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000000000000000000000000000000000000000007444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444cccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccoeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeurrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrriddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddyrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrEffect of a Clean Surgical Airflow Layer on the Incidence of Infection in Total Hip Arthroplasty
Lucas K. Routh, MD; Nancy L. Parks, MS; Jeanine M. Gargiulo, Pa-C; William G. Hamilton, MD
Orthopedics. https://doi.org/10.3928/01477447-20200721-13
Posted August 6, 2020
ABSTRACT
FULL TEXT
FIGURES/TABLES
REFERENCES
VIEW PDF
Abstract
The Center for Health Design estimates that more than 30% of surgical site infections are caused by airborne pathogens. A device that creates a localized clean air field directly adjacent to and surrounding the incision site is meant to shield a surgical site from particulate in the operating room. The purpose of this study was to determine whether the routine use of this device would reduce the rate of infection following total hip arthroplasty (THA). The authors conducted a retrospective review of primary THA cases performed with and without the airflow device. Since July 2013, a total of 1093 primary THA cases were performed with the device at the authors' institution. The incidence of wound dehiscence and deep infection was compared with that of 1171 THA cases performed prior to July 2013 without the airflow device. There were no significant differences between the study groups regarding average patient age, sex, body mass index, or diagnosis. In the airflow group, there were 7 (0.64%) deep infections and 5 (0.46%) cases of wound dehiscence that required a return to the operating room for irrigation and wound revision. In the control group, there were 7 (0.60%) cases of deep infection and 4 (0.34%) wound revisions. The groups were not significantly different in the rates of infection (P=1.0) or wound revision (P=.75). Both groups had a very low incidence of infection and wound revision, with rates below 1%. Despite compelling bench data showing a dramatic reduction of particle load in the wound, the use of the airflow device did not reduce the clinical rate of infection over a large number of cases. [Orthopedics. 2020;43(x):xx–xx.]
Authors
The authors are from Anderson Orthopaedic Research Institute, Alexandria, Virginia.
Dr Routh, Ms Parks, and Ms Gargiulo have no relevant financial relationships to disclose. Dr Hamilton is a paid consultant for and receives royalties from DePuy and Total Joint Orthopaedics.
Correspondence should be addressed to: Nancy L. Parks, MS, PO Box 7088, Alexandria, VA 22307 ( [email protected]).
Copyright 2020, SLACK Incorporated
Received: February 08, 2019
Accepted: July 22, 2019
Posted Online: August 03, 2020
10.3928/01477447-20200721-13rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrpeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppp44444444444444444444444403333333333Effect of a Clean Surgical Airflow Layer on the Incidence of Infection in Total Hip Arthroplasty
Lucas K. Routh, MD; Nancy L. Parks, MS; Jeanine M. Gargiulo, Pa-C; William G. Hamilton, MD
Orthopedics. https://doi.org/10.3928/01477447-20200721-13
Posted August 6, 2020
ABSTRACT
FULL TEXT
FIGURES/TABLES
REFERENCES
VIEW PDF
Abstract
The Center for Health Design estimates that more than 30% of surgical site infections are caused by airborne pathogens. A device that creates a localized clean air field directly adjacent to and surrounding the incision site is meant to shield a surgical site from particulate in the operating room. The purpose of this study was to determine whether the routine use of this device would reduce the rate of infection following total hip arthroplasty (THA). The authors conducted a retrospective review of primary THA cases performed with and without the airflow device. Since July 2013, a total of 1093 primary THA cases were performed with the device at the authors' institution. The incidence of wound dehiscence and deep infection was compared with that of 1171 THA cases performed prior to July 2013 without the airflow device. There were no significant differences between the study groups regarding average patient age, sex, body mass index, or diagnosis. In the airflow group, there were 7 (0.64%) deep infections and 5 (0.46%) cases of wound dehiscence that required a return to the operating room for irrigation and wound revision. In the control group, there were 7 (0.60%) cases of deep infection and 4 (0.34%) wound revisions. The groups were not significantly different in the rates of infection (P=1.0) or wound revision (P=.75). Both groups had a very low incidence of infection and wound revision, with rates below 1%. Despite compelling bench data showing a dramatic reduction of particle load in the wound, the use of the airflow device did not reduce the clinical rate of infection over a large number of cases. [Orthopedics. 2020;43(x):xx–xx.]
