RESUMO
BACKGROUND: Ensuring aseptic airborne environments for sterile fields and back instrument tables in operating rooms (ORs) is crucial to reducing microbial and particle contamination during surgery. Configurations of in-ceiling air delivery mechanisms impact the effectiveness of the system at eliminating contamination in critical zones. METHODS: The environmental quality indicator method was used to assess airborne environments in ORs equipped with a single large diffuser (SLD), a multidiffuser array (MDA), or a 4-way throw diffuser during dynamic, simulated surgical procedures. Environmental quality indicators measured included particles, microbes, carbon dioxide, velocity, humidity, and temperature at 26 air changes per hour. RESULTS: SLD ORs performed better than MDA ORs and 4-way throw diffuser ORs at removing microbes and carbon dioxide from the sterile field (P < .05). SLD ORs had higher velocity and lower temperature over the sterile field than the other 2 ORs (P < .05). MDA ORs had lower total particle counts than the other ORs (P < .05). The sterile fields in all ORs were cleaner than the respective back instrument tables (P < .05). CONCLUSIONS: Air delivery systems that eliminate blockages to uniform airflow directly over sterile zones, such as boom mounts and access panels, and deliver unidirectional, downward flow of clean filtered air provided a cleaner airborne environment within the sterile field. Expansion of air delivery systems to include areas outside the sterile field, where other surgical aides reside, may further reduce contamination within critical zones.
Assuntos
Poluição do Ar em Ambientes Fechados , Salas Cirúrgicas , Ventilação/métodos , Microbiologia do Ar , Dióxido de Carbono/análise , Umidade , Material Particulado/análise , TemperaturaRESUMO
BACKGROUND: There is increasing need to perform invasive surgical procedures in intensive care units (ICUs). Traditional ICUs differ from operating rooms (ORs) in several ways including air changes per hour (ACH) and pressurization. Increased ACH and positive pressurization of ORs intend to provide more aseptic environments for surgery. Development of procedure ready ICUs that transition through unoccupied, occupied, and procedure modes is one solution to improve environmental quality when performing surgery in ICUs. This study assessed the efficacy of two airflow control systems, variable air volume (VAV) and Venturi control, in preventing contaminants from entering ICU from adjacent corridors. STUDY DESIGN: Controlled contaminants, sulfur hexafluoride (SF6) and baker's yeast (CFU/m3), were released in the corridor adjacent to the ICU. SF6 and CFU/m3 were detected inside the ICU at the patient bed during a dynamic simulation of code blue event. VAV and Venturi were compared as they cycled the room through unoccupied, occupied, and procedure modes. RESULTS: VAV and Venturi showed significantly fewer CFU/m3 at the patient bed than corridor point of release (p < .05). Although not significant, Venturi cultured 14% fewer CFU/m3 than VAV at the patient bed. There was less SF6 detected at the patient bed with VAV and Venturi (p < .05). There was less SF6 detected at the patient bed with Venturi compared to VAV (p < .05). Venturi transitioned between modes faster than VAV (p < .05). CONCLUSION: Using efficient mode transitioning systems in ICUs may be effective in creating a more aseptic environment that mimics that of the OR.
Assuntos
Poluição do Ar em Ambientes Fechados/prevenção & controle , Unidades de Terapia Intensiva , Ventilação/métodos , Reanimação Cardiopulmonar , Contagem de Colônia Microbiana , Ambiente de Instituições de Saúde , Controle de Infecções/métodos , Quartos de Pacientes , Saccharomyces cerevisiae , Hexafluoreto de Enxofre , Procedimentos Cirúrgicos Operatórios/métodosRESUMO
BACKGROUND: Covering the instrument table during surgery may decrease contamination. We hypothesized that (1) covering the instrument table in an operating room (OR) during static periods of nonuse and dynamic periods of active use would dramatically decrease the bacterial bioburden on the table, and (2) the use of sterile plastic table covers would be equivalent to sterile impervious paper covers in reducing the bioburden in a dynamic environment. METHODS: Bacterial contamination of the instrument table was evaluated by settle plates in static and dynamic ORs. Airborne particulate and bacterial contaminants were sampled throughout the room. Tested groups included instrument tables covered with sterile impervious paper covers, sterile plastic covers, or no covers. RESULTS: Covering the instrument table during static and dynamic operating room conditions resulted in a significantly decreased bacterial load on the instrument table. No differences were seen between paper and plastic covers. CONCLUSIONS: A significant decrease in bacterial bioburden on the instrument table when the table was covered during static and dynamic periods was observed, suggesting the utility for covering the instrument table during periods of nonuse and during active surgeries.
Assuntos
Microbiologia Ambiental/normas , Contaminação de Equipamentos/prevenção & controle , Controle de Infecções/métodos , Salas Cirúrgicas/normas , Infecção da Ferida Cirúrgica/prevenção & controle , Humanos , Controle de Infecções/normas , Propriedades de SuperfícieRESUMO
BACKGROUND: The use of long sleeves by nonscrubbed personnel in the operating room has been called into question. We hypothesized that wearing long sleeves and gloves, compared with having bare arms without gloves, while applying the skin preparation solution would decrease particulate and microbial contamination. METHODS: A mock patient skin prep was performed in 3 different operating rooms. A long-sleeved gown and gloves, or bare arms, were used to perform the procedure. Particle counters were used to assess airborne particulate contamination, and active and passive microbial assessment was achieved through air samplers and settle plate analysis. Data were compared with Student's t-test or Mann-Whitney U, and P < .05 was considered to be significant. RESULTS: Operating room B demonstrated decreased 5.0- µm particle sizes with the use of sleeves, while operating rooms A and C showed decreased total microbes only with the use of sleeves. Despite there being no difference in the average number of total microbes for all operating rooms assessed, the use of sleeves specifically appeared to decrease the shed of Micrococcus. CONCLUSION: The use of long sleeves and gloves while applying the skin preparation solution decreased particulate and microbial shedding in several of the operating rooms tested. Although long sleeves may not be necessary for all operating room personnel, they may decrease airborne contamination while the skin prep is applied, which may lead to decreased surgical site infections.
