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838.html. Updated July 6, 2017. Accessed December 2, 2018.
Is unidirectional airflow in operating theater still recommended to reduce surgical site infections? The French point of view through the recent international literature
Didier Lepelletier1,2 , Bruno Grandbastien1,3, Olivia Keita-Perse1,4, Pierre Parneix1,5, Crespin C. Adjidé6, Raoul Baron1,7
and Ludwig Serge Aho Glélé1,8 for the French Society of Hospital Hygiene Working Group 1French Society of Hospital Hygiene, France, 2Bacteriology and Hospital Hygiene Department, Nantes University Hospital, Nantes, France, 3Hospital Hygiene and Preventive Medicine Department, Centre Hospitalier Universitaire Vaudois, Lausanne, France, 4Epidemiology and Hospital Hygiene Department, Princess Grâce Hospital, Monaco, 5Regional Center for Infection Control and Prevention, Bordeaux University Hospital, Bordeaux, France, 6Hospital Hygiene Department, Amiens University Hospital, Amiens, France, 7Hospital Hygiene Department, Brest University Hospital, Brest, France and 8Epidemiology and Hospital Hygiene Department, Dijon University Hospital, Dijon, France
— To the Editor The indication of unidirectional airflow (UAF)
with an airflow velocity between 0.25 and 0.45 m s−1 in the oper- ating room to reduce surgical site infections (SSIs) is actually ques- tionable, according to the recent international publications.1-3 The WHO20164 and CDC20175 guidelines no longer advocate the use of an UAF as a preventive measure to reduce the risk of SSI. However, some authors still recommend doing so in prosthetic orthopedic surgery.6 The question of the choice of the type of air- flow and the air control performance arises or will arise in hospitals during the renovation or the construction of a new operating room.
Recent International Literature
In the study published by Barbadoro et al7 in 2016, 2 periods were compared: 2001–2013 with turbulent flow use and 2004–2013 with UAF use.7 After multivariate analysis, a significant decrease of SSI
Author for correspondence: Didier Lepelletier, Email:
didier.lepelletier@chu-nantes.fr French Society of Hospital Hygiene Working Group: Véronique Merle (Centre
Hospitalier Universitaire, de Rouen, Rouen, France), Philippe Vanhems (Hospices Civils de Lyon, Lyon, France), Arnaud Florentin (Centre Hospitalier de Nancy, Nancy, France), Pascale Chaize (Centre Hospitalier de Montpellier, Montpellier, France), Michèle Aggoune (Assistance Publique - Hôpitaux de Paris, Paris, France), Anne Savey (Centre de prévention desinfectionsassociéesauxsoins,Lyon,France),ChantalLéger (Centredepréventiondesinfec- tions associées aux soins, Poitiers, France), Jean-RalphZahar (Assistance Publique -Hôpitaux de Paris, Paris, France. Cite this article: Lepelletier D, et al. (2019). Is unidirectional airflowin operating theater
still recommended to reduce surgical site infections? The French point of view through the recent international literature. Infection Control & Hospital Epidemiology, 40: 384–385,
https://doi.org/10.1017/ice.2018.345
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. incidence in an operating room equipped of UAF was observed in
clean þ clean-contaminated surgeries (odds ratio [OR], 0.57; 95% confidenceinterval[CI], 0.48–0.68)andincontaminatedþdirty sur- geries (OR, 0.31; 95% CI, 0.17–0.56), respectively. However, this
studysuffers fromnumerousbiases(ie,nonrandomizedsingle-center survey, no control group, and “before and after” study design). The meta-analysis published by Bischoff et al2 in 2017 com-
pared the efficiency of UAF versus turbulent flow in different sur- geries. Overall, 12 studies were selected including observational studies (n = 9) or registered database analysis (n = 3). The meta-analysis of 8 cohorts showed no difference in deep SSI incidence after 330,146 hip replacement procedures (OR, 1.29; 95% CI, 0.98–1.71; P = .07; I² = 83%). Furthermore, no difference was detected after 134,368 knee arthroplasties (meta-analysis of 6 cohort studies; OR, 1.08; 95% CI, 0.77–1.52; P = .65; I² =71%). There was no significant difference between digestive and vascular surgeries. The findings of this study are under debate.6 In 2017, Oguz et al8 published a single-center randomized study
assessing the influence of 4 factors on the bacterial air contamination after orthopedic surgery: (1) use ofUAF, (2)durationof surgical pro- cedure, (3) presence of professionals in the operating room and (4) type of warming (ie, pulsed-air or non–pulsed-air heating system). The patients were randomized into 2 groups, according to the type of warming: pulsating air or electric heating. The unidirectional ver- sus nonunidirectional flow comparison was performed within each randomized group. In multivariate analysis, a significant increase of the number of bacteria in the airwas detected according to the dura- tion of the intervention in the absence of UAF.
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