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Challener DW, Tande AJ, Koutras C, Wade RL, McIntee MA, Strauss DM, Yao X, Chang YH, Berbari E. Evaluation of germicidal ultraviolet-C disinfection in a real-world outpatient health care environment. Am J Infect Control 2024; 52:1030-1034. [PMID: 38795903 DOI: 10.1016/j.ajic.2024.05.014] [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: 03/22/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic has highlighted the need for effective infection control in outpatient health care settings. Germicidal ultraviolet-C (GUV) light, known for inactivating microorganisms by damaging their deoxyribonucleic acid or ribonucleic acid, offers a potential solution. This study examines the efficacy of GUV air disinfection systems in real-world outpatient environments. METHODS We deployed upper-room and far-UV GUV fixtures in 3 outpatient facilities, assessing their impact on bacterial loads through air and surface sampling and bioindicator tests. Occupancy was also monitored. RESULTS While manual air and surface sampling did not show a significant difference in bacterial loads between control and Ultraviolet C-treated groups, bioindicator tests demonstrated a high level of spore inactivation (up to 99.7% for upper-room GUV and 96.26% for far-UV). Occupancy levels did not significantly influence these outcomes. DISCUSSION The discrepancy between bioindicator efficacy and environmental sampling results suggests limitations in the latter's ability to accurately capture environmental bioburden. Bioindicators proved to be reliable for in-situ validation of Ultraviolet C surface disinfection. CONCLUSIONS Bioindicators are effective for validating GUV surface disinfection efficacy in health care settings, though further research is needed to optimize environmental sampling methods for assessing GUV's impact on real-world bacterial loads.
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Affiliation(s)
- Douglas W Challener
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN.
| | - Aaron J Tande
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Maggie A McIntee
- Department of Medicine Innovation Technology and Services, Mayo Clinic, Rochester, MN
| | - David M Strauss
- Department of Medicine Innovation Technology and Services, Mayo Clinic, Rochester, MN
| | - Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Yu-Hui Chang
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ
| | - Elie Berbari
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN
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2
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Tomazin R, Matos T. Mycological Methods for Routine Air Sampling and Interpretation of Results in Operating Theaters. Diagnostics (Basel) 2024; 14:288. [PMID: 38337804 PMCID: PMC10855394 DOI: 10.3390/diagnostics14030288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Many infectious diseases are transmitted via the air and are, therefore, particularly difficult to combat. These infections include various invasive mycoses caused by molds. The usual route of infection is the inhalation of conidia. In hospitals, infection can also occur through the deposition of conidia in otherwise sterile anatomical sites during surgical and other invasive procedures. Therefore, knowledge of airborne mold concentrations can lead to measures to protect patients from fungal infections. The literature on this topic contains insufficient and sometimes ambiguous information. This is evidenced by the fact that there are no international recommendations or guidelines defining the methodology of air sampling and the interpretation of the results obtained. Surgical departments, intensive care units and medical mycology laboratories are, therefore, left to their own devices, leading to significant differences in the implementation of mycological surveillance in hospitals. The aim of this mini-review is to provide an overview of the current methods of air sampling and interpretation of results used in medical mycology laboratories.
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Affiliation(s)
| | - Tadeja Matos
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
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3
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Abu-Rub LI, Johar ARA, Al Mana H, Abdelrahman HA, Althani AA, Qotba H, Yassine HM, Eltai NO. Bacterial indoor air contaminations in hospitals in MENA region: a systematic review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2023; 33:1218-1232. [PMID: 35658652 DOI: 10.1080/09603123.2022.2083087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
Poor indoor air quality in healthcare settings has been tied with the increase in hospital-acquired infections. Thus, this systematic review was conducted to assess the levels and compositions of bacteria in indoor hospital air in the Middle East and North Africa (MENA) region. We examined results provided by different search engines published between 2000 and 2021. Our data showed that most studies were conducted in Iran (80.9%) with a bacterial concentration mean of 172.9 CFU/m3. Comparing sensitive and non-sensitive areas of hospitals, no significant difference was detected in the mean bacterial concentration. The most investigated sensitive hospital areas were operating rooms and intensive care units with mean indoor bacterial concentrations of 180.3 CFU/m3 and 204.6 CFU/m3, respectively. Staphylococcaceae, Enterobacteriaceae, Pseudomonadaceae, and Bacillaceae were commonly identified bacterial families. In conclusion, the mean concentrations of the airborne bacteria were within the acceptable limit compared to WHO standards (300 CFU/m3) for the air in areas occupied by immunosuppressed people.
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Affiliation(s)
| | - Al-Reem A Johar
- Research and Development Department, Barzan Holdings, Doha, Qatar
| | - Hassan Al Mana
- Biomedical Research Center, Qatar University, Doha, Qatar
| | | | | | - Hamda Qotba
- Clinical Research Department, Primary Health Care Corporation, Clinical Research Primary Healthcare Center, Doha, Qatar
| | - Hadi M Yassine
- Biomedical Research Center, Qatar University, Doha, Qatar
| | - Nahla O Eltai
- Biomedical Research Center, Qatar University, Doha, Qatar
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4
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Rondon ES, Pirani O, Sant'Ana De Camargo P, Leal CRB, Filho RACC. Surgical gowns as a safety barrier under non-standard environmental conditions. Braz J Microbiol 2023; 54:3321-3325. [PMID: 37919460 PMCID: PMC10689306 DOI: 10.1007/s42770-023-01162-4] [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: 11/26/2021] [Accepted: 10/21/2023] [Indexed: 11/04/2023] Open
Abstract
In this prospective study, we aimed to investigate whether surgical gowns become contaminated during surgery. Samples from the gowns of five surgeons during 19 surgeries were collected using sterile swabs in circular standard delimited areas on both wrists and the mid-chest at three time-points: immediately before surgical incision (t=0), 30 min (t=30), and 60 min (t=60) later. Additionally, at t=0 and t=60, three settle plates of plate count agar were positioned at 1.5 m from the ground and remained open for 20 min. The operating room temperature and relative humidity were monitored. The swabs were cultivated and incubated, and colony-forming units per gram (CFU/g) counts were measured. The CFU/g counts for bacteria or fungi did not differ among the three sampling sites. The surgeons' lateral dominance in manual dexterity did not influence the gowns' contamination. There were significant variations in the temperature and relative humidity over time, but not in the CFU/g counts. In conclusion, during the first hour of surgery, surgical gowns did not become a source of contamination and are an effective barrier against bacterial and fungal contamination even under non-standard surgical environmental conditions.
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Affiliation(s)
| | - Otávio Pirani
- Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
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5
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Hanna F, Alameddine I, Zaraket H, Alkalamouni H, El-Fadel M. Airborne influenza virus shedding by patients in health care units: Removal mechanisms affecting virus transmission. PLoS One 2023; 18:e0290124. [PMID: 37878553 PMCID: PMC10599543 DOI: 10.1371/journal.pone.0290124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/01/2023] [Indexed: 10/27/2023] Open
Abstract
In this study, we characterize the distribution of airborne viruses (influenza A/B) in hospital rooms of patients with confirmed infections. Concurrently, we monitored fine particulate matter (PM2.5 & PM10) and several physical parameters including the room air exchange rate, temperature, and relative humidity to identify corresponding correlations with virus transport and removal determinants. The results continue to raise concerns about indoor air quality (IAQ) in healthcare facilities and the potential exposure of patients, staff and visitors to aerosolized viruses as well as elevated indoor PM levels caused by outdoor sources and/or re-suspension of settled particles by indoor activities. The influenza A virus was detected in 42% of 33 monitored rooms, with viruses detectible up to 1.5 m away from the infected patient. Active coughing was a statistically significant variable that contributed to a higher positive rate of virus detection in the collected air samples. Viral load across patient rooms ranged between 222 and 5,760 copies/m3, with a mean of 820 copies/m3. Measured PM2.5 and PM10 levels exceeded IAQ daily exposure guidelines in most monitored rooms. Statistical and numerical analyses showed that dispersion was the dominant viral removal pathway followed by settling. Changes in the relative humidity and the room's temperature were had a significant impact on the viral load removal. In closure, we highlight the need for an integrated approach to control determinants of IAQ in patients' rooms.
