Correlation between a real-time bioparticle detection device and a traditional microbiological active air sampler monitoring air quality in an operating room during elective arthroplasty surgery: a prospective feasibility study
DOI:
https://doi.org/10.2340/17453674.2025.43002Keywords:
Arthroplasty, Hip, Implants, Infection, KneeAbstract
Background and purpose: The standard method for controlling operating room (OR) air quality is measuring bacteria-carrying particles per volume unit of air: colony forming units (CFU/m3). The result takes at least 2 days after sampling. Another method is real-time measurements of fluorescing bioparticles per unit volume of air (FBP/dm3). We aimed to compare simultaneous measurements of FBP/50 dm3 and CFU/m3 during ongoing arthroplasty surgery.
Methods: 18 arthroplasties were performed in a modern OR with turbulent mixed airflow ventilation. The sampling heads of a BioAerosol Monitoring System (BAMS) and a microbiological active air sampler (Sartorius MD8 Air Sampler) were placed next to each other, and 6 parallel 10-minute registrations of FBP/50 dm3 and CFU/m3 were performed for each surgery. Parallel measurements were plotted against each other, Passing–Bablok nonparametric linear regression was performed, and the Spearman correlation coefficient (r) was calculated.
Results: The r between FBP ≥ 3 μm/50 dm3 and CFU/m3 sampled for 96 x 10-minute intervals, was 0.70 (95% confidence interval [CI] 0.57–0.79). In the 25th percentile with the lowest 10-minute FBP ≥ 3μm/50 dm3, there were no CFU measurements with ≥ 10 and 4% with ≥ 5 CFU/m3. In the 75th percentile with the highest 10-minute FBP ≥ 3 μm/50 dm3, there were 58% CFU measurements with ≥ 10 and 88% with ≥ 5 CFU/m3. The r between FBP ≥ 3 μm/50 dm3 and CFU/m3 means sampled during 18 operations was 0.87 (CI 0.68–0.95).
Conclusion: Low FBP ≥ 3 μm/50 dm3 measured by BAMS indicates low CFU/m3; conversely, high FBP ≥ 3 μm/50 dm3 indicates high CFU/m3. Real-time measurements of FBP ≥ 3 μm/50 dm3 can be used as a supplement to CFU/m3 monitoring OR air bacterial load.
Downloads
References
Eriksson H K, Lazarinis S. Patient-related factors associated with superficial surgical site infection and progression to a periprosthetic joint infection after elective primary total joint arthroplasty: a single-centre, retrospective study in Sweden. BMJ Open 2022; 12(9): e060754. doi: 10.1136/bmjopen-2022-060754. DOI: https://doi.org/10.1136/bmjopen-2022-060754
Springer B D, Cahue S, Etkin C D, Lewallen D G, McGrory B J. Infection burden in total hip and knee arthroplasties: an international registry-based perspective. Arthroplasty Today 2017; 3(2): 137-40. doi: 10.1016/j.artd.2017.05.003. DOI: https://doi.org/10.1016/j.artd.2017.05.003
Keemu H, Alakylä K J, Klén R, Panula V J, Venäläinen M S, Haapakoski J J, et al. Risk factors for revision due to prosthetic joint infection following total knee arthroplasty based on 62,087 knees in the Finnish Arthroplasty Register from 2014 to 2020. Acta Orthop 2023; 94: 215-23. doi: 10.2340/17453674.2023.12307. DOI: https://doi.org/10.2340/17453674.2023.12307
Kapadia B H, Berg R A, Daley J A, Fritz J, Bhave A, Mont M A. Periprosthetic joint infection. Lancet 2016; 387(10016): 386-94. doi: 10.1016/S0140-6736(14)61798-0. DOI: https://doi.org/10.1016/S0140-6736(14)61798-0
Rezapoor M, Parvizi J. Prevention of periprosthetic joint infection. J Arthroplasty 2015; 30(6): 902-7. doi: 10.1016/j.arth.2015.02.044. DOI: https://doi.org/10.1016/j.arth.2015.02.044
Charnley J. Postoperative infection after total hip replacement with special reference to air contamination in the operating room. Clin Orthop Relat Res 1972; (87): 167-87. doi: 10.1097/00003086-197209000-00020. DOI: https://doi.org/10.1097/00003086-197209000-00020
Lidwell O M, Lowbury E J L, Whyte W, Blowers R, Stanley S J, Lowe D. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. Br Med J (Clin Res Ed) 1982; 285(6334): 10-14. doi: 10.1136/bmj.285.6334.10. DOI: https://doi.org/10.1136/bmj.285.6334.10
Whyte W, Hodgson R, Tinkler J. The importance of airborne bacterial contamination of wounds. J Hosp Infect 1982; 3(2): 123-35. doi: 10.1016/0195-6701(82)90004-4. DOI: https://doi.org/10.1016/0195-6701(82)90004-4
Institute SS. Technical specification. Microbiological cleanliness in the operating room – Preventing airborne contamination – Guidance and fundamental requirements. SIS-TS 39:2015; 2015. Available at https://www.sis.se/en/produkter/health-care-technology/general/sists392015/
