Effect of unidirectional airflow ventilation on surgical site infection in cardiac surgery: environmental impact as a factor in the choice for turbulent mixed air flow.

Autor: Friedericy HJ; Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: h.j.friedericy@lumc.nl., Friedericy AF; Department of Health Sciences, Free University of Amsterdam, Amsterdam, The Netherlands., de Weger A; Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands., van Dorp ELA; Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands., Traversari RAAL; TNO, Delft, The Netherlands., van der Eijk AC; Operating Room Department and Central Sterile Supply Department, Leiden University Medical Centre, Leiden, The Netherlands., Jansen FW; Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands; Faculty of Biomedical Engineering, Delft University of Technology, Delft, The Netherlands.
Jazyk: angličtina
Zdroj: The Journal of hospital infection [J Hosp Infect] 2024 Jun; Vol. 148, pp. 51-57. Date of Electronic Publication: 2024 Mar 25.
DOI: 10.1016/j.jhin.2024.03.008
Abstrakt: Background: Surgical site infection (SSI) in the form of postoperative deep sternal wound infection (DSWI) after cardiac surgery is a rare, but potentially fatal, complication. In addressing this, the focus is on preventive measures, as most risk factors for SSI are not controllable. Therefore, operating rooms are equipped with heating, ventilation and air conditioning (HVAC) systems to prevent airborne contamination of the wound, either through turbulent mixed air flow (TMA) or unidirectional air flow (UDAF).
Aim: To investigate if the risk for SSI after cardiac surgery was decreased after changing from TMA to UDAF.
Methods: This observational retrospective single-centre cohort study collected data from 1288 patients who underwent open heart surgery over 2 years. During the two study periods, institutional SSI preventive measures remained the same, with the exception of the type of HVAC system that was used.
Findings: Using multi-variable logistic regression analysis that considered confounding factors (diabetes, obesity, duration of surgery, and re-operation), the hypothesis that TMA is an independent risk factor for SSI was rejected (odds ratio 0.9, 95% confidence interval 0.4-1.8; P>0.05). It was not possible to demonstrate the preventive effect of UDAF on the incidence of SSI in patients undergoing open heart surgery when compared with TMA.
Conclusion: Based on these results, the use of UDAF in open heart surgery should be weighed against its low cost-effectiveness and negative environmental impact due to high electricity consumption. Reducing energy overuse by utilizing TMA for cardiac surgery can diminish the carbon footprint of operating rooms, and their contribution to climate-related health hazards.
(Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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