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Affiliation(s)
- Francis Hanna
- Department of Civil Infrastructure & Environmental Engineering, College of Engineering, Khalifa University, United Arab Emirates
- Department of Civil & Environmental Engineering, Faculty of Engineering & Architecture, American University of Beirut, Lebanon
| | - Ibrahim Alameddine
- Department of Civil & Environmental Engineering, Faculty of Engineering & Architecture, American University of Beirut, Lebanon
| | - Hassan Zaraket
- Department of Experimental Pathology, Immunology & Microbiology, Faculty of Medicine, American University of Beirut, Lebanon
| | - Habib Alkalamouni
- Department of Experimental Pathology, Immunology & Microbiology, Faculty of Medicine, American University of Beirut, Lebanon
| | - Mutasem El-Fadel
- Department of Civil Infrastructure & Environmental Engineering, College of Engineering, Khalifa University, United Arab Emirates
- Department of Civil & Environmental Engineering, Faculty of Engineering & Architecture, American University of Beirut, Lebanon
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6
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Sabuco-Tébar EA, Arense-Gonzalo JJ, Campayo-Rojas FJ. Relationship Between Airborne Fungi Presence and the Position of the High Efficiency Particulate Air Filter in the Heating, Ventilation, and Air Conditioning System. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:56-68. [PMID: 37365804 DOI: 10.1177/19375867231181556] [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] [Indexed: 06/28/2023]
Abstract
AIM Establish the influence of the terminal or nonterminal position of High Efficiency Particulate Air (HEPA) filters in the Heating, Ventilation, and Air Conditioning (HVAC) system on the presence of airborne fungi in controlled environment rooms. BACKGROUND Fungal infections are an important cause of morbidity and mortality in hospitalized patients. METHODS This study was realized from 2010 to 2017, in rooms with terminal and nonterminal HEPA filters, in eight Spanish hospitals. In rooms with terminal HEPA filters, 2,053 and 2,049 samples were recollected, and in rooms with nonterminal HEPA filters, 430 and 428 samples were recollected in the air discharge outlet (Point 1) and in the center of the room (Point 2), respectively. Temperature, relative humidity, air changes per hour, and differential pressure were recollected. RESULTS Multivariable analysis showed higher odds ratio (OR) of airborne fungi presence when HEPA filters were in nonterminal position (OR: 6.78; 95% CI [3.77, 12.20]) in Point 1 and (OR: 4.43; 95% CI [2.65, 7.40]) in Point 2. Other parameters influenced airborne fungi presence, such as temperature (OR: 1.23; 95% CI [1.06, 1.41]) in Point 2 differential pressure (OR: 0.86; 95% CI [0.84, 0.90]) and (OR: 0.88; 95% CI [0.86, 0.91]) in Points 1 and 2, respectively. CONCLUSIONS HEPA filter in terminal position of the HVAC system reduces the presence of airborne fungi. To decrease the presence of airborne fungi, adequate maintenance of the environmental and design parameters is necessary in addition to the terminal position of the HEPA filter.
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Affiliation(s)
- Emiliana A Sabuco-Tébar
- Department of Preventive Medicine, "Reina Sofia" University Clinical Hospital, Murcia, Spain
| | - Julián J Arense-Gonzalo
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, Spain
| | - F Javier Campayo-Rojas
- Department of Preventive Medicine, "Reina Sofia" University Clinical Hospital, Murcia, Spain
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Serra Neto A, Marques SG, Bomfim MRQ, Monteiro SG, de Souza RC, Nunes RA. Microbiological Analysis of Surgeons' Hands in a Public Hospital in São Luis, Maranhão State, Brazil: A Cross-Sectional Study. Microorganisms 2023; 11:1895. [PMID: 37630455 PMCID: PMC10456775 DOI: 10.3390/microorganisms11081895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/15/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
Antisepsis of the hands of medical personnel is one of the most important steps in the process of patient care, since direct contact can cause the cross-transfer of potentially pathogenic microorganisms at surgical sites. This study aimed to analyze the prevalence of microorganisms on the hands of 131 surgeons in a university hospital before the surgical procedure. Swabs were collected from each clinician's hands before and after handwashing. The samples were placed in a transport medium and immediately delivered to a private clinical analysis laboratory from São Luis-Maranhão. The microorganisms were identified by ionization source mass spectrometry and matrix-assisted laser desorption (MALDI-TOF), and antibiotic susceptibility tests (AST) were performed using the Vitek2 and Phoenix-BD automated system. The results showed a high frequency (100%) of microorganisms before handwashing, but after surgical antisepsis, the rate dropped significantly (p < 0.05) to 27.5%. The gram-positive species most detected were Staphylococcus spp. and Micrococcus luteus, representing 83.9%, followed by gram-negative species, Stenotrophomonas maltophilia, Acinetobacter baumanii, Pseudomonas aeruginosa, Pseudomonas gessardi, Pantoea septica, Serratia marcescens, and Burkholderia lata. The effectiveness of hand antisepsis was 72.5%, demonstrating that surgeons' hands are an important source of microorganisms that can cause infections in hospitalized patients in different care settings.
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Affiliation(s)
- Artur Serra Neto
- Departamento de Cirurgia Geral, Hospital Universitário da Universidade Federal do Maranhão (HUUFMA), São Luís 65020-070, Brazil
| | - Sirlei G. Marques
- Departamento de Planejamento de Gestão da Qualidade e Vigilância em Saúde, Hospital Universitário da Universidade Federal do Maranhão (HUUFMA), São Luís 65020-070, Brazil;
| | - Maria Rosa Q. Bomfim
- Departamento de Biologia Molecular, Universidade Ceuma (UNICEUMA), São Luís 65075-120, Brazil;
| | - Silvio G. Monteiro
- Departamento de Biologia, Universidade Federal do Maranhão (UFMA), São Luís 65080-805, Brazil;
| | - Rosangela C. de Souza
- Departamento de Medicina, Universidade Federal do Maranhão (UFMA), São Luís 65080-805, Brazil;
| | - Rodolfo A. Nunes
- Departamento de Cirurgia Geral, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro 20550-900, Brazil;
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8
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LiBrizzi CL, Sabharwal S, Forsberg JA, Leddy L, Doung YC, Morris CD, Levin AS. Does the Use of Negative Pressure Wound Therapy and Postoperative Drains Impact the Development of Surgical Site Infections?: A PARITY Trial Secondary Analysis. J Bone Joint Surg Am 2023; 105:34-40. [PMID: 37466578 DOI: 10.2106/jbjs.22.01185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) represent a major complication following oncologic reconstructions. Our objectives were (1) to assess whether the use of postoperative drains and/or negative pressure wound therapy (NPWT) were associated with SSIs following lower-extremity oncologic reconstruction and (2) to identify factors associated with the duration of postoperative drains and with the duration of NPWT. METHODS This is a secondary analysis of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial, a multi-institution randomized controlled trial of lower-extremity oncologic reconstructions. Data were recorded regarding the use of drains alone, NPWT alone, or both NPWT and drains, including the total duration of each postoperatively. We analyzed postoperative drain duration and associations with tourniquet use, intraoperative thromboprophylaxis or antifibrinolytic use, incision length, resection length, and total operative time, through use of a linear regression model. A Cox proportional hazards model was used to evaluate the independent predictors of SSI. RESULTS Overall, 604 patients were included and the incidence of SSI was 15.9%. Postoperative drains alone were used in 409 patients (67.7%), NPWT alone was used in 15 patients (2.5%), and both postoperative drains and NPWT were used in 68 patients (11.3%). The median (and interquartile range [IQR]) duration of drains and of NPWT was 3 days (IQR, 2 to 5 days) and 6 days (IQR, 4 to 8 days), respectively. The use of postoperative drains alone, NPWT alone, or both drains and NPWT was not associated with SSI (p = 0.14). Increased postoperative drain duration was associated with longer operative times and no intraoperative tourniquet use, as shown on linear regression analysis (p < 0.001 and p = 0.03, respectively). A postoperative drain duration of ≥14 days (hazard ratio [HR], 3.6; 95% confidence interval [CI], 1.3 to 9.6; p = 0.01) and an operative time of ≥8 hours (HR, 4.5; 95% CI, 1.7 to 11.9; p = 0.002) were independent predictors of SSI following lower-extremity oncologic reconstruction. CONCLUSIONS A postoperative drain duration of ≥14 days and an operative time of ≥8 hours were independent predictors of SSI following lower-extremity oncologic reconstruction. Neither the use of postoperative drains nor the use of NPWT was a predictor of SSI. Future research is required to delineate the association of the combined use of postoperative drains and NPWT with SSI. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christa L LiBrizzi
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Samir Sabharwal
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan A Forsberg
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lee Leddy
- Department of Orthopaedic Surgery, The Medical University of South Carolina, Charleston, South Carolina
| | - Yee-Cheen Doung
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Carol D Morris
- Division of Orthopaedic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Adam S Levin
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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9
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Ekhlasmand kermani M, Kheiri A, Amid R, Torshabi M, Houshmand B, Parsayan S. Sterility and bioactivity evaluation of two types of bone graft substitutes after removing the original packaging. JOURNAL OF ADVANCED PERIODONTOLOGY & IMPLANT DENTISTRY 2023; 15:15-21. [PMID: 37645549 PMCID: PMC10460786 DOI: 10.34172/japid.2023.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/30/2023] [Indexed: 08/31/2023]
Abstract
Background Xenograft and allograft bone substitutes are widely used to replace the missing bone in defects. Since removing the packaging of these grafts can nullify their sterilization, this study aimed to evaluate the sterility and bioactivity changes of an allograft and a xenograft following uncapping/recap. Methods Two types of commercial allograft and xenograft vials were unpacked and further exposed to operating room air, where implant surgery was performed for one second, ten minutes, and one hour. After three repetitions, samples were analyzed using microbiological tests and scanning electron microscopy (SEM) with energy dispersive x-ray analysis (EDX) for sterility and bioactivity evaluation. Results None of the bone graft samples showed microbial growth or bioactivity-negative changes after seven days of unpacking the vials. Conclusion Despite the positive results of this study, future studies and more analysis considering influential factors are required. Also, disinfection and air exchange must still be observed during biomaterial application and bone grafting procedures.