Assuntos
Microbiologia do Ar , Vestuário , Salas Cirúrgicas , Período Pré-Operatório , Roupa de Proteção , Bactérias/classificação , Bactérias/isolamento & purificação , Luvas Protetoras , Humanos , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
BACKGROUND: Hospitals face growing pressure to meet the dual but often competing goals of providing a safe environment while controlling operating costs. Evidence-based data are needed to provide insight for facility management practices to support these goals. METHODS: The quality of the air in 3 operating rooms was measured at different ventilation rates. The energy cost to provide the heating, ventilation, and air conditioning to the rooms was estimated to provide a cost-benefit comparison of the effectiveness of different ventilation rates currently used in the health care industry. RESULTS: Simply increasing air change rates in the operating rooms tested did not necessarily provide an overall cleaner environment, but did substantially increase energy consumption and costs. Additionally, and unexpectedly, significant differences in microbial load and air velocity were detected between the sterile fields and back instrument tables. CONCLUSIONS: Increasing the ventilation rates in operating rooms in an effort to improve clinical outcomes and potentially reduce surgical site infections does not necessarily provide cleaner air, but does typically increase operating costs. Efficient distribution or management of the air can improve quality indicators and potentially reduce the number of air changes required. Measurable environmental quality indicators could be used in lieu of or in addition to air change rate requirements to optimize cost and quality for an operating room and other critical environments.
Assuntos
Salas Cirúrgicas/normas , Infecção da Ferida Cirúrgica/prevenção & controle , Ventilação/economia , Ar Condicionado/economia , Análise Custo-Benefício , Humanos , Salas Cirúrgicas/economia , Infecção da Ferida Cirúrgica/economiaRESUMO
BACKGROUND: The effectiveness of operating room headgear in preventing airborne contamination has been called into question. We hypothesized that bouffant style hats would be as effective in preventing bacterial and particulate contamination in the operating room compared with disposable or cloth skull caps, and bouffant style hats would have similar permeability, particle penetration, and porosity compared with skull caps. STUDY DESIGN: Disposable bouffant and skull cap hats and newly laundered cloth skull caps were tested. A mock surgical procedure was used in a dynamic operating room environment. Airborne particulate and microbial contaminants were sampled. Hat fabric was tested for permeability, particle transmission, and pore sizes. RESULTS: No significant differences were observed between disposable bouffant and disposable skull caps with regard to particle or actively sampled microbial contamination. However, when compared with disposable skull caps, disposable bouffant hats did have significantly higher microbial shed at the sterile field, as measured by passive settle plate analysis (p < 0.05). When compared with cloth skull caps, disposable bouffants yielded higher levels of 0.5 µm and 1.0 µm particles and significantly higher microbial shed detected with passive analysis. Fabric assessment determined that disposable bouffant hats had larger average and maximum pore sizes compared with cloth skull caps, and were significantly more permeable than either disposable or cloth skull caps. CONCLUSIONS: Disposable bouffant hats had greater permeability, penetration, and greater microbial shed, as assessed by passive microbial analysis compared with disposable skull caps. When compared with cloth skull caps, disposable bouffants yielded greater permeability, greater particulate contamination, and greater passive microbial shed. Disposable style bouffant hats should not be considered superior to skull caps in preventing airborne contamination in the operating room.
Assuntos
Equipamentos Descartáveis/provisão & distribuição , Ambiente Controlado , Salas Cirúrgicas/normas , Têxteis/normas , HumanosRESUMO
BACKGROUND: Sufficient quantities of quality air and controlled, unidirectional flow are important elements in providing a safe building environment for operating rooms. METHODS: To make dynamic assessments of an operating room environment, a validated method of testing the multiple factors influencing the air quality in health care settings needed to be constructed. These include the following: temperature, humidity, particle load, number of microbial contaminants, pressurization, air velocity, and air distribution. The team developed the name environmental quality indicators (EQIs) to describe the overall air quality based on the actual measurements of these properties taken during the mock surgical procedures. These indicators were measured at 3 different hospitals during mock surgical procedures to simulate actual operating room conditions. EQIs included microbial assessments at the operating table and the back instrument table and real-time analysis of particle counts at 9 different defined locations in the operating suites. Air velocities were measured at the face of the supply diffusers, at the sterile field, at the back table, and at a return grille. RESULTS: The testing protocol provided consistent and comparable measurements of air quality indicators between institutions. At 20 air changes per hour (ACH), and an average temperature of 66.3°F, the median of the microbial contaminants for the 3 operating room sites ranged from 3-22 colony forming units (CFU)/m3 at the sterile field and 5-27 CFU/m3 at the back table. At 20 ACH, the median levels of the 0.5-µm particles at the 3 sites were 85,079, 85,325, and 912,232 in particles per cubic meter, with a predictable increase in particle load in the non-high-efficiency particulate air-filtered operating room site. Using a comparison with cleanroom standards, the microbial and particle counts in all 3 operating rooms were equivalent to International Organization for Standardization classifications 7 and 8 during the mock surgical procedures. CONCLUSIONS: The EQI protocol was measurable and repeatable and therefore can be safely used to evaluate air quality within the health care environment to provide guidance for operational practices and regulatory requirements.