The role of airborne bacteria in theatre-acquired surgical wound infection

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A desire to minimize the risk of postoperative wound infection dictates many of the routine procedures of modern surgical practice. Nonetheless, an estimated 7.5% of all operations are followed by wound infection1 despite traditional emphasis on aseptic technique, antiseptic practice, and careful tissue and wound management.

Recent technologic advances, primarily in the aerospace and electronics industries, have produced air filtration and delivery systems that are apparently far more efficient than traditional air-conditioning systems in reducing airborne particulate and microbial contamination.2 These systems incorporate high efficiency particulate final air filters and high flow ventilation to achieve clean, minimally turbulent, unidirectional air flow. They have been variously described as laminar, linear, or unidirectional air flow (UAF) systems, but the last term appears most descriptive of their effects in hospital operating theatres.3, 4 Unidirectional air flow, for the control of surgical wound infection, has received enthusiastic support in the medical literature.2, 4, 5 As a result of these developments, we at the Center for Disease Control (CDC) have received numerous inquiries from hospitals requesting our advice regarding installation of these systems, and some hospitals have expressed concern that a failure to use these systems may result in excessive medical-legal liability.

Before endorsing use of UAF systems in hospital operating theatres, we must carefully evaluate their potential benefits. It is most important to remember that the primary goal in the use of UAF in hospitals is to decrease the incidence of patient disease, since there is little benefit in decreasing environmental contamination unless the . . .