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Affiliation(s)
- Mehdi Ekhlasmand kermani
- Department of Periodontics, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - Aida Kheiri
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Amid
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Torshabi
- Department of Dental Biomaterials, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behzad Houshmand
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Parsayan
- Dental Student, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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10
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Najafi F, Fernández-Rodríguez D, Parvizi J. Sterile Setup Table in the Operating Room Is Not So Sterile. J Arthroplasty 2023; 38:562-566.e3. [PMID: 36154865 DOI: 10.1016/j.arth.2022.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND One of the important factors for surgical site infection prevention is the implementation of an ultraclean operating room. This study was designed to evaluate back-table sterility during total joint arthroplasty. METHODS This prospective study includes 52 patients undergoing primary total joint arthroplasty between November 2021 and January 2022. A total of 4 swabs (2 air swabs and 2 table swabs) were obtained for each case, at the conclusion of surgery and prior to the takedown of drapes. One swab from each set was sent for culture, and the other was sent for next-generation sequencing (NGS) analysis. RESULTS Among 104 back-table swabs, a total of 13 (12.5%) organisms were isolated. Of these, 7 organisms were isolated by culture and 6 by NGS. No microorganisms were isolated by both culture and NGS from back-table swabs. Among 104 air swabs, a total of 11 (10.6%) organisms were isolated. Of these, 6 microorganisms were isolated by culture and 5 by NGS. In 4 of the 104 swabs, both culture- and NGS-isolated organisms were from air swabs. Of the 104 (12.5%) back-table and air swabs, 13 were culture positive. While more than 1 pathogen was identified in 2 air swabs, all back-table swabs were monomicrobial by culture. Pathogens were identified from 11 of 104 (10.6%) swabs by NGS, while more than 1 pathogen was identified in 4 swabs (2 air and 2 back table). CONCLUSION The findings of this study raise an important issue that the surgical field including the sterile table setup for instruments is not "sterile" and can harbor pathogens.
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Affiliation(s)
- Farideh Najafi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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11
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Wang Q, Cao M, Tao H, Fei Z, Huang X, Liang P, Liu B, Liu J, Lu X, Ma P, Si S, Wang S, Zhang Y, Zheng Y, Zang L, Chen X, Dong Z, Ge W, Guo W, Hu X, Huang X, Li L, Liang J, Liu B, Liu D, Liu L, Liu S, Liu X, Miao L, Ren H, Shi G, Shi L, Sun S, Tao X, Tong R, Wang C, Wang B, Wang J, Wang J, Wang X, Wang X, Xie J, Xie S, Yang H, Yang J, You C, Zhang H, Zhang Y, Zhao C, Zhao Q, Zhu J, Ji B, Guo R, Hang C, Xi X, Li S, Gong Z, Zhou J, Wang R, Zhao Z. Evidence-based guideline for the prevention and management of perioperative infection. J Evid Based Med 2023; 16:50-67. [PMID: 36852502 DOI: 10.1111/jebm.12514] [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: 08/08/2022] [Accepted: 01/09/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND We have updated the guideline for preventing and managing perioperative infection in China, given the global issues with antimicrobial resistance and the need to optimize antimicrobial usage and improve hospital infection control levels. METHODS We conducted a comprehensive evaluation of the evidence for prevention and management of perioperative infection, based on the concepts of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations was graded and voted using the Delphi method and the nominal group technique. Revisions were made to the guidelines in response to feedback from the experts. RESULTS There were 17 questions prepared, for which 37 recommendations were made. According to the GRADE system, we evaluated the body of evidence for each clinical question. Based on the meta-analysis results, recommendations were graded using the Delphi method to generate useful information. CONCLUSIONS This guideline provides evidence to perioperative antimicrobial prophylaxis that increased the rational use of prophylactic antimicrobial use, with substantial improvement in the risk-benefit trade-off.
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Affiliation(s)
- Qiaoyu Wang
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Mingnan Cao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Hua Tao
- Department of Pharmacy, Beijing United Family Hospital, Beijing, P. R. China
| | - Zhimin Fei
- Department of Neurosurgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Xiufeng Huang
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, P. R. China
| | - Pixia Liang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Baiyun Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Jianping Liu
- Centre for Evidence-Based Medicine, Beijing University of Chinese Medicine, Beijing, P. R. China
| | - Xiaoyang Lu
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P. R. China
| | - Penglin Ma
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, P. R. China
| | - Shuyi Si
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Yuewei Zhang
- Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Yingli Zheng
- Department of Pharmacy, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Lei Zang
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China
| | - Xiao Chen
- Department of Pharmacy, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P. R. China
| | - Zhanjun Dong
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, P. R. China
| | - Weihong Ge
- Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, P. R. China
| | - Wei Guo
- Department of Emergency, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Xin Hu
- Department of Pharmacy, Beijing Hospital, Beijing, P. R. China
| | - Xin Huang
- Department of Pharmacy, The First Affiliated Hospital of Shandong First Medical University/Shandong Province Qianfoshan Hospital, Jinan, P. R. China
| | - Ling Li
- Department of Pharmacy, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Jianshu Liang
- Department of Nursing, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Baoge Liu
- Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Dong Liu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, HUST, Wuhan, P. R. China
| | - Linna Liu
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, Xi'an, P. R. China
| | - Songqing Liu
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China
| | - Xianghong Liu
- Department of Pharmacy, Qilu Hospital of Shandong University, Jinan, P. R. China
| | - Liyan Miao
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China
| | - Haixia Ren
- Department of Pharmacy, Tianjin First Central Hospital, Tianjin, P. R. China
| | - Guangzhi Shi
- Department of Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Luwen Shi
- Department of Pharmaceutical Administration, School of Pharmaceutical Sciences, Peking University, Beijing, P. R. China
| | - Shumei Sun
- Department of Pediatrics, Nanfang Hospital of Southern Medical University, Guangzhou, P. R. China
| | - Xia Tao
- Department of Pharmacy, Second Affiliated Hospital of Naval Medical University, Shanghai, P. R. China
| | - Rongsheng Tong
- Department of Pharmacy, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, P. R. China
| | - Cheng Wang
- Department of Pharmacy, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, P. R. China
| | - Bin Wang
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, P. R. China
| | - Jincheng Wang
- Orthopaedic Medical Center, The 2nd Hospital of Jilin University, Changchun, P. R. China
| | - Jingwen Wang
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, P. R. China
| | - Xiaoling Wang
- Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, Beijing, P. R. China
| | - Xiaoyan Wang
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Jian Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Shouxia Xie
- Department of Pharmacy, Shenzhen People's Hospital, Shenzhen, P. R. China
| | - Hua Yang
- Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, P. R. China
| | - Jianxin Yang
- Department of Intervention Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Chao You
- Department of Neurosurgery, West China Hospital Sichuan University, Chengdu, P. R. China
| | - Hongyi Zhang
- Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Yi Zhang
- Department of Pharmacy, Tianjin First Central Hospital, Tianjin, P. R. China
| | - Chengson Zhao
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Jiangsu Suzhou, P. R. China
| | - Qingchun Zhao
- Department of Pharmacy, General Hospital of Northern Theater Command, Shenyang, P. R. China
| | - Jiangguo Zhu
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China
| | - Bo Ji
- Clinical Pharmacy, General Hospital of Southern Theatre Command of PLA, Guangzhou, P. R. China
| | - Ruichen Guo
- Department of Pharmacy, Qilu Hospital of Shandong University, Jinan, P. R. China
| | - Chunhua Hang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, P. R. China
| | - Xiaowei Xi
- Department of Gynecological Oncology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, P. R. China
| | - Sheyu Li
- Department of Endocrinology and Metabolism/China Evidence-based Medicine Center, West China Hospital Sichuan University, Chengdu, P. R. China
| | - Zhicheng Gong
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Jianxin Zhou
- Department of Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Rui Wang
- Department of Drug Clinical Trial, PLA General Hospital, Beijing, P. R. China
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
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12
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Dreikausen L, Blender B, Trifunovic-Koenig M, Salm F, Bushuven S, Gerber B, Henke M. Analysis of microbial contamination during use and reprocessing of surgical instruments and sterile packaging systems. PLoS One 2023; 18:e0280595. [PMID: 36668667 PMCID: PMC9858816 DOI: 10.1371/journal.pone.0280595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023] Open
Abstract
A surgical site infection (SSI) is one of the most common surgical complications. This study analyzed different sources of microorganisms in the air, on reusable surgical instruments, and the outer surface of sterile packaging systems during the use and reprocessing of sterile goods (from the operating room (OR) to the Central Sterile Supply Department (CSSD)). The microbial load in the air was analyzed via active air sampling and settle plates. Furthermore, the airborne particle load was measured by a particle counter. Contact agar plates were used to determine the microbial load on surgical instruments and sterile packaging systems. The highest average microbial and particle load was measured in the air of the OR (active air sampling: max. 56 CFU/m3; settle plates: max. 9 CFU; ≥0.3 μm particles in size: 1,958,403 no./m3). However, no microbial load (0 CFU) was detected on surgical instruments sampled in the OR. The outer surface of stored sterile packaging systems showed a maximal microbial load of 64 CFU. The most common identified pathogen was coagulase-negative staphylococci. Compared to properly reprocessed reusable surgical instruments and sterile packaging systems, the air still seems to be the primary potential source of microbial contamination, especially within the OR.
