Royal Orthopaedic Hospital, UK.
University Hospital Birmingham, UK.
Ann R Coll Surg Engl. 2022 Sep;104(8):600-604. doi: 10.1308/rcsann.2021.0328. Epub 2022 Apr 20.
The importance of ultraclean air in reducing deep infection was studied by Charnley who showed that the rate decreased as the airborne bacterial load was reduced. The effectiveness was shown in a large Medical Research Council (MRC) trial, but registry data have not shown a consistent benefit. Because we treat patients with rheumatoid arthritis, we decided to look at our theatre air quality.
In phase 1 we monitored air quality using settle plates, exposed for one hour after the incision, on the instrument trolleys in a joint replacement theatre. In phase 1 the scrub person did not wear a body exhaust system. In phase 2 all three staff used a body exhaust system, and we played close attention to the orientation and position of the surgical lights and trolleys.
In phase 1 we grew 0.24 colonies/plate/hour in the ultraclean zone, which is comparable to the Charnley trial findings. In the second phase we grew 0.03 colonies/plate/hour (<0.001). When plates were placed on the trolleys in controlled positions there was a tendency for the colonies to appear on the corners of the trolleys at the edge of the clean zone (NS).
The study showed that in phase 1 colony counts comparable to the original Charnley studies were achieved. Colony counts of 0.03 colonies/plate/hour can be achieved in contemporary practice, with all team members using body exhausts.
查恩利研究表明，减少空气中的细菌负荷可降低深部感染率，从而强调了超净空气的重要性。大型医学研究委员会（MRC）试验证明了其有效性，但注册数据并未显示出一致的益处。由于我们治疗类风湿关节炎患者，因此我们决定检查我们手术室的空气质量。
在第 1 阶段，我们使用沉降平板监测空气质量，在关节置换手术室中，于切口后 1 小时暴露于仪器手推车上。在第 1 阶段，洗手护士未佩戴全身排气系统。在第 2 阶段，所有 3 名工作人员均使用全身排气系统，并且我们密切注意手术灯和手推车的方向和位置。
在第 1 阶段，我们在超净区每平板/小时生长 0.24 个菌落，与查恩利试验的发现相当。在第 2 阶段，我们每平板/小时生长 0.03 个菌落（<0.001）。当将平板放置在手推车的受控位置时，菌落有出现在清洁区边缘手推车角落的趋势（NS）。
该研究表明，在第 1 阶段达到了与原始查恩利研究相当的菌落计数。在当前实践中，所有团队成员都使用全身排气系统，可以实现每平板/小时 0.03 个菌落的菌落计数。