Agodi A, Auxilia F, Barchitta M, Cristina M L, D’Alessandro D, Mura I, et al. Operating theatre ventilation systems and microbial air contamination in total joint replacement surgery: results of the GISIO-ISChIA study. J Hosp Infect 2015; 90(3): 213-19. doi: 10.1016/j.jhin.2015.02.014. DOI: https://doi.org/10.1016/j.jhin.2015.02.014
Stocks G W, Self S D, Thompson B, Adame X A, O’Connor D P. Predicting bacterial populations based on airborne particulates: a study performed in nonlaminar flow operating rooms during joint arthroplasty surgery. Am J Infect Control 2010; 38(3): 199-204. doi: 10.1016/j.ajic.2009.07.006. DOI: https://doi.org/10.1016/j.ajic.2009.07.006
Lytsy B, Hambraeus A, Ljungqvist B, Ransjö U, Reinmüller B. Source strength as a measurement to define the ability of clean air suits to reduce airborne contamination in operating rooms. J Hosp Infect 2022; 119: 9-15. doi: 10.1016/j.jhin.2021.09.018. DOI: https://doi.org/10.1016/j.jhin.2021.09.018
Annaqeeb M K, Zhang Y, Dziedzic J W, Xue K, Pedersen C, Stenstad L I, et al. Influence of surgical team activity on airborne bacterial distribution in the operating room with a mixing ventilation system: a case study at St. Olavs Hospital. J Hosp Infect 2021; 116: 91-8. doi: 10.1016/j.jhin.2021.08.009. DOI: https://doi.org/10.1016/j.jhin.2021.08.009
Andersson A E, Bergh I, Karlsson J, Eriksson B I, Nilsson K. Traffic flow in the operating room: an explorative and descriptive study on air quality during orthopedic trauma implant surgery. Am J Infect Control 2012; 40(8): 750-5. doi: 10.1016/j.ajic.2011.09.015. DOI: https://doi.org/10.1016/j.ajic.2011.09.015
Perez P, Holloway J, Ehrenfeld L, Cohen S, Cunningham L, Miley G B, et al. Door openings in the operating room are associated with increased environmental contamination. Am J Infect Control 2018; 46(8): 954-6. doi: 10.1016/j.ajic.2018.03.005. DOI: https://doi.org/10.1016/j.ajic.2018.03.005
Stålfelt F, Malchau K S, Björn C, Mohaddes M, Andersson A E. Can particle counting replace conventional surveillance for airborne bacterial contamination assessments? A systematic review using narrative synthesis. Am J Infect Control 2023; 51(12): 1417-24. doi: 10.1016/j.ajic.2023.05.004. DOI: https://doi.org/10.1016/j.ajic.2023.05.004
Dai C, Zhang Y, Ma X, Yin M, Zheng H, Gu X, et al. Real-time measurements of airborne biologic particles using fluorescent particle counter to evaluate microbial contamination: results of a comparative study in an operating theater. Am J Infect Control 2015; 43(1): 78-81. doi: 10.1016/j.ajic.2014.10.004. DOI: https://doi.org/10.1016/j.ajic.2014.10.004
Ljungqvist B, Nordenadler J, Reinmüller B. A comparative study of a standard slit-to-agar sampler and a real-time bacterial detector. Eur J Parent Pharmaceut Sci 2024; 291. https://doi.org/10.37521/ejpps.29102. DOI: https://doi.org/10.37521/ejpps.29102
Eaton T, Davenport C J, Whyte W H. Airborne microbial monitoring in an operational cleanroom using an instantaneous detection system and high efficiency microbiological samplers. Eur J Parent Pharmaceut Sci 2012; 17(2): 61-9.
Alsved M, Civilis A, Ekelund P, Tammelin A, Andersson A E, Jakobsson J et al. Temperature-controlled airflow ventilation in operating rooms compared with laminar airflow and turbulent mixed airflow. J Hosp Infect 2018; 98(2): 181-90. doi: 10.1016/j.jhin.2017.10.013. DOI: https://doi.org/10.1016/j.jhin.2017.10.013
Landrin A, Bissery A, Kac G. Monitoring air sampling in operating theatres: can particle counting replace microbiological sampling? J Hosp Infect 2005; 61(1): 27-9. doi: 10.1016/j.jhin.2005.03.002. DOI: https://doi.org/10.1016/j.jhin.2005.03.002
Birgand G, Toupet G, Rukly S, Antoniotti G, Deschamps M N, Lepelletier D, et al. Air contamination for predicting wound contamination in clean surgery: a large multicenter study. Am J Infect Control 2015; 43(5): 516-21. doi: 10.1016/j.ajic.2015.01.026. DOI: https://doi.org/10.1016/j.ajic.2015.01.026
Hamilton V, Sheikh S, Szczepanska A, Maskell N, Hamilton F, Reid J P, et al. Diathermy and bone sawing are high aerosol yield procedures. Bone Joint Res 2023; 12(10): 636-43. doi: 10.1302/2046-3758.1210.BJR-2023-0028.R1. DOI: https://doi.org/10.1302/2046-3758.1210.BJR-2023-0028.R1
Additional Files
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Lise-Lott Larsson, Johan Nordenadler, Gunilla Björling, Li Felländer-Tsai, Stergios Lazarinis, Bengt Ljungqvist, Janet Mattsson, Berit Reinmüller, Harald Brismar
This work is licensed under a Creative Commons Attribution 4.0 International License.