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Affiliation(s)
- Lena Dreikausen
- Front End Innovation & Materials (FEIM), Aesculap AG, Tuttlingen, Germany
| | - Bernd Blender
- Front End Innovation & Materials (FEIM), Aesculap AG, Tuttlingen, Germany
| | - Milena Trifunovic-Koenig
- Institute for Infection Control and Infection Prevention, Health Care Association District of Constance, Konstanz, Germany
| | - Florian Salm
- Institute for Infection Control and Infection Prevention, Health Care Association District of Constance, Konstanz, Germany
| | - Stefan Bushuven
- Institute for Infection Control and Infection Prevention, Health Care Association District of Constance, Konstanz, Germany
| | - Bianka Gerber
- Institute for Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau Bodensee Hospital Singen, Singen, Germany
| | - Matthias Henke
- Front End Innovation & Materials (FEIM), Aesculap AG, Tuttlingen, Germany
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13
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Tan H, Wong KY, Othman MHD, Kek HY, Wahab RA, Ern GKP, Chong WT, Lee KQ. Current and potential approaches on assessing airflow and particle dispersion in healthcare facilities: a systematic review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:80137-80160. [PMID: 36194323 PMCID: PMC9531230 DOI: 10.1007/s11356-022-23407-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/27/2022] [Indexed: 06/04/2023]
Abstract
An indoor environment in a hospital building requires a high indoor air quality (IAQ) to overcome patients' risks of getting wound infections without interrupting the recovery process. However, several problems arose in obtaining a satisfactory IAQ, such as poor ventilation design strategies, insufficient air exchange, improper medical equipment placement and high door opening frequency. This paper presents an overview of various methods used for assessing the IAQ in hospital facilities, especially in an operating room, isolation room, anteroom, postoperative room, inpatient room and dentistry room. This review shows that both experimental and numerical methods demonstrated their advantages in the IAQ assessment. It was revealed that both airflow and particle tracking models could result in different particle dispersion predictions. The model selection should depend on the compatibility of the simulated result with the experimental measurement data. The primary and secondary forces affecting the characteristics of particle dispersion were also discussed in detail. The main contributing forces to the trajectory characteristics of a particle could be attributed to the gravitational force and drag force regardless of particle size. Meanwhile, the additional forces could be considered when there involves temperature gradient, intense light source, submicron particle, etc. The particle size concerned in a healthcare facility should be less than 20 μm as this particle size range showed a closer relationship with the virus load and a higher tendency to remain airborne. Also, further research opportunities that reflect a more realistic approach and improvement in the current assessment approach were proposed.
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Affiliation(s)
- Huiyi Tan
- School of Chemical and Energy Engineering, Faculty of Engineering, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Keng Yinn Wong
- School of Mechanical Engineering, Faculty of Engineering, Universiti Teknologi Malaysia, Johor, Malaysia.
| | - Mohd Hafiz Dzarfan Othman
- Advanced Membrane Technology Research Centre (AMTEC), Universiti Teknologi Malaysia, Johor, Malaysia
| | - Hong Yee Kek
- School of Mechanical Engineering, Faculty of Engineering, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Roswanira Abdul Wahab
- Advanced Membrane Technology Research Centre (AMTEC), Universiti Teknologi Malaysia, Johor, Malaysia
- Department of Chemistry, Faculty of Sciences, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Garry Kuan Pei Ern
- School of Health Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Life Sciences, Brunel University, Uxbridge, London, UK
| | - Wen Tong Chong
- Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Kee Quen Lee
- Malaysia-Japan International Institute of Technology, Universiti Teknologi Malaysia Kuala Lumpur, 54100, Kuala Lumpur, Malaysia
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14
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Yimer RM, Alemu MK. Bacterial Contamination Level of Indoor Air and Surface of Equipment in the Operation Room in Dil-Chora Referral Hospital, Dire Dawa, Eastern Ethiopia. Infect Drug Resist 2022; 15:5085-5097. [PMID: 36071817 PMCID: PMC9442909 DOI: 10.2147/idr.s380774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/20/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study investigated the bacterial contamination level of the indoor air and surface of the operation room, surgical, and gynecology wards of Dilchora Referral hospitals between January and August 2020. Methods A laboratory based cross-sectional study was carried out on the OR and wards of Dilchora referral hospital in Eastern Ethiopia. A passive air sampling method was used to collect 128 indoor air samples; the bacterial load was enumerated and the result was expressed as colony forming units (CFU/m3). Additional qualitative analysis was carried out to identify particular bacterial species that were isolated from the indoor air and swabs taken from the surface of the equipment using conventional techniques. All laboratory data were entered and analyzed using MS Excel 2007 and SPSS version 20. Results The mean bacterial counts of 94.63 CFU/dm/hr in major OR during active time as well as 509.75 and 509.38 CFU/dm/hr in male and female clothing rooms during the afternoon were unacceptable (>450 CFU/dm2). Similarly, 43.75% of the bacterial counts found in the afternoon samples fell short of Fisher’s criterion. The difference between the bacterial counts recorded in the morning and afternoon was significant (p=0.000). A total of 54 (42.2%) indoor air samples and 28 (93.3%) cotton swabs were positive for bacterial growth, with S. aureus (51.04%) and Bacillus sp (55%) being the dominant bacteria isolated from indoor air and the surface of equipment, respectively. Conclusion The bacterial load of investigated wards is considerably “high” to “very high”, which implies a significant risk of hospital acquired infections. Therefore, devising effective control strategies targeted on surface cleansing and sterilizing of the air environment and practicing periodic microbial surveillance of the hospital environment is a paramant.
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Affiliation(s)
- Robel Mekonnen Yimer
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
- Correspondence: Robel Mekonnen Yimer, P.O.Box 1362, 3000 Dire Dawa University, Dire Dawa, Ethiopia, Tel +251 913 278 009, Fax +251 25 112 79 71, Email ;
| | - Mesfin Kebede Alemu
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
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15
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AlRayess S, Sleiman A, Alameddine I, Abou Fayad A, Matar GM, El-Fadel M. Airborne bacterial and PM characterization in intensive care units: correlations with physical control parameters. AIR QUALITY, ATMOSPHERE & HEALTH 2022; 15:1869-1880. [PMID: 35815238 PMCID: PMC9255450 DOI: 10.1007/s11869-022-01222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Abstract
In this study, the spatial variation of airborne bacteria in intensive care units (ICUs) was characterized. Fine particulate matter and several physical parameters were also monitored including temperature and relative humidity. The results showed that the total bacterial load ranged between 20.4 and 134.3 CFU/m3 across the ICUs. Bacterial cultures of the collected samples did not isolate any multi-drug-resistant Gram-negative bacilli indicating the absence of such aerosolized pathogens in the ICUs. Meanwhile, particulate matter levels in several ICUs were found to exceed the international guidelines set for 24-h PM exposure. Moreover, examining bacterial load contribution by size suggested that bacteria with sizes less than 0.65 µm contributed the least to the total bacterial loads, while those with sizes between 0.65 and 1.1 µm contributed the most. A multiple linear regression model was also built to predict the bacterial loads in the ICUs. The regression analysis explained 77% of the variability observed in the measured bacterial concentrations. The model showed that the level of activity in the ICU rooms as well as its occupancy level had strong positive correlations with bacterial loads, while distance away from the patient had a non-linear relationship with measured loads. No statistically significant correlation was found between bacterial load and particulate matter concentrations.
