Stålfelt Frans, Tenghamn Johan, Malchau Henrik, Svensson Malchau Karin
Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Bone Jt Open. 2025 Apr 24;6(4):499-505. doi: 10.1302/2633-1462.64.BJO-2025-0002.
Surgical site infections (SSIs) are a major complication of orthopaedic implant surgeries, causing patient morbidity and reduced quality of life, and represent a substantial economic burden. Current methods for monitoring airborne contamination in operating theatres (OTs) are labour-intensive and delayed, limiting timely preventive actions. Advanced real-time monitoring technologies offer potential for improving infection control in surgical settings. This study evaluated real-time monitoring for airborne contamination; two scenarios were analyzed with the developed system: 1) the use of reusable non-disposable versus disposable surgical sheets; and 2) surgical team shift changes. SSI outcomes were also evaluated in relation to elevated particle levels.
This study was conducted in four OTs at Sahlgrenska University Hospital, Sweden. Particle counters were employed in each OT for detection of airborne contamination for continuous surveillance. SSIs leading to reoperations were extracted from national registries and integrated into the analysis.
The use of reusable surgical sheets significantly reduced airborne particle concentrations across all sizes (0.5, 1, 5, and 10 µm; p = 0.022, p = 0.004, p = 0.009, and p = 0.015, respectively) compared with single-use sheets. Team shift changes were associated with increased airborne particle levels for 0.5, 1, and 5.0 µm (p = 0.001, p = 0.004, and p = 0.009, respectively). While smaller particle concentrations showed no consistent association with SSIs, larger particles (10 µm) were significantly elevated in SSI cases (p = 0.005 for maximum values and p = 0.009 for mean values).
Real-time monitoring systems proved effective in identifying factors influencing airborne contamination in OTs. Notably, non-disposable sheets outperformed disposable sheets in minimizing particulate dispersion, and surgical events with team shift changes showed an increase in maximum particle levels. Although the system shows promise for infection prevention and workflow optimization, its direct impact on SSI rates requires validation in larger cohorts. Future research should focus on integrating predictive algorithms and machine-learning to enhance clinical utility and drive improvements in surgical safety.
手术部位感染（SSIs）是骨科植入手术的主要并发症，会导致患者发病并降低生活质量，还带来巨大的经济负担。当前监测手术室（OTs）空气传播污染的方法 labor-intensive 且延迟，限制了及时的预防措施。先进的实时监测技术为改善手术环境中的感染控制提供了潜力。本研究评估了空气传播污染的实时监测；使用开发的系统分析了两种情况：1）使用可重复使用的非一次性手术单与一次性手术单；2）手术团队轮班更换。还评估了与颗粒水平升高相关的手术部位感染结果。
本研究在瑞典萨尔格伦斯卡大学医院的四个手术室进行。每个手术室使用颗粒计数器检测空气传播污染以进行连续监测。从国家登记处提取导致再次手术的手术部位感染并纳入分析。
与一次性手术单相比，使用可重复使用的手术单在所有尺寸（0.5、1、5 和 10 微米）的空气传播颗粒浓度方面均显著降低（分别为 p = 0.022、p = 0.004、p = 0.009 和 p = 0.015）。团队轮班更换与 0.5、1 和 5.0 微米的空气传播颗粒水平升高相关（分别为 p = 0.001、p = 0.004 和 p = 0.009）。虽然较小颗粒浓度与手术部位感染没有一致的关联，但在手术部位感染病例中较大颗粒（10 微米）显著升高（最大值 p = 0.005，平均值 p = 0.009）。
实时监测系统被证明在识别影响手术室空气传播污染的因素方面是有效的。值得注意的是，非一次性手术单在最小化颗粒扩散方面优于一次性手术单，并且团队轮班更换的手术事件显示最大颗粒水平增加。尽管该系统在预防感染和优化工作流程方面显示出前景，但其对手术部位感染率的直接影响需要在更大的队列中进行验证。未来的研究应专注于整合预测算法和机器学习，以提高临床实用性并推动手术安全性的改善。
