Source strength as a measurement to define the ability of clean air suits to reduce airborne contamination in operating rooms

B Lytsy,A Hambraeus,B Ljungqvist,U Ransjö,B Reinmüller

doi:10.1016/j.jhin.2021.09.018

B Lytsy, A Hambraeus + Show 3 more

Open Access

https://doi.org/10.1016/j.jhin.2021.09.018

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Abstract

Surgical site infections after total hip and knee replacement are linked to the quality of the operating room (OR) air. Applying tight occlusive clothing, effective ventilation and correct working methods are key concepts to obtain low bacterial concentrations in the OR air. The dry penetration test referred to in European standard EN 13795-2:2019 is a screening method for materials used in surgical clothing. Source strength, defined as the dispersal of bacteria-carrying particles from persons during activity, is a functional test of clothing systems and has been calculated in a dispersal chamber and in ORs. Results from both tests can be used when comparing surgical clothing systems. This study relates results of dry penetration tests to source strength values for five surgical clothing systems available on the Swedish market. Experimental data are reported on the function of these products, expressed as source strength calculated from results in a dispersal chamber and in ORs during orthopaedic operations. All materials tested with dry penetration ≤50 colony-forming units (cfu) had source strength values <3 cfu/s for one person in the dispersal chamber, whereas the material of one product when laundered >50 times had source strength in the dispersal chamber of up to 8 cfu/s. The dry penetration test could predict the performance of clean air suits of the same design, but more studies are needed to obtain a more valid correlation. Requirements of source strength should be included in standards.

Highlights

Total hip and knee replacements are one of the most common orthopedic surgical procedures and are expected to increase further as the population ages [1, 2]
All materials tested fulfilled the requirement of dry penetration ≤ 50 cfu in EN 13795-2 for high performance clean air suit except material b when laundered more than
We have compared the dry penetration test for clean air suits used in the European standard (EN 13795-2:2019) for five operating room (OR) garments available in Sweden

Summary

Introduction

Total hip and knee replacements are one of the most common orthopedic surgical procedures and are expected to increase further as the population ages [1, 2]. Deep surgical site infections after total hip and knee replacement are a feared, costly, and disabling complication. These infections continue to occur; one study of 69 993 US Medicare patients receiving total knee replacements reported that 1400 (2 %) infections developed [4]. A source for deep surgical site infections after implant surgery is thought to originate from bacteria-carrying particles in the air of the operating room (OR) which deposit in the open wound and on surgical equipment [5, 6].

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