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Affiliation(s)
- S. AlRayess
- Department of Civil & Environmental Engineering, American University of Beirut, Beirut, Lebanon
| | - A. Sleiman
- Department of Experimental Pathology, Immunology and Microbiology, American University of Beirut, Beirut, Lebanon
- Center for Infectious Disease Research (CIDR), American University of Beirut, Beirut, Lebanon
- WHO Collaborating Center for Reference and Research On Bacterial Pathogens, Beirut, Lebanon
| | - I. Alameddine
- Department of Civil & Environmental Engineering, American University of Beirut, Beirut, Lebanon
| | - A. Abou Fayad
- Department of Experimental Pathology, Immunology and Microbiology, American University of Beirut, Beirut, Lebanon
- Center for Infectious Disease Research (CIDR), American University of Beirut, Beirut, Lebanon
- WHO Collaborating Center for Reference and Research On Bacterial Pathogens, Beirut, Lebanon
| | - G. M. Matar
- Department of Experimental Pathology, Immunology and Microbiology, American University of Beirut, Beirut, Lebanon
- Center for Infectious Disease Research (CIDR), American University of Beirut, Beirut, Lebanon
- WHO Collaborating Center for Reference and Research On Bacterial Pathogens, Beirut, Lebanon
| | - M. El-Fadel
- Department of Civil & Environmental Engineering, American University of Beirut, Beirut, Lebanon
- Department of Industrial and Systems Engineering, Khalifa University, Abu Dhabi, UAE
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16
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Zarei M, Babajani-Vafsi S, Kazemi-Galougahi MH, Bakhshi A, Ajorpaz NM, Ghorbani M. The safety of a novel single-drape cover for sterile back tables in the operating room compared to the standard two-drape method: an experimental study. Patient Saf Surg 2022; 16:18. [PMID: 35655219 PMCID: PMC9161583 DOI: 10.1186/s13037-022-00330-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Covering the prepared sterile back tables (PSBTs) during periods of nonuse and during active surgeries may decrease contamination of sterile surgical instruments that have direct contact to surgical wound. The Association of periOperative Registered Nurses (AORN) declared that an easy method for covering and removing the drape will ultimately be most effective (e.g. standard two-drape method). Hence, this study was designed to test the hypothesis that using a novel single-drape cover had more efficiency and safety in decreasing airborne bacteria-carrying particles (ABCPs) settling on the PSBTs during static and dynamic periods than the standard two-drape method. METHODS This experimental study was conducted with using 918 agar plates to detect contamination of the PSBTs with ABCPs on two conditions (static and dynamic) at an academic medical center in Kashan, Iran, from September 25, 2021, to January 20, 2022. The contamination of PSBTs was evaluated by 6 agar settle plates (n = 918 in total) on each PSBT in static and dynamic operating room (OR) conditions. At each time-point, this set-up was repeated on two occasions else during data collection, establishing 81 PSBTs in total. Tested groups included the PSBTs covered with the standard two-drape method, the novel single-drape cover, or no cover. The plates were collected after 15, 30, 45, 60, 120, 180, 240 min and 24 h. The primary outcome measured was comparison of mean bioburden of ABCPs settling on covered PSBTs on two conditions by using agar settle plates. The secondary outcomes measured were to determine the role of covering in decreasing contamination of PSBTs and the estimation of time-dependent surgical instrument contamination in the uncovered PSBTs on two conditions by using agar settle plates. RESULTS Covering the PSBTs during static and dynamic OR conditions lead to a significantly decreased bioburden of ABCPs on them (P < 0.05). No differences were seen between the standard two-drape method and the novel single-drape cover (P > 0.05). CONCLUSIONS We found that there is no preference for using the novel single-drape cover than the standard two-drape method. Our results showed a significant decrease in bioburden of ABCPs on the PSBTs when those were covered during static and dynamic OR conditions, indicating the efficiency for covering the PSBTs during periods of nonuse and during active surgery.
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Affiliation(s)
- Mohammadreza Zarei
- Department of Surgical Technology, Faculty of Paramedical Sciences, Aja University of medical sciences, Tehran, Iran
| | - Saeed Babajani-Vafsi
- Department of Surgical Technology, Faculty of Paramedical Sciences, Aja University of medical sciences, Tehran, Iran
| | | | - Ashraf Bakhshi
- Department of Microbiology, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Neda Mirbagher Ajorpaz
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahdi Ghorbani
- Department of Medical Laboratory sciences, Aja University of Medical Sciences, Tehran, Iran.
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17
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Magee LC, Piazza B, Harwood K, Lawrence JTR. C-arm contamination of the surgical field: Can contamination be reduced with an intervening drape? Injury 2022; 53:1994-1998. [PMID: 35414407 DOI: 10.1016/j.injury.2022.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/18/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Contamination of the surgical field by the C-arm in orthopaedic procedures is a significant potential source for surgical site infections. The purpose of this study was to explore the utility of a split sheet to aid in prevention of secondary contamination from the C-arm on the C-arm side of the operative field. METHODS A C-arm and a surgical table were draped by standard techniques. The surgical table was split in thirds: the surgeon's side, the C-arm side of the operative field, and the middle for contamination analysis. Fluorescent powder was used to simulate a contaminant and placed on the C-arm, floor and lower portions of drapes. The C-arm was cycled between PA and Lateral positions. Powder transfer to the field was visualized with a camera under uniform UV light. Photographs were taken to measure fluorescent pixels prior to cycling the C-arm and at 5, 10 and 15 cycles. This protocol was repeated using a split sheet (U-drape) to isolate the C-arm below the operative field. Image J was utilized to calculate differences in the number of pixels brighter than the control image. RESULTS Using standard draping techniques, there was contamination of the surgical field with the C-arm side of the operative field having the highest level of fluorescent pixels. The number of fluorescent pixels was linearly correlated with the number of PA to Lateral cycles. At the end of 15 cycles, the average number of fluorescent pixels for the intervening draping technique was 2.9 pixels compared to the standard draping technique of 3939 pixels (p = 0.0078). DISCUSSION The addition of a U-drape between the C-arm and the table results in a statistically significant reduction in surgical field contamination as a result of secondary transfer from the C-arm. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Lacey C Magee
- Children's Hospital of Philadelphia, 2nd Floor Wood Building, 3401 Civic Centre Boulevard, Philadelphia, PA 19104, United States
| | - Brian Piazza
- Children's Hospital of Philadelphia, 2nd Floor Wood Building, 3401 Civic Centre Boulevard, Philadelphia, PA 19104, United States
| | - Kathleen Harwood
- Children's Hospital of Philadelphia, 2nd Floor Wood Building, 3401 Civic Centre Boulevard, Philadelphia, PA 19104, United States
| | - J Todd R Lawrence
- Children's Hospital of Philadelphia, 2nd Floor Wood Building, 3401 Civic Centre Boulevard, Philadelphia, PA 19104, United States.
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18
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Agra PA, Agra PA, Marceliano-Alves MFV, Conceição GMSD, Assumpção SLDL, Crespo CDF, Philippi LMB, Lins RX. Effect of Ozone Gas on Removal of Airborne Particles. Eur J Dent 2022; 16:695-702. [PMID: 35436785 PMCID: PMC9507573 DOI: 10.1055/s-0041-1741375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective
Airborne particles are one of the most important factors in the spread of infectious pathogens and must be monitored in healthcare facilities. Viable particles are living microorganisms, whereas non-viable particles do not contain microorganisms but act as transport for viable particles. The effectiveness of ozone in reducing these particles in a non-controlled room and a controlled cleanroom using high-efficiency particles air (HEPA) filter was analyzed in this study.
Materials and Methods
Viable particles and non-viable particles sized 0.5 and 5 μm were quantified before and after ozonation in two different health environments: non-controlled (group 1) and controlled area, which was associated with a HEPA filtering system (group 2). Active air sampling using a MAS 100 was used to count the number of viable particles, while the number of non-viable particles/m
3
was obtained following the manufacturer's recommendations of the Lasair III 310C system.
