EPOS trial: the effect of air filtration through a plasma chamber on the incidence of surgical site infection in orthopaedic surgery: a study protocol of a randomised, double-blind, placebo-controlled trial

The implementation of portable air-cleaning technologies in healthcare settings - a scoping review

The COVID-19 pandemic revealed opportunities to improve prevention practices in healthcare settings, mainly related to the spread of airborne microbes (also known as bioaerosols). This scoping review aimed to map methodologies used to assess the implementation of portable air cleaners in healthcare settings, identify gaps, and propose recommendations for future research. The protocol was registered in the Open Science Framework and reported following the checklist provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis - an extension for Scoping Reviews (PRISMA-ScR) statement. The search strategy was performed in five databases and one grey literature source. At the last selection phase, 24 articles that fulfilled our inclusion criteria were summarized and disseminated. Of these, 17 studies were conducted between 2020 and 2022; one of them was a protocol of a multicentre randomized controlled trial. The outcomes measured among the studies include airborne microbe counts, airborne particle concentrations, and rate of infections/interventions. The leading healthcare settings assessed were dental clinics (28%), patient's wards (16%), operating rooms (16%), and intensive care units (12%). Most of the devices demonstrated a significant potential to mitigate the impact of bioaerosols. Although some indoor air quality parameters can influence the mechanics of aerosols, only a few studies controlled these parameters in their analyses. Future clinical research should assess the rate of infections through randomized controlled trials with long-term follow-up and large sample sizes to determine the clinical importance of the findings.

Evaluating the effect of air purifier Novarerus NV800 during orthopedic operations to reduce bioburden in the air

A locally installed air purifier Novaerus Protect 800 has recently been shown to reduce the air bioburden in an intensive care unit and the incidence of healthcare-associated infections (HAI). The aim of this study was to explore whether the same type of local air purifying unit could reduce bacterial concentrations in the air of an operating room (OR) during ongoing orthopedic operations, thereby reducing the risk of surgical site infections (SSI). Three air purifying units were installed in an OR in a Swedish hospital in 2018 in this prospective experimental study. The air was actively sampled during 11 operations by a slit-to-slit agar impactor with the air purifying units either in operation or switched off. Air movements were visualized with aid of smoke in mock-up studies. There was no statistically significant difference in the bacterial concentration in the air when the air purifying units were switched off and switched on (p=0,54). The air movements around and above the surgical wound were disordered and resembled that of dilution mixing air. In conclusion, the three air purifying units installed in the OR did not reduce the airborne bacterial levels in the critical zone during ongoing orthopedic operations in this study.