title: Sterile surgical helmet system in elective total hip and knee arthroplasty.
abstract: OBJECTIVE
  To evaluate the sterility of the sterile surgical helmet system (SSHS) during elective total hip and knee arthroplasty in theatres with (n=20) and without (n=20) laminar flow.
  
  
  METHODS
  Three surgeons performed 14 total knee arthroplasties (TKAs) and 6 total hip arthroplasties (THAs) in a laminar flow theatre and 15 TKAs and 5 THAs in a non-laminar flow theatre. An SSHS was used in all the procedures. Samples were taken from the hood at 30-minute intervals during surgery. Swabs were then broken into cooked meat broths for cultivation of organisms. The broths were then directly inoculated onto blood agar and fastidious anaerobic agar for culture of aerobic and anaerobic bacteria, respectively. After 24 hours, these plates were reinoculated with broths that had been incubated for 24 hours. Microbial growth was quantified as 0 (none), 1 (mild), 2 (moderate) and 3 (heavy). Bacterial contamination in the 2 groups at 30, 60 and 90 minutes was compared.
  
  
  RESULTS
  Respectively in the laminar and non-laminar flow theatres, 0 and 9 of the SSHSs showed bacterial growth after direct inoculation, and 14 and 18 of the SSHSs grew 18 and 24 types of organisms in the swab cultures after 24 hours of incubation. Respectively at 30, 60, and 90 minutes, the degree of contamination from direct incubation was significant, but the degree of contamination on swabs after 24 hours of inoculation was not significant. The mean time-dependent contamination after direct inoculation was 0 for the laminar flow group and 0.5, 0.75, and 1.0 for the non-laminar flow group, whereas the corresponding values after 24 hours of incubation were 1.8, 1.8, and 2.6, and 2, 2.75, and 2.95. Coagulase negative Staphylococcus aureus was the most common organism in both groups.
  
  
  CONCLUSIONS
  80% of SSHSs used were contaminated intra-operatively. Direct contact with the SSHS should be avoided by the operating team during surgery. Routine changing of gloves in case of contact with the SSHS should be practised.
authors.affiliation: Department of Trauma and Orthopaedics, Epsom and St. Helier Hospital, Carshalton, United Kingdom. orthopaediks@googlemail.com
authors.forename: Vinay Kumar
authors.initials: VK
authors.lastname: Singh
authors.forename: Shazeena
authors.initials: S
authors.lastname: Hussain
authors.forename: Sadaf
authors.initials: S
authors.lastname: Javed
authors.forename: Ivor
authors.initials: I
authors.lastname: Singh
authors.forename: Rohinton
authors.initials: R
authors.lastname: Mulla
authors.forename: Yegappan
authors.initials: Y
authors.lastname: Kalairajah
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D017558:Elective Surgical Procedures; D004780:Environment, Controlled; D004866:Equipment Contamination / Q000517:prevention & control; D004867:Equipment Design; D006260:Head Protective Devices / Q000382:microbiology; D006801:Humans; D008828:Microbiological Techniques; D009873:Operating Rooms; D016459:Prosthesis-Related Infections / Q000517:prevention & control; D011481:Protective Clothing; D013242:Sterilization; D014691:Ventilation