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Association of Airborne Microorganisms in the Operating Room With Implant Infections: A Randomized Controlled Trial

Published online by Cambridge University Press:  26 October 2016

Rabih O. Darouiche ,
David M. Green ,
Melvyn A. Harrington ,
Bruce L. Ehni ,
Panagiotis Kougias ,
Carlos F. Bechara  and
Daniel P. O’Connor
Rabih O. Darouiche*
Affiliation:
Departments of Medicine, Surgery, and Physical Medicine and Rehabilitation, Michael E. DeBakey Veterans Affairs Medical Center (VAMC), and Infectious Disease Service, Baylor College of Medicine, Houston, Texas
David M. Green
Affiliation:
Section of Orthopedic Surgery, Michael E. DeBakey VAMC, Houston, Texas
Melvyn A. Harrington
Affiliation:
Baylor College of Medicine Medical Center, Houston, Texas
Bruce L. Ehni
Affiliation:
Section of Neurosurgery, Michael E. DeBakey VAMC, Houston, Texas
Panagiotis Kougias
Affiliation:
Section of Vascular Surgery, Michael E. DeBakey VAMC, Houston, Texas
Carlos F. Bechara
Affiliation:
Houston Methodist Cardiovascular Surgery Associates, Houston, Texas
Daniel P. O’Connor
Affiliation:
University of Houston, Houston, Texas
*
Address correspondence to Rabih O. Darouiche, MD, Departments of Medicine, Surgery, and Physical Medicine and Rehabilitation, Michael E. DeBakey VAMC, Bldg 100, Rm 4B-370, 2002 Holcombe Blvd, Houston, TX 77030 (rdarouiche@aol.com).
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Abstract

OBJECTIVE

To evaluate the association of airborne colony-forming units (CFU) at incision sites during implantation of prostheses with the incidence of either incisional or prosthesis-related surgical site infections.

DESIGN

Randomized, controlled trial.

SETTING

Primary, public institution.

PATIENTS

Three hundred patients undergoing total hip arthroplasty, instrumented spinal procedures, or vascular bypass graft implantation.

METHODS

Patients were randomly assigned in a 1:1 ratio to either the intervention group or the control group. A novel device (Air Barrier System), previously shown to reduce airborne CFU at incision sites, was utilized in the intervention group. Procedures assigned to the control group were performed without the device, under routine operating room atmospheric conditions. Patients were followed up for 12 months to determine whether airborne CFU levels at the incision sites predicted the incidence of incisional or prosthesis-related infection.

RESULTS

Data were available for 294 patients, 148 in the intervention group and 146 in the control group. CFU density at the incision site was significantly lower in the intervention group than in the control group (P<.001). The density of airborne CFU at the incision site during the procedures was significantly related to the incidence of implant infection (P=.021). Airborne CFU densities were 4 times greater in procedures with implant infection versus no implant infection. All 4 of the observed prosthesis infections occurred in the control group.

CONCLUSION

Reduction of airborne CFU specifically at the incision site during operations may be an effective strategy to reduce prosthesis-related infections. Trial Registration: clinicaltrials.gov Identifier: NCT01610271

Infect Control Hosp Epidemiol 2016;1–8

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 1 , January 2017 , pp. 3 - 10
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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