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Friedericy HJ, Friedericy AF, de Weger A, van Dorp ELA, Traversari RAAL, van der Eijk AC, Jansen FW. Effect of unidirectional airflow ventilation on surgical site infection in cardiac surgery: environmental impact as a factor in the choice for turbulent mixed air flow. J Hosp Infect 2024; 148:51-57. [PMID: 38537748 DOI: 10.1016/j.jhin.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Surgical site infection (SSI) in the form of postoperative deep sternal wound infection (DSWI) after cardiac surgery is a rare, but potentially fatal, complication. In addressing this, the focus is on preventive measures, as most risk factors for SSI are not controllable. Therefore, operating rooms are equipped with heating, ventilation and air conditioning (HVAC) systems to prevent airborne contamination of the wound, either through turbulent mixed air flow (TMA) or unidirectional air flow (UDAF). AIM To investigate if the risk for SSI after cardiac surgery was decreased after changing from TMA to UDAF. METHODS This observational retrospective single-centre cohort study collected data from 1288 patients who underwent open heart surgery over 2 years. During the two study periods, institutional SSI preventive measures remained the same, with the exception of the type of HVAC system that was used. FINDINGS Using multi-variable logistic regression analysis that considered confounding factors (diabetes, obesity, duration of surgery, and re-operation), the hypothesis that TMA is an independent risk factor for SSI was rejected (odds ratio 0.9, 95% confidence interval 0.4-1.8; P>0.05). It was not possible to demonstrate the preventive effect of UDAF on the incidence of SSI in patients undergoing open heart surgery when compared with TMA. CONCLUSION Based on these results, the use of UDAF in open heart surgery should be weighed against its low cost-effectiveness and negative environmental impact due to high electricity consumption. Reducing energy overuse by utilizing TMA for cardiac surgery can diminish the carbon footprint of operating rooms, and their contribution to climate-related health hazards.
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Affiliation(s)
- H J Friedericy
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - A F Friedericy
- Department of Health Sciences, Free University of Amsterdam, Amsterdam, The Netherlands
| | - A de Weger
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - E L A van Dorp
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - A C van der Eijk
- Operating Room Department and Central Sterile Supply Department, Leiden University Medical Centre, Leiden, The Netherlands
| | - F W Jansen
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands; Faculty of Biomedical Engineering, Delft University of Technology, Delft, The Netherlands
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Lans JLA, Mathijssen NMC, Bode A, van den Dobbelsteen JJ, van der Elst M, Luscuere PG. What is the effect of reducing the air change rate on the ventilation effectiveness in ultra-clean operating rooms? J Hosp Infect 2024; 147:115-122. [PMID: 38423130 DOI: 10.1016/j.jhin.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/20/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The operating room (OR) department is one of the most energy-intensive departments of a hospital. The majority of ORs in the Netherlands have an air-handling installation with an ultra-clean ventilation system. However, not all surgeries require an ultra-clean OR. AIM To determine the effect of reducing the air change rate on the ventilation effectiveness in ultra-clean ORs. METHODS Lower air volume ventilation effectiveness (VELv) of conventional ventilation (CV), controlled dilution ventilation (cDV), temperature-controlled airflow (TcAF) and unidirectional airflow (UDAF) systems were evaluated within a 4 × 4 m measuring grid of 1 × 1 m. The VELv was defined as the recovery degree (RD), cleanliness recovery rate (CRR) and air change effectiveness (ACE). FINDINGS The CV, cDVLv and TcAFLv ventilation systems showed a comparable mixing character in all areas (A, B and AB) when reducing the air change rate to 20/h. Ventilation effectiveness decreased when the air change rate was reduced, with the exception of the ACE. At all points for the UDAF-2Lv and at the centre point (C3) of the TcAFLv, higher RD10Lv and CRRLv were measured when compared with the other examined ventilation systems. CONCLUSIONS The ventilation effectiveness decreased when an ultra-clean OR with an ultra-clean ventilation air-supply system was switched to an air change rate of 20/h. Reducing the air change rate in the OR from an ultra-clean OR to a generic OR will reduce the recovery degree (RD10) by a factor of 10-100 and the local air change rate (CRR) by between 42% and 81%.
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Affiliation(s)
- J L A Lans
- Faculty Architecture and the Built Environment, Delft University of Technology, Delft, The Netherlands.
| | - N M C Mathijssen
- RHOC, Reinier Haga Orthopaedic Center, Zoetermeer, The Netherlands; Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - A Bode
- Expert/Advisor Healthcare and Construction, IJsselstein, The Netherlands
| | - J J van den Dobbelsteen
- Faculty of Mechanical Engineering (ME), Delft University of Technology, Delft, The Netherlands
| | - M van der Elst
- Faculty of Mechanical Engineering (ME), Delft University of Technology, Delft, The Netherlands; Department of Trauma surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - P G Luscuere
- Faculty Architecture and the Built Environment, Delft University of Technology, Delft, The Netherlands
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Termaat J, Tighe R, Kopf L, Voss LJ. Seeing is Believing: Chasing Sevoflurane Vapor Trails. J Perianesth Nurs 2024; 39:235-239. [PMID: 37999688 DOI: 10.1016/j.jopan.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/02/2023] [Accepted: 07/23/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE Sevoflurane is an inhalational general anesthetic that has been used recently to treat chronic, painful lesions, reportedly supporting analgesia and wound healing. The potential for repeated exposure to off-gassed sevoflurane vapor, especially outside the air-conditioned operating theatre environment, is of some concern. DESIGN This paper explores the qualitative and quantitative pathing of off-gassed sevoflurane from a topically applied liquid source. METHODS Using a small, unventilated test-box (total volume 0.5 m3) with infra-red imaging and gas-analysing, we investigated the spatial distribution of sevoflurane vapor following complete vaporization of a 20 mL liquid sample. Utilizing the infra-red absorption of sevoflurane, it was possible to visualize (as an apparent reduction in temperature) the streaming path of the sevoflurane vapor. Sevoflurane levels (%) in the test-box were measured using an infra-red gas analyzer. FINDINGS In keeping with its higher density than air, sevoflurane vapor was seen to "waterfall" from the liquid source and accumulate in the bottom of the test-box. Sevoflurane vapor concentration was minimal above the liquid source. When extrapolated to a larger (unventilated) room, we estimate that the sevoflurane concentration would be less than 10 ppm one centimetre above the liquid pool. With vacuum extraction, these levels would be even lower. CONCLUSIONS Due to sevoflurane's tendency to accumulate on the floor, it is concluded that topical application of liquid sevoflurane posses virtually no risk to off-gas exposure in unventilated spaces.
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Affiliation(s)
- Jonathan Termaat
- Anesthesia Department, Te Whatu Ora Health New Zealand Waikato, Waikato Hospital, Hamilton, New Zealand
| | - Rachael Tighe
- School of Engineering, University of Waikato, Hamilton, New Zealand
| | - Larissa Kopf
- School of Engineering, University of Waikato, Hamilton, New Zealand
| | - Logan J Voss
- Anesthesia Department, Te Whatu Ora Health New Zealand Waikato, Waikato Hospital, Hamilton, New Zealand.
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Gonzalez-Pizarro P, Brazzi L, Koch S, Trinks A, Muret J, Sperna Weiland N, Jovanovic G, Cortegiani A, Fernandes TD, Kranke P, Malisiova A, McConnell P, Misquita L, Romero CS, Bilotta F, De Robertis E, Buhre W. European Society of Anaesthesiology and Intensive Care consensus document on sustainability: 4 scopes to achieve a more sustainable practice. Eur J Anaesthesiol 2024; 41:260-277. [PMID: 38235604 DOI: 10.1097/eja.0000000000001942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Climate change is a defining issue for our generation. The carbon footprint of clinical practice accounts for 4.7% of European greenhouse gas emissions, with the European Union ranking as the third largest contributor to the global healthcare industry's carbon footprint, after the United States and China. Recognising the importance of urgent action, the European Society of Anaesthesiology and Intensive Care (ESAIC) adopted the Glasgow Declaration on Environmental Sustainability in June 2023. Building on this initiative, the ESAIC Sustainability Committee now presents a consensus document in perioperative sustainability. Acknowledging wider dimensions of sustainability, beyond the environmental one, the document recognizes healthcare professionals as cornerstones for sustainable care, and puts forward recommendations in four main areas: direct emissions, energy, supply chain and waste management, and psychological and self-care of healthcare professionals. Given the urgent need to cut global carbon emissions, and the scarcity of evidence-based literature on perioperative sustainability, our methodology is based on expert opinion recommendations. A total of 90 recommendations were drafted by 13 sustainability experts in anaesthesia in March 2023, then validated by 36 experts from 24 different countries in a two-step Delphi validation process in May and June 2023. To accommodate different possibilities for action in high- versus middle-income countries, an 80% agreement threshold was set to ease implementation of the recommendations Europe-wide. All recommendations surpassed the 80% agreement threshold in the first Delphi round, and 88 recommendations achieved an agreement >90% in the second round. Recommendations include the use of very low fresh gas flow, choice of anaesthetic drug, energy and water preserving measures, "5R" policies including choice of plastics and their disposal, and recommendations to keep a healthy work environment or on the importance of fatigue in clinical practice. Executive summaries of recommendations in areas 1, 2 and 3 are available as cognitive aids that can be made available for quick reference in the operating room.