Authors
The authors are from Anderson Orthopaedic Research Institute, Alexandria, Virginia.
Dr Routh, Ms Parks, and Ms Gargiulo have no relevant financial relationships to disclose. Dr Hamilton is a paid consultant for and receives royalties from DePuy and Total Joint Orthopaedics.
Correspondence should be addressed to: Nancy L. Parks, MS, PO Box 7088, Alexandria, VA 22307 ( [email protected]).
Copyright 2020, SLACK Incorporated
Received: February 08, 2019
Accepted: July 22, 2019
Posted Online: August 03, 2020
10.3928/01477447-20200721-133333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333330000000000000000000000000000000000000000074444444444444444444cccccccccccccccccccccccccccccccccccccccccccccccccccccEffect of a Clean Surgical Airflow Layer on the Incidence of Infection in Total Hip Arthroplasty
Lucas K. Routh, MD; Nancy L. Parks, MS; Jeanine M. Gargiulo, Pa-C; William G. Hamilton, MD
Orthopedics. https://doi.org/10.3928/01477447-20200721-13
Posted August 6, 2020
ABSTRACT
FULL TEXT
FIGURES/TABLES
REFERENCES
VIEW PDF
Abstract
The Center for Health Design estimates that more than 30% of surgical site infections are caused by airborne pathogens. A device that creates a localized clean air field directly adjacent to and surrounding the incision site is meant to shield a surgical site from particulate in the operating room. The purpose of this study was to determine whether the routine use of this device would reduce the rate of infection following total hip arthroplasty (THA). The authors conducted a retrospective review of primary THA cases performed with and without the airflow device. Since July 2013, a total of 1093 primary THA cases were performed with the device at the authors' institution. The incidence of wound dehiscence and deep infection was compared with that of 1171 THA cases performed prior to July 2013 without the airflow device. There were no significant differences between the study groups regarding average patient age, sex, body mass index, or diagnosis. In the airflow group, there were 7 (0.64%) deep infections and 5 (0.46%) cases of wound dehiscence that required a return to the operating room for irrigation and wound revision. In the control group, there were 7 (0.60%) cases of deep infection and 4 (0.34%) wound revisions. The groups were not significantly different in the rates of infection (P=1.0) or wound revision (P=.75). Both groups had a very low incidence of infection and wound revision, with rates below 1%. Despite compelling bench data showing a dramatic reduction of particle load in the wound, the use of the airflow device did not reduce the clinical rate of infection over a large number of cases. [Orthopedics. 2020;43(x):xx–xx.]
Authors
The authors are from Anderson Orthopaedic Research Institute, Alexandria, Virginia.
Dr Routh, Ms Parks, and Ms Gargiulo have no relevant financial relationships to disclose. Dr Hamilton is a paid consultant for and receives royalties from DePuy and Total Joint Orthopaedics.
Correspondence should be addressed to: Nancy L. Parks, MS, PO Box 7088, Alexandria, VA 22307 ( [email protected]).
