Journal: Ann Surg 248(5):695-700, 2008. 32 References
Reprint: University Hospital of the Goethe-University, Institute of Medical Microbiology and Infection Control, Paul-Ehrlich-Str. 20, Frankfurt am Main 60596, Germany (C Brandt, MD)
Faculty Disclosure: Abstracted by R. Ouellette, who has nothing to disclose.
Ventilation systems are widely used in operating rooms in many countries, impacting on the cost of healthcare. Their use is based on the assumption that they contribute to the prevention of surgical site infections (SSI). Operating room (OR) ventilation systems themselves entail high investment costs and operating expenses. There is sparse evidence to support this costly intervention, because, to date, few controlled clinical studies have been published with the end point SSI. This retrospective cohort-study based on routine surveillance data was conducted to evaluate whether operating room ventilation with vertical laminar airflow impacts on SSI rates.
Sixty-three surgical departments participated in the German National Nosocomial Krankenhaus Infections Surveillance System (KISS), which included 99,230 operations. Active SSI surveillance was performed according to the methods and definitions given by the US National Nosocomial Infection Surveillance system. Surgical departments were assigned to 3 groups according to the OR ventilation technique in place: (1) OR without artificial ventilation, (2) conventional turbulent ventilation with HEPA-filtered air, and (3) HEPA-filtered laminar airflow ventilation by vertical laminar airflow supply air diffusers. The number of hospital departments without artificial ventilation was so low that it was not included in the study. The data were obtained by a questionnaire from the infection control teams performing active SSI surveillance in the participating hospitals.
The inclusion criteria were met by 63 surgical departments in 55 hospitals. The pool of data analyzed consisted of 99,230 operations with 1901 SSIs. The results revealed higher SSI rates in departments with laminar airflow OR ventilation as compared with turbulent OR ventilation for all of the examined operative procedures, with the exception of colon surgery. The risk for severe SSI after hip prosthesis implantation was significantly higher using laminar airflow OR ventilation as compared with turbulent ventilation.
OR ventilation with laminar airflow showed no benefit and was associated with a significantly higher risk for severe SSI after hip prosthesis implantation. |
