title: In-vitro evaluation of surgical helmet systems for protecting surgeons from droplets generated during orthopaedic procedures.
abstract: BACKGROUND
  Operating theatres and surgical clothing are designed to protect the patient from surgical site infections. However, there is still a risk of infection of the surgical team with blood-borne pathogens via ocular or mucocutaneous exposure. Whereas conventional surgical clothing provides some protection against contamination, surgical helmet systems (SHS) are intended to provide a high level of protection by forming a barrier for particles, aerosols and fluids between surgeon and surgical field of work.
  
  
  OBJECTIVE
  The aim of this study was to quantify the contamination of the surgeon by droplets during orthopaedic procedures by an in-vitro simulation of hip and knee arthroplasty while wearing SHS versus conventional surgical clothing.
  
  
  METHODS
  Hip and knee arthroplasty procedures were performed on artificial foam bone, which was continuously kept wet with a marker fluid. Each of the procedures was carried out by ten subjects wearing conventional surgical clothing or wearing SHS with integrated toga. After the simulated operation, pictures of the subjects were taken under ultraviolet illumination. Images wearing the full gown, and after removal of the gown, were evaluated for stained areas.
  
  
  RESULTS
  The contamination risk was 30% while wearing conventional clothing. In none of the 20 subjects using the SHS stains could staining be detected after removal of the protective clothing.
  
  
  CONCLUSIONS
  This study has demonstrated that the protective properties of the SHS are superior to conventional surgical clothing. Using SHS in high-risk procedures could reduce occupational exposure to blood-borne infections in surgeons.
authors.affiliation: University Medical Center Schleswig-Holstein, Clinic for Orthopaedic and Trauma Surgery, Lübeck, Germany. Electronic address: robert.wendlandt@uksh.de.
authors.forename: R
authors.initials: R
authors.lastname: Wendlandt
authors.affiliation: University Medical Center Schleswig-Holstein, Clinic for Orthopaedic and Trauma Surgery, Lübeck, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Thomas
authors.affiliation: BG Trauma Hospital Hamburg, Hamburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Kienast
authors.affiliation: University Medical Center Schleswig-Holstein, Clinic for Orthopaedic and Trauma Surgery, Lübeck, Germany; BG Trauma Hospital Hamburg, Hamburg, Germany.
authors.forename: A P
authors.initials: AP
authors.lastname: Schulz
mesh_terms: D000336:Aerosols; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D006260:Head Protective Devices; D006801:Humans; D016273:Occupational Exposure / Q000517:prevention & control*; D019637:Orthopedic Procedures; D066231:Surgeons
chemical_list: D000336:Aerosols
keywords: Blood-borne pathogen; Healthcare worker; Infection; Occupational hazard; Orthopaedic; Surgical helmet system