Results
Our results of the viable particles counting were not quantifiable and analyzed using statistical tests. Both groups showed a slight tendency to reduce the number of viable particles after ozonation of the environmental air. A statistically significant reduction of non-viable 5 μm particles after ozonation was observed in both groups (G1:
p
= 0,009; G2:
p
= 0,002). Reduction in the non-viable 0.5 μm particles after ozonation was observed only in group 2, associated with the HEPA filter. In group 1, after ozonation, a significant increase in 0.5 μm particles was observed, probably due to the breaking of 5 μm particles by ozone gas. Our results suggest that ozone gas can break 5 μm particles and, when associated with a HEPA filter, increases its effectiveness in removing 0.5 μm particles.
Conclusion
Considering that 5 μm particles are important in the air transport of microorganisms, their reduction in the environment can be a relevant parameter in controlling the dissemination of infections.
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Affiliation(s)
- Priscilla Alvarenga Agra
- Post Graduate Program in Dentistry, Health Institute of Nova Friburgo, Federal Fluminense University, Nova Friburgo, Rio de Janeiro, Brazil
| | - Patricia Alvarenga Agra
- Immunobiological Technology Institute, Bio-Manguinhos, Oswaldo Cruz Foundation,-Rio de Janeiro, Brazil
| | | | | | | | - Celso de Farias Crespo
- Immunobiological Technology Institute, Bio-Manguinhos, Oswaldo Cruz Foundation,-Rio de Janeiro, Brazil
| | | | - Renata Ximenes Lins
- Post Graduate Program in Dentistry, Health Institute of Nova Friburgo, Federal Fluminense University, Nova Friburgo, Rio de Janeiro, Brazil
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19
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Colella Y, Valente AS, Rossano L, Trunfio TA, Fiorillo A, Improta G. A Fuzzy Inference System for the Assessment of Indoor Air Quality in an Operating Room to Prevent Surgical Site Infection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063533. [PMID: 35329215 PMCID: PMC8955589 DOI: 10.3390/ijerph19063533] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 02/04/2023]
Abstract
Indoor air quality in hospital operating rooms is of great concern for the prevention of surgical site infections (SSI). A wide range of relevant medical and engineering literature has shown that the reduction in air contamination can be achieved by introducing a more efficient set of controls of HVAC systems and exploiting alarms and monitoring systems that allow having a clear report of the internal air status level. In this paper, an operating room air quality monitoring system based on a fuzzy decision support system has been proposed in order to help hospital staff responsible to guarantee a safe environment. The goal of the work is to reduce the airborne contamination in order to optimize the surgical environment, thus preventing the occurrence of SSI and reducing the related mortality rate. The advantage of FIS is that the evaluation of the air quality is based on easy-to-find input data established on the best combination of parameters and level of alert. Compared to other literature works, the proposed approach based on the FIS has been designed to take into account also the movement of clinicians in the operating room in order to monitor unauthorized paths. The test of the proposed strategy has been executed by exploiting data collected by ad-hoc sensors placed inside a real operating block during the experimental activities of the “Bacterial Infections Post Surgery” Project (BIPS). Results show that the system is capable to return risk values with extreme precision.
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Affiliation(s)
- Ylenia Colella
- Department of Electrical Engineering and Information Technologies, University of Naples “Federico II”, 80125 Naples, Italy; (Y.C.); (A.S.V.); (L.R.)
| | - Antonio Saverio Valente
- Department of Electrical Engineering and Information Technologies, University of Naples “Federico II”, 80125 Naples, Italy; (Y.C.); (A.S.V.); (L.R.)
| | - Lucia Rossano
- Department of Electrical Engineering and Information Technologies, University of Naples “Federico II”, 80125 Naples, Italy; (Y.C.); (A.S.V.); (L.R.)
| | - Teresa Angela Trunfio
- Department of Advanced Biomedical Sciences, University Hospital of Naples “Federico II”, 80131 Naples, Italy;
- Correspondence:
| | - Antonella Fiorillo
- Department of Advanced Biomedical Sciences, University Hospital of Naples “Federico II”, 80131 Naples, Italy;
| | - Giovanni Improta
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy;
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples “Federico II”, 80131 Naples, Italy
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20
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Indoor Air Quality in Healthcare Units—A Systematic Literature Review Focusing Recent Research. SUSTAINABILITY 2022. [DOI: 10.3390/su14020967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The adequate assessment and management of indoor air quality in healthcare facilities is of utmost importance for patient safety and occupational health purposes. This study aims to identify the recent trends of research on the topic through a systematic literature review following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology. A total of 171 articles published in the period 2015–2020 were selected and analyzed. Results show that there is a worldwide growing research interest in this subject, dispersed in a wide variety of scientific journals. A textometric analysis using the IRaMuTeQ software revealed four clusters of topics in the sampled articles: physicochemical pollutants, design and management of infrastructures, environmental control measures, and microbiological contamination. The studies focus mainly on hospital facilities, but there is also research interest in primary care centers and dental clinics. The majority of the analyzed articles (85%) report experimental data, with the most frequently measured parameters being related to environmental quality (temperature and relative humidity), microbiological load, CO2 and particulate matter. Non-compliance with the WHO guidelines for indoor air quality is frequently reported. This study provides an overview of the recent literature on this topic, identifying promising lines of research to improve indoor air quality in healthcare facilities.
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Humphreys H. Infection prevention and control considerations regarding ventilation in acute hospitals. Infect Prev Pract 2022; 3:100180. [PMID: 34988422 PMCID: PMC8696268 DOI: 10.1016/j.infpip.2021.100180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/13/2021] [Indexed: 12/31/2022] Open
Abstract
Infection prevention and control team members (IPCTM) are often intimidated by aspects of ventilation as they relate to healthcare, because they consider them technical and outside their area of comfort and expertise. However, engineers, estates departments and planners need IPCTM input to ensure appropriate design and use. The main areas of importance centre on the operating theatre, the provision of air-controlled ventilated isolation rooms, and how to respond to major outbreaks/pandemics. Concentrating on basic principles of infection prevention and control, developing relationships with key departments and individuals, and applying best practice to these and other areas as they arise, are of great value. Some background, information and suggestions are provided for IPCTM with a view to providing simple practical advice in these areas.
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Key Words
- ACH, air changes per hour
- ACV, air controlled ventilated
- Air sampling
- Air-controlled ventilation
- ED, emergency department
- IPC, infection prevention and control
- IPCTM, infection prevention and control team members
- Isolation facilities
- MIS, minimally invasive surgery
- NIPPV, non-invasive positive pressure ventilation
- Operating theatres
- PJA, prosthetic joint arthroplasty
- Pandemic preparedness
- SSI, surgical site infection
- UDAF, unidirectional air flow
- Upgrades/refurbishments
- cfu, colony forming units
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Affiliation(s)
- Hilary Humphreys
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
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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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Indoor Air Quality in Healthcare and Care Facilities: Chemical Pollutants and Microbiological Contaminants. ATMOSPHERE 2021. [DOI: 10.3390/atmos12101337] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The indoor air quality of healthcare and care facilities is poorly studied. The aim of this study was to qualitatively and quantitatively describe the chemical pollution and the microbiological contaminations of the indoor environment of these facilities. Methods: A wide range of chemical compounds (39 volatile and 13 semi-volatile organic compounds, carbon dioxide, fine particulate matter) and microorganisms (fungi and bacteria) were studied. Sampling campaigns were conducted in two French cities in summer 2018 and winter 2019 in six private healthcare facilities (general practitioner’s offices, dental offices, pharmacies) and four care facilities (nursing homes). Results: The highest median concentrations of chemical compounds (μg/m3) were measured for alcohols (ethanol: 378.9 and isopropanol: 23.6), ketones (acetone: 18.8), aldehydes (formaldehyde: 11.4 and acetaldehyde: 6.5) and terpenes (limonene: 4.3). The median concentration of PM2.5 was 9.0 µg/m3. The main bacteria of these indoor environments were Staphylococcus, Micrococcus and Bacillus genera, with median bacterial concentrations in the indoor air of 14 cfu/m3. The two major fungal genera were Cladosporium and Penicillium, with median fungal concentrations of 7 cfu/m3. Conclusions: Indoor air in healthcare and care facilities contains a complex mixture of many pollutants found in higher concentrations compared to the indoor air in French hospitals in a previous study.
