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. 1977 Feb;185(2):219–223. doi: 10.1097/00000658-197702000-00015

Environmental air and airborne infections.

C T Drake, E Goldman, R L Nichols, K Piatriszka, L M Nyhus
PMCID: PMC1396107  PMID: 836095

Abstract

The results of a study on the epidemiology of airborne (aerobic) surgical infections are presented. The first phase of the study was carried out in a surgical suite which contained no environmental or traffic control systems.The second phase of the study took place within a modern "up to date" operating room suite containing multiple air screens as well as an elaborate ventilation system utilizing HEPA type filters which provided the operating room with clinically sterile air. One hundred and fifty-six patients were also studied. All patients underwent major procedures. The ratio of clean, clean-contaminated, and dirty cases was the same in both groups. Preoperatively, a nasal swab, clean voided urine (or vaginal swab) and a rectal swab were obtained on each patient. Daily nasal cultures and cultures of suspected sites of infection were obtained postoperatively. Daily nasal cultures and "glove sweat" cultures were obtained on all personnel attending the patient. Environmental cultures of the operating room, the operating room hallway, recovery room and patients' rooms were also taken. All samples were checked for the presence of staphylococci, streptococci, Escherichia coli, proteus species, enterobacter, klebsiella, and pseudomonas. In all, 15,000 cultures were taken during the study. The rate of infection was essentially the same in both phases of the study. Environmental air only occasionaly served as the source of infecting organisms. The results of the study support the conclusion that the most common source of infecting organisms in surgical infections is thepatient or those around him. The most common time of contamination is during the surgical procedure itself. Surgical infections can best be minimized by meticulous observation of fundamental principles of antisepsis rather than by dependence on elaborate and costly ventilation and air control systems.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander J. W. Emerging concepts in the control of surgical infections. Surgery. 1974 Jun;75(6):934–946. [PubMed] [Google Scholar]
  2. BURKE J. F. IDENTIFICATION OF THE SOURCES OF STAPHYLOCOCCI CONTAMINATING THE SURGICAL WOUND DURING OPERATION. Ann Surg. 1963 Nov;158:898–904. doi: 10.1097/00000658-196311000-00021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bernard H. R., Cole W. R., Gravens D. L. Reduction of iatrogenic bacterial contamination in operating rooms. Ann Surg. 1967 Apr;165(4):609–613. doi: 10.1097/00000658-196704000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Charnley J., Eftekhar N. Postoperative infection in total prosthetic replacement arthroplasty of the hip-joint. With special reference to the bacterial content of the air of the operating room. Br J Surg. 1969 Sep;56(9):641–649. doi: 10.1002/bjs.1800560902. [DOI] [PubMed] [Google Scholar]
  5. Dillon M. L., Postlethwait R. W., Bowling K. A. Operative wound cultures and wound infections: a study of 342 patients. Ann Surg. 1969 Dec;170(6):1029–1034. doi: 10.1097/00000658-196912000-00025. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Flower M., Barden G., Kerstein M. D. The role of the nurse epidemiologist in infection control and continuing education. Surg Gynecol Obstet. 1975 Oct;141(4):552–554. [PubMed] [Google Scholar]
  7. HOWE C. W. BACTERIAL FLORA OF CLEAN WOUNDS AND ITS RELATION TO SUBSEQUENT SEPSIS. Am J Surg. 1964 May;107:696–700. doi: 10.1016/0002-9610(64)90295-8. [DOI] [PubMed] [Google Scholar]
  8. Herndon C. H. The clean air operating room at University Hospitals of Cleveland. Cleve Clin Q. 1973 Winter;40(4):183–190. doi: 10.3949/ccjm.40.4.183. [DOI] [PubMed] [Google Scholar]
  9. Laufman H. Confusion in application of clean air systems to operating rooms. Cleve Clin Q. 1973 Winter;40(4):203–209. doi: 10.3949/ccjm.40.4.203. [DOI] [PubMed] [Google Scholar]
  10. Nelson C. L. Clean air and the total hip arthroplasty. Orthop Clin North Am. 1973 Apr;4(2):533–538. [PubMed] [Google Scholar]
  11. Nelson J. P., Glassburn A. R., Jr, Talbott R. D., McElhinney J. P. Clean room operating rooms. Clin Orthop Relat Res. 1973 Oct;(96):179–187. [PubMed] [Google Scholar]
  12. Ritter M. A., Hart J. B., French M. L., Eitzen H. E. A systems analysis approach to postoperative wound infections. Phase I. Evaluation of a horizontal wall-less laminar air flow system. Cleve Clin Q. 1973 Winter;40(4):211–219. doi: 10.3949/ccjm.40.4.211. [DOI] [PubMed] [Google Scholar]
  13. SHOOTER R. A., SMITH M. A., GRIFFITHS J. D., BROWN M. E., WILLIAMS R. E., RIPPON J. E., JEVONS M. P. Spread of staphylococci in a surgical ward. Br Med J. 1958 Mar 15;1(5071):607–613. doi: 10.1136/bmj.1.5071.607. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. SHOOTER R. A., THOM B. T., DUNKERLEY D. R., TAYLOR G. W., PARKER M. T., JOHN M., RICHARDS I. D. PRE-OPRATIVE SEGREGATION OF PATIENTS IN A SURGICAL WARD. Br Med J. 1963 Dec 21;2(5372):1567–1569. doi: 10.1136/bmj.2.5372.1567. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. WEINSTEIN H. J. The relation between the nasal-staphylococcal-carrier state and the incidence of postoperative complications. N Engl J Med. 1959 Jun 25;260(26):1303–1308. doi: 10.1056/NEJM195906252602601. [DOI] [PubMed] [Google Scholar]
  16. Wiley A. M., Barnett M. The prevention of surgical sepsis. Clean surgeons and clean air. Clin Orthop Relat Res. 1973 Oct;(96):168–175. [PubMed] [Google Scholar]

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