title: Carbon dioxide insufflation deflects airborne particles from an open surgical wound model.
abstract: BACKGROUND
  Surgical site infections remain a significant burden on healthcare systems and may benefit from new countermeasures.
  
  
  OBJECTIVE
  To assess the merits of open surgical wound CO2insufflation via a gas diffuser to reduce airborne contamination, and to determine the distribution of CO2in and over a wound.
  
  
  METHODS
  An experimental approach with engineers and clinical researchers was employed to measure the gas flow pattern and motion of airborne particles in a model of an open surgical wound in a simulated theatre setting. Laser-illuminated flow visualizations were performed and the degree of protection was quantified by collecting and characterizing particles deposited in and outside the wound cavity.
  
  
  RESULTS
  The average number of particles entering the wound with a diameter of <5μm was reduced 1000-fold with 10L/min CO2insufflation. Larger and heavier particles had a greater penetration potential and were reduced by a factor of 20. The degree of protection was found to be unaffected by exaggerated movements of hands in and out of the wound cavity. The steady-state CO2concentration within the majority of the wound cavity was >95% and diminished rapidly above the wound to an atmospheric level (∼0%) at a height of 25mm.
  
  
  CONCLUSIONS
  Airborne particles were deflected from entering the wound by the CO2in the cavity akin to a protective barrier. Insufflation of CO2may be an effective means of reducing intraoperative infection rates in open surgeries.
authors.affiliation: Fisher & Paykel Healthcare Ltd, Auckland, New Zealand.
authors.forename: P
authors.initials: P
authors.lastname: Kokhanenko
authors.affiliation: Fisher & Paykel Healthcare Ltd, Auckland, New Zealand.
authors.forename: G
authors.initials: G
authors.lastname: Papotti
authors.affiliation: Department of Engineering Science, University of Auckland, Auckland, New Zealand.
authors.forename: J E
authors.initials: JE
authors.lastname: Cater
authors.affiliation: Department of Colorectal Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: A C
authors.initials: AC
authors.lastname: Lynch
authors.affiliation: Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
authors.forename: J A
authors.initials: JA
authors.lastname: van der Linden
authors.affiliation: Fisher & Paykel Healthcare Ltd, Auckland, New Zealand. Electronic address: callum.spence@fphcare.co.nz.
authors.forename: C J T
authors.initials: CJ
authors.lastname: Spence
mesh_terms: D002245:Carbon Dioxide / Q000008:administration & dosage*; D006801:Humans; D007327:Insufflation; D052638:Particulate Matter / Q000032:analysis*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D052638:Particulate Matter; D002245:Carbon Dioxide
keywords: Flow visualization; Infection; Medical device; Surgical site infection