Airborne bacterial contamination during orthopedic surgery: A randomized controlled pilot trial

Abstract Study objective Several factors such as lack of unidirectional, turbulent free laminar airflow, duration of surgery, patient warming system, or the number of health professionals in the OR have been shown or suspected to increase the number of airborne bacteria. The objective of this study was to perform a multivariate analysis of bacterial counts in the OR in patients during minor orthopedic surgery. Design Prospective, randomized pilot study. Setting Medical University of Vienna, Austria. Patients Eighty patients undergoing minor orthopedic surgery were included in the study. Interventions Surgery took place in ORs with and without a unidirectional turbulent free laminar airflow system, patients were randomized to warming with a forced air or an electric warming system. Measurement The number of airborne bacteria was measured using sedimentation agar plates and nitrocellulose membranes at 6 standardized locations in the OR. Main results The results of the multivariate analysis showed, that the absence of unidirectional turbulent free laminar airflow and longer duration of surgery increased bacterial counts significantly. The type of patient warming system and the number of health professionals had no significant influence on bacterial counts on any sampling site. Conclusion ORs with unidirectional turbulent free laminar airflow, and a reduction of surgery time decreased the number of viable airborne bacteria. These factors may be particularly important in critical patients with a high risk for the development of surgical site infections.