Konopitski Andrew P, Jones Hugh, Mathis Kenneth B, Noble Philip C, Rodriguez-Quintana David
Department of Orthopaedic Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania.
Department of Orthopaedic Surgery, McGovern School of Medicine, UTHealth Houston, Bellaire, Texas.
J Arthroplasty. 2024 Sep;39(9):2377-2382. doi: 10.1016/j.arth.2024.04.066. Epub 2024 Apr 27.
Sterile surgical helmet systems are frequently utilized in total knee arthroplasty procedures to protect the surgeon while maintaining a comfortable working environment. However, common helmet systems pressurize the space between the surgical gown and the surgeon's skin. In gowns with a back seam, this may allow contaminated skin particles to escape into the surgical field. By measuring bacterial colony-forming units (CFUs), this study sought to determine if occlusion of the open back seam reduced the risk of potential contamination.
First, qualitative analysis depicting airflow variations between gown configurations was performed using the Schlieren Spherical Mirror imaging system. Each gown configuration consisted of a sterile surgical helmet and one of 3 gown configurations: a standard gown with rear-tied closure, a standard gown with a surgical vest, and a zippered Toga-style gown. Next, a surgeon then performed simulated surgical activities for 60 minutes within a 1.4 m isolation chamber with work surfaces and controllable filtered air exchanges. During each procedure, contaminated particles were collected on sets of agar settle plates positioned directly behind the surgeon. Upon completion, the agar plates were incubated in a biolab, and the number of bacterial and fungal CFUs was counted. The experimental procedure was repeated 12 times for each gown configuration, with sterilization of the chamber between runs. Contamination rates were expressed as CFUs/m/h.
The mean contamination rate measured with the standard gown was 331.7 ± 52.0 CFU/m/h. After the addition of a surgical vest, this rate decreased by 45% to 182.2 ± 30.8 CFU/m/h (P = .02). Similarly, with the Toga-style gown, contamination rates dropped by 49% to 170.5 ± 41.9 CFU/m/h (P = .01).
When used in conjunction with surgical helmet systems, conventional surgical gowns do not prevent potential contamination of the surgical field. We recommend that staff within the surgical field cover the back seam of standard gowns with a vest or don a zippered Toga-style gown.
无菌手术头盔系统常用于全膝关节置换手术中，在保持舒适工作环境的同时保护外科医生。然而，常见的头盔系统会对手术服与外科医生皮肤之间的空间施加压力。在有背部缝线的手术服中，这可能会使受污染的皮肤颗粒逸入手术区域。通过测量细菌菌落形成单位（CFU），本研究旨在确定封闭背部开口缝线是否能降低潜在污染风险。
首先，使用纹影球面镜成像系统对不同手术服配置之间的气流变化进行定性分析。每种手术服配置包括一个无菌手术头盔和三种手术服配置之一：后系扣标准手术服、带手术背心的标准手术服和拉链式托加袍。接下来，一名外科医生在一个1.4米的隔离室内进行60分钟的模拟手术活动，室内有工作面和可控的过滤空气交换。在每个手术过程中，污染颗粒收集在直接位于外科医生身后的琼脂沉降平板上。完成后，将琼脂平板在生物实验室中培养，并计算细菌和真菌CFU的数量。每种手术服配置的实验过程重复12次，每次运行之间对隔离室进行消毒。污染率以CFU/米/小时表示。
标准手术服测得的平均污染率为331.7±52.0 CFU/米/小时。添加手术背心后，该率下降了45%，降至182.2±30.8 CFU/米/小时（P = 0.02）。同样，使用托加袍时，污染率下降了49%，降至170.5±41.9 CFU/米/小时（P = 0.01）。
与手术头盔系统一起使用时，传统手术服不能防止手术区域的潜在污染。我们建议手术区域的工作人员用背心覆盖标准手术服的背部缝线或穿着拉链式托加袍。
