Ventilation design conditions associated with airborne bacteria levels within the wound area during surgical procedures: a systematic review

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dc.contributor.authorAganovic, Amarcs
dc.contributor.authorCao, Guangyucs
dc.contributor.authorFečer, Tomášcs
dc.contributor.authorLjungqvist, Bengtcs
dc.contributor.authorLytsy, Birgittacs
dc.contributor.authorRadtke, Andreascs
dc.contributor.authorReinmüller, Beritcs
dc.contributor.authorTraversari, Robertocs
dc.coverage.issue1cs
dc.coverage.volume113cs
dc.date.accessioned2021-07-22T14:55:58Z
dc.date.available2021-07-22T14:55:58Z
dc.date.issued2021-04-27cs
dc.description.abstractWithout confirmation of the ventilation design conditions (typology and airflow rate), the common practice of identifying unidirectional airflow (UDAF) systems as equivalent to ultra-clean air ventilation systems may be misleading, but also any claims about the ineffectiveness of UDAF systems should be doubted. The aim of this review was to assess and compare ventilation system design conditions for which ultra-clean air (mean <10 cfu/m(3)) within 50 cm from the wound has been reported. Six medical databases were systematically searched to identify and select studies reporting intraoperative airborne levels expressed as cfu/m3 close to the wound site, and ventilation system design conditions. Available data on confounding factors such as the number of persons present in the operating room, number of door openings, and clothing material were also included. Predictors for achieving mean airborne bacteria levels within <10 cfu/m(3) were identified using a penalized multivariate logistic regression model. Twelve studies met the eligibility criteria and were included for analysis. UDAF systems considered had significantly higher air volume flows compared with turbulent ventilation (TV) systems considered. Ultra-clean environments were reported in all UDAF-ventilated (N = 7) rooms compared with four of 11 operating rooms equipped with TV. On multivariate analysis, the total number of air exchange rates (P=0.019; odds ratio (OR) 95% confidence interval (CI): 0.66-0.96) and type of clothing material (P=0.031; OR 95% CI: 0.01-0.71) were significantly associated with achieving mean levels of airborne bacteria <10 cfu/m(3). High-volume UDAF systems complying with DIN 1946-4:2008 standards for the airflow rate and ceiling diffuser size unconditionally achieve ultra-clean air close to the wound site. In conclusion, the studied articles demonstrate that high-volume UDAF systems perform as ultra-clean air systems and are superior to TV systems in reducing airborne bacteria levels close to the wound site. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of The Healthcare Infection Society.en
dc.formattextcs
dc.format.extent85-95cs
dc.format.mimetypeapplication/pdfcs
dc.identifier.citationJOURNAL OF HOSPITAL INFECTION. 2021, vol. 113, issue 1, p. 85-95.en
dc.identifier.doi10.1016/j.jhin.2021.04.022cs
dc.identifier.issn0195-6701cs
dc.identifier.other171466cs
dc.identifier.urihttp://hdl.handle.net/11012/200416
dc.language.isoencs
dc.publisherW B SAUNDERS CO LTDcs
dc.relation.ispartofJOURNAL OF HOSPITAL INFECTIONcs
dc.relation.urihttps://www.sciencedirect.com/science/article/pii/S0195670121001754cs
dc.rightsCreative Commons Attribution 4.0 Internationalcs
dc.rights.accessopenAccesscs
dc.rights.sherpahttp://www.sherpa.ac.uk/romeo/issn/0195-6701/cs
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/cs
dc.subjectUltra-clean airen
dc.subjectIntraoperative airborne contaminationen
dc.subjectVentilation systemen
dc.subjectUnidirectional airflow (UDAF)en
dc.subjectOperating roomen
dc.titleVentilation design conditions associated with airborne bacteria levels within the wound area during surgical procedures: a systematic reviewen
dc.type.driverarticleen
dc.type.statusPeer-revieweden
dc.type.versionpublishedVersionen
sync.item.dbidVAV-171466en
sync.item.dbtypeVAVen
sync.item.insts2021.09.03 12:52:47en
sync.item.modts2021.09.03 12:14:33en
thesis.grantorVysoké učení technické v Brně. Fakulta stavební. Ústav automatizace inženýrských úloh a informatikycs
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