Horizontal flow operating room clean rooms

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During the past several years there has been increasing interest, particularly among orthopaedic surgeons, in the application of clean room technology to the operating room. The stimulus for this interest can be attributed to Mr. Charnley,1 who has demonstrated a marked reduction in infections in total hip replacement surgery using this technology. The more precise operative discipline which Mr. Charnley developed to complement this technology also appears to have contributed significantly to more efficient surgical asepsis.

It is the purpose of this paper to discuss our experiences with horizontal flow clean rooms during the past 18 months. We shall review the literature which contributed to our interest in operating room clean rooms, our reaction to utilization of such rooms and our experience with wound cultures, air bacterial sampling, and wound infections.

Literature review

In 1895 Brewer2 reported that 39% of all clean surgical wounds became infected. Reviews of infection rates for all surgery showed a 9.4% rate in Great Britain3 in 1960 and 7.5% in the United States4 in 1964. Infections following hip surgery have been reported as 6.4%.5 Early reports of series of total hip replacements not done in the clean room environment have indicated infection rates of 4% to 12%.6–10 However, Coventry11 reports an approximate 1% infection rate for his relatively large series done in a standard operating room. The figures serve to emphasize the diminished but still present threat of infection, particularly in extensive surgical procedures.

Wound contamination may occur endogenously from local or hematogenous sources. It. . .



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