Shoulder periprosthetic infections - is the air in the OR the problem?

A localized laminar flow device decreases airborne particulates during shoulder arthroplasty: A randomized controlled trial

These authors suggest that airborne particulates may be a potential source of wound contamination.

They evaluated the effectiveness of a localized laminar flow device in reducing the intrusion of ambient airborne particles and bacteria into the surgery site during shoulder arthroplasty as measured by overall particle counts and colony forming units.

Patients were randomly assigned to the air barrier system (ABS) or control group. For all patients, the ABS was placed on the surgical field but was only turned on by the technician for subjects randomized to ABS. 

The initial cost of this system is reported to be under $5,000 with a disposable cost under $300.The use of the device was not associated with a longer case duration; however, there was some additional set up time prior to surgical incision to place the device.

Bacterial colony forming units (CFU) were collected from within 5 cm of the surgical wound every 10 minutes, while airborne particulates were collected every minute. 

Poisson regression showed that ABS group had significantly lower CFUs (β=-0.583, p<0.001) along with surgical time and particulates with a diameter greater than 5μm. Staff count and particulates smaller than 5μm were not significant predictors of CFUs. 

Comment: This study shows that the ABS device can reduce "colony forming units" and "large particulates" from the area of the shoulder arthroplasty incision. Unfortunately, the article does not identify the organisms that grew out on the agar plates. Without this information, we cannot know which organisms existed in the air of the operating room and whether the system reduced the levels of organisms that have been identified as sources of periprosthetic shoulder infection.

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