Tateiwa Toshiyuki, Masaoka Toshinori, Takahashi Yasuhito, Ishida Tsunehito, 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.
Arthroplasty. 2024 Oct 1;6(1):49. doi: 10.1186/s42836-024-00272-0.
Surgical site infection (SSI) is a major problem following total hip arthroplasty (THA). This study investigated the impact of a standard intraoperative routine where the surgical team wears full-body exhaust suits (space suits) within a laminar airflow (LAF)-ventilated operating room (OR) on environmental contamination. Our primary objective was to identify potential modifiable intraoperative factors that could be better controlled to minimize SSI risk.
We implemented an approach involving simultaneous and continuous air sampling throughout actual primary cementless THA procedures. This method concurrently monitored both airborne particle and microbial contamination levels from the time the patient entered the OR for surgery until extubation.
Airborne particulate and microbial contamination significantly increased during the first and second patient repositionings (postural changes) when the surgical team was not wearing space suits. However, their concentration exhibited inconsistent changes during the core surgical procedures, between incision and suturing, when the surgeons wore space suits. The microbial biosensor detected zero median microbes from draping to suturing. In contrast, the particle counter indicated a significant level of airborne particles during head resection and cup press-fitting, suggesting these procedures might generate more non-viable particles.
This study identified a significant portion of airborne particles during the core surgical procedures as non-viable, suggesting that monitoring solely for particle counts might not suffice to estimate SSI risk. Our findings strongly support the use of space suits for surgeons to minimize intraoperative microbial contamination within LAF-ventilated ORs. Therefore, minimizing unnecessary traffic and movement of unsterile personnel is crucial. Additionally, since our data suggest increased contamination during patient repositioning, effectively controlling contamination during the first postural change plays a key role in maintaining low microbial contamination levels throughout the surgery. The use of sterile gowns during this initial maneuver might further reduce SSIs. Further research is warranted to investigate the impact of sterile attire on SSIs.
手术部位感染（SSI）是全髋关节置换术（THA）后面临的一个主要问题。本研究调查了一种标准的术中常规操作的影响，即在层流气流（LAF）通风的手术室（OR）中，手术团队穿着全身排气服（太空服）对环境污染的影响。我们的主要目标是确定潜在的可改变的术中因素，这些因素可以得到更好的控制，以尽量降低SSI风险。
我们采用了一种方法，即在实际的初次非骨水泥THA手术过程中同时进行连续空气采样。该方法从患者进入手术室进行手术到拔管期间，同时监测空气传播颗粒和微生物污染水平。
在手术团队未穿太空服的情况下，在患者第一次和第二次重新定位（体位改变）期间，空气传播颗粒和微生物污染显著增加。然而，在核心手术过程中，即从切开到缝合期间，当外科医生穿着太空服时，它们的浓度呈现出不一致的变化。微生物生物传感器检测到从铺巾到缝合期间的微生物中位数为零。相比之下，粒子计数器显示在股骨头切除和髋臼压配期间存在显著水平的空气传播颗粒，表明这些操作可能产生更多的无生命颗粒。
本研究确定在核心手术过程中有很大一部分空气传播颗粒是无生命的，这表明仅监测颗粒计数可能不足以估计SSI风险。我们的研究结果有力地支持外科医生使用太空服，以尽量减少LAF通风手术室中的术中微生物污染。因此，尽量减少非无菌人员的不必要走动和移动至关重要。此外，由于我们的数据表明在患者重新定位期间污染增加，在第一次体位改变期间有效控制污染在维持整个手术过程中的低微生物污染水平方面起着关键作用。在这一初始操作过程中使用无菌手术衣可能会进一步降低SSI。有必要进行进一步的研究来调查无菌着装对SSI的影响。
