Infection Control & Hospital Epidemiology Recent International Guidelines
In 2016, the WHO published recommendations for SSI preven- tion4 and concluded: “laminar flow ventilation should not be used in patients receiving arthroplasty.” The quality of the recommen- dation was “conditional” and the level of evidence “low to low enough.” In 2017, the Centers for Disease Control and Prevention (CDC)5 and the American College of Surgeons and Surgical Infection Society9 published respectively new guidelines for SSI prevention without a specific recommendation on that topic (ie, “no recommendation” or “unresolved issue”).
Discussion
Since the publication by Lidwell et al10 in 1987, no new randomized clinical trial was published on this topic until the latest randomized study assessing the air quality in the operating room published by Oguz et al8 in 2017. However, the endpoint was microbiological, and patients were not randomized according to the type of flow. Bischoff et al’s meta-analysis2 or the recent World Health Organization (WHO) guidelines4 synthesized disparate and heterogeneous studies but relied on solid methods (grading of rec- ommendations, assessment, development and evaluations, GRADE). However, theGRADEmethod is not always suitable and was not per- formed in 2015 to grade the French recommendations. With the cur- rent state of knowledge, the French Society of Hospital Hygiene highlights the importance of initiating a global risk analysis beyond on theair performanceclass in theoperating
room.Thenew French guidelines oublished in 2018 recommend the possible use of UAF only in prosthetic orthopedic surgery to reduce aerobiocon- tamination (with no SSI reduction evidence) and with a low level of recommendation. But this measure needs to be included in a bundle of prevention measures, including personal behavior and antibiotic prophylaxis, which remains the major preventive factor. This French opinion and new recommendations aimto help international
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hospitals in their choice of appropriated airflow, especially when designing or renovating an operating room.
Author ORCIDs. Didier Lepelletier, References
1. Pinder EM, Bottle A, Aylin P, Loeffler MD. Does laminar flow ventilation reduce the rate of infection? An observational study of trauma in England. Bone Jt J 2016;98B:1262–1269.
2. Bischoff P, Kubilay NZ, Allegranzi B, Egger M, Gastmeier P. Effect of lam- inar airflow ventilation on surgical site infections: a systematic review and meta-analysis. Lancet Infect Dis 2017;17:553–561.
3. Singh S, Reddy S, Shrivastava
R.Does laminar airflowmake a difference to the infection rates for lower limb arthroplasty: a study using the National Joint Registryandlocalsurgical siteinfectiondatafortwohospitalswithandwithout laminar airflow. Eur J Orthop Surg Traumatol 2017;27:261–265.
4. AllegranziB,ZayedB,Bischoff P, et
al.NewWHOrecommendationsonintra- operative and postoperativemeasures for surgical site infectionprevention: an evidence-based global perspective. Lancet Infect Dis 2016;16:e276–e303.
5. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infec- tion, 2017. JAMA Surg 2017;152:784–791.
6. Jutte PC, Traversari RA, Walenkamp GH. Laminar flow: the better choice in orthopaedic implants. Lancet Infect Dis 2017;17:695–696.
7. Barbadoro P, Bruschi R, Martini E, et al. Impact of laminar air flow on oper- ating room contamination and surgical wound infection rates in clean and contaminated surgery. Eur J Surg Oncol 2016;42:1756–1758.
8. Oguz R, Diab-Elschahawi M, Berger J, et al. Airborne bacterial contamina- tion during orthopedic surgery: a randomized controlled pilot trial. J Clin Anesth 2017;38:160–164.
9. Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: surgical site infection guidelines, 2016 update. J Am Coll Surg 2017;224:59–74.
10. Lidwell OM, Elson RA, Lowbury EJ, et al. Ultraclean air and antibiotics for prevention of postoperative infection. A multicenter study of 8, 052 joint replacement operations. Acta Orthop Scand 1987;58:4–13.
Improving the availability, accessibility, and use of eye protection in patient care settings
Amber Hogan Mitchell DrPH, MPH, CPH International Safety Center, League City, Texas
— To the Editor The International Safety Center has been collecting
occupational mucocutaneous exposure incidents for blood and body fluid splashes and splatters since the early 1990s through the Exposure Prevention Information Network (EPINet). In the last 5 years, according to aggregate data submitted via the EPINet network healthcare facilities and reported publicly, eye exposures often exceed 60% of all other mucocutaneous exposures reported to employee health.1–5 Because EPINet is the only surveillance systemin the world that captures mucocutaneous exposures from health systems and
Author for correspondence: Amber Hogan Mitchell, DrPH, MPH, CPH, 901 Davis
Road, League City, TX 77573. E-mail:
Amber.Mitchell@
internationalsafetycenter.org Cite this article: Mitchell DrPH, MPH, CPH AH. (2019). Improving the availability,
accessibility, and use of eye protection in patient care settings. Infection Control&Hospital Epidemiology, 40: 385–386,
https://doi.org/10.1017/ice.2018.346
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.
reporting thempublicly, it provides the only representative data that exist, and these data clearly illustrate that eye exposuresmake up the largest percent of any other reported/reportable non-sharp blood and/or body fluid exposure and that small percentages of employees indicate they arewearingany formof eyeprotection(eg,goggles, eye- glasseswithsideshields, or faceshield).Most of these exposures occur in the patient room or the exam room (28.1%–61.3%) (Table 1).1–5 I read with interest Dr Mermel’s letter, “Eye Protection for
Preventing Transmission of Respiratory Viral Infections to Healthcare Workers” (November 2018) about the serious risks of any type of infectious or bloodborne disease to the unprotected eye.6,7 Improving eye protection availability, accessibility, and use in patient andexamroomsis crucial toprotectingnotonly worker safety but also patient safety and clinical outcomes. There is growing support for Dr. Mermel’s recommendation “ :: : to wear eye protection when caring
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