Nakajima Daisuke, Tateiwa Toshiyuki, Masaoka Toshinori, Takahashi Yasuhito, Shishido Takaaki, Yamamoto Kengo
Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Department of Bone and Joint Biomaterial Research, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Eur J Orthop Surg Traumatol. 2017 Dec;27(8):1139-1143. doi: 10.1007/s00590-016-1874-8. Epub 2016 Oct 31.
The purpose of this study was to evaluate a potential risk of intraoperative contamination associated with clothing systems and surgeon's motion in total joint replacement.
The airborne particle concentrations at different locations around a single operating surgeon wearing standard surgical gown (SG) or modern "space suit" (SS) were compared. The particles in the size of ≥0.5 μm (roughly corresponding to a mean diameter of squamous epithelial cells) were counted at the following three locations: (1) ≈10 cm inferior to the wrist; (2) ≈10 cm posterior to the feet; and (3) near the chest (operative field) under condition either with or without the surgeon's motion (stepping in place at ~1 Hz).
The difference in the surgical clothing systems did not significantly affect the mean particle counts detected near the wrist and chest (p = 0.307 and 0.155, respectively). However, the particle count near the feet was 154 times higher in SS than SG (4630 ± 2795 vs. 30 ± 23 N/F, p = 0.023). The simple stepping of the surgeon with SS increased contaminants near the chest 31 times as compared to the condition without motion (1053 ± 709 vs. 34 ± 31 N/F, p = 0.0032). Although the particle count was less affected by the motion in SG than SS, contaminants near the chest increased ten times after the stepping in the use of SG (p = 0.032).
The present results suggest that the intraoperative motion of a surgeon may considerably increase airborne particle/bacterial concentration in the operative field. This can be a much higher likelihood in SS rather than SG because of air blow-off from the incorporated cooling fan.
本研究的目的是评估全关节置换术中与服装系统和外科医生动作相关的术中污染潜在风险。
比较了穿着标准手术衣（SG）或现代“太空服”（SS）的单一手术外科医生周围不同位置的空气传播颗粒浓度。在以下三个位置对尺寸≥0.5μm（大致对应鳞状上皮细胞的平均直径）的颗粒进行计数：（1）手腕下方约10厘米处；（2）脚后方约10厘米处；（3）在有或没有外科医生动作（以约1Hz原地踏步）的情况下，靠近胸部（手术区域）。
手术服装系统之间的差异对在手腕和胸部附近检测到的平均颗粒计数没有显著影响（分别为p = 0.307和0.155）。然而，SS组脚附近的颗粒计数比SG组高154倍（4630±2795对30±23 N/F，p = 0.023）。与无动作的情况相比（1053±709对34±31 N/F，p = 0.0032），穿着SS的外科医生简单踏步使胸部附近的污染物增加了31倍。尽管SG组中颗粒计数受动作的影响小于SS组，但使用SG时踏步后胸部附近的污染物增加了10倍（p = 0.032）。
目前的结果表明，外科医生的术中动作可能会显著增加手术区域空气中的颗粒/细菌浓度。由于内置冷却风扇吹出的空气，这种情况在SS中比在SG中更有可能发生。
