Air sampling methods to evaluate microbial contamination in operating theatres: results of a comparative study in an orthopaedics department.

AIM To evaluate the level of microbial contamination of air in operating theatres using active [i.e. surface air system (SAS)] and passive [i.e. index of microbial air contamination (IMA) and nitrocellulose membranes positioned near the wound] sampling systems. METHODS Sampling was performed between January 2010 and January 2011 in the operating theatre of the orthopaedics department in a university hospital in Southern Italy. FINDINGS During surgery, the mean bacterial loads recorded were 2232.9 colony-forming units (cfu)/m(2)/h with the IMA method, 123.2 cfu/m(3) with the SAS method and 2768.2 cfu/m(2)/h with the nitrocellulose membranes. Correlation was found between the results of the three methods. Staphylococcus aureus was detected in 12 of 60 operations (20%) with the membranes, five (8.3%) operations with the SAS method, and three operations (5%) with the IMA method. CONCLUSION Use of nitrocellulose membranes placed near a wound is a valid method for measuring the microbial contamination of air. This method was more sensitive than the IMA method and was not subject to any calibration bias, unlike active air monitoring systems.

[1]  Claude Carbón,et al.  Prosthetic joint infection: when can prosthesis salvage be considered? , 1999, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[2]  J. Charnley,et al.  SECTION II GENERAL ORTHOPAEDICS Postoperative Infection after Total Hip Replacement with Special Reference to Air Contamination in the Operating Room , 1972, Clinical orthopaedics and related research.

[3]  S. Langsrud,et al.  The performance of SAS-super-180 air sampler and settle plates for assessing viable fungal particles in the air of dry-cured meat production facility. , 2009 .

[4]  C. Salgado,et al.  Higher Risk of Failure of Methicillin-resistant Staphylococcus aureus Prosthetic Joint Infections , 2007, Clinical orthopaedics and related research.

[5]  Ruth B. Kundsin,et al.  Architectural design and indoor microbial pollution , 1988 .

[6]  T. Přistoupil,et al.  On the mechanism of adsorption of proteins to nitrocellulose in membrane chromatography. , 1969, Journal of chromatography.

[7]  J. Tinkler,et al.  The importance of airborne bacterial contamination of wounds. , 1982, The Journal of hospital infection.

[8]  D. Fish,et al.  Antibiotic-impregnated cement use in U.S. hospitals. , 1992, American journal of hospital pharmacy.

[9]  Teresa C. Horan,et al.  Guideline for Prevention of Surgical Site Infection, 1999 , 1999, Infection Control & Hospital Epidemiology.

[10]  C Pasquarella,et al.  Lack of influence of body exhaust gowns on aerobic bacterial surface counts in a mixed-ventilation operating theatre. A study of 62 hip arthroplasties. , 2003, The Journal of hospital infection.

[11]  B Friberg,et al.  Inconsistent correlation between aerobic bacterial surface and air counts in operating rooms with ultra clean laminar air flows: proposal of a new bacteriological standard for surface contamination. , 1999, The Journal of hospital infection.

[12]  W. Zimmerli,et al.  Management of Infection Associated with Prosthetic Joints , 2003, Infection.

[13]  T. Horan,et al.  Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. , 1999, American journal of infection control.

[14]  K. L. Rogers,et al.  Coagulase-negative staphylococcal infections. , 2009, Infectious disease clinics of North America.

[15]  Maria José Figueras,et al.  Atlas of clinical fungi. , 2005 .

[16]  T P Schmalzried,et al.  Limited Role of Direct Exchange Arthroplasty in the Treatment of Infected Total Hip Replacements , 2000, Clinical orthopaedics and related research.

[17]  A. Cresci,et al.  [Evaluation of microbial contamination in a hospital environment. Comparison between the Surface Air System and the traditional method]. , 1983, Nuovi annali d'igiene e microbiologia.

[18]  W. Sayer,et al.  Hospital airborne bacteria as estimated by the Andersen sampler versus the gravity settling culture plate. , 1972, American journal of clinical pathology.

[19]  W Whyte,et al.  In support of settle plates. , 1996, PDA journal of pharmaceutical science and technology.

[20]  T. Horan,et al.  Guideline for prevention of surgical site infection. , 2000, Bulletin of the American College of Surgeons.

[21]  S. Petti,et al.  [Comparison between different methods to monitor the microbial level of indoor air contamination in the dental office]. , 2003, Annali di igiene : medicina preventiva e di comunita.

[22]  Cesira Pasquarella,et al.  [Air microbial sampling: the state of the art]. , 2008, Igiene e sanita pubblica.

[23]  B Friberg,et al.  Correlation between surface and air counts of particles carrying aerobic bacteria in operating rooms with turbulent ventilation: an experimental study. , 1999, The Journal of hospital infection.

[24]  A P MacGowan,et al.  Importance of air quality and related factors in the prevention of infection in orthopaedic implant surgery. , 1998, The Journal of hospital infection.

[25]  B. Brunekreef,et al.  Enumeration and identification of airborne viable mould propagules in houses , 1990, Allergy.

[26]  O M Lidwell,et al.  Air, antibiotics and sepsis in replacement joints. , 1988, The Journal of hospital infection.

[27]  G. Blomquist.  Sampling of biological particles. , 1994, The Analyst.

[28]  H. Humphreys,et al.  Air sampling: settle plates or slit samplers? , 2001, The Journal of hospital infection.

[29]  W. Whyte.  Sterility assurance and models for assessing airborne bacterial contamination. , 1986, Journal of parenteral science and technology : a publication of the Parenteral Drug Association.

[30]  C Pasquarella,et al.  A mobile laminar airflow unit to reduce air bacterial contamination at surgical area in a conventionally ventilated operating theatre. , 2007, The Journal of hospital infection.

[31]  M. L. Cristina,et al.  [Relationship between settling microbial load and suspended microbial load in operating rooms]. , 2000, Annali di igiene : medicina preventiva e di comunita.

[32]  C Pasquarella,et al.  The index of microbial air contamination. , 2000, The Journal of hospital infection.