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Deep Infection After Total Knee Replacement: Impact of Laminar Airflow Systems and Body Exhaust Suits in the Modern Operating Room

Published online by Cambridge University Press:  02 January 2015

Andrew L. Miner
Affiliation:
Department of Ambulatory Care and Prevention and Channing Laboratory, Department of Medicine, Boston, Massachusetts Centers for Disease Control and Prevention Eastern Massachusetts Prevention Epicenter, Boston, Massachusetts
Elena Losina
Affiliation:
Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Boston, Massachusetts Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
Jeffrey N. Katz
Affiliation:
Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Boston, Massachusetts Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Anne H. Fossel
Affiliation:
Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Boston, Massachusetts
Richard Platt*
Affiliation:
Department of Ambulatory Care and Prevention and Channing Laboratory, Department of Medicine, Boston, Massachusetts Centers for Disease Control and Prevention Eastern Massachusetts Prevention Epicenter, Boston, Massachusetts
*
133 Brookline Avenue, Boston, MA 02215 ([email protected])

Abstract

We investigated the relationship between the risk of deep infection and intraoperative use of laminar airflow systems and body exhaust suits during 8,288 total knee replacements performed in 256 hospitals. The overall 90-day cumulative incidence of deep infection requiring subsequent operation was 0.34% (28 procedures). In all combinations of laminar airflow systems and body exhaust suits, the 90-day cumulative incidence of infection requiring subsequent operation was 0.27%-0.43%. The risk ratio was 1.57 (95% confidence interval, 0.75-3.31) for laminar airflow systems and 0.75 (95% confidence interval, 0.34-1.62) for body exhaust suits suits. The risk was not statistically associated with use of either method, but infections were rare.

Type
Concise Communication
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1.Nelson, JP. Five years experience with operating room clean rooms and personnel-isolator systems. Med lustrum 1976;10:277281.Google ScholarPubMed
2.Lidwell, OM, Lowbury, EJ, Whyte, W, Blowers, R, Stanley, SJ, Lowe, D. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. Br Med J (Clin Res Ed) 1982;285:1014.CrossRefGoogle ScholarPubMed
3.Salvati, EA, Robinson, RP, Zeno, SM, Koslin, BL, Brause, BD, Wilson, PD Jr. Infection rates after 3,175 total hip and total knee replacements performed with and without a horizontal unidirectional filtered air-flow system. J Bone Joint Surg Am 1982;64:525535.CrossRefGoogle Scholar
4.Fitzgerald, RH Jr. Total hip arthroplasty sepsis: prevention and diagnosis. Orthop Clin North Am 1992;23:259264.CrossRefGoogle ScholarPubMed
5.Marotte, JH, Lord, GA, Blanchard, JP, et al. Infection rate in total hip arthroplasty as a function of air cleanliness and antibiotic prophylaxis. 10-year experience with 2,384 cementless Lord Madreporic prostheses. J Arthroplasty 1987;2:7782.CrossRefGoogle Scholar
6.Der Tavitian, J, Ong, SM, Taub, NA, Taylor, GJ. Body-exhaust suit versus occlusive clothing: a randomised, prospective trial using air and wound bacterial counts. J Bone Joint Surg Br 2003;85:490494.CrossRefGoogle ScholarPubMed
7.Friberg, B, Friberg, S, Burman, LG. Inconsistent correlation between aerobic bacterial surface and air counts in operating rooms with ultra clean laminar air flows: proposal of a new bacteriological standard for surface contamination. J Hosp Infect 1999;42:287293.CrossRefGoogle ScholarPubMed
8.Katz, JN, Barrett, J, Mahomed, NN, Baron, JA, Wright, J, Losina, E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am 2004;86:19091916.CrossRefGoogle ScholarPubMed
9.Miner, AL, Losina, E, Katz, JN, Fossel, AH, Platt, R. Infection control practices to reduce airborne bacteria during total knee replacement: a hospital survey in four states. Infect Control Hosp Epidemiol 2005;26:910915.CrossRefGoogle ScholarPubMed
10.Phillips, CB, Barrett, JA, Losina, E, et al. Incidence rates of dislocation, pulmonary embolism, and deep infection during the first six months after elective total hip replacement. J Bone Joint Surg Am 2003;85:2026.CrossRefGoogle ScholarPubMed
11.Berg-Perier, M, Cederblad, A, Persson, U. Ultraviolet radiation and ultra-clean air enclosures in operating rooms: UV-protection, economy, and comfort. J Arthroplasty 1992;7:457463.CrossRefGoogle ScholarPubMed
12.Persson, U, Montgomery, F, Carlsson, A, Lindgren, B, Ahnfeit, L. How far does prophylaxis against infection in total joint replacement offset its cost? Br Med J (Clin Res Ed) 1988;296:99102.CrossRefGoogle ScholarPubMed
13.McQuarrie, DG, Glover, JL, Olson, MM. Laminar airflow systems: issues surrounding their effectiveness. AORN J 1990;51:10351048.CrossRefGoogle ScholarPubMed