Publication detail

Ventilation design conditions associated with airborne bacteria levels within the wound area during surgical procedures: a systematic review

AGANOVIC, A. CAO, G. FEČER, T. LJUNGQVIST, B. LYTSY, B. RADTKE, A. REINMÜLLER, B. TRAVERSARI, R.

Original Title

Ventilation design conditions associated with airborne bacteria levels within the wound area during surgical procedures: a systematic review

Type

journal article in Web of Science

Language

English

Original Abstract

Without confirmation of the ventilation design conditions (typology and airflow rate), the common practice of identifying unidirectional airflow (UDAF) systems as equivalent to ultra-clean air ventilation systems may be misleading, but also any claims about the ineffectiveness of UDAF systems should be doubted. The aim of this review was to assess and compare ventilation system design conditions for which ultra-clean air (mean <10 cfu/m(3)) within 50 cm from the wound has been reported. Six medical databases were systematically searched to identify and select studies reporting intraoperative airborne levels expressed as cfu/m3 close to the wound site, and ventilation system design conditions. Available data on confounding factors such as the number of persons present in the operating room, number of door openings, and clothing material were also included. Predictors for achieving mean airborne bacteria levels within <10 cfu/m(3) were identified using a penalized multivariate logistic regression model. Twelve studies met the eligibility criteria and were included for analysis. UDAF systems considered had significantly higher air volume flows compared with turbulent ventilation (TV) systems considered. Ultra-clean environments were reported in all UDAF-ventilated (N = 7) rooms compared with four of 11 operating rooms equipped with TV. On multivariate analysis, the total number of air exchange rates (P=0.019; odds ratio (OR) 95% confidence interval (CI): 0.66-0.96) and type of clothing material (P=0.031; OR 95% CI: 0.01-0.71) were significantly associated with achieving mean levels of airborne bacteria <10 cfu/m(3). High-volume UDAF systems complying with DIN 1946-4:2008 standards for the airflow rate and ceiling diffuser size unconditionally achieve ultra-clean air close to the wound site. In conclusion, the studied articles demonstrate that high-volume UDAF systems perform as ultra-clean air systems and are superior to TV systems in reducing airborne bacteria levels close to the wound site. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of The Healthcare Infection Society.

Keywords

Ultra-clean air; Intraoperative airborne contamination; Ventilation system; Unidirectional airflow (UDAF); Operating room

Authors

AGANOVIC, A.; CAO, G.; FEČER, T.; LJUNGQVIST, B.; LYTSY, B.; RADTKE, A.; REINMÜLLER, B.; TRAVERSARI, R.

Released

27. 4. 2021

Publisher

W B SAUNDERS CO LTD

Location

LONDON

ISBN

0195-6701

Periodical

JOURNAL OF HOSPITAL INFECTION

Year of study

113

Number

1

State

United Kingdom of Great Britain and Northern Ireland

Pages from

85

Pages to

95

Pages count

11

URL

https://www.sciencedirect.com/science/article/pii/S0195670121001754

Full text in the Digital Library

http://hdl.handle.net/11012/200416

BibTex

@article{BUT171466,
  author="Amar {Aganovic} and Guangyu {Cao} and Tomáš {Fečer} and Bengt {Ljungqvist} and Birgitta {Lytsy} and Andreas {Radtke} and Berit {Reinmüller} and Roberto {Traversari}",
  title="Ventilation design conditions associated with airborne bacteria levels within the wound area during surgical procedures: a systematic review",
  journal="JOURNAL OF HOSPITAL INFECTION",
  year="2021",
  volume="113",
  number="1",
  pages="85--95",
  doi="10.1016/j.jhin.2021.04.022",
  issn="0195-6701",
  url="https://www.sciencedirect.com/science/article/pii/S0195670121001754"
}