Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Apr;469(4):945-53.
doi: 10.1007/s11999-010-1688-7.

Current concepts for clean air and total joint arthroplasty: laminar airflow and ultraviolet radiation: a systematic review

Richard P Evans  1
Affiliations

Current concepts for clean air and total joint arthroplasty: laminar airflow and ultraviolet radiation: a systematic review

Richard P Evans. Clin Orthop Relat Res. 2011 Apr.

Abstract

Background: With the trend toward pay-for-performance standards plus the increasing incidence and prevalence of periprosthetic joint infection (PJI), orthopaedic surgeons must reconsider all potential infection control measures. Both airborne and nonairborne bacterial contamination must be reduced in the operating room.

Questions/purposes: Analysis of airborne bacterial reduction technologies includes evaluation of (1) the effectiveness of laminar air flow (LAF) and ultraviolet light (UVL); (2) the financial and potential health costs of each; and (3) an examination of current national and international standards, and guidelines.

Methods: We systematically reviewed the literature from Ovid, PubMed (Medline), Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, NHSEED, CINAHLPLUS, and Google Scholar published until June 2010 focusing on ultraclean air, ultraviolet light, and laminar air.

Results: High-level data demonstrating substantial PJI reduction of any infection control method may not be feasible as a result of the relatively low rates of occurrence and the expense and difficulty of conducting a large enough study with adequate power. UVL has potentially unacceptable health costs and the Centers for Disease Control and Prevention (CDC) recommends against its use. European countries have standardized LAF and it is used by the majority of American joint surgeons.

Conclusions: Both LAF and UVL reduce PJI. The absence of a high level of evidence from randomized trials is not proof of ineffectiveness. The historically high cost of LAF has decreased substantially. Only LAF has been standardized by several European countries. The CDC recommends further study of LAF but recommends UVL not be used secondary to documented potential health risks to personnel.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
A hip arthroplasty laminar flow space suit developed by Martin Marietta circa 1972 is shown. Reprinted with permission of Colleen Mann.
See this image and copyright information in PMC

References

    1. Aglietti P, Salvati EA, Wilson PD, Jr, Kutner LJ. Effect of a surgical horizontal unidirectional filtered air flow unit on wound bacterial contamination and wound healing. Clin Orthop Relat Res. 1974;101:99–104. - PubMed
    1. Ayliffe GA. Role of the environment of the operating suite in surgical wound infection. Rev Infect Dis. 1991;13(Suppl 10):S800–S804. - PubMed
    1. Berg M, Bergman BR, Hoborn J. Ultraviolet radiation compared to an ultra-clean air enclosure: comparison of air bacteria counts in operating rooms. J Bone Joint Surg Br. 1991;73:811–815. - PubMed
    1. Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010;468:45–51. doi: 10.1007/s11999-009-0945-0. - DOI - PMC - PubMed
    1. Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am. 2005;87:1746–1751. doi: 10.2106/JBJS.D.02937. - DOI - PubMed

Publication types

MeSH terms