Deep Periprosthetic Infection Rates In Total Hip Arthroplasty and Total Knee Arthroplasty Performed With Laminar Air Flow and Space Suits: Short-Term Results
Abstract
Purpose: To investigate the effects of use of laminar airflow and clean-room dress on early and late infections following surgeon total hip arthroplasty THA and total knee arthroplasty TKA .Patients and Methods: Three hundred and sixty seven patients who had undergone 428 primary THA 29 simultaneous bilateral, 32 staged bilateral and 127 patients who had undergone 211 TKA 29 simultaneous bilateral, 32 staged bilateral between February 2009 and January 2014 were retrospectively analyzed. Standard operation room with LAF was used in all TKA and THA cases, and clean-room dress in 100% of TKA cases and 99.06% of THA cases. All operations were performed by senior surgeon. The infected and non-infected patients were statistically compared for infection rates including the following criteria; a body mass index BMI of 40 and over, active smoking, preoperative positivity in urine culture and in nasal swab culture.Results: Mean follow-up period of the patients following the initial surgery was 36 range: 6 to 59 months. Late infection rate following THA was 0.46% n=2 and early infection rate 0.23% n=1 . Early infection rate following TKA was 0.47% n=1 . No significant differences was found in the rates of infection according to positive colonization in the preoperative nasal swab p=0.27 , asymptomatic bacteriuria and positivity in urine culture p=1.0 , a BMI of ≥40 p=1.0 , active smoking p=0.28 and groups that had different bearing couples p>0,12 . Infection rates were also not different according to simultaneous or staged arthroplasty performance p>0,05 .Conclusion: Deep infection rates of total joint arthroplasties, which were performed in our clinic with the simultaneous use of LAF and clean-room dress were consistant with the literature and we had lower early infection rates as described in some series. Multi-centered and prospective randomized controlled long follow-up studies are needed to demonstrate the effect of LAF and clean-room dress on prevention of early and late periprosthetic infections
References
- Whyte W, Hodgson R, Tinkler J. The importance of airborne bacterial contamination of wounds. J Hosp Infect 1982;3(2):123–35.
- Friberg B, et al. Surgical area contamination –comparable bacterial counts using disposable head and mask and helmet aspirator system, but dramatic increase upon omission of head-gear: an experimental study in horizontal laminar air-flow. J Hosp Infect 2001;47:110–5. doi: 10.1053/jhin.2000.0909
- Lidwell OM, et al. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. Br Med J (Clin Res Ed) 1982;285:10–4.
- Salvati EA, et al. Infection rates after 3175 total hip and total knee replacements performed with and without a horizontal unidirectional filtered air-flow system. J Bone Joint Surg Am 1982;64:525–35.
- Marotte JH, et al. Infection rate in total hip arthroplasty as a function of air cleanliness and antibiotic prophylaxis 10-year experience with 2,384 cementless Lord madreporic prostheses. J Arthroplasty 1987;2:77–82.
- Hooper GJ, et al. Does the use of laminar flow and space suits reduce early deep infection after total hip and knee replacement?: the ten- year results of the New Zealand Joint Registry. J Bone Joint Surg Br 2011;93:85–90. doi: 10.1302/0301-620X.93B1.24862
- Der Tavitian J, et al. Body-exhaust suit versus occlusive clothing. A randomised, prospective trial using air and wound bacterial counts. J Bone Joint Surg Br 2003;85:490–4.