Copyright 2020, SLACK Incorporated
Received: February 08, 2019
Accepted: July 22, 2019
Posted Online: August 03, 2020
10.3928/01477447-20200721-13Effect of a Clean Surgical Airflow Layer on the Incidence of Infection in Total Hip Arthroplasty
Lucas K. Routh, MD; Nancy L. Parks, MS; Jeanine M. Gargiulo, Pa-C; William G. Hamilton, MD
Orthopedics. https://doi.org/10.3928/01477447-20200721-13
Posted August 6, 2020
ABSTRACT
FULL TEXT
FIGURES/TABLES
REFERENCES
VIEW PDF
Abstract
The Center for Health Design estimates that more than 30% of surgical site infections are caused by airborne pathogens. A device that creates a localized clean air field directly adjacent to and surrounding the incision site is meant to shield a surgical site from particulate in the operating room. The purpose of this study was to determine whether the routine use of this device would reduce the rate of infection following total hip arthroplasty (THA). The authors conducted a retrospective review of primary THA cases performed with and without the airflow device. Since July 2013, a total of 1093 primary THA cases were performed with the device at the authors' institution. The incidence of wound dehiscence and deep infection was compared with that of 1171 THA cases performed prior to July 2013 without the airflow device. There were no significant differences between the study groups regarding average patient age, sex, body mass index, or diagnosis. In the airflow group, there were 7 (0.64%) deep infections and 5 (0.46%) cases of wound dehiscence that required a return to the operating room for irrigation and wound revision. In the control group, there were 7 (0.60%) cases of deep infection and 4 (0.34%) wound revisions. The groups were not significantly different in the rates of infection (P=1.0) or wound revision (P=.75). Both groups had a very low incidence of infection and wound revision, with rates below 1%. Despite compelling bench data showing a dramatic reduction of particle load in the wound, the use of the airflow device did not reduce the clinical rate of infection over a large number of cases. [Orthopedics. 2020;43(x):xx–xx.]
Authors
The authors are from Anderson Orthopaedic Research Institute, Alexandria, Virginia.
Dr Routh, Ms Parks, and Ms Gargiulo have no relevant financial relationships to disclose. Dr Hamilton is a paid consultant for and receives royalties from DePuy and Total Joint Orthopaedics.
Correspondence should be addressed to: Nancy L. Parks, MS, PO Box 7088, Alexandria, VA 22307 ( [email protected]).
Copyright 2020, SLACK Incorporated
Received: February 08, 2019
Accepted: July 22, 2019
Posted Online: August 03, 2020
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Inhaled nitric oxide at higher dose shows benefit in pulmonary hypertension, fibrotic ILD
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Deeper disease insight signals 'exciting time' for PsA drug pipeline
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Healthy travelers at low risk for acquiring C. auris, study suggests
Healthy travelers at low risk for acquiring <i>C. </i><i>auris</i>, study suggests
A culture-based protocol implemented to screen healthy United States travelers for Candida auris suggested that travelers are not likely to acquire the aggressive and often drug-resistant fungus while abroad, according to data presented at ASM Microbe.
August 06, 2020
1 min read
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FDA clears EyeArt AI system for diabetic retinopathy screening
Eyenuk has received 510(k) clearance from the FDA to market EyeArt, an autonomous AI system for diabetic retinopathy screening, according to a press release.
August 06, 2020
2 min read
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Extended antibiotics effective in patients at high risk for PJI through 1-year follow-up
Extended antibiotics effective in patients at high risk for PJI through 1-year follow-up
Extending oral antibiotics use to 7 days postoperatively in patients at high risk for prosthetic joint infection was effective at reducing infection rates, findings of a retrospective study of prospectively collected data showed.
August 06, 2020
2 min read
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Q&A: COVID-19 pandemic linked to drop in colorectal cancer screenings
Colorectal cancer screening rates in recent years have significantly decreased in at-risk groups such patients aged 50 to 52 years and patients under 50 years with Crohn’s disease and ulcerative colitis, according to data collected by the Blue Cross Blue Shield Association and reported in The Health of America report, Rise in Chronic Conditions is Putting More Americans at risk for Colorectal Cancer.
August 06, 2020
1 min read
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COVID-19 psychiatry updates: Pandemic-related grief, virus' impact on the brain and more
COVID-19 psychiatry updates: Pandemic-related grief, virus' impact on the brain and more
The ongoing COVID-19 pandemic and measures to combat the spread of the virus have significantly affected the mental health of individuals throughout the United States and the world.
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Individualizing Treatment for Patients with T2DM: The Virtual Patient Management Simulator
This activity is supported by independent educational grants from Boehringer Ingelheim Pharmaceuticals, Inc. and Lilly USA, LLC; and Merck & Co., Inc.
t2dm
1.75
CME
105
MINS
$0
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PRIMARY CARE
MONOGRAPH
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Influenza360: Consults in