title: Comparison of three distinct clean air suits to decrease the bacterial load in the operating room: an observational study.
abstract: BACKGROUND
  Lowering air-borne bacteria counts in the operating room is essential in prevention of surgical site infections in orthopaedic joint replacement surgery. This is mainly achieved by decreasing bacteria counts through dilution, with appropriate ventilation and by limiting the bacteria carrying skin particles, predominantly shed by the personnel. The aim of this study was to investigate if a single use polypropylene clothing system or a reusable polyester clothing system could offer similar air quality in the operating room as a mobile laminar airflow device-assisted reusable cotton/polyester clothing system.
  
  
  METHODS
  Prospective observational study design, comparing the performance of three Clean Air Suits by measuring Colony Forming Units (CFU)/m(3) of air during elective hip and knee arthroplasties, performed at a large university-affiliated hospital. The amount of CFU/m(3) of air was measured during 37 operations of which 13 were performed with staff dressed in scrub suits made of a reusable mixed material (69 % cotton, 30 % polyester, 1 % carbon fibre) accompanied by two mobile laminar airflow units. During 24 procedures no mobile laminar airflow units were used, 13 with staff using a reusable olefin fabric clothing (woven polypropylene) and 11 with staff dressed in single-use suits (non-woven spunbonded polypropylene). Air from the operating field was sampled through a filter, by a Sartorius MD8, and bacterial colonies were counted after incubation. There were 6-8 measurements from each procedure, in total 244 measurements. Statistical analysis was performed by Mann-Whitney U-test.
  
  
  RESULTS
  The single-use polypropylene suit reduced the amount of CFU/m(3) to a significantly lower level than both other clothing systems.
  
  
  CONCLUSIONS
  Single-use polypropylene clothing systems can replace mobile laminar airflow unit-assisted reusable mixed material-clothing systems. Measurements in standardized laboratory settings can only serve as guidelines as environments in real operation settings present a much more difficult challenge.
authors.affiliation: Department of Clinical Science and Education, Orthopaedic Unit, Karolinska Institutet, Södersjukhuset, S-118 83 Stockholm, Sweden.
authors.forename: Piotr
authors.initials: P
authors.lastname: Kasina
authors.affiliation: Department of Medicine, Solna (MedS), Unit of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ann
authors.initials: A
authors.lastname: Tammelin
authors.affiliation: Department of Clinical Science and Education, Orthopaedic Unit, Karolinska Institutet, Södersjukhuset, S-118 83 Stockholm, Sweden.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Blomfeldt
authors.affiliation: Department of Energy and Environment, Division of Building Services Engineering, Chalmers University of Technology, Göteborg, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Ljungqvist
authors.affiliation: Department of Energy and Environment, Division of Building Services Engineering, Chalmers University of Technology, Göteborg, Sweden.
authors.forename: Berit
authors.initials: B
authors.lastname: Reinmüller
authors.affiliation: Department of Clinical Science and Education, Orthopaedic Unit, Karolinska Institutet, Södersjukhuset, S-118 83 Stockholm, Sweden.
authors.forename: Carin
authors.initials: C
authors.lastname: Ottosson
keywords: Air-borne bacteria; Operating room; Orthopaedic surgery; Surgical clothing; Ventilation