating suite. 3. Importance of floor contamination as a source of airborne bacteria. Journal of Hygiene 80, 169.CrossRefGoogle Scholar
Hambraeus, A., Bengtsson, S. & Laurell, G. (1978c). Bacterial contamination in a modern operating suite. 4. Bacterial contamination of clothes worn in the suite. Journal of Hygiene 80, 175.CrossRefGoogle Scholar
Hart, D. (1938). Pathogenic bacteria in the air of operating rooms. Their widespread distribution and methods of control. Archives of Surgery 37, 521.CrossRefGoogle Scholar
Jepsen, O. B., Olesen-Larsen, S. & Thomsen, F. W. (1969). Postoperative wound sepsis in general surgery. I. Materials, methods and frequency. Acta chirurgica scandinavica, Suppl. 396.Google Scholar
Laufman, H. (1973). Current status of special air-handling systems in operating rooms. Medical Instrumentation 7, 7.Google ScholarPubMed
Laufman, H. (1976). Is laminar airflow necessary for prophylaxis against wound infection? Medical Instrumentation 10, 269.Google ScholarPubMed
Lidwell, O. M. (1961). Sepsis in surgical wounds. Multiple regression analysis applied to records of postoperative hospital sepsis. Journal of Hygiene 59, 259.CrossRefGoogle ScholarPubMed
Lidwell, O. M. (1976). Clean air, less infection. Hospital Engineering 30 (Oct.), 9.Google Scholar
Lindbom, G., Laurell, G. & Grenvik, Å. (1967). Studies on the epidemiology of staphylococcal infections. 3. Influence of factors inherent in the patient and his wound. Acta pathologica et microbiologica scandinavica 69, 219.CrossRefGoogle Scholar
Mclauchlan, J., Logie, J. L. C., Smylie, H. G. & Smith, G. (1976). The role of clean air in wound infection acquired during operation. Surgery, Gynecology and Obstetrics 143, 6.Google ScholarPubMed
Miller, D. L., Mcdonald, J. C., Jevons, M. P. & Williams, R. E. O. (1962). Staphylococcal disease and nasal carriage in the Royal Air Force. Journal of Hygiene 60, 451.Google ScholarPubMed
Nelson, C. L. (1975). Clean air systems. Contemporary Surgery 6, 44.Google Scholar
Nelson, J. P. (1976). Five years experience with operating room, clean rooms and personnel systems. Medical Instrumentation 10, 277.Google Scholar
Noble, W. C., Lidwell, O. M. & Kingston, D. (1963). The size distribution of airborne particles carrying micro-organisms. Journal of Hygiene 61, 385.Google ScholarPubMed
Operating-Theatre Hygiene Subcommittee of the Committee on Control of Cross-Infection (1962). Design and ventilation of operating-room suites for control of infection and for comfort. A report to the Medical Research Council. Lancet ii, 945.Google Scholar
Osiris User's Manual (1973). The Institute for Social Research, University of Michigan.Google Scholar
Payne, R. W. (1967). Severe outbreak of surgical sepsis due to Staphylococcus aureus of unusual type and origin. British Medical Journal iv, 17.CrossRefGoogle Scholar
Seropion, R. & Reynolds, B. M. (1969). The importance of airborne contamination as a factor in postoperative wound infection. Archives of Surgery 98, 654.CrossRefGoogle Scholar
Shaw, D., Doig, C. M. & Douglas, D. (1973). Is airborne infection in operating theatres an important cause of wound infection in general surgery? Lancet i, 17.CrossRefGoogle Scholar
Wells, W. F. (1955). Airborne Contagion and Air Hygiene. Cambridge. Harvard University Press.Google Scholar
Williams, R. E. O., Noble, W. C., Jevons, M. P., Lidwell, O. M., Shooter, R. H., White, R. G., Thom, B. T. & Taylor, G. K. (1962). Isolation for the control of staphylococcal infection in surgical wards. British Medical Journal ii, 275.CrossRefGoogle Scholar