Ultraclean air and antibiotics for prevention of postoperative infection. A multicenter study of 8,052 joint replacement operations.

To determine the value of ultraclean air in operating rooms, 8,052 operations for total hip- or knee-joint replacement were followed up for 1-4 years. For operations done in ultraclean air, bacterial contamination of the wound, deep joint sepsis, and major wound sepsis were substantially less than for operations done in conventionally ventilated rooms. Sepsis was also less frequent when prophylactic antibiotics had been given.

Extended follow-up of patients suspected of having joint sepsis after total joint replacement.

During an average follow-up time of about 2 1/2 years after total hip or knee-joint replacement in 8052 patients, suspected joint infection was recorded in 85 patients whose joints had not been re-operated during that period. The hospital records of 72 of these patients were examined after a further period, averaging about 5 years. Thirty-five of these had suffered continuing major problems with the joint, 18 of which had been revised, and a further 9 joints needed such treatment.

Infection and sepsis after operations for total hip or knee-joint replacement: influence of ultraclean air, prophylactic antibiotics and other factors.

Operating in ultraclean air and the prophylactic use of antibiotics have been found to reduce the incidence of joint sepsis confirmed at re-operation, after total hip or knee-joint replacement. The reduction was about 2-fold when operations were done in ultraclean air, 4.5-fold when body-exhaust suits also were worn, and about 3- to 4-fold when antibiotics had been given prophylactically.

Trial of a laminar air-flow enclosure for the control of infection in a burns operating theatre.

A series of 22 patients with full-skin thickness burns had skin grafting operations in a Piekenrood-Vinitex BV open-topped laminar air-flow enclosure, and a parallel control series of 18 patients were grafted in the same operating room without the use of the laminar flow unit; the operating room in which both series of operations were performed had standard plenum ventilation with 20 air changes per hour. None of the patients acquired on their burns Staph. aureus of phage types and antibiotic sensitivity patterns corresponding with those isolated from carriers who were in the theatre at the time of the operation; 16 patients acquired on their burns strains of types corresponding with those of strains isolated from burns of other patients in the ward.

Suggested bacteriological standards for air in ultraclean operating rooms.

Bacteriological standards for the air in ultraclean operating rooms are needed since physical tests alone cannot guarantee satisfactory results. 10 m-3 is suggested as the highest acceptable value for an ultraclean system. Methods are described for determining this.

Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates.

During operations for total joint replacement done in operating rooms with conventional ventilation the mean air contamination varied considerably among the 15 hospitals studied. The range was from 51 to as many as 539 bacteria-carrying particles per cubic metre. When the data from all the hospitals were grouped according to the mean level of bacterial airborne contamination, including operations done in control and in ultraclean air, there was a good correlation between the air contamination and the joint sepsis rate.

Bacteria isolated from deep joint sepsis after operation for total hip or knee replacement and the sources of the infections with Staphylococcus aureus.

A wide variety of bacterial species, many usually regarded as of low pathogenicity, were isolated from septic joints after operation for total hip or knee joint replacement in a multi-centre trial of ultraclean air in operating rooms. The prophylactic antibiotics generally used appeared to reduce considerably the rates of infection with most species but to be ineffective against 'gut' organisms. For about half the septic infections involving Staphylococcus aureus nasal swabs had been obtained from the patient and operating staff at the time of operation for insertion of the prosthesis.

Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study.

In a multicentre study of sepsis after total hip or knee replacement the operations performed by each surgeon were allocated at random between control and ultraclean-air operating rooms. Records were obtained from over 8000 such operations. In the patients whose prostheses were inserted in an operating room ventilated by an ultraclean-air system the incidence of joint sepsis confirmed at reoperation within the next one to four years was about half that of patients who had had the operation in a conventionally ventilated room at the same hospital.

Control of infection in the hospital: problems in surgery and the management of burns.

Three aspects of hospital infection control are discussed: disinfection of skin, antimicrobial prophylaxis of burns, and methods of preventing the emergence of antibiotic-resistant bacteria. The relative values and limitations of alternative methods of reducing resident and transient skin flora are evaluated on the basis of laboratory studies of volunteers; the special value of alcohol, rubbed to dryness, against both resident and transient flora is illustrated. In prophylaxis against infection of burns, first-and second-line defenses, i.

Staphylococcal sepsis in a burns unit.

An outbreak of staphylococcal sepsis in a burns unit occurred between January 1976 and May 1978. Many patients and members of staff had boils, and a number of patients also developed septicaemia. Most of the boils in the early period of the trial and a large proportion of boils in patients during the later period yielded Staphylococcus aureus resistant to penicillin, tetracycline and erythromycin only (PTE), and were shown to be of phage type 95 in the early period while strains were phage typed.

Delayed antimicrobial effects of skin disinfection by alcohol.

Aqueous suspensions of Staphylococcus aureus were deposited on a Millipore filter and then exposed for a few seconds to 70% ethyl alcohol. Viable counts of bacteria extracted from the filter immediately after exposure to alcohol, and, in replicate experiments, after a further period of 3 h, showed that the mean immediate reduction of 97.6% in viable counts after treatment with alcohol was followed by a further mean reduction of 67.

Limits to progressive reduction of resident skin bacteria by disinfection.

Antiseptic preparations used repeatedly to disinfect the skin caused a reduction in yield of resident flora to a low equilibrium level beyond which further reduction did not occur. This equilibrium varied with the antiseptic preparation used. In a comparison of three preparations, the lowest equilibrium level was obtained with 95% ethyl alcohol.

Decline of the hospital Staphylococcus? Incidence of multiresistant Staph. aureus in three Birmingham hospitals.

The prevalance of antibiotic-resistant strains of Staphylococcus aureus was studied in three Birmingham hospitals. In a general hospital periodic surveys showed a progressive decline in the proportions of patients with Staph. aureus in their noses which were resistant to tetracycline, erythromycin, and kanamycin.

Gentamicin- and silver-resistant pseudomonas in a burns unit.

In 1977-8 gentamicin-resistant strains of Pseudomonas aeruginosa became very common in a burns unit, over 90% being resistant at the peak of the outbreak. Some strains were also resistant to silver nitrate, though silver resistance was not found in any other strains of Ps aeruginosa isolated. Unlike the gentamicin resistance, the silver resistance was unstable, and strains became sensitive on repeated subculture.

Detergents compared with each other and with antiseptics as skin 'degerming' agents.

Three detergent preparations (bar soap, 'Hibiscrub' base and 'LIC 76'), TWO ANTISEPTic preparations (0.5% chlorhexidine in 95% ethyl alcohol and an alcohol jelly, 'Alcogel'), and one antiseptic-detergent solution (4% chlorhexidine gluconate in a detergent base, 'Hibiscrub') were compared for their effectiveness, on a single use, in reducing the yield of bacteria from the hands of volunteers. The antiseptic and antiseptic--detergent preparations were more effective than the detergents, with a mean reduction in yield of skin bacteria of 96.