Despite the well-documented relationship between microbiological air quality and deep infection rates in joint replacement surgery, routine monitoring of operating theatres during use is still not standard practice. Wan Li Low provides an insight into a pilot study and national audit on air quality in operating theatres, and considers the best approach to drive improvement.
Surgical site infections (SSIs), pose a significant challenge in healthcare, leading to substantial patient morbidity and increased healthcare costs. They account for approximately 16% of all hospital associated infections, and often result in extended hospital stays, pain, and prolonged or permanent disability.1,2 Specifically, SSIs can double the length of postoperative hospital stays, and greatly elevate care costs,3,4 due to the association with additional surgical procedures, treatment in intensive care units, and higher mortality rates.5
In 2021, the National Joint Registry documented a significant number of revision procedures, arthrodesis and amputations due to infected hip and knee replacements.6 Some patients with these SSIs cannot be cured and require treatment with long-term antibiotics. Such infections not only incur a tremendous cost in human suffering, but also impose a substantial financial burden on the NHS.
The link between infection rates and the microbiological quality of operating theatre air is well established, particularly in orthopaedic surgery. This relationship was first suggested by Charnley's investigations in 1972 and later confirmed by the Medical Research Council trial of ultra clean air (UCA).7,8
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