Baptist Health-Fort Smith, Orthopedics Clinic, Fort Smith, AR.
Am J Infect Control. 2023 Jul;51(7):758-764. doi: 10.1016/j.ajic.2022.10.016. Epub 2022 Nov 11.
Airborne contamination from microbe carrying particles (MCPs) is a risk factor for devastating early onset periprosthetic joint infection(PJIs). There are no published guidelines to quantify this risk factor for PJI events. This observational cohort project addresses this gap and utilizes a simple passive system to produce quantitative data from 80 total joint replacement cases performed in operating rooms built to current USA standards.
A petri dish-based system inspired by industrial cleanroom technology was deployed. Surgical helmet systems (SHSs) and strict protocols were used in all cases. 450 MCPs/m was used as a cutoff for bioburden. This benchmark corresponds to the ultraclean air standard of 10 MCPs/m.
75/80 cases (94%) achieved desired benchmark levels of bioburden at the wound zone compared to only 52/80 (65%) of back table zones. No surgical site infections (SSI) or PJI events (0/80; 95% CI, 0.00-3.68%) at minimum 18-month (average 25.8 months) follow-up were detected.
The current USA ventilation design uses low velocity airflow and appears to achieve ultraclean air conditions at the surgical site but requires SHSs and strict protocols. Higher contamination levels seen in back tables are consistent with this design.
This settle plate system may be useful for early onset PJI event investigations and thus lower the incidence of these complications.
携带微生物的颗粒（MCP）的空气传播污染是灾难性早发性假体周围关节感染（PJI）的风险因素。目前尚无量化该 PJI 事件风险因素的指南。本观察性队列项目填补了这一空白，并利用简单的被动系统，从按照当前美国标准建造的手术室中进行的 80 例全关节置换病例中产生定量数据。
借鉴工业洁净室技术的基于培养皿的系统被部署。所有病例均使用手术头盔系统（SHS）和严格的方案。450 MCPs/m 被用作生物负荷的截止值。该基准对应于 10 MCPs/m 的超净空气标准。
与仅 52/80（65%）的后台区域相比，75/80 例（94%）在伤口区域达到了所需的生物负荷基准水平。在至少 18 个月（平均 25.8 个月）的随访中，未检测到任何手术部位感染（SSI）或 PJI 事件（0/80；95%CI，0.00-3.68%）。
目前美国的通风设计采用低风速气流，似乎在手术部位达到了超净空气条件，但需要使用 SHS 和严格的方案。在后台区域观察到的更高污染水平与这种设计一致。
该沉降板系统可能有助于早期 PJI 事件的调查，从而降低这些并发症的发生率。
