Does modern space suit reduce intraoperative contamination in total joint replacement? An experimental study.

Background: The purpose of this study was to evaluate a potential risk of intraoperative contamination associated with clothing systems and surgeon's motion in total joint replacement.

Methods: The airborne particle concentrations at different locations around a single operating surgeon wearing standard surgical gown (SG) or modern "space suit" (SS) were compared. The particles in the size of ≥0.5 μm (roughly corresponding to a mean diameter of squamous epithelial cells) were counted at the following three locations: (1) ≈10 cm inferior to the wrist; (2) ≈10 cm posterior to the feet; and (3) near the chest (operative field) under condition either with or without the surgeon's motion (stepping in place at ~1 Hz).

Results: The difference in the surgical clothing systems did not significantly affect the mean particle counts detected near the wrist and chest (p = 0.307 and 0.155, respectively). However, the particle count near the feet was 154 times higher in SS than SG (4630 ± 2795 vs. 30 ± 23 N/F, p = 0.023). The simple stepping of the surgeon with SS increased contaminants near the chest 31 times as compared to the condition without motion (1053 ± 709 vs. 34 ± 31 N/F, p = 0.0032). Although the particle count was less affected by the motion in SG than SS, contaminants near the chest increased ten times after the stepping in the use of SG (p = 0.032).

Conclusion: The present results suggest that the intraoperative motion of a surgeon may considerably increase airborne particle/bacterial concentration in the operative field. This can be a much higher likelihood in SS rather than SG because of air blow-off from the incorporated cooling fan.