Birgand Gabriel, Toupet Gaëlle, Rukly Stephane, Antoniotti Gilles, Deschamps Marie-Noelle, Lepelletier Didier, Pornet Carole, Stern Jean Baptiste, Vandamme Yves-Marie, van der Mee-Marquet Nathalie, Timsit Jean-François, Lucet Jean-Christophe
INSERM, IAME, UMR 1137, Paris, France; Universite Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; Infection Control Unit, AP-HP, Hôpital Bichat, Paris, France.
Infection Control Unit, AP-HP, Hôpital Bichat, Paris, France.
Am J Infect Control. 2015 May 1;43(5):516-21. doi: 10.1016/j.ajic.2015.01.026. Epub 2015 Mar 6.
The best method to quantify air contamination in the operating room (OR) is debated, and studies in the field are controversial. We assessed the correlation between 2 types of air sampling and wound contaminations before closing and the factors affecting air contamination.
This multicenter observational study included 13 ORs of cardiac and orthopedic surgery in 10 health care facilities. For each surgical procedure, 3 microbiologic air counts, 3 particles counts of 0.3, 0.5, and 5 μm particles, and 1 bacteriologic sample of the wound before skin closure were performed. We collected data on surgical procedures and environmental characteristics.
Of 180 particle counts during 60 procedures, the median log10 of 0.3, 0.5, and 5 μm particles was 7 (interquartile range [IQR], 6.2-7.9), 6.1 (IQR, 5.4-7), and 4.6 (IQR, 0-5.2), respectively. Of 180 air samples, 50 (28%) were sterile, 90 (50%) had 1-10 colony forming units (CFU)/m(3) and 40 (22%) >10 CFU/m(3). In orthopedic and cardiac surgery, wound cultures at closure were sterile for 24 and 9 patients, 10 and 11 had 1-10 CFU/100 cm(2), and 0 and 6 had >10 CFU/100 cm(2), respectively (P < .01). Particle sizes and a turbulent ventilation system were associated with an increased number of air microbial counts (P < .001), but they were not associated with wound contamination (P = .22).
This study suggests that particle counting is a good surrogate of airborne microbiologic contamination in the OR.
量化手术室空气污染的最佳方法存在争议，该领域的研究也颇具争议。我们评估了两种空气采样方法与手术结束前伤口污染之间的相关性以及影响空气污染的因素。
这项多中心观察性研究纳入了10家医疗机构的13间心脏和骨科手术室。对于每台手术，在皮肤缝合前进行3次微生物空气计数、3次0.3、0.5和5μm颗粒的粒子计数以及1次伤口细菌学样本采集。我们收集了手术程序和环境特征的数据。
在60台手术的180次粒子计数中，0.3、0.5和5μm颗粒的对数中位数分别为7（四分位间距[IQR]，6.2 - 7.9）、6.1（IQR，5.4 - 7）和4.6（IQR，0 - 5.2）。在180份空气样本中，50份（28%）无菌，90份（50%）有1 - 10菌落形成单位（CFU）/m³，40份（22%）>10 CFU/m³。在骨科和心脏手术中，手术结束时伤口培养无菌的患者分别为24例和9例，10例和11例有1 - 10 CFU/100 cm²，0例和6例>10 CFU/100 cm²（P <.01）。粒径和湍流通风系统与空气微生物计数增加相关（P <.001），但与伤口污染无关（P =.22）。
本研究表明，粒子计数是手术室空气中微生物污染的良好替代指标。
