Investigating the particle amount hanging in the air in the operating room during instrumented and non-instrumented neurosurgery operations

Year 2021, Volume: 5 Issue: 3, 205 - 208, 01.03.2021

İnci Arıkan , Meryem Cansu Şahin , İsmail Kaya , İlker Deniz Cingöz , Hasan Aydın , Gözde Bolu

https://doi.org/10.28982/josam.730104

Abstract

Background/Aim: To improve patient safety and surgical results, it is highly significant to understand the factors which cause high particle matter (PM) levels in the air of the operating room. The objective of this study was to investigate the particle amounts hanging in the air in the operating room in instrumented and non-instrumented cases during Neurosurgery operations.
Methods: This was an analytical study comparing PM amounts measured in 21 non-instrumented and 22 instrumented cases performed in Kütahya Evliya Çelebi Training and Research Hospital NRS operating room between March-May 2019. Five spots were identified in the operating room and measurements were performed at these spots by the same researcher during the operation. “Particles Plus 8306” particle measurement device was used for the measurements performed for 11 weeks. Also, detailed information such as operation duration, number of team members in the operating room and operating time of vaporizers per operation were registered on a form.
Results: PM0.5 and PM1 amounts were higher in instrumented operations compared to non-instrumented operations. All PM amounts (except PM 0.5) measured in instrumented and non-instrumented operations decreased towards the end of the operation compared to the beginning (P=0.001, P=0.001, P=0.001, P=0.001 for all).
Conclusions: PM smaller than one micron were detected more in instrumented operations compared to non-instrumented operations, and the amounts of these particles increased with the number of team members present. All PM amounts increased with operation durations, and all PM (except PM 0.5) amounts measured in non-instrumented and instrumented operations gradually decreased towards the end of the operation compared to the beginning. Regularly checking the air flow and restricting entry and exit in and out of the operating room are necessary.

Keywords

Clean room, Instrumentation, Neurosurgery, Operating Room, Particles

References

• 1. Rezapoor M, Alvand A, Jacek E, Paziuk T, Maltenfort MG, Parvizi J. Operating Room Traffic Increases Aerosolized Particles and Compromises the Air Quality: A Simulated Study. J Arthroplasty. 2018 Mar;33(3):851-5. doi: 10.1016/j.arth.2017.10.012. Epub 2017 Oct 16. PMID: 29174409.
• 2. Cristina ML, Spagnolo AM, Sartini M, Panatto D, Gasparini R, Orlando P, et al. Can particulate air sampling predict microbial load in operating theatres for arthroplasty? PLoS One. 2012;7(12):e52809. doi: 10.1371/journal.pone.0052809. Epub 2012 Dec 21. PMID: 23285189; PMCID: PMC3528722.
• 3. Teter J, Guajardo I, Al-Rammah T, Rosson G, Perl TM, Manahan M. Assessment of operating room airflow using air particle counts and direct observation of door openings. Am J Infect Control. 2017 May 1;45(5):477-82. doi: 10.1016/j.ajic.2016.12.018. Epub 2017 Feb 13. PMID: 28209451.
• 4. Mora M, Mahnert A, Koskinen K, Pausan MR, Oberauner-Wappis L, Krause R, Perras AK, Gorkiewicz G, Berg G, Moissl-Eichinger C. Microorganisms in Confined Habitats: Microbial Monitoring and Control of Intensive Care Units, Operating Rooms, Cleanrooms and the International Space Station. Front Microbiol. 2016 Oct 13;7:1573. doi: 10.3389/fmicb.2016.01573. PMID: 27790191; PMCID: PMC5061736.
• 5. Bernander S, Hambraeus A, Myrbäck KE, Nyström B, Sundelöf B. Prevalence of hospital-associated infections in five Swedish hospitals in November 1975. Scand J Infect Dis. 1978;10(1):66-70. doi: 10.3109/inf.1978.10.issue-1.15. PMID: 635478.
• 6. Hambraeus A, Lytsy B. Infection Control and What to Wear in the Operating Room. Clin Infect Dis. 2018 Jun 18;67(1):159. doi: 10.1093/cid/ciy059. PMID: 29370341.
• 7. Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, Keohane C, Denham CR, Bates DW. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med. 2013 Dec 9-23;173(22):2039-46. doi: 10.1001/jamainternmed.2013.9763. PMID: 23999949.
• 8. International Organization for Standardization- ISO 14644-1:2015: Cleanrooms and associated controlled environments Part 1: Classification of air cleanliness by particle concentration. Second edition, Switzerland; 2015.
• 9. Seal DV, Clark RP. Electronic particle counting for evaluating the quality of air in operating theatres: a potential basis for standards? J Appl Bacteriol. 1990 Mar;68(3):225-30. doi: 10.1111/j.1365-2672.1990.tb02568.x. PMID: 2341326.
• 10. Stocks GW, Self SD, Thompson B, Adame XA, O'Connor DP. Predicting bacterial populations based on airborne particulates: a study performed in nonlaminar flow operating rooms during joint arthroplasty surgery. Am J Infect Control. 2010 Apr;38(3):199-204. doi: 10.1016/j.ajic.2009.07.006. Epub 2009 Nov 12. PMID: 19913327.
• 11. Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, Banerjee SN, Edwards JR, Tolson JS, Henderson TS, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med. 1991 Sep 16;91(3B):152S-157S. doi: 10.1016/0002-9343(91)90361-z. PMID: 1656747.
• 12. 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. 2012 Oct;470(10):2690-4. doi: 10.1007/s11999-012-2252-4. PMID: 22302655; PMCID: PMC3441983.
• 13. Lafrenière R, Bohnen JM, Pasieka J, Spry CC. Infection control in the operating room: current practices or sacred cows? J Am Coll Surg. 2001 Oct;193(4):407-16. doi: 10.1016/s1072-7515(01)01035-3. PMID: 11584969.
• 14. Smith SM. A review of hand-washing techniques in primary care and community settings. J Clin Nurs. 2009 Mar;18(6):786-90. doi: 10.1111/j.1365-2702.2008.02546.x. PMID: 19239662.
• 15. Reformat DD, David JA, Diaz-Siso JR, Plana NM, Wang A, Brownstone ND, Ceradini DJ. How many people work in your operating room? An assessment of factors associated with instrument recounts within plastic surgery. J Plast Reconstr Aesthet Surg. 2017 Sep;70(9):1285-91. doi: 10.1016/j.bjps.2017.06.028. Epub 2017 Jun 28. PMID: 28734751.