Visualization of Airborne Particles as a Risk for Microbial Contamination in Orthopedic Surgery

Abstract

Background: The operating theater is recognized to involve a high frequency of occupational blood and body fluid contacts. Objectives: This study aimed to visualize the production of blood and body fluid airborne particles by surgical procedures and to investigate risks of microbial contamination of the conjunctival membranes of surgical staff during orthopedic operations. Methods: Two physicians simulated total knee arthroplasty (TKA) and total hip arthroplasty (THA) in a bio-clean theater using model bones. The generation and behaviors of airborne particles were filmed using a fine particle visualization system, and numbers of airborne particles per 2.83 L of air were counted at the height of the operating and instrument tables. Each action was repeated five times, and particle counts were evaluated statistically. Results: Numerous airborne particles were dispersed to higher and wider areas while "cutting bones in TKA" and "striking and driving the cup component on the pelvic bone in THA" compared to other surgical procedures. The highest particle counts were detected while "cutting bones in TKA" under unidirectional laminar air flow. Discussion: These results provide a clearer image of the dispersion and distribution of airborne particles and identified higher-risk surgical procedures for microbial contamination of the conjunctival membranes. Surgical staff including surgeons, nurses, anesthesiologists, and visitors, should pay attention to and take measures against occupational infection particularly in high-risk surgical situations.

Keywords: airborne particles; microbial contamination; occupational infection; orthopedic surgery; surgery.

Figure 1

Resecting the distal femoral condyle with the bone saw. The fine particle visualization system shows dispersal of reflective airborne particles (bright dots). (A) Many particles including bone tissue and BBF disperse in the direction of saw blade oscillation. (B) The particle density hazard map shows risk areas as ultra-high (red), high (light blue) or medium (white) density zones.

Figure 2

Hammering the trial shell to the acetabulum. (A) The generated particles are widely dispersed and carried higher from the acetabulum and drop down to the floor. (B) The particle density hazard map displays risk areas expanding in all directions over a 3-m distance.