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Affiliation(s)
- Patricio Gonzalez-Pizarro
- From the Department of Paediatric Anaesthesia and Critical Care. La Paz University Hospital, Madrid, Spain (PGP), the Department of Anaesthesia, Intensive Care and Emergency, 'Citta' della Salute e della Scienza' University Hospital, Department of Surgical Science, University of Turin, Turin, Italy (LB), the University of Southern Denmark (SDU) Odense, Department of Anesthesia, Hospital of Nykobing Falster, Denmark (SK), the Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt Universität zu Berlin, Campus Charité Mitte, and Campus Virchow Klinikum (SK), the Department of Anaesthesiology. LMU University Hospital, LMU Munich, Germany (AT), the Department of Anaesthesia and Intensive Care. Institute Curie & PSL Research University, Paris, France (JM), the Department of Anaesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands (NSW), the Department of Anaesthesia and Perioperatve Medicine. Medical Faculty, University of Novi Sad, Novi Sad, Serbia (GJ), the Department of Surgical, Oncological and Oral Science, University of Palermo, Italy. Department of Anesthesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, Palermo, Italy (AC), the Department of Anaesthesiology, Hospital Pedro Hispano, Matosinhos, Portugal (TDF), the Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Germany (PK), the Department of Anaesthesiology and Pain. P&A Kyriakou Children's Hospital Athens Greece (AM), Royal Alexandra Hospital. Paisley, Scotland, United Kingdom (PM), Department of Neuro-anaesthesia and Neurocritical Care, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, England, United Kingdom (LM), the Department of Anesthesia, Critical care and Pain Unit, Hospital General Universitario de Valencia. Research Methods Department, European University of Valencia, Spain (CR), the "Sapienza" University of Rome, Department of Anesthesiology and Critical Care, Rome, Italy (FB), the Division of Anaesthesia, Analgesia, and Intensive Care - Department of Medicine and Surgery - University of Perugia Ospedale S. Maria della Misericordia, Perugia, Italy (EDR), the Division of Anaesthesiology, Intensive Care and Emergency Medicine, Department of Anaesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands (WB)
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Kek HY, Tan H, Othman MHD, Nyakuma BB, Ho WS, Sheng DDCV, Kang HS, Chan YT, Lim NHAS, Leng PC, Wahab NHA, Wong KY. Critical review on airborne microplastics: An indoor air contaminant of emerging concern. ENVIRONMENTAL RESEARCH 2024; 245:118055. [PMID: 38154562 DOI: 10.1016/j.envres.2023.118055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/15/2023] [Accepted: 12/25/2023] [Indexed: 12/30/2023]
Abstract
Airborne Microplastics (MPs), an emerging environmental issue, have gained recent attention due to their newfound presence in indoor environments. Utilizing the Web of Science database for literature collection, the paper presents a comprehensive review of airborne MPs including emission sources, assessment methods, exposure risks, and mitigation strategies. This review delves into the diverse sources and mechanisms influencing indoor airborne MP pollution, underscoring the complex interplay between human activities, ventilation systems, and the characteristics of indoor environments. Major sources include the abrasion of synthetic textiles and the deterioration of flooring materials, with factors like carpeting, airflow, and ventilation significantly impacting MP levels. Human activities, such as increased movement in indoor spaces and the intensive use of plastic-based personal protective equipment (PPE) post-pandemic, notably elevate indoor MP concentrations. The potential health impacts of airborne MPs are increasingly concerning, with evidence suggesting their role in respiratory, immune, and nervous system diseases. Despite this, there is a scarcity of information on MPs in diverse indoor environments and the inhalation risks associated with the frequent use of PPE. This review also stresses the importance of developing effective strategies to reduce MP emissions, such as employing HEPA-filtered vacuums, minimizing the use of synthetic textiles, and enhancing indoor ventilation. Several future research directions were proposed, including detailed temporal analyses of indoor MP levels, interactions of MP with other atmospheric pollutants, the transport dynamics of inhalable MPs (≤10 μm), and comprehensive human exposure risk assessments.
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Affiliation(s)
- Hong Yee Kek
- Faculty of Mechanical Engineering, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia
| | - Huiyi Tan
- Faculty of Chemical and Energy Engineering, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia
| | - Mohd Hafiz Dzarfan Othman
- Advanced Membrane Technology Research Centre (AMTEC), Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia
| | - Bemgba Bevan Nyakuma
- Department of Chemical Sciences, Faculty of Science and Computing, Pen Resource University, P. M. B. 086, Gombe, Gombe State, Nigeria
| | - Wai Shin Ho
- Faculty of Chemical and Energy Engineering, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia
| | | | - Hooi Siang Kang
- Faculty of Mechanical Engineering, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia; Marine Technology Centre, Institute for Vehicle System & Engineering, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia
| | - Yoon Tung Chan
- Faculty of Civil Engineering, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia
| | | | - Pau Chung Leng
- Faculty of Built Environment and Surveying, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia
| | | | - Keng Yinn Wong
- Faculty of Mechanical Engineering, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia.
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Tian Y. A review on factors related to patient comfort experience in hospitals. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:125. [PMID: 37941052 PMCID: PMC10634154 DOI: 10.1186/s41043-023-00465-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023]
Abstract
The creation of a welcoming hospital atmosphere is necessary to improve patient wellbeing and encourage healing. The goal of this study was to examine the variables affecting hospitalised patients' comfort. The study procedure included a thorough search of the Web of Science and Scopus databases, as well as the use of software analytic tools to graphically map enormous literature data, providing a deeper understanding of the linkages within the literature and its changing patterns. Insights from a range of disciplines, including engineering, psychology, immunology, microbiology, and environmental science, were included into our study using content analysis and clustering approaches. The physical environment and the social environment are two crucial factors that are related to patient comfort. The study stress the need of giving patient comfort a top priority as they heal, especially by tackling indoor air pollution. Our research also emphasises how important hospital care and food guidelines are for improving patient comfort. Prioritising patients who need specialised care and attention, especially those who have suffered trauma, should be the focus of future study. Future research in important fields including trauma, communication, hospital architecture, and nursing will be built on the findings of this study. To enhance research in these crucial areas, worldwide collaboration between experts from other nations is also advised. Although many studies stress the significance of patient comfort, few have drawn conclusions from a variety of disciplines, including medicine, engineering, immunology, microbiology, and environmental science, the most crucial issue of thoroughly researching the improvement of patient comfort has not been addressed. Healthcare workers, engineers, and other professions will benefit greatly from this study's investigation of the connection between hospital indoor environments and patient comfort.
