title: A comparison of airborne bacterial fallout between orthopaedic and vascular surgery.
abstract: INTRODUCTION The objective of the study was to compare bacterial fallout during vascular prosthesis insertion and orthopaedic major joint replacement performed in conventional and laminar flow ventilation, respectively. MATERIALS AND METHODS A prospective single-centre case control study of 21 consecutive elective vascular procedures involving prosthetic graft insertion and 24 consecutive elective orthopaedic major joint replacements were tested for degree of bacterial fallout using agar settle plates. Preparation time, waiting time and total procedure duration were collected at the time of surgery, and bacterial colony counts on the agar settle plates from airborne bacterial fallout were counted after an incubation period. RESULTS Bacterial fallout count in vascular prosthetic graft insertion was 15-fold greater than in orthopaedic prosthetic joint insertion (15, (IQR 15) vs 1, (IQR 3) respectively, P < 0.0001, Wilcoxon). Waiting time and patient transfer did not significantly increase bacterial fallout counts during the procedure (P = 0.9). CONCLUSIONS Vascular surgical theatres have significantly higher bacterial fallout compared with orthopaedic theatres. This may be partly explained by orthopaedic surgery being routinely performed in laminar flow ventilation, a practice which has not been widely adopted for vascular surgery, in which prosthetic infection may also result in significant mortality and morbidity.
authors.affiliation: Colchester Hospital University NHS Foundation Trust, Colchester , Essex , UK.
authors.forename: P
authors.initials: P
authors.lastname: Stather
authors.affiliation: Colchester Hospital University NHS Foundation Trust, Colchester , Essex , UK.
authors.forename: M
authors.initials: M
authors.lastname: Salji
authors.affiliation: Colchester Hospital University NHS Foundation Trust, Colchester , Essex , UK.
authors.forename: S-U
authors.initials: SU
authors.lastname: Hassan
authors.affiliation: Colchester Hospital University NHS Foundation Trust, Colchester , Essex , UK.
authors.forename: M
authors.initials: M
authors.lastname: Abbas
authors.affiliation: Colchester Hospital University NHS Foundation Trust, Colchester , Essex , UK.
authors.forename: A
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: Colchester Hospital University NHS Foundation Trust, Colchester , Essex , UK.
authors.forename: H
authors.initials: H
authors.lastname: Mills
authors.affiliation: Colchester Hospital University NHS Foundation Trust, Colchester , Essex , UK.
authors.forename: T
authors.initials: T
authors.lastname: Elston
authors.affiliation: Colchester Hospital University NHS Foundation Trust, Colchester , Essex , UK.
authors.forename: C
authors.initials: C
authors.lastname: Backhouse
authors.affiliation: Colchester Hospital University NHS Foundation Trust, Colchester , Essex , UK.
authors.forename: A
authors.initials: A
authors.lastname: Howard
authors.affiliation: Colchester Hospital University NHS Foundation Trust, Colchester , Essex , UK.
authors.forename: S
authors.initials: S
authors.lastname: Choksy
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement; D001419:Bacteria / Q000302:isolation & purification*; D019917:Blood Vessel Prosthesis Implantation; D016022:Case-Control Studies; D017558:Elective Surgical Procedures; D004780:Environment, Controlled; D006801:Humans; D009873:Operating Rooms; D061646:Operative Time; D011446:Prospective Studies; D016459:Prosthesis-Related Infections; D014691:Ventilation
keywords: Airborne; Infection; Prosthesis; Vascular; Ventilation