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Bright R, Hayles A, Fernandes D, Visalakshan RM, Ninan N, Palms D, Burzava A, Barker D, Brown T, Vasilev K. In Vitro Bactericidal Efficacy of Nanostructured Ti6Al4V Surfaces is Bacterial Load Dependent. ACS APPLIED MATERIALS & INTERFACES 2021; 13:38007-38017. [PMID: 34374279 DOI: 10.1021/acsami.1c06919] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The demand for medical implants globally has increased significantly due to an aging population amongst other reasons. Despite the overall increase in the survivorship of Ti6Al4V implants, implant infection rates are increasing due to factors such as diabetes, obesity, and bacterial resistance to antibiotics. Two commonly found bacteria implicated in implant infections are Staphylococcus aureus and Pseudomonas aeruginosa. Based on prior work that showed nanostructured surfaces might have potential in passively killing these bacterial species, we developed a hierarchical, hydrothermally etched, nanostructured titanium surface. To evaluate the antibacterial efficacy of this surface, etched and as-received surfaces were inoculated with S. aureus or P. aeruginosa at concentrations ranging from 102 to 109 colony-forming units per disc. Live/dead staining revealed there was a 60% decrease in viability for S. aureus and greater than a 98% decrease for P. aeruginosa on etched surfaces at the lowest inoculum of 102 CFU/disc, when compared to the control surface. Bactericidal efficiency decreased with increasing bacterial concentrations in a stepwise manner, with decreases in bacterial viability noted for S. aureus above 105 CFU/disc and above 106 CFU/disc for P. aeruginosa. Surprisingly, biofilm depth analysis revealed a decrease in bacterial viability in the 2 μm layer furthest from the nanostructured surface. The nanostructured Ti6Al4V surface developed here holds the potential to reduce the rate of implant infections.
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Affiliation(s)
- Richard Bright
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
- Future Industries Institute, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Andrew Hayles
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
- Future Industries Institute, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Daniel Fernandes
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Rahul M Visalakshan
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Neethu Ninan
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Dennis Palms
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Anouck Burzava
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Dan Barker
- Corin Australia, Baulkham Hills, NSW 2153, Australia
| | - Toby Brown
- Corin Australia, Baulkham Hills, NSW 2153, Australia
| | - Krasimir Vasilev
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
- Future Industries Institute, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
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Sanguinet J, Edmiston C. Evaluation of dry hydrogen peroxide in reducing microbial bioburden in a healthcare facility. Am J Infect Control 2021; 49:985-990. [PMID: 33737038 DOI: 10.1016/j.ajic.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Standard manual cleaning and disinfection practices are often inadequate. Persistent contamination in the environment poses an infection risk that may be mitigated by no-touch disinfection systems. This study evaluates the efficacy of dry hydrogen peroxide (DHP) on microbial air and surface contamination as an adjunct to routine cleaning and disinfection in a large urban hospital. METHODS Surface samples were collected in five different hospital units, two pediatric and three adult, after manual cleaning on multiple days before and after DHP implementation. Air samples were also collected in each unit pre- and post-DHP use. Data outcomes were reported as colony forming units (CFU) with species identification. RESULTS The overall mean surface microbial burden was reduced by 96.5 percent for all units post-DHP compared to baseline (P < 0.001), with the greatest reductions achieved on privacy curtains (99.5 %). Mean microbial air sample counts were also reduced post-DHP compared to pre-DHP. CONCLUSIONS This study demonstrates that DHP was effective in reducing both air and surface microbial contamination in a variety of settings within a large, tertiary care hospital.
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Guo Y, Jing Y, Wang Y, To A, Du S, Wang L, Bai D. Control of SARS-CoV-2 transmission in orthodontic practice. Am J Orthod Dentofacial Orthop 2020; 158:321-329. [PMID: 32682660 PMCID: PMC7274582 DOI: 10.1016/j.ajodo.2020.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 02/05/2023]
Abstract
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has attracted worldwide concerns because of its high person-to-person infectivity and lethality, and it was labeled as a pandemic as the rapid increase in the number of confirmed patients in most areas around the world became evident. The SARS-CoV-2 is mainly transmitted through respiratory droplets and close contact. There is also evidence of transmission through aerosols and digestive tracts. Because orthodontic treatment involves a large population who need routine return-visits, it was significantly affected and suspended because of the COVID-19 pandemic and the shutdown of the dental clinics and hospitals. Although the spread of COVID-19 has been effectively controlled in China, and many areas have gradually resumed work and classes, orthodontic participants are still under high risks of SARS-CoV-2 infection. This is due to the fact that the asymptomatic carriers of SARS-CoV-2 or patients in the incubation period may cause the cross-infection between orthodontic practitioners and patients. The close proximity between the practitioners and the patients, and the generation of droplets and aerosols that contain saliva and blood during treatment further increase the risks of transmission. In this article, we summarized the preventive strategies for control of SARS-CoV-2 transmission to protect both staff and patients during the orthodontic practice.
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Affiliation(s)
- Yongwen Guo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yan Jing
- Department of Orthodontics, Texas A&M College of Dentistry, Texas A&M University, Dallas, Tex
| | - Yunshi Wang
- Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Aileen To
- Texas A&M College of Dentistry, Texas A&M University, Dallas, Tex
| | - Shufang Du
- Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Liuzheng Wang
- Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Ding Bai
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
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Tel A, Bortuzzo F, Pascolo P, Costa F, Sembronio S, Bresadola V, Baldi D, Robiony M. Maxillofacial Surgery 5.0: a new paradigm in telemedicine for distance surgery, remote assistance, and webinars. ACTA ACUST UNITED AC 2020; 69:191-202. [DOI: 10.23736/s0026-4970.20.04274-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tipper GA, Chiwera L, Lucas J. Reducing Surgical Site Infection in Pediatric Scoliosis Surgery: A Multidisciplinary Improvement Program and Prospective 4-Year Audit. Global Spine J 2020; 10:633-639. [PMID: 32677570 PMCID: PMC7359689 DOI: 10.1177/2192568219868200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
STUDY DESIGN Single-center prospective cohort. OBJECTIVES To evaluate a multidisciplinary led, structured protocol for reducing surgical site infections (SSIs) in pediatric scoliosis surgery. METHODS Following a spike to 8.6% in local annual infection rate, a multidisciplinary team was convened to identify interventions. The team consisted of spinal surgeons, infectious diseases consultants, physiotherapists, specialist nurses, and theatre managers. A protocol was initiated, including preoperative skin decontamination; standardized operative site prepreparation; betadine-soaked swabs sutured to wound edges; blood loss minimization; 3 L0.9% saline pulsed-lavage; defined protocol of glove changes; antibiotic regime of preoperative gentamicin, intraoperative subfascial vancomycin powder, 48-hour cefuroxime; and intraoperative normothermia. A 4-year audit was initiated of all patients aged ≤18 years undergoing corrective spinal deformity surgery. Institutional board review was not required. RESULTS Between January 1, 2014 and January 1, 2018, 414 operations were performed on 355 patients: male:female = 1:2.2, mean age 13.7 years (range 2.5-17.9), 233 idiopathic (mean operated vertebral levels 12), 122 neuromuscular (mean operated vertebral levels 14), 66 growing rod procedures, 41 multistage procedures. The mean number of operated vertebral levels both overall and in infected cases was 13 (range 2-17). Nine SSIs occurred in 8 patients at 3 months (4 neuromuscular), resulting in an overall SSI per operation of 2.2%. CONCLUSION A multidisciplinary approach with standardized measures significantly reduced SSIs in the unit's pediatric scoliosis surgery.
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Affiliation(s)
- Geoffrey A. Tipper
- The National Hospital for Neurology and Neurosurgery, London, UK,Geoffrey A. Tipper, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
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Rajakulasingam R, Da Silva EJ, Azzopardi C, Fernandez T, Botchu R, Hargunani R. Standard operating procedure of image-guided intervention during the COVID-19 pandemic: a combined tertiary musculoskeletal oncology centre experience. Clin Radiol 2020; 75:794.e19-794.e26. [PMID: 32732094 PMCID: PMC7373026 DOI: 10.1016/j.crad.2020.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the response measures in continuing an image-guided intervention service in two tertiary-level musculoskeletal oncology centres during the COVID-19 pandemic. MATERIALS AND METHODS This study was a retrospective review of all patients undergoing image-guided intervention in the computed tomography (CT) and normal ultrasound (US) rooms from 24 March 2020 to 24 May 2020 (during the COVID-19 pandemic peak) at Royal National Orthopaedic Hospital, London, and Royal Orthopaedic Hospital, Birmingham, UK. Measures were put in place to address air pressures, airflow direction, aerosol generation, and the safe utilisation of existing scanning rooms and work lists for interventional procedures. RESULTS Three hundred and thirty-one patients (164 at Royal National Orthopaedic Hospital and 167 at Royal Orthopaedic Hospital) underwent image-guided procedures at both sites in the CT and US rooms. At the Royal National Orthopaedic Hospital, 40% of all procedures were performed under general anaesthesia. These consisted of 47 CT biopsies, 7 CT radiofrequency ablations (RFAs), and 12 US biopsies. At the Royal Orthopaedic Hospital, 86% of all procedures were performed under local anaesthetic, with no general anaesthetic procedures. These consisted of 61 CT biopsies and 83 US biopsies. All 256 patients having procedures in the CT room had no post-procedural complications or COVID-19-related symptoms and morbidity on follow-up. CONCLUSION By adopting a pragmatic approach with meticulous planning, a limited, but fully functional image-guided interventional list can be run without any adverse patient outcomes. COVID-19 has had a significant impact on CT interventional procedures. Air pressures and appropriate ventilation systems need to be considered. A pragmatic and meticulous approach is crucial in operating a functional service.