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Affiliation(s)
- Yu Tian
- Department of Mechanical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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Shen M, Sicat CS, Schwarzkopf R, Slover JD, Bosco JA, Rozell JC. Larger operating rooms have better air quality than smaller rooms in primary total knee arthroplasty. Arch Orthop Trauma Surg 2023; 143:6335-6338. [PMID: 37099163 DOI: 10.1007/s00402-023-04886-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/10/2023] [Indexed: 04/27/2023]
Abstract
INTRODUCTION Operating room air quality can be affected by several factors including temperature, humidity, and airborne particle burden. Our study examines the role of operating room (OR) size on air quality and airborne particle (ABP) count in primary total knee arthroplasty (TKA). MATERIALS AND METHODS We analyzed all primary, elective TKAs performed within two ORs measuring 278 sq ft. (small) and 501 sq ft. (large) at a single academic institution in the United States from April 2019 to June 2020. Intraoperative measurements of temperature, humidity, and ABP count were recorded. p values were calculated using t test for continuous variables and chi-square for categorical values. RESULTS 91 primary TKA cases were included in the study, with 21 (23.1%) in the small OR and 70 (76.9%) in the large OR. Between-groups comparisons revealed significant differences in relative humidity (small OR 38.5% ± 7.24% vs. large OR 44.4% ± 8.01%, p = 0.002). Significant percent decreases in ABP rates for particles measuring 2.5 μm (- 43.9%, p = 0.007) and 5.0 μm (- 69.0%, p = 0.0024) were found in the large OR. Total time spent in the OR was not significantly different between the two groups (small OR 153.09 ± 22.3 vs. large OR 173 ± 44.6, p = 0.05). CONCLUSIONS Although total time spent in the room did not differ between the large and small OR, there were significant differences in humidity and ABP rates for particles measuring 2.5 μm and 5.0 μm, suggesting the filtration system encounters less particle burden in larger rooms. Larger studies are required to determine the impact this may have on OR sterility and infection rates.
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Affiliation(s)
- Michelle Shen
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th St, New York, NY, 10010, USA.
| | - Chelsea Sue Sicat
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th St, New York, NY, 10010, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th St, New York, NY, 10010, USA
| | - James D Slover
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th St, New York, NY, 10010, USA
| | - Joseph A Bosco
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th St, New York, NY, 10010, USA
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th St, New York, NY, 10010, USA
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Dexter F, Epstein RH, Loftus RW. Quantifying and Interpreting Inequality in Surgical Site Infections per Quarter Among Anesthetizing Locations and Specialties. Cureus 2023; 15:e36878. [PMID: 37123760 PMCID: PMC10147407 DOI: 10.7759/cureus.36878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 03/31/2023] Open
Abstract
Background Earlier studies have shown that prevention of surgical site infection can achieve net cost savings when targeted to operating rooms with the most surgical site infections. Methodology This retrospective cohort study included all 231,057 anesthetics between May 2017 and June 2022 at a large teaching hospital. The anesthetics were administered in operating rooms, procedure rooms, radiology, and other sites. The 8,941 postoperative infections were identified from International Classification of Diseases diagnosis codes relevant to surgical site infections documented during all follow-up encounters over 90 days postoperatively. To quantify the inequality in the counts of infections among anesthetizing locations, the Gini index was used, with the Gini index being proportional to the sum of the absolute pairwise differences among anesthetizing locations in the counts of infections. Results The Gini index for infections among the 112 anesthetizing locations at the hospital was 0.64 (99% confidence interval = 0.56 to 0.71). The value of 0.64 is so large that, for comparison, it exceeds nearly all countries' Gini index for income inequality. The 50% of locations with the fewest infections accounted for 5% of infections. The 10% of locations with the most infections accounted for 40% of infections and 15% of anesthetics. Among the 57 operating room locations, there was no association between counts of cases and infections (Spearman correlation coefficient r = 0.01). Among the non-operating room locations (e.g., interventional radiology), there was a significant association (Spearman r = 0.79). Conclusions Targeting specific anesthetizing locations is important for the multiple interventions to reduce surgical site infections that represent fixed costs irrespective of the number of patients (e.g., specialized ventilatory systems and nightly ultraviolet-C disinfection).
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Liu Z, Ma J, Lv J, Wang Y, He J, Yao G, Cao G. Transmission characteristics of infectious pathogen-laden aerosols in a negative-pressure operating room. JOURNAL OF HAZARDOUS MATERIALS 2023; 446:130650. [PMID: 36580790 DOI: 10.1016/j.jhazmat.2022.130650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
The infectious pathogen-laden aerosols generated by infected patients have a significant impact on the safety of surgical staff in highly clean negative-pressure operating rooms. Understanding the transmission characteristics of infectious pathogen-laden aerosols is therefore essential. Therefore, in this study, we conducted experiments in a full-size negative-pressure operating room, and the Phi-X174 phage was used as a bioaerosol release source to investigate the migration and deposition of bioaerosols. The high-concentration spatial regions and high-concentration deposition surfaces of the bioaerosols in the operating room were determined. The results showed that there was a high concentration of bioaerosols in the vortex region below the medical lamp for extended periods of time. Three surgical staff members close to the patient's surgical site had high bioaerosol concentrations at their facial sampling points, with the highest concentration reaching 16,553 PFU/m³ . At the end of bioaerosol generation, 99.9% of the bioaerosols were discharged within 10 mins. The bioaerosol deposition rates per unit area were high at 1.48%/m2, 0.46%/m2 and 1.79%/m2 for the central control panel, storage cabinet, and door surface, respectively. This research can be used as a scientific reference for controlling bioaerosols and determining key disinfection parts in a negative-pressure operating room.
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Affiliation(s)
- Zhijian Liu
- School of Energy and Power Engineering, North China Electric Power University, Baoding 071003, China.
| | - Juntao Ma
- School of Energy and Power Engineering, North China Electric Power University, Baoding 071003, China
| | - Jiabin Lv
- School of Energy and Power Engineering, North China Electric Power University, Baoding 071003, China
| | - Yongxin Wang
- School of Energy and Power Engineering, North China Electric Power University, Baoding 071003, China
| | - Junzhou He
- School of Energy and Power Engineering, North China Electric Power University, Baoding 071003, China
| | - Guangpeng Yao
- School of Energy and Power Engineering, North China Electric Power University, Baoding 071003, China
| | - Guoqing Cao
- Institute of Building Environment and Energy, China Academy of Building Research, Beijing 100013, PR China
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Peng G, Gao Q, Dong Z, Liang L, Chen J, Zhu C, Zhang P, Lu L. Surface Cleanliness Maintenance with Laminar Flow Based on the Characteristics of Laser-Induced Sputtering Particles in High-Power Laser Systems. MICROMACHINES 2023; 14:598. [PMID: 36985007 PMCID: PMC10051549 DOI: 10.3390/mi14030598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
In high-power laser systems, the primary cause of contamination of optical components and degradation of spatial cleanliness is laser-induced sputtering of particles. To mitigate this problem, laminar flow is frequently utilized to control the direction and transport of these particles. This study characterizes the properties of laser-induced sputtering particles, including their flying trend, diameter range, and velocity distribution at varying time intervals. A time-resolved imaging method was employed to damage the rear surface of fused silica using a 355 nm Nd: YAG pump laser. The efficacy of laminar flow in controlling these particles was then assessed, with a particular focus on the influence of laminar flow direction, laminar flow velocity, particle flight height, and particle diameter. Our results indicate that the optimal laminar flow velocity for preventing particle invasion is highly dependent on the maximum particle attenuation distance (or safety distance), which can vary by up to two orders of magnitude. Furthermore, a laminar flow velocity of 0.5 m/s can effectively prevent particle sedimentation. Future research will aim to optimize laminar flow systems based on these findings to achieve high surface cleanliness in high-power laser systems with minimal energy consumption.
