Effect of unidirectional airflow ventilation on surgical site infection in cardiac surgery: environmental impact as a factor in the choice for turbulent mixed air flow

Friedericy, H. J.; Friedericy, A. F.; de Weger, A.; van Dorp, E. L.A.; Traversari, R. A.A.L.; van der Eijk, A.C.; Jansen, F.W.

doi:10.1016/j.jhin.2024.03.008

Effect of unidirectional airflow ventilation on surgical site infection in cardiac surgery

Title

Effect of unidirectional airflow ventilation on surgical site infection in cardiac surgery: environmental impact as a factor in the choice for turbulent mixed air flow

Author

Friedericy, H. J. (Leiden University Medical Center)
Friedericy, A. F. (Vrije Universiteit Amsterdam)
de Weger, A. (Leiden University Medical Center)
van Dorp, E. L.A. (Leiden University Medical Center)
Traversari, R. A.A.L. (TNO)
van der Eijk, A.C. (Leiden University Medical Center)
Jansen, F.W. (TU Delft Medical Instruments & Bio-Inspired Technology; Leiden University Medical Center)

Date

2024

Abstract

Background: Surgical site infection (SSI) in the form of postoperative deep sternal wound infection (DSWI) after cardiac surgery is a rare, but potentially fatal, complication. In addressing this, the focus is on preventive measures, as most risk factors for SSI are not controllable. Therefore, operating rooms are equipped with heating, ventilation and air conditioning (HVAC) systems to prevent airborne contamination of the wound, either through turbulent mixed air flow (TMA) or unidirectional air flow (UDAF). Aim: To investigate if the risk for SSI after cardiac surgery was decreased after changing from TMA to UDAF. Methods: This observational retrospective single-centre cohort study collected data from 1288 patients who underwent open heart surgery over 2 years. During the two study periods, institutional SSI preventive measures remained the same, with the exception of the type of HVAC system that was used. Findings: Using multi-variable logistic regression analysis that considered confounding factors (diabetes, obesity, duration of surgery, and re-operation), the hypothesis that TMA is an independent risk factor for SSI was rejected (odds ratio 0.9, 95% confidence interval 0.4–1.8; P>0.05). It was not possible to demonstrate the preventive effect of UDAF on the incidence of SSI in patients undergoing open heart surgery when compared with TMA. Conclusion: Based on these results, the use of UDAF in open heart surgery should be weighed against its low cost-effectiveness and negative environmental impact due to high electricity consumption. Reducing energy overuse by utilizing TMA for cardiac surgery can diminish the carbon footprint of operating rooms, and their contribution to climate-related health hazards.

Subject

Carbon footprint
Cardiac surgery
Environmental impact
Surgical site infection
Turbulent mixed air flow
Unidirectional air flow

To reference this document use:

http://resolver.tudelft.nl/uuid:a8ad61bc-6958-4288-b861-8ee358afd2a7

DOI

https://doi.org/10.1016/j.jhin.2024.03.008

ISSN

0195-6701

Source

Journal of Hospital Infection, 148, 51-57

Part of collection

Institutional Repository