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Archive July 2018 XIX, No. 7

Do You Care to Clear the Air?

Can new airflow and air purification products help solve the drawbacks of traditional ceiling-to-floor laminar airflow?

Jeannette Sabatini, Associate Editor



The "sterile field" maintained above the surgical site by ceiling-to-floor laminar airflow may be a fiction. Although the practice may work under perfect conditions, the conditions in an OR are rarely perfect. When doors open, when a tech rolls a C-arm in, when lights and microscopes interrupt overhead air, and when people move back and forth, particles may end up settling on the wound, the instruments and the implants.

In an article in the British publication Surgeon titled "Laminar airflow and the prevention of surgical site infection. More harm than good?" the authors remark that while laminar airflow seems to work in vitro, it doesn't work in vivo. "Few clinical studies demonstrate a convincing correlation between decreased SSI rates and laminar airflow," and in fact many suggest the opposite. A search of 25 years' worth of literature by British and Australian authors published in BMJ Open found "no convincing evidence in favor of the use of laminar airflow over conventional ventilation for prevention of total-hip-replacement-related SSIs," again finding that laminar airflow probably increased the rate of infection. The International Society for Infectious Diseases's Guide to Infection Control in the Hospital agrees, saying while studies are imperfect, few show a significant decrease in SSI rates due to laminar airflow.

But there may be good news. Several new products are aimed at correcting the problems of laminar airflow, and some research indicates that they may work better (see "Could These Devices Help Prevent SSIs?" on page 54).

Blown away

Two products use horizontal laminar airflow directly over the surgical site. One product attaches to the patient near the surgical site and blows sterile air horizontally over the site, creating a sterile "cocoon" of space and reducing the particle count by more than 84%, the maker says. Another device attaches to the Mayo stand and is designed to blow sterile air horizontally over the instruments and implants as well as over the surgical site. The maker says it reduces particles to fewer than five per cubic meter.

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