- Miner AL, et al. Deep infection after total knee replacement: impact of laminar airflow systems and body exhaust suits in the modern operating room. Infect Control Hosp Epidemiol 2007;28:222–6. doi: 10.1086/509852
- Namba RS, Inacio MC, Paxton EW. Risk factors associated with surgical site infection in 30,491 primary total hip replacements. J Bone Joint Surg Br 2012;94:1330–8. doi: 10.1302/0301-620X.94B10.29184
- Brandt C, et al. Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery. Ann Surg 2008;248:695–700. doi: 10.1097/SLA.0b013e31818b757d
Laminar Akım ve Uzay Giysisi Kullanılarak Yapılan Total Kalça Artroplastisi ve Total Diz Artoplastisinde Derin Periprostetik Enfeksiyon Oranları; Kısa Dönem Sonuçlar
Abstract
Amaç: Laminar hava akımı LHA ile birlikte uzay giysisi kullanımının erken ve geç derin total kalça protezi TKP ve total diz protezi TDP enfeksiyonu üzerindeki etkilerini araştırmak.Çalışma Planı: Şubat 2009 ve Ocak 2014 tarihleri arasında hastanemize başvuran 367 hastada yapılan 428 primer TKP 29 eş zamanlı bilateral, 32 sıralı bilateral ve 127 hastada yapılan 211 primer TDP 68 eş zamanlı bilateral, 16 sıralı bilateral geriye dönük olarak analiz edildi. LHA’ya sahip standart operasyon odası tüm TDP ve TKP olgularda, uzay giysisi ise TDP olgularında %100 ve TKP olgularında %99,06 oranında kullanıldı. Tüm operasyonlar kıdemli cerrah tarafından yapıldı. Vücut kitle indeksinin BMI 40 ve üzerinde olması, aktif sigara kullanımı, operasyon öncesi idrar kültüründe üreme ve burun sürüntüsünde taşıyıcılık olması, enfeksiyon riski açısından için enfekte olan ve olmayan hastalar arasında istatistiksel olarak karşılaştırıldı.Bulgular: Hastaların ortalama olarak ilk operasyondan sonrasındaki takip süresi 36 ay dağılım; 6–59 ay idi. TKP sonrası geç enfeksiyon oranı %0,46 n=2 ve erken enfeksiyon oranı %0,23 n=1 olarak tespit edildi. TDP sonrasında erken enfeksiyon oranı %0,47 n=1 olarak tespit edildi. TKP sonrasında sırası ile preoperatif burun sürüntüsünde pozitif kolonizasyon p=0,27 , asemptomatik bakteriüri ile idrar kültürü pozitifliği p=1,0 , BMI ≥40 olması p=1,0 , aktif sigara kullanımı p=0,28 ve farklı yüzey seçeneklerinin kullanıldığı gruplarda p=0,12 enfeksiyon görülme oranları arasında fark tespit edilemedi. Bilateral eş zamanlı ile sıralı uygulamalar arasında protez çevresi enfeksiyonu gelişme oranları arasında fark yoktu p>0,05 . Çıkarımlar: Kliniğimizde LHA ve uzay giysisinin birlikte kullanılarak yapılan total eklem artroplastisi sonrası takiplerinde, derin enfeksiyon oranları literatür ile uyumlu olarak tespit edilmiş ve erken dönem enfeksiyonda literatürde daha önce belirtilen değerlerden daha düşük oranlar elde edilmiştir. LHA ile birlikte uzay giysisinin erken ve geç dönem periprostetik enfeksiyonu önlemedeki etkisini ortaya koymak için çok merkezli ve prospektif randomize kontrollü uzun takipli çalışmalara ihtiyaç vardır
References
- Whyte W, Hodgson R, Tinkler J. The importance of airborne bacterial contamination of wounds. J Hosp Infect 1982;3(2):123–35.
- Friberg B, et al. Surgical area contamination –comparable bacterial counts using disposable head and mask and helmet aspirator system, but dramatic increase upon omission of head-gear: an experimental study in horizontal laminar air-flow. J Hosp Infect 2001;47:110–5. doi: 10.1053/jhin.2000.0909
- Lidwell OM, et al. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. Br Med J (Clin Res Ed) 1982;285:10–4.
- Salvati EA, et al. Infection rates after 3175 total hip and total knee replacements performed with and without a horizontal unidirectional filtered air-flow system. J Bone Joint Surg Am 1982;64:525–35.
- Marotte JH, et al. Infection rate in total hip arthroplasty as a function of air cleanliness and antibiotic prophylaxis 10-year experience with 2,384 cementless Lord madreporic prostheses. J Arthroplasty 1987;2:77–82.
- Hooper GJ, et al. Does the use of laminar flow and space suits reduce early deep infection after total hip and knee replacement?: the ten- year results of the New Zealand Joint Registry. J Bone Joint Surg Br 2011;93:85–90. doi: 10.1302/0301-620X.93B1.24862
- Der Tavitian J, et al. Body-exhaust suit versus occlusive clothing. A randomised, prospective trial using air and wound bacterial counts. J Bone Joint Surg Br 2003;85:490–4.
- Miner AL, et al. Deep infection after total knee replacement: impact of laminar airflow systems and body exhaust suits in the modern operating room. Infect Control Hosp Epidemiol 2007;28:222–6. doi: 10.1086/509852
- Namba RS, Inacio MC, Paxton EW. Risk factors associated with surgical site infection in 30,491 primary total hip replacements. J Bone Joint Surg Br 2012;94:1330–8. doi: 10.1302/0301-620X.94B10.29184
- Brandt C, et al. Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery. Ann Surg 2008;248:695–700. doi: 10.1097/SLA.0b013e31818b757d
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | December 1, 2017 |
| Published in Issue | Year 2017Issue: 4 |