Air contamination for predicting wound contamination in clean surgery: A large multicenter study.
BACKGROUND
The best method to quantify air contamination in the operating room (OR) is debated, and studies in the field are controversial. We assessed the correlation between 2 types of air sampling and wound contaminations before closing and the factors affecting air contamination.


METHODS
This multicenter observational study included 13 ORs of cardiac and orthopedic surgery in 10 health care facilities. For each surgical procedure, 3 microbiologic air counts, 3 particles counts of 0.3, 0.5, and 5 μm particles, and 1 bacteriologic sample of the wound before skin closure were performed. We collected data on surgical procedures and environmental characteristics.


RESULTS
Of 180 particle counts during 60 procedures, the median log10 of 0.3, 0.5, and 5 μm particles was 7 (interquartile range [IQR], 6.2-7.9), 6.1 (IQR, 5.4-7), and 4.6 (IQR, 0-5.2), respectively. Of 180 air samples, 50 (28%) were sterile, 90 (50%) had 1-10 colony forming units (CFU)/m(3) and 40 (22%) >10 CFU/m(3). In orthopedic and cardiac surgery, wound cultures at closure were sterile for 24 and 9 patients, 10 and 11 had 1-10 CFU/100 cm(2), and 0 and 6 had >10 CFU/100 cm(2), respectively (P < .01). Particle sizes and a turbulent ventilation system were associated with an increased number of air microbial counts (P < .001), but they were not associated with wound contamination (P = .22).


CONCLUSIONS
This study suggests that particle counting is a good surrogate of airborne microbiologic contamination in the OR.
INSERM, IAME, UMR 1137, Paris, France; Universite Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; Infection Control Unit, AP-HP, Hôpital Bichat, Paris, France. Electronic address: gbirgand@gmail.com.
Gabriel
G
Birgand
Infection Control Unit, AP-HP, Hôpital Bichat, Paris, France.
Gaëlle
G
Toupet
INSERM, IAME, UMR 1137, Paris, France; Universite Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France.
Stephane
S
Rukly
Groupe Générale de santé, Direction des risques, Paris, France.
Gilles
G
Antoniotti
Service d'hygiene, clinique Ambroise Paré, Clinique Hartmann, Neuilly-sur-Seine, France.
Marie-Noelle
MN
Deschamps
Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France.
Didier
D
Lepelletier
Department of Hygiene, Caen University Hospital, Caen, France.
Carole
C
Pornet
Département Thoracique, Institut Mutualiste Montsouris, Paris, France.
Jean Baptiste
JB
Stern
Department of Infectious Diseases and Internal Medicine, Centre Hospitalier Universitaire d'Angers, Angers, France.
Yves-Marie
YM
Vandamme
Department of Bacteriology and Hospital Hygiene, Trousseau University Hospital, Tours, France.
Nathalie
N
van der Mee-Marquet
INSERM, IAME, UMR 1137, Paris, France; Universite Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; Medical Intensive Care Unit, AP-HP, Hôpital Bichat, Paris, France.
Jean-François
JF
Timsit
INSERM, IAME, UMR 1137, Paris, France; Universite Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; Infection Control Unit, AP-HP, Hôpital Bichat, Paris, France.
Jean-Christophe
JC
Lucet
D000391:Air Microbiology; D015169:Colony Count, Microbial; D006801:Humans; D052638:Particulate Matter / Q000032:analysis; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology*
D052638:Particulate Matter
Environmental contamination; Infectious risk; Laminar airflow; Operating room; Surgical site infection; Ventilation systems