Evaluation of Air Contamination in Orthopaedic Operating Theatres in Hospitals in Southern Italy: The IMPACT Project

Abstract

Postoperative infections are a concern, especially in total knee and total hip arthroplasty. We evaluated the air quality in orthopaedic operating theatres in southeastern Italy to determine the level of bacterial contamination as a risk factor for postoperative infection. Thirty-five hospitals with operating theatres focused on total knee and total hip arthroplasty participated. We sampled the air passively and actively before surgeries began for the day (at rest) and 15 min after the surgical incision (in operation). We evaluated bacterial counts, particle size, mixed vs turbulent airflow systems, the number of doors, number of door openings during procedures and number of people in the operating theatre. We found no bacterial contamination at rest for all sampling methods, and significantly different contamination levels at rest vs in operation. We found no association between the number of people in the surgical team and bacteria counts for both mixed and turbulent airflow systems, and low bacterial loads, even when doors were always open. Overall, the air quality sampling method and type of ventilation system did not affect air quality.

Keywords: air quality; operating theatre; orthopaedic surgery; surgical site infection.

Figure 1

Location of the 30 enrolled hospitals in Apulia, Southern Italy.

Figure 2

Position of the air sampling instruments in the operating theatres during the in operation samplings.

Figure 3

(a) Scatter plots evaluating the relationship between counts using the Coriolis^®μ and particles ≥ 5 µm (r_S = 0.68, p-value = 0.0158) in operating theatres with mixed airflow. (b) Scatter plots evaluating the relationship between counts using the Coriolis^®μ and ≥ 5 µm particles (r_S = 0.47, p-value = 0.1041) in operating theatres with turbulent airflow.