Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.
Department of Bone and Joint Biomaterial Research, Tokyo Medical University, Tokyo, Japan.
J Orthop Surg (Hong Kong). 2020 Sep-Dec;28(3):2309499020976232. doi: 10.1177/2309499020976232.
In view of preventing surgical site infection (SSI) in the orthopedic operating room (OR), evidence concerning types of footwear and clothing is limited. This study aimed to investigate how different footwear and clothing affect the cleanliness of the OR environment.
The airborne dust concentration in a bioclean room (NASA class 100) was measured around an operator by using a handheld particle counter under the following conditions: (I) wearing a sterilized full-type space suit with OR dedicated clean sandals; (II) wearing a sterilized full-type space suit with non-dedicated (outside) shoes or severely contaminated outside shoes with surgical glove powder (2 µm mean particle size); and (III) wearing an unsterilized medical scrub uniform with OR dedicated sandals. The participant was standing still or stepping in place at 1 Hz during the testing.
The concentrations of airborne dusts in the operative field were independent of footwear and clothing types under the stand-still condition. However, these values significantly increased 1.96- to 16.23-fold after simple stepping motion in all the test conditions, and often became dissatisfaction level with the NASA100 requirement for the OR cleanliness. The worst contamination occurred when an operator wore the powder-contaminated shoes and also the unsterilized scrub uniform.
The present study showed that the stepping motion triggered a considerable contamination in the operative field (beyond the level of NASA100 threshold) particularly when an operator used the outside shoes or unsterilized scrub uniform. Therefore, these results tell us that the one-footwear system (i.e., no use of OR dedicated clean shoes) and unsterilized scrub are likely to be a potential risk factor for SSI. Nevertheless, further studies are necessary to conclude the real efficacy of OR dedicated shoes and sterilized clothes on the SSI prevention.
为了预防骨科手术室（OR）的手术部位感染（SSI），有关鞋类和服装类型的证据有限。本研究旨在调查不同的鞋类和服装如何影响 OR 环境的清洁度。
在生物清洁室（NASA 100 级）中，使用手持式粒子计数器在操作员周围测量空气传播尘埃浓度，条件如下：（I）穿着经过消毒的全型航天服和 OR 专用清洁凉鞋；（II）穿着经过消毒的全型航天服和非专用（外部）鞋子或带有手术手套粉末（2 µm 平均粒径）的严重污染外部鞋子；和（III）穿着 OR 专用凉鞋的未消毒的医用刷服。在测试过程中，参与者在站立或原地踏步时以 1Hz 的频率进行测试。
在静止状态下，空气传播尘埃的浓度与鞋类和服装类型无关。然而，在所有测试条件下，简单的踏步运动后，这些值显著增加了 1.96 到 16.23 倍，并且经常达到 OR 清洁度的 NASA100 要求的不满意水平。当操作员穿着带有粉末污染的鞋子和未消毒的刷服时，污染最为严重。
本研究表明，踏步运动引发了手术区域的相当大的污染（超出 NASA100 阈值水平），特别是当操作员使用外部鞋子或未消毒的刷服时。因此，这些结果告诉我们，单鞋系统（即不使用 OR 专用清洁鞋）和未消毒的刷服可能是 SSI 的潜在危险因素。然而，需要进一步的研究来得出关于 OR 专用鞋和消毒服装对 SSI 预防的实际效果的结论。