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Affiliation(s)
- R Rajakulasingam
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London HA7 4LP, UK
| | - E J Da Silva
- Department of Anaesthetics, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham B31 2AP, UK
| | - C Azzopardi
- Department of Radiology, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham B31 2AP, UK
| | - T Fernandez
- Department of Anaesthetics, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London HA7 4LP, UK
| | - R Botchu
- Department of Radiology, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham B31 2AP, UK.
| | - R Hargunani
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London HA7 4LP, UK
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Comparative Analysis of Energy Consumption, Indoor Thermal–Hygrometric Conditions, and Air Quality for HVAC, LDAC, and RDAC Systems Used in Operating Rooms. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10113721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
As controlling temperature and humidity is crucial for maintaining comfort and preventing microbial growth, operating rooms (ORs) are the most energy-intensive areas in hospitals. We aimed to evaluate the energy consumption of three dehumidification air conditioning systems used in ORs and their corresponding air quality for ORs at rest. This study selected three ORs using a conventional heating, ventilation, and air conditioning (HVAC) system; a liquid desiccant air conditioning (LDAC) system; and a rotary desiccant air conditioning (RDAC) system, respectively. The indoor thermal–hygrometric conditions, air quality, and energy consumption of the ORs were monitored in this study. The median levels of relative humidity (RH) were 66.7% in the OR using the conventional HVAC system, 60.8% in the OR using the LDAC system, and 60.5% in the OR using the RDAC system. The median daily total energy consumption of the RDAC system (10.1 kWh/m2) and LDAC system (11.8 kWh/m2) were 28.12% and 16.54% lower, respectively, than that of the conventional HVAC system (14.1 kWh/m2). The PM≥0.5 levels and airborne bacterial concentrations in the ORs met the ISO 14644-1 Class 7 standard and China’s GB50333-2013 standard, respectively. The RDAC system was clearly superior to the LDAC and conventional HVAC systems in terms of energy consumption.
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Zhang H, Xu MP, Dong ZQ, Liu SH, Yang AJ. Does using outpatient room air for bleomycin foam preparation increase the risk of infection? Phlebology 2020; 35:583-588. [PMID: 32312165 DOI: 10.1177/0268355520919267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate whether the risk of infections is increased with the use of air from outpatient rooms to prepare bleomycin foam. METHODS Settling plates were adopted to collect bacteria from outpatient room air, operating theatre air, human serum albumin, bleomycin solution and bleomycin foam prepared with both outpatient room and operating theatre air. The plates were placed in an incubator at 37°C for 48 h, and the number of bacterial colonies was recorded using colony-forming units. The results were analysed by the t-test. A retrospective study was then performed to evaluate the outpatient safety of bleomycin foam. RESULTS The number of colony-forming units in the bleomycin foam produced using both operating and outpatient room air was very low, with no statistic difference. No infection cases were reported in clinical evaluation. CONCLUSION Using the air from outpatient treatment rooms for bleomycin foam preparation does not increase the risk of infections.
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Affiliation(s)
- Hao Zhang
- Department of Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University, Jinan, China.,Institute of Stomatology, Shandong University, Jinan, China.,Department of Oral and Maxillofacial Surgery, School of Stomatology, Shandong University, Jinan, China
| | - Ming Pei Xu
- Institute of Stomatology, Shandong University, Jinan, China.,Department of Plastic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Zuo Qing Dong
- Department of Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University, Jinan, China.,Institute of Stomatology, Shandong University, Jinan, China
| | - Shao Hua Liu
- Department of Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University, Jinan, China.,Institute of Stomatology, Shandong University, Jinan, China
| | - Ai Jun Yang
- Library of Shandong University, Jinan, China
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Ong S, Khee TT. Practical considerations in the anaesthetic management of patients during a COVID-19 epidemic. Anaesthesia 2020; 75:823-824. [PMID: 32221974 DOI: 10.1111/anae.15053] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- S Ong
- Singapore General Hospital, Singapore
| | - T T Khee
- Singapore General Hospital, Singapore
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Salmons HI, Lendner M, Divi SN, Dworkin M, McKenzie J, Tarazona D, Gala Z, Lendner Y, Woods B, Kaye D, Savage J, Kepler C, Kurd M, Hsu V, Radcliff K, Rihn J, Anderson G, Hilibrand A, Vaccaro A, Schroeder G. Effects of Operating Room Size on Surgical Site Infection Following Lumbar Fusion Surgery. Int J Spine Surg 2019; 13:423-428. [PMID: 31741831 DOI: 10.14444/6057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Surgical site infections (SSIs) represent a devastating complication after spine surgery. Many factors have been identified, but the influence of operating room (OR) size on infection rate has not been assessed. Methods Two thousand five hundred and twenty-three patients who underwent open lumbar spine fusion at a single institution between 2010 and 2016 were included. Patients were dichotomized into large versus small groups based on OR volume. Bivariate logistic regression and a final multivariate model following a multicollinearity check were used to calculate odds of infection for all variables. Results A total of 63 patients (2.5%) developed SSIs with 46 (73%) in the larger OR group and 17 (27%) in the smaller OR group. The rate of SSIs in larger ORs was 3.02% compared with 1.81% in smaller ORs. Significant parameters impacting SSI in bivariate analysis included an earlier year of surgery, BMI > 30, more comorbidities, more levels decompressed and fused, smoking, and larger OR volumes. Multivariate analysis identified BMI > 30, Elixhauser scores, smoking, and increasing levels decompressed as significant predictors. Topical vancomycin was found to significantly decrease rate of infection in both analyses. Conclusions OR size (large versus small) was ultimately not a significant predictor of infection related to rates of SSIs, although it did show a clinical trend toward significance, suggesting association. Future prospective analysis is warranted. Level of Evidence 3.
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Affiliation(s)
- Harold I Salmons
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Mayan Lendner
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Srikanth N Divi
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Myles Dworkin
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - James McKenzie
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Daniel Tarazona
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Zachary Gala
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Yovel Lendner
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Barrett Woods
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - David Kaye
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jason Savage
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Christopher Kepler
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Mark Kurd
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Victor Hsu
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Kris Radcliff
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jeff Rihn
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Greg Anderson
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alan Hilibrand
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alex Vaccaro
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Gregory Schroeder
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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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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Loftus RW, Dexter F, Robinson AD. High-risk Staphylococcus aureus transmission in the operating room: A call for widespread improvements in perioperative hand hygiene and patient decolonization practices. Am J Infect Control 2018; 46:1134-1141. [PMID: 29907449 DOI: 10.1016/j.ajic.2018.04.211] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/02/2018] [Accepted: 04/02/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Increased awareness of the epidemiology of transmission of pathogenic bacterial strain characteristics may help to improve compliance with intraoperative infection control measures. Our aim was to characterize the epidemiology of intraoperative transmission of high-risk Staphylococcus aureus sequence types (STs). METHODS S aureus isolates collected from 3 academic medical centers underwent whole cell genome analysis, analytical profile indexing, and biofilm absorbance. Transmission dynamics for hypertransmissible, strong biofilm-forming, antibiotic-resistant, and virulent STs were assessed. RESULTS S aureus ST 5 was associated with increased risk of transmission (adjusted incidence risk ratio, 6.67; 95% confidence interval [CI], 1.82-24.41; P = .0008), greater biofilm absorbance (ST 5 median absorbance ± SD, 3.08 ± 0.642 vs other ST median absorbance ± SD, 2.38 ± 1.01; corrected P = .021), multidrug resistance (odds ratio, 7.82; 95% CI, 2.19-27.95; P = .002), and infection (6/38 ST 5 vs 6/140 STs; relative risk, 3.68; 95% CI, 1.26-10.78; P = .022). Provider hands (n = 3) and patients (n = 4) were confirmed sources of ST 5 transmission. Transmission locations included provider hands (n = 3), patient skin sites (n = 4), and environmental surfaces (n = 2). All observed transmission stories involved the within-case mode of transmission. Two of the ST 5 transmission events were directly linked to infection. CONCLUSIONS Intraoperative S aureus ST 5 isolates are hypertransmissible and pathogenic. Improved compliance with hand hygiene and patient decolonization may help to control the spread of these dangerous pathogens.
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