Intraoperative contamination and space suits: a potential mechanism
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The body exhaust suit (BES) of Charnley creates ‘negative pressure’ inside the gown using intake/outtake tubing. Modern ‘space suit’ (SS) systems incorporate helmet-based intake fans, which use the hood material as a filter and create ‘positive pressure’ inside the gown. While early studies of BES demonstrate a clear reduction in infection rates following arthroplasty, recent clinical data on SS use has paradoxically reported a marked increase. We hypothesized that the positive pressure inside the gown could carry air and particles via the unsealed area around the surgeon’s cuff into the operative field. We performed 12 simulated operations with the surgeons hands covered in fluorescent 0.5 micron powder that approximates the size of shedded skin squames. Photographs under UV light and air particle counts were used to compare potential contamination rates between SS and conventional gowns using a standardised scoring system. The highest powder migration was seen in the SS group with a score of 15.3 out of 28. No powder migration was seen in the standard gown group (p = 0.028). This study provides a plausible explanation for the increase in infection rates seen with SS use. We recommend SS be considered for personal protection only and supplemented with sealant tape around the inner glove.
KeywordsInfection Arthroplasty Operating theatre Clothing Spacesuits
We thank associate Professor Chris Frampton, for his statistical analysis.
Conflict of interest
- 1.Charnley J (1964) A clean‐air operating enclosure. Br J Surg 51(3):195–202Google Scholar
- 7.Hooper GJ, Rothwell AG, Frampton C, Wyatt MC (2011) Does the use of laminar flow and space suits reduce early deep infection after total hip and knee replacement?: the ten-year results of the New Zealand Joint Registry. J Bone Joint Surg Br 93(1):85–90. doi: 10.1302/0301-620X.93B1.24862 PubMedCrossRefGoogle Scholar
- 12.Kearns K, Witmer D, Makda J, Parvizi J et al SpringerLink—Clinical Orthopaedics and Related Research®. Online First™. Clinical Orthopaedics and …Google Scholar
- 13.Singh VK, Hussain S, Javed S, Singh I, Mulla R, Kalairajah Y (2011) Sterile surgical helmet system in elective total hip and knee arthroplasty. J Orthop Surg (Hong Kong) 19(2):234–237Google Scholar
- 16.Shaw JA, Bordner MA, Hamory BH (1996) Efficacy of the steri-shield filtered exhaust helmet in limiting bacterial counts in the operating room during total joint arthroplasty. J Arthroplasty 11(4):469–473Google Scholar
- 17.Pasquarella C, Pitzurra O, Herren T, Poletti L, Savino A (2003) Lack of influence of body exhaust gowns on aerobic bacterial surface counts in a mixed-ventilation operating theatre. A study of 62 hip arthroplasties. J Hosp Infect 54(1):2–9. doi: 10.1016/S0195-6701(03)00077-X PubMedCrossRefGoogle Scholar
- 18.Friberg B, Friberg S, Ostensson R, Burman LG (2001) Surgical area contamination—comparable bacterial counts using disposable head and mask and helmet aspirator system, but dramatic increase upon omission of head-gear: an experimental study in horizontal laminar air-flow. J Hosp Infect 47(2):110–115. doi: 10.1053/jhin.2000.0909 PubMedCrossRefGoogle Scholar