Clean air in the operating room

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The idea that airborne bacteria might be a common source of infection of surgical wounds in the operating room is as old or even older than Lister, and remains still a hypothesis not universally accepted. In this contribution I shall concentrate on the evidence for believing that airborne infection in the operating room is common; but I shall touch only briefly on the technical details of operating in clean air.

One difficulty in accepting the idea of airborne infection relates to the whole bacteriological concept of “airborne bacteria” which covers a much wider field than infection in the operating room, including as it does the epidemiology of many infectious diseases. It is generally agreed that living bacteria, in contrast to spores, are rarely present in the air by themselves, tuberculosis being one of the few for which experimental evidence is available. For this reason the insistence on filtration of air to submicron size, which is a strong selling-point of air engineers in the clean-rooms of industry, evokes no great sympathy from the bacteriologist. Postoperative infection by spore-bearing organisms, for which submicron filtration might be needed, is so rare in orthopaedic surgery as to be negligible, as evidenced in my own series of 85 infections in 5,000 operations where one case only was due to spore-bearing organism (Bacillus cereus), and even here there were good grounds for believing that it was not acquired at the time of operation.

On the other hand, few people would contest the idea that wounds might . . .