Separate Septic and Aseptic Operating Areas

Microbial Load in Septic and Aseptic Procedure Rooms Results From a Prospective, Comparative Observational Study by Dr. med. Julian-Camill Harnoss, Prof. Dr. med. Ojan Assadian, Prof. Dr. med. Markus Karl Diener, Dr. med. Thomas Müller, Dr. rer. med. Romy Baguhl, Prof. Dr. med. Markus Dettenkofer, cand. med. Lukas Scheerer, Prof. Dr. phil. Thomas Kohlmann, Prof. Dr. med. Claus-Dieter Heidecke, Dr. med. Stephan Gessner, Prof. Dr. med. Dr. h.c. mult. Markus Wolfgang Büchler, and Prof. Dr. med. Axel Kramer in issue 27–28/2017

The authors deserve thanks for discussing the controversial topic of microbial load in operating rooms (1), as sustainable measures to reduce microbial load in this setting are essential.

Tables 1 and 2 in the article compare septic and aseptic surgical procedures and find mostly higher average values of microorganisms in the air of operating rooms for septic procedures, especially of aerobic spore forming bacteria (1). The authors emphasize that “the fact that the differences between the 2 procedure types were statistically insignificant cannot […] be interpreted as direct evidence of equal microbial load”. However, in their conclusion, the authors recommend not to separate operating rooms.

Operating areas have a key role. According to a prospective study at Geneva University Hospital, which included 6101 joint prostheses (mean follow-up 70 months), 90% of infections originated during surgery, and 31% presented with initial symptoms after >2 years (2).

A prospective randomized study shows the risk posed by microorganisms in the air of operating rooms (3): „Analysis of the relationship between the number of bacteria washed from the wound at the end of operation to both the number of bacteria in the air of the operating room and those on the patient’s skin at the wound site, clearly showed that the most important and consistent route of contamination was airborne.”

A multicenter study of 8052 joint prostheses indicates that in operating rooms the rate of infection rises with increasing contamination of the air, with Laminar Air Flow offering better protection than turbulent mixing ventilation (4). However, infections develop in spite of ventilation technology.

On the basis of the study reported by Harnoss et al. (1) and in view of the study results mentioned above, no recommendation can be given to abolish the separation between septic and aseptic operating rooms for surgical procedures that entail a high risk of surgical site infection.

DOI: 10.3238/arztebl.2017.0755a

Prof. Dr. med. Karin Büttner-Janz

Extraordinary Professor at Charité—Universitätsmedizin Berlin
IWE Ärzte Management AG, Berlin

Conflict of interest statement

Prof. Büttner-Janz provided the primary deposit for IWE Ärzte Management AG.

References

1. Harnoss JC, Assadian O, Diener MK, Müller T, Baguhl R, Dettenkofer M, Scheerer L, Kohlmann T, Heidecke CD, Gessner S, Büchler MW, Kramer A: Microbial load in septic and aseptic procedure rooms—results from a prospective, comparative observational study. Dtsch Arztebl Int 2017; 114: 465–72

2. Uckay I, Lübbeke A, Emonet S: Low incidence of haematogenous seeding to total hip and knee prostheses in patients with remote infections. J Infect 2009; 59: 337–45

3. Whyte W, Hodgson R, Tinkler J: The importance of airborne bacterial contamination of wounds. J Hosp Infect 1982; 3: 123–35

4. Lidwell OM, Elson RA, Lowbury EJL: 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