title: Does modern space suit reduce intraoperative contamination in total joint replacement? An experimental study.
abstract: BACKGROUND
  The purpose of this study was to evaluate a potential risk of intraoperative contamination associated with clothing systems and surgeon's motion in total joint replacement.
  
  
  METHODS
  The airborne particle concentrations at different locations around a single operating surgeon wearing standard surgical gown (SG) or modern "space suit" (SS) were compared. The particles in the size of ≥0.5 μm (roughly corresponding to a mean diameter of squamous epithelial cells) were counted at the following three locations: (1) ≈10 cm inferior to the wrist; (2) ≈10 cm posterior to the feet; and (3) near the chest (operative field) under condition either with or without the surgeon's motion (stepping in place at ~1 Hz).
  
  
  RESULTS
  The difference in the surgical clothing systems did not significantly affect the mean particle counts detected near the wrist and chest (p = 0.307 and 0.155, respectively). However, the particle count near the feet was 154 times higher in SS than SG (4630 ± 2795 vs. 30 ± 23 N/F3, p = 0.023). The simple stepping of the surgeon with SS increased contaminants near the chest 31 times as compared to the condition without motion (1053 ± 709 vs. 34 ± 31 N/F3, p = 0.0032). Although the particle count was less affected by the motion in SG than SS, contaminants near the chest increased ten times after the stepping in the use of SG (p = 0.032).
  
  
  CONCLUSIONS
  The present results suggest that the intraoperative motion of a surgeon may considerably increase airborne particle/bacterial concentration in the operative field. This can be a much higher likelihood in SS rather than SG because of air blow-off from the incorporated cooling fan.
authors: Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. dnaka@tokyo-med.ac.jp.
authors: Daisuke
authors: D
authors: Nakajima
authors: Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors: Toshiyuki
authors: T
authors: Tateiwa
authors: Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors: Toshinori
authors: T
authors: Masaoka
authors: Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.|Department of Bone and Joint Biomaterial Research, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors: Yasuhito
authors: Y
authors: Takahashi
authors: Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors: Takaaki
authors: T
authors: Shishido
authors: Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors: Kengo
authors: K
authors: Yamamoto
mesh_terms: D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D005528:Foot; D006801:Humans; D009068:Movement; D009873:Operating Rooms; D010316:Particle Size; D052638:Particulate Matter; D011481:Protective Clothing; D058257:Surgical Attire; D013530:Surgical Wound Infection / Q000209:etiology* / Q000517:prevention & control; D013909:Thorax; D014953:Wrist
chemical_list: D052638:Particulate Matter
keywords: Airborne particle; Intraoperative contamination; Space suit; Surgical gown; Total joint replacement