Reduction of Total and Viable Air Particles in the OR Setting by using Ultraviolet In-room Air Disinfection and Recirculation Units
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1 Reduction of Total and Viable Air Particles in the OR Setting by using Ultraviolet In-room Air Disinfection and Recirculation Units Gannon L. Curtis, MD Mhamad Faour, MD Michael Jawad, BS Alison K. Klika, MS Wael K. Barsoum, MD Carlos A. Higuera, MD November 4 th, 217
2 Disclosures This study was funded by Aerobiotix (Miamisburg, OH) Author disclosures can be found on the AAOS Website, aaos.com/disclosures
3 Background - Airborne bacteria are a major cause of surgical site contamination [1,2] - Sources: OR staff Shed 1, viable organisms/min [3] Door Openings Primary TJA average 6 door openings [4] Defeats positive-pressure 4% of the time [5] - Reducing airborne bioburden is critical for infection prevention
4 T1 Crystalline Ultraviolet C (C-UVC) disinfection-recirculation unit Aerobiotix, Miamisburg, OH - 45 ft 3 of air/minute - HEPA filter - C-UVC radiation
5 Questions 1. Can the C-UVC unit reduce air particulate caused by OR traffic? 2. Does placement of the C-UVC unit within the OR affect it s efficacy?
6 Methods BioTrak Real-Time Viable Particle Counter (TSI, Shoreview, MN) - Laser-Induced Fluorescence - Developed for biological warfare - Used in pharmaceutical ultraclean rooms
7 Methods 3 experiments - Empty, + Pressure OR - Control vs. 4 m - 4 m vs. 8 m 23 minutes - 16 air samples at 9 second intervals - 4 walkthroughs at pre-set times (3, 7.5, 15, 19.5 minutes)
8 Methods Total Particle Counts (TPC) - Nonviable particles (e.g. dust) - Viable particles Viable Particle Counts (VPC) - Bacteria - Squamous cells (e.g. skin)
9 Results Total Particle Count (TPC)
10 Results Total Particle Count (TPC)
11 Results Viable Particle Count (VPC)
12 Results Viable Particle Count (VPC)
13 Outcome Measurements 1. Overall Particle Counts - Mean sum of all particles counted during each experiment 2. Change (Δ) in Particle Counts - Mean difference in particle count following each door opening and walkthrough 3. Maximum Particle Count - Mean single highest recorded particle count per experiment
14 Outcome Measurements 1. Overall Particle Counts - Mean sum of all particles counted during each experiment 2. Change (Δ) in Particle Counts - Mean difference in particle count following each door opening and walkthrough 3. Maximum Particle Count - Mean single highest recorded particle count per experiment
15 Results 14 Overall TPC 5 Overall VPC Particles/m Control C-UVC (4m) C-UVC (8m)
16 Results 14 Overall TPC 5 Overall VPC Particles/m Control C-UVC (4m) C-UVC (8m) 71% P =.3 58% P =.7
17 Results 14 Overall TPC 5 Overall VPC Particles/m Control C-UVC (4m) C-UVC (8m) 2% P >.999 2% P =.796
18 Outcome Measurements 1. Overall Particle Counts - Mean sum of all particles counted during each experiment 2. Change (Δ) in Particle Counts - Mean difference in particle count following each door opening and walkthrough 3. Maximum Particle Count - Mean single highest recorded particle count per experiment
19 Results 16 Change (Δ) TPC 8 Change (Δ) VPC Particles/m Control C-UVC (4m) C-UVC (8m)
20 Results 16 Change (Δ) TPC 8 Change (Δ) VPC Particles/m Control C-UVC (4m) C-UVC (8m) 81% P <.1 79% P =.28
21 Results 16 Change (Δ) TPC 8 Change (Δ) VPC Particles/m Control C-UVC (4m) C-UVC (8m) 8% P = % P =.395
22 Outcome Measurements 1. Overall Particle Counts - Mean sum of all particles counted during each experiment 2. Change (Δ) in Particle Counts - Mean difference in particle count following each door opening and walkthrough 3. Maximum Particle Count - Mean single highest recorded particle count per experiment
23 Control C-UVC (4m) C-UVC (8m) Results 5 Maximum TPC 25 Maximum VPC Particles/m
24 Results 5 Maximum TPC 25 Maximum VPC Particles/m Control C-UVC (4m) C-UVC (8m) 72% P =.5 63% P =.19
25 Results 5 Maximum TPC 25 Maximum VPC Particles/m Control C-UVC (4m) C-UVC (8m) 6% P = % P =.579
26 Limitations Controlled environment - Active OR s may affect efficacy of C-UVC to reduce particles Horizontal laminar flow rooms were not studied Particle counters are an emerging tool for microbial surveillance - Studies [5,6] have reported their reliability in this setting
27 Conclusion C-UVC units can reduce airborne bioburden in a controlled OR setting - Potential to reduce surgical site contamination Placement did not affect the units ability to reduce air particles Future studies need to be conducted in live arthroplasty cases
28 References 1. Lidwell OM, Lowbury EJ, Whyte W, Blowers R, Stanley SJ, Lowe D. Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates. J Hosp Infect. 1983;4(2): Parvizi J, Barnes S, Shohat N, Edmiston CE. Environment of care: Is it time to reassess microbial contamination of the operating room air as a risk factor for surgical site infection in total joint arthroplasty?. Am J Infect Control Howorth FH. Prevention of airborne infection during surgery. Lancet. 1985;1(8425): Panahi P, Stroh M, Casper DS, Parvizi J, Austin MS. Operating room traffic is a major concern during total joint arthroplasty. Clin Orthop Relat Res. 212;47(1): Mears SC, Blanding R, Belkoff SM. Door Opening Affects Operating Room Pressure During Joint Arthroplasty. Orthopedics. 215;38(11):e Birgand G, Toupet G, Rukly S, et al. Air contamination for predicting wound contamination in clean surgery: A large multicenter study. Am J Infect Control. 215;43(5): Dai C, Zhang Y, Ma X, et al. Real-time measurements of airborne biologic particles using fluorescent particle counter to evaluate microbial contamination: results of a comparative study in an operating theater. Am J Infect Control. 215;43(1):78-81.
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