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Affiliation(s)
- Ge Peng
- Center for Precision Engineering, School of Mechatronics Engineering, Harbin Institute of Technology, West Dazhi Street, Harbin 150001, China
| | - Qiang Gao
- Center for Precision Engineering, School of Mechatronics Engineering, Harbin Institute of Technology, West Dazhi Street, Harbin 150001, China
- Chongqing Research Institute of Harbin Institute of Technology, Chongqing 401135, China
| | - Zhe Dong
- Center for Precision Engineering, School of Mechatronics Engineering, Harbin Institute of Technology, West Dazhi Street, Harbin 150001, China
| | - Lingxi Liang
- National Key Laboratory of Science and Technology on Tunable Laser, Harbin Institute of Technology, West Dazhi Street, Harbin 150080, China
| | - Jiaxuan Chen
- Center for Precision Engineering, School of Mechatronics Engineering, Harbin Institute of Technology, West Dazhi Street, Harbin 150001, China
| | - Chengyu Zhu
- National Key Laboratory of Science and Technology on Tunable Laser, Harbin Institute of Technology, West Dazhi Street, Harbin 150080, China
| | - Peng Zhang
- Center for Precision Engineering, School of Mechatronics Engineering, Harbin Institute of Technology, West Dazhi Street, Harbin 150001, China
| | - Lihua Lu
- Center for Precision Engineering, School of Mechatronics Engineering, Harbin Institute of Technology, West Dazhi Street, Harbin 150001, China
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Bolten A, Kringos DS, Spijkerman IJB, Sperna Weiland NH. The carbon footprint of the operating room related to infection prevention measures: a scoping review. J Hosp Infect 2022; 128:64-73. [PMID: 35850380 DOI: 10.1016/j.jhin.2022.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Infection prevention measures are widely used in operating rooms (ORs). However, the extent to which they are at odds with ambitions to reduce the health sector's carbon footprint remains unclear. AIM To synthesize the evidence base for the carbon footprint of commonly used infection prevention measures in the OR, namely medical devices and instruments, surgical attire and air treatment systems. METHODS A scoping review of the international scientific literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search was performed in PubMed and Google Scholar. Articles published between 2010 and June 2021 on infection prevention measures, their impact on the health sector's carbon footprint, and risk for surgical site infections (SSIs) were included. FINDINGS Although hospitals strive to reduce their carbon footprint, many infection prevention measures result in increased emissions. Evidence suggests that the use of disposable items instead of reusable items generally increases the carbon footprint, depending on sources of electricity. Controversy exists regarding the correlation between air treatment systems, contamination and the incidence of SSIs. The literature indicates that new air treatment systems consume more energy and do not necessarily reduce SSIs compared with conventional systems. CONCLUSION Infection prevention measures in ORs can be at odds with sustainability. The use of new air treatment systems and disposable items generally leads to significant greenhouse gas emissions, and does not necessarily reduce the incidence of SSIs. Alternative infection prevention measures with less environmental impact are available. Implementation could be facilitated by embracing environmental impact as an additional dimension of quality of care, which should change current risk-based approaches for the prevention of SSIs.
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Affiliation(s)
- A Bolten
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - D S Kringos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - I J B Spijkerman
- Department of Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - N H Sperna Weiland
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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Abuljadail S, Akkaya M, Sangaletti R, Sandiford N, Gehrke T, Citak M. Is the risk of periprosthetic joint infection in patients undergoing total hip and knee joint arthroplasty in the multi-unit operating room higher than in the classical single-unit operating room? INTERNATIONAL ORTHOPAEDICS 2022; 46:1465-1471. [PMID: 35411435 DOI: 10.1007/s00264-022-05391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study was performed to answer the question: Is the risk of PJI in patients undergoing primary TKA and THA in multi-unit OR higher than in a classical single-unit OR? We hypothesized that the risk of PJI following TKA and THA is not associated with the OR type. METHODS We reviewed the medical records of all cases of THA and TKA in our centre, between January 2015 and September 2018, in our single- and multi-unit OR. A total of 8674 patients met the inclusion criteria. Patients were divided into two groups: group 1, surgery in the multi-unit OR (n = 8282); group 2, surgery in the single-unit OR (n = 450). The infection rate between both groups was compared using chi-square test. RESULTS There was no significant difference between both groups regarding the septic revision rate at three (p = 0.1 and 0.58 respectively) and six months post-operatively (p = 0.22 and 0.7 respectively). In group 1, five patients after TKA and 4 patients after THA were revised within three months. At six months, 11 patients after TKA and six patients after THA required revision surgery. In group 2, one patient after TKA and one patient after THA were revised within three months. At six months, one patient after TKA and one patient after THA underwent revision surgery. CONCLUSION The incidence of SSI does not differ significantly based on OR design in patients undergoing TKA and THA. The number of patients per surgical table in multi-unit OR is higher than in the single-unit OR. This shows that more number of surgeries can be achieved in multi-unit OR and as safe as single-unit OR.
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Affiliation(s)
| | - Mustafa Akkaya
- Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Rudy Sangaletti
- Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Nemandra Sandiford
- Department of Orthopaedic Surgery, Southland Teaching Hospital, Invercargill, New Zealand
| | - Thorsten Gehrke
- Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Mustafa Citak
- Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
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A systematic review and meta-analysis of indoor bioaerosols in hospitals: The influence of heating, ventilation, and air conditioning. PLoS One 2021; 16:e0259996. [PMID: 34941879 PMCID: PMC8699671 DOI: 10.1371/journal.pone.0259996] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To evaluate (1) the relationship between heating, ventilation, and air conditioning (HVAC) systems and bioaerosol concentrations in hospital rooms, and (2) the effectiveness of laminar air flow (LAF) and high efficiency particulate air (HEPA) according to the indoor bioaerosol concentrations. METHODS Databases of Embase, PubMed, Cochrane Library, MEDLINE, and Web of Science were searched from 1st January 2000 to 31st December 2020. Two reviewers independently extracted data and assessed the quality of the studies. The samples obtained from different areas of hospitals were grouped and described statistically. Furthermore, the meta-analysis of LAF and HEPA were performed using random-effects models. The methodological quality of the studies included in the meta-analysis was assessed using the checklist recommended by the Agency for Healthcare Research and Quality. RESULTS The mean CFU/m3 of the conventional HVAC rooms and enhanced HVAC rooms was lower than that of rooms without HVAC systems. Furthermore, the use of the HEPA filter reduced bacteria by 113.13 (95% CI: -197.89, -28.38) CFU/m3 and fungi by 6.53 (95% CI: -10.50, -2.55) CFU/m3. Meanwhile, the indoor bacterial concentration of LAF systems decreased by 40.05 (95% CI: -55.52, -24.58) CFU/m3 compared to that of conventional HVAC systems. CONCLUSIONS The HVAC systems in hospitals can effectively remove bioaerosols. Further, the use of HEPA filters is an effective option for areas that are under-ventilated and require additional protection. However, other components of the LAF system other than the HEPA filter are not conducive to removing airborne bacteria and fungi. LIMITATION OF STUDY Although our study analysed the overall trend of indoor bioaerosols, the conclusions cannot be extrapolated to rare, hard-to-culture, and highly pathogenic species, as well as species complexes. These species require specific culture conditions or different sampling requirements. Investigating the effects of HVAC systems on these species via conventional culture counting methods is challenging and further analysis that includes combining molecular identification methods is necessary. STRENGTH OF THE STUDY Our study was the first meta-analysis to evaluate the effect of HVAC systems on indoor bioaerosols through microbial incubation count. Our study demonstrated that HVAC systems could effectively reduce overall bioaerosol concentrations to maintain better indoor air quality. Moreover, our study provided further evidence that other components of the LAF system other than the HEPA filter are not conducive to removing airborne bacteria and fungi. PRACTICAL IMPLICATION Our research showed that HEPA filters are more effective at removing bioaerosols in HVAC systems than the current LAF system. Therefore, instead of opting for the more costly LAF system, a filter with a higher filtration rate would be a better choice for indoor environments that require higher air quality; this is valuable for operating room construction and maintenance budget allocation.
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Annaqeeb MK, Zhang Y, Dziedzic JW, Xue K, Pedersen C, Stenstad LI, Novakovic V, Cao G. Influence of surgical team activity on airborne bacterial distribution in the operating room with a mixing ventilation system: a case study at St. Olavs Hospital. J Hosp Infect 2021; 116:91-98. [PMID: 34403767 DOI: 10.1016/j.jhin.2021.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Operating rooms (ORs) have strict requirements regarding cleanliness. While existing standards concerning the ventilation and staff guidelines are theoretically sufficient to subvert the threats posed by micro-organisms within the room, there exist potential sources of contamination due to human activity around the area. Studies exploring this influence of human activity on distribution of micro-organism contamination in ORs have relied on manual observations, or indirect methods such as number of door openings. AIM To utilize depth registration sensing technology to identify the activities of surgical staff and investigate their effect on the distribution of airborne micro-organism contamination in ORs. METHODS A mock surgical experiment was performed using a depth registration technique for the dynamic capturing of human presence and activity levels. Field measurements were carried out in one real OR to analyse its influence on the bacterial distribution in ORs with mixing ventilation system. FINDINGS Bacterial contamination levels tended to correlate with higher activity levels, albeit with some inconsistencies. The highest activity levels were around the surgical bed when the patient was placed, and around the instrument table during the surgical procedure. Locations with obstructions had the highest cfu densities, indicating that airflow patterns are important in such spaces. CONCLUSION Our activity monitoring methods demonstrate a novel means of studying the influences of human activities in hospital rooms.
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Affiliation(s)
- M K Annaqeeb
- Department of Energy and Process Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - Y Zhang
- College of Civil Engineering and Architecture, Hainan University, Haikou, China.
| | - J W Dziedzic
- Department of Energy and Process Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Xue
- School of Civil Engineering, Chongqing University, Chongqing, China
| | - C Pedersen
- MultiConsult Norge AS, Seksjon VVS Tromsø, Norway
| | - L I Stenstad
- St. Olavs Hospital, Operating Room of the Future, Trondheim, Norway
| | - V Novakovic
- Department of Energy and Process Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - G Cao
- Department of Energy and Process Engineering, Norwegian University of Science and Technology, Trondheim, Norway
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Marsault LV, Ravn C, Overgaard A, Frich LH, Olsen M, Anstensrud T, Nielsen J, Overgaard S. Laminar airflow versus turbulent airflow in simulated total hip arthroplasty: measurements of colony-forming units, particles, and energy consumption. J Hosp Infect 2021; 115:117-123. [PMID: 34182062 DOI: 10.1016/j.jhin.2021.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/14/2021] [Accepted: 06/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The optimal type of ventilation in operating theatres for joint arthroplasty has been debated for decades. Recently, the World Health Organization changed its recommendations based on articles that have since been criticized. The economic and environmental impact of ventilation is also currently an important research topic but has not been well investigated. AIM To compare how large, high-volume, laminar airflow (LAF) and turbulent airflow (TAF) ventilation systems perform during standardized simulated total hip arthroplasty (THA), as they pertain to colony-forming units (cfu), particle counts, and energy consumption. METHODS Two identical operating theatres were used to perform simulated THA. The only difference was that one was equipped with LAF and the other with TAF. Cfu and particles were collected from key points in the operating theatre, and energy was measured for each simulation. Thirty-two simulations were done in total. FINDINGS LAF had significantly reduced cfu and particle count when compared with TAF, at both 100% and 50% air influx. Furthermore, it was shown that lowering the air influx by 50% in LAF did not significantly affect cfu or particles, although reducing the fresh air influx from 100% to 50% significantly lowered the energy consumption. Most simulations in TAF did not meet the cleanroom requirements. CONCLUSION Cfu were significantly lower in LAF at both 100% and 50% air influx. It is possible to reduce fresh air influx in LAF operating theatres by 50%, significantly reducing energy consumption, while still maintaining cfu and particle counts below the ISO classification threshold required for THA surgery.
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Affiliation(s)
- L V Marsault
- Odense University Hospital, Department of Orthopaedic Surgery and Traumatology, Odense, Denmark
| | - C Ravn
- Odense University Hospital, Department of Orthopaedic Surgery and Traumatology, Odense, Denmark; Kolding Hospital Lillebaelt, Department of Orthopaedic Surgery and Traumatology, Kolding, Denmark
| | - A Overgaard
- Gentofte-Herlev Hospital, Department of Orthopaedic Surgery and Traumatology, Hellerup, Denmark; The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L H Frich
- University of Southern Denmark, Department of Clinical Research, Odense, Denmark
| | | | | | - J Nielsen
- Fournais Energy ApS, Vedbæk, Denmark
| | - S Overgaard
- Odense University Hospital, Department of Orthopaedic Surgery and Traumatology, Odense, Denmark; University of Southern Denmark, Department of Clinical Research, Odense, Denmark; Copenhagen University Hospital, Bispebjerg, Department of Orthopaedic Surgery and Traumatology, Copenhagen; University of Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Denmark.
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16
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Dexter F, Epstein RH, Loftus RW. Quantifying and interpreting inequality of surgical site infections among operating rooms. Can J Anaesth 2021; 68:812-824. [PMID: 33547628 DOI: 10.1007/s12630-021-01931-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 01/27/2023] Open
Abstract
PURPOSE The incidence of surgical site infection differs among operating rooms (ORs). However, cost effectiveness of interventions targeting ORs depends on infection counts. The purpose of this study was to quantify the inequality of infection counts among ORs. METHODS We performed a single-centre historical cohort study of elective surgical cases spanning a 160-week period from May 2017 to May 2020, identifying cases of infection within 90 days using International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes. We used the Gini index to measure inequality of infections among ORs. As a reference, the Gini index for inequality of household disposable income in the US in 2017 was 0.39, and 0.31 for Canada. RESULTS There were 3,148 (3.67%) infections among the 85,744 cases studied. The 20% of 57 ORs with the most and least infections accounted for 44% (99% confidence interval [CI], 36 to 52) and 5% (99% CI, 2 to 8), respectively. The Gini index was 0.40 (99% CI, 0.31 to 0.50), which is comparable to income inequality in the US. There were more infections in ORs with more minutes of cases (Spearman correlation ρ = 0.68; P < 0.001), but generally not in ORs with more total cases (ρ = 0.11; P = 0.43). Moderately long (3.3 to 4.8 hr) cases had a large effect, having greater incidences of infection, while not being so long as to have just one case per day per OR. There was substantially greater inequality in infection counts among the 557 observed combinations of OR specialty (Gini index 0.85; 99% CI, 0.81 to 0.88). CONCLUSIONS Inequality of infections among ORs is substantial and caused by both inequality in the incidence of infections and inequality in the total minutes of cases. Inequality in infections among OR and specialty combinations is due principally to inequality in total minutes of cases.
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Affiliation(s)
- Franklin Dexter
- Division of Management Consulting, Department of Anesthesia, University of Iowa, 200 Hawkins Drive, 6-JCP, Iowa City, IA, 52242, USA.
| | | | - Randy W Loftus
- Department of Anesthesia, University of Iowa, Iowa City, IA, USA
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17
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Operating room air delivery design to protect patient and surgical site results in particles released at surgical table having greater concentration along walls of the room than at the instrument tray. Am J Infect Control 2021; 49:593-596. [PMID: 33039512 PMCID: PMC7544698 DOI: 10.1016/j.ajic.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 11/04/2022]
Abstract
Background During the coronavirus disease 2019 (COVID-19) pandemic, recommendations have included that personnel not involved in procedures releasing airborne contaminants reduce their exposure by moving >2 m away. We tested whether air particle concentrations in operating rooms (ORs) are greater in the periphery, downstream from the supply airflow. Methods We analyzed data from 15 mock surgical procedures performed in 3 ORs. Two ORs were modern, one with a single large diffuser system above the surgical table, and the other using a multiple diffuser array design. An air particle counting unit was located on the instrument table, another adjacent to an air return grille. Results Concentrations of air particles were greater at return grille than instrument table for the single large diffuser at 26 air exchanges per hour, and the multiple diffuser array at both 26 and 20 air exchanges per hour (all P ≤ .0044), including during electrocautery (all P ≤ .0072). The ratios of concentrations, return grille versus instrument table, were greater during electrocautery for 0.5 to 1.0-micron particles and 1.0 to 5.0-micron particles (both P < .0001). Conclusions Modern OR airflow systems are so effective at protecting the surgical field and team from airborne particles emitted during surgery that concentrations of particles released at the OR table are greater at the OR walls than near the center of the room.
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18
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Aganovic A, Cao G, Fecer T, Ljungqvist B, Lytsy B, Radtke A, Reinmüller B, Traversari R. Ventilation design conditions associated with airborne bacteria levels within the wound area during surgical procedures: a systematic review. J Hosp Infect 2021; 113:85-95. [PMID: 33930488 DOI: 10.1016/j.jhin.2021.04.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Without confirmation of the ventilation design conditions (typology and airflow rate), the common practice of identifying unidirectional airflow (UDAF) systems as equivalent to ultra-clean air ventilation systems may be misleading, but also any claims about the ineffectiveness of UDAF systems should be doubted. The aim of this review was to assess and compare ventilation system design conditions for which ultra-clean air (mean <10 cfu/m3) within 50 cm from the wound has been reported. Six medical databases were systematically searched to identify and select studies reporting intraoperative airborne levels expressed as cfu/m3 close to the wound site, and ventilation system design conditions. Available data on confounding factors such as the number of persons present in the operating room, number of door openings, and clothing material were also included. Predictors for achieving mean airborne bacteria levels within <10 cfu/m3 were identified using a penalized multivariate logistic regression model. Twelve studies met the eligibility criteria and were included for analysis. UDAF systems considered had significantly higher air volume flows compared with turbulent ventilation (TV) systems considered. Ultra-clean environments were reported in all UDAF-ventilated (N = 7) rooms compared with four of 11 operating rooms equipped with TV. On multivariate analysis, the total number of air exchange rates (P=0.019; odds ratio (OR) 95% confidence interval (CI): 0.66-0.96) and type of clothing material (P=0.031; OR 95% CI: 0.01-0.71) were significantly associated with achieving mean levels of airborne bacteria <10 cfu/m3. High-volume UDAF systems complying with DIN 1946-4:2008 standards for the airflow rate and ceiling diffuser size unconditionally achieve ultra-clean air close to the wound site. In conclusion, the studied articles demonstrate that high-volume UDAF systems perform as ultra-clean air systems and are superior to TV systems in reducing airborne bacteria levels close to the wound site.
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Affiliation(s)
- A Aganovic
- Department of Automation and Process Engineering, The Arctic University of Norway, Norway.
| | - G Cao
- Department of Energy and Process Engineering, Norwegian University of Science and Technology - NTNU, Norway
| | - T Fecer
- Department of Computer Aided Engineering and Computer Science, Faculty of Civil Engineering, Brno University of Technology, Czech Republic
| | - B Ljungqvist
- Department of Civil and Environmental Engineering, Chalmers University of Technology, Sweden
| | - B Lytsy
- Department of Medical Sciences, Clinical Microbiology, Uppsala University, Sweden
| | - A Radtke
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Norway
| | - B Reinmüller
- Department of Civil and Environmental Engineering, Chalmers University of Technology, Sweden
| | - R Traversari
- Netherlands Organization for Applied Scientific Research, Netherlands
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Dagli R, Çelik F, Özden H, Şahin S. Does the Laminar Airflow System Affect the Development of Perioperative Hypothermia? A Randomized Clinical Trial. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:202-214. [PMID: 33535795 DOI: 10.1177/1937586720985859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We aimed to compare tympanic membrane temperature changes and the incidence of inadvertent perioperative hypothermia (IPH) in patients undergoing laparoscopic cholecystectomy under general anesthesia in laminar airflow systems (LAS-OR) and conventional turbulent airflow systems (CAS-OR). BACKGROUND Different heating, ventilation, and air-conditioning (HVAC) systems are used in the operating room (OR), such as LAS and CAS. Laminar airflow is directed directly to the patient in LAS-OR. Does laminar airflow in ORs cause faster heat loss by convection? METHODS This is a prospective, randomized study. We divided 200 patients with simple randomization (1:1), as group LAS and group CAS, and took the patients into the LAS-OR or CAS-OR for the operation. Clinical trial number: IRCT20180324039145N3. The tympanic membrane temperatures of patients were measured (°C) before anesthesia induction (T 0) and then every 15 min during surgery (Tn). Changes (Δn) between T 0 and Tn were measured. RESULTS In the first 30 min, there was a temperature decrease of approximately 0.8 °C (1.44 °F) in both groups. Temperature decreases at 45 min were higher in group LAS than in group CAS but not statistically significant, Δ45, respectively, 0.89 (95% confidence interval [CI] [0.77, 1.02]) versus 0.77 (95% CI [0.69, 0.84]; p = .09). IPH occurred in a total of 60.9% (112 of 184) of patients in the entire surgical evaluation period in group LAS and group CAS (58.9% vs. 62.8%, p = . 59). CONCLUSIONS IPH is seen frequently in both HVAC systems. Clinically, the advantage of HVAC systems relative to each other has not been demonstrated during laparoscopic cholecystectomy.
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Affiliation(s)
- Recai Dagli
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Kirsehir Ahi Evran University, Turkey
| | - Fatma Çelik
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Kirsehir Ahi Evran University, Turkey
| | - Hüseyin Özden
- Department of Surgery, Faculty of Medicine, Kirsehir Ahi Evran University, Turkey
| | - Serdar Şahin
- Department of Surgery, Faculty of Medicine, Kirsehir Ahi Evran University, Turkey
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Operating Theatre Ventilation Systems and Their Performance in Contamination Control: "At Rest" and "In Operation" Particle and Microbial Measurements Made in an Italian Large and Multi-Year Inspection Campaign. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197275. [PMID: 33027963 PMCID: PMC7579584 DOI: 10.3390/ijerph17197275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/21/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022]
Abstract
In Operating Theatres (OT), the ventilation system plays an important role in controlling airborne contamination and reducing the risks of Surgical Site Infections (SSIs). The air cleanliness is really crucial in this field and different measurements are used in order to characterize the situation in terms of both airborne microbiological pollutants and particle size and concentration. Although the ventilation systems and airborne contamination are strictly linked, different air diffusion schemes (in particular, the Partial Unidirectional Airflow, P-UDAF, and the Mixing Airflow, MAF) and various design parameters are used, and there is still no consensus on real performance and optimum solutions. This study presents measurements procedures and results obtained during Inspection and Periodic Performance Testing (1228 observations) in a large sample of Italian OTs (175 OTs in 31 Italian hospitals) in their operative life (period from 2010 to 2018). The inspections were made after a cleaning procedure, both in “at-rest” conditions and “in operation” state. Inert and microbial contamination data (in air and on surfaces) are analyzed and commented according to four relevant air diffusion schemes and design classes. Related data on Recovery Time (RT) and personnel presence were picked up and are commented. The results confirm that the ventilation systems are able to maintain the targeted performance levels in the OT operative life. However, they attest that significant differences in real OT contamination control capabilities do exist and could be ascribed to various design choices and to different operation and maintenance practices. The study shows and confirms that the air diffusion scheme and the design airflow rate are critical factors. Beside large variations in measurements, the performance values, in terms of control of airborne particle and microbial contamination (in air and on surfaces), for P-UDAF systems are better than those that were assessed for the MAF air diffusion solution. The average performances do increase with increasing airflows, and the results offer a better insight on this relationship leading to some possible optimization.
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Dexter F, Elhakim M, Loftus RW, Seering MS, Epstein RH. Strategies for daily operating room management of ambulatory surgery centers following resolution of the acute phase of the COVID-19 pandemic. J Clin Anesth 2020; 64:109854. [PMID: 32371331 PMCID: PMC7188624 DOI: 10.1016/j.jclinane.2020.109854] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 12/15/2022]
Abstract
We performed a narrative review to explore the economics of daily operating room management decisions for ambulatory surgery centers following resolution of the acute phase of the Coronavirus Disease 2019 (COVID-19) pandemic. It is anticipated that there will be a substantive fraction of patients who will be contagious, but asymptomatic at the time of surgery. Use multimodal perioperative infection control practices (e.g., including patient decontamination) and monitor performance (e.g., S. aureus transmission from patient to the environment). The consequence of COVID-19 is that such processes are more important than ever to follow because infection affects not only patients but the surgery center staff and surgeons. Dedicate most operating rooms to procedures that are not airway aerosol producing and can be performed without general anesthesia. Increase throughput by performing nerve blocks before patients enter the operating rooms. Bypass the phase I post-anesthesia care unit whenever possible by appropriate choices of anesthetic approach and drugs. Plan long-duration workdays (e.g., 12-h). For cases where the surgical procedure does not cause aerosol production, but general anesthesia will be used, have initial (phase I) post-anesthesia recovery in the operating room where the surgery was done. Use anesthetic practices that achieve fast initial recovery of the brief ambulatory cases. When the surgical procedure causes aerosol production (e.g., bronchoscopy), conduct phase I recovery in the operating room and use multimodal environmental decontamination after each case. Use statistical methods to plan for the resulting long turnover times. Whenever possible, have the anesthesia and nursing teams stagger cases in more than one room so that they are doing one surgical case while the other room is being cleaned. In conclusion, this review shows that while COVID-19 is prevalent, it will markedly affect daily ambulatory workflow for patients undergoing general anesthesia, with potentially substantial economic impact for some surgical specialties.
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Affiliation(s)
| | - Mohamed Elhakim
- Department of Anesthesia and Critical Care Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
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Liu Z, Liu H, Yin H, Rong R, Cao G, Deng Q. Prevention of surgical site infection under different ventilation systems in operating room environment. FRONTIERS OF ENVIRONMENTAL SCIENCE & ENGINEERING 2020; 15:36. [PMID: 32874704 PMCID: PMC7453373 DOI: 10.1007/s11783-020-1327-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/27/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Abstract
Biological particles in the operating room (OR) air environment can cause surgical site infections (SSIs). Various ventilation systems have been employed in ORs to ensure an ultraclean environment. However, the effect ofdifferent ventilation systems on the control ofbacteria-carrying particles (BCPs) released from the surgical staff during surgery is unclear. In this study, the performance of four different ventilation systems (vertical laminar airflow ventilation (VLAF), horizontal laminar airflow ventilation (HLAF), differential vertical airflow ventilation (DVAF), and temperature-controlled airflow ventilation (TAF)) used in an OR was evaluated and compared based on the spatial BCP concentration. The airflow field in the OR was solved by the Renormalization Group (RNG) k-ε turbulence model, and the BCP phase was calculated by Lagrangian particle tracking (LPT) and the discrete random walk (DRW) model. It was found that the TAF system was the most effective ventilation system among the four ventilation systems for ensuring air cleanliness in the operating area. This study also indicated that air cleanliness in the operating area depended not only on the airflow rate of the ventilation system but also on the airflow distribution, which was greatly affected by obstacles such as surgical lamps and surgical staff.
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Affiliation(s)
- Zhijian Liu
- Department of Power Engineering, North China Electric Power University, Baoding, 071003 China
| | - Haiyang Liu
- Department of Power Engineering, North China Electric Power University, Baoding, 071003 China
| | - Hang Yin
- Department of Civil Engineering, Technical University of Denmark, Copenhagen, DK-2800 Kgs Denmark
| | - Rui Rong
- Department of Power Engineering, North China Electric Power University, Baoding, 071003 China
| | - Guoqing Cao
- Institute of Building Environment and Energy, China Academy of Building Research, Beijing, 100013 China
| | - Qihong Deng
- School of Energy Science and Engineering, Central South University, Changsha, 410083 China
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Shetty SS, Wollenberg B, Shabadi N, Kudpaje AS, Rao V, Merchant Y. Vicissitudes in oncological care during COVID19. Oral Oncol 2020; 107:104782. [PMID: 32414644 PMCID: PMC7211714 DOI: 10.1016/j.oraloncology.2020.104782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Sameep S Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore 575001, India; Manipal Academy of Higher Education, A Constituent of MAHE, Light House Hill Road, India.
| | - Barbara Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar der TU München, Ismaningerstraße 22, 81675 München, Germany.
| | - Nikita Shabadi
- Coorg Institute of Dental Sciences, Virajpet 571218, India
| | | | - Vishal Rao
- Head and Neck Surgical Oncologist, Health Care Global Enterprises Ltd, Bangalore, India.
| | - Yash Merchant
- Dept. of Head and Neck Oncology, Health Care Global Enterprises Ltd, Bangalore, India
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Langvatn H, Schrama J, Cao G, Hallan G, Furnes O, Lingaas E, Walenkamp G, Engesæter L, Dale H. Operating room ventilation and the risk of revision due to infection after total hip arthroplasty: assessment of validated data in the Norwegian Arthroplasty Register. J Hosp Infect 2020; 105:216-224. [DOI: 10.1016/j.jhin.2020.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/06/2020] [Indexed: 01/25/2023]
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25
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Howard TA, Murray IR, Amin AK, Simpson AH, Hall AC. Damage control articular surgery: Maintaining chondrocyte health and minimising iatrogenic injury. Injury 2020; 51 Suppl 2:S83-S89. [PMID: 31685207 DOI: 10.1016/j.injury.2019.10.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/22/2019] [Indexed: 02/02/2023]
Abstract
Articular cartilage has limited intrinsic regenerative potential. The maintenance of healthy articular cartilage is essential to prevent joint degeneration and the morbidity associated with arthritis. In this review, we outline the structure and function of healthy articular cartilage. We summarise some of the recent literature outlining the influence of surgical factors on chondrocyte health. These factors include mechanical injury from instrumentation and drilling, drying, and the influence of irrigation fluids, antimicrobial solutions and local anaesthetics. We demonstrate that there is scope for improving cartilage viability at the time of surgery if simple chondroprotective measures are routinely adopted.
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Affiliation(s)
- Thomas A Howard
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 49 Little France Crescent, EH16 4SA, UK
| | - Iain R Murray
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 49 Little France Crescent, EH16 4SA, UK; The University of Edinburgh, UK
| | - Anish K Amin
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 49 Little France Crescent, EH16 4SA, UK; The University of Edinburgh, UK
| | - A Hamish Simpson
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 49 Little France Crescent, EH16 4SA, UK; The University of Edinburgh, UK.
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26
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Assessing the Energy Demand Reduction in a Surgical Suite by Optimizing the HVAC Operation During Off-Use Periods. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10072233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hospital surgical suites are high consumers of energy due to the strict indoor air quality (IAQ) conditions. However, by varying the ventilation strategies, the potential for energy savings is great, particularly during periods without activity. In addition, there is no international consensus on the ventilation and hygrothermal requirements for surgical areas. In this work, a dynamic energy model of a surgical suite of a Spanish hospital is developed. This energy model is calibrated and validated with experimental data collected during real operation. The model is used to simulate the yearly energy performance of the surgical suite under different ventilation scenarios. The common issue in the studied ventilation strategies is that the hygrothermal conditions ranges are extended during off-use hours. The maximum savings obtained are around 70% of the energy demand without compromising the safety and health of patients and medical staff, as the study complies with current heating, ventilation and air conditioning (HVAC) regulations.
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Dutheil de la Rochère A, Evstratov A, Bayle S, Sabourin L, Frering A, Lopez-Cuesta JM. Exploring the antimicrobial properties of dark-operating ceramic-based nanocomposite materials for the disinfection of indoor air. PLoS One 2019; 14:e0224114. [PMID: 31644566 PMCID: PMC6808436 DOI: 10.1371/journal.pone.0224114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/04/2019] [Indexed: 12/15/2022] Open
Abstract
As people spend more and more time inside, the quality of indoor air becomes crucial matter. This study explores the germicidal potential of two dark-operating germicidal composite materials designed to be applied for the indoor air disinfection under flow conditions. The first material, MnO2/AlPO4/γ-Al2O3 beads, is a donor-acceptor interactive composite capable of creating hydroxyl radicals HO∙. The second one is a ZnO/γ-Al2O3 material with intercropped hexagons on its surface. To determine the antimicrobial efficiency of these materials in life-like conditions, a pilot device was constructed that allows the test of the materials in dynamic conditions and agar diffusion inhibitory tests were also conducted. The results of the tests showed that the MnO2/AlPO4/γ-Al2O3 material has a germicidal effect in static conditions whereas ZnO/γ-Al2O3 does not. In dynamic conditions, the oxidizing MnO2/AlPO4/γ-Al2O3 material is the most efficient when using low air speed whereas the ZnO/γ-Al2O3 one becomes more efficient than the other materials when increasing the air linear speed. This ZnO/γ-Al2O3 dark-operating germicidal material manifests the ability to proceed the mechanical destruction of bacterial cells. Actually, the antimicrobial efficiency of materials in dynamic conditions varies regarding the air speed through the materials and that static tests are not representative of the behavior of the material for air disinfection. Depending on the conditions, the best strategy to inactivate microorganisms changes and abrasive structures are a field that needs further exploration as they are in most of the conditions tested the best way to quickly decrease the number of microorganisms.
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Affiliation(s)
| | - Alexeï Evstratov
- Centre des Matériaux des Mines d’Alès, IMT-Mines Alès, Alès, France
| | - Sandrine Bayle
- Laboratoire de Génie de l’Environnement Industriel, IMT-Mines-Alès, Alès, France
| | - Lionel Sabourin
- Centre des Matériaux des Mines d’Alès, IMT-Mines Alès, Alès, France
| | - Arnaud Frering
- Centre des Matériaux des Mines d’Alès, IMT-Mines Alès, Alès, France
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Traversari A, van Heumen S, Hoksbergen A. Effect of using ceiling-mounted systems for imaging in hybrid operating rooms on the level of colony-forming units during surgery. J Hosp Infect 2019; 103:e61-e67. [DOI: 10.1016/j.jhin.2018.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/16/2018] [Indexed: 11/26/2022]
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Cao G, Nilssen AM, Cheng Z, Stenstad LI, Radtke A, Skogås JG. Laminar airflow and mixing ventilation: Which is better for operating room airflow distribution near an orthopedic surgical patient? Am J Infect Control 2019; 47:737-743. [PMID: 30691933 DOI: 10.1016/j.ajic.2018.11.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND There has been little research on the performance of laminar airflow (LAF) and mixing ventilation (MV) systems regarding clean airflow distribution near a surgical patient in operating rooms (ORs). The objective of this study was to examine the performance of LAF and MV systems in ORs at St Olavs Hospital in Norway. METHODS Experimental measurements were conducted in 2 ORs equipped with LAF and MV systems. RESULTS Under real operating conditions, airflow distribution from the LAF system was disrupted, and airflow velocity became significantly lower than that of MV above the lying patient. Airflow pattern was observed as distributed vertically downward and horizontally with LAF and MV, respectively. Turbulence intensity of supply airflow from LAF was much lower than that of MV. CONCLUSIONS The airflow distribution by LAF system in close proximity to a patient is greatly affected by thermal plumes generated above incisions by both patients and surgical facilities. The effect of surgical facilities on airflow distribution by using MV is not significant compared to LAF ventilation. New guidelines are needed for the design of clean airflow distribution systems in the vicinity of surgical patients in ORs.
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Traversari AAL, van Heumen SPM, van Tiem FLJ, Bottenheft C, Hinkema MJ. Design variables with significant effect on system performance of unidirectional displacement airflow systems in hospitals. J Hosp Infect 2019; 103:e81-e87. [PMID: 30923013 DOI: 10.1016/j.jhin.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The effectiveness of an airflow system in preventing entrainment of particles carrying micro-organisms from the periphery of an operating room (OR) or instrument lay-up room (ILR) is affected by many variables. It is suspected that differences in the design of the systems affect the effective protection ratio (EPR): the ratio of the size of the protected area to the surface area of the supply canopy. However, no analysis has yet been done to determine which design variables have a significant effect on this ratio. AIM To evaluate which design variables have a significant effect on the performance of airflow systems (EPR) in ORs and ILRs. METHODS All general and teaching hospitals in the Netherlands (N = 77) were asked to provide data from their standardized (at-rest measurement method) compulsory systems assessment reports for ORs and ILRs. Nineteen hospitals (25%) with a total of 22 hospital sites supplied information of sufficient completeness and homogeneity, resulting in measurement data for 101 ORs and 23 ILRs. This dataset was analysed using Statistical Package for Social Sciences. FINDINGS For ORs, important predictors for the EPR were: shape of the canopy; air speed under the supply canopy; height of the canopy screen; type of system; and size of the canopy. These significant predictors (P < 0.05) explain 48% of the outcome in the dataset. For ILRs, significant predictors for the EPR were: the position of exhaust air terminals; height of the canopy screen; and size of the canopy. These significant predictors explain 66% of the outcome in the dataset. CONCLUSION On the basis of the dataset available for analysis, it is concluded that the ratio of the size of the protected area to the surface area of the supply canopy (EPR) improves with the presence and the height of a screen around the canopy, the surface area of the supply canopy, and the air speed of the supply air under the canopy. This information can be used as guidance for the future design of unidirectional displacement airflow systems.
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Affiliation(s)
- A A L Traversari
- The Netherlands Organisation for Applied Scientific Research TNO, Delft, the Netherlands.
| | - S P M van Heumen
- The Netherlands Organisation for Applied Scientific Research TNO, Delft, the Netherlands
| | | | - C Bottenheft
- The Netherlands Organisation for Applied Scientific Research TNO, Soesterberg, the Netherlands
| | - M J Hinkema
- The Netherlands Organisation for Applied Scientific Research TNO, Delft, the Netherlands
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Influence of the Arrangement of Surgical Light Axes on the Air Environment in Operating Rooms. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:4861273. [PMID: 31049187 PMCID: PMC6458874 DOI: 10.1155/2019/4861273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 01/06/2019] [Accepted: 01/22/2019] [Indexed: 11/17/2022]
Abstract
Purpose Surgical lights in the operating rooms are typically installed in a single axis in the center of the room or in two axes on both sides of the operating table. In the single-axis installation, the air-conditioning outlet cannot be placed in the center of the ceiling, which may affect the air current. Therefore, we measured the air current and cleanliness in two equivalent operating rooms using a vertical laminar airflow system equipped with either single-axis or double-axis surgical lights. Methods Air current was measured using a three-dimensional ultrasonic anemometer. Cleanliness was evaluated by measuring the amount of dust before and after air-conditioner activation. To visualize the air current, smoke was illuminated on a sheet of laser light while the air-conditioning was stopped, and changes after air-conditioning activation were observed. Results In the single-axis room, an oblique fast air current flowing from the surrounding air outlet toward the center was observed, and the flow velocity fluctuated greatly. In the double-axis room, uniform downward laminar airflow was observed. The amount of dust at the center decreased significantly faster in the double-axis room; thus, the cleanliness at the center was higher in the double-axis room. Persistent stagnation of smoke was observed below the single-axis lighting, whereas smoke below the double-axis lighting was immediately dispersed and the air cleared even when surgical lights were in the position for surgery. Conclusion Uniform vertical laminar airflow was formed and high cleanliness was achieved in the center of the room when the surgical lights were arranged in two axes.
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32
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Aalirezaie A, Akkaya M, Barnes CL, Bengoa F, Bozkurt M, Cichos KH, Ghanem E, Darouiche RO, Dzerins A, Gursoy S, Illiger S, Karam JA, Klaber I, Komnos G, Lohmann C, Merida E, Mitt P, Nelson C, Paner N, Perez-Atanasio JM, Reed M, Sangster M, Schweitzer D, Simsek ME, Smith BM, Stocks G, Studers P, Talevski D, Teuber J, Travers C, Vince K, Wolf M, Yamada K, Vince K. General Assembly, Prevention, Operating Room Environment: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S105-S115. [PMID: 30348570 DOI: 10.1016/j.arth.2018.09.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Totaro M, Costa AL, Casini B, Profeti S, Gallo A, Frendo L, Porretta A, Valentini P, Privitera G, Baggiani A. Microbiological Air Quality in Heating, Ventilation and Air Conditioning Systems of Surgical and Intensive Care Areas: The Application of a Disinfection Procedure for Dehumidification Devices. Pathogens 2019; 8:pathogens8010008. [PMID: 30650590 PMCID: PMC6472009 DOI: 10.3390/pathogens8010008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/07/2019] [Accepted: 01/11/2019] [Indexed: 12/17/2022] Open
Abstract
International literature data report that the increase of infectious risk may be due to heating, ventilation and air conditioning (HVAC) systems contaminated by airborne pathogens. Moreover, the presence of complex rotating dehumidification wheels (RDWs) may complicate the cleaning and disinfection procedures of the HVAC systems. We evaluated the efficacy of a disinfection strategy applied to the RDW of two hospitals’ HVAC systems. Hospitals have four RDW systems related to the surgical areas (SA1 and SA2) and to the intensive and sub-intensive care (IC and sIC) units. Microbiological air and surface analyses were performed in HVAC systems, before and after the disinfection treatment. Hydrogen peroxide (12%) with silver ions (10 mg/L) was aerosolized in all the air sampling points, located close to the RDW device. After the air disinfection procedure, reductions of total microbial counts at 22 °C and molds were achieved in SA2 and IC HVAC systems. An Aspergillus fumigatus contamination (6 CFU/500 L), detected in one air sample collected in the IC HVAC system, was eradicated after the disinfection. The surface samples proved to be of good microbiological quality. The results suggest the need for a disinfection procedure to improve the microbiological quality of the complex HVAC systems, mostly in surgical and intensive care areas.
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Affiliation(s)
- Michele Totaro
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
| | - Anna Laura Costa
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
| | - Beatrice Casini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
| | - Sara Profeti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
| | - Antonio Gallo
- Department of Public Health and Hygiene, Azienda USL Toscana Nord Ovest, 56100 Pisa, Italy.
| | - Lorenzo Frendo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
| | - Andrea Porretta
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
| | - Paola Valentini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
| | - Gaetano Privitera
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
| | - Angelo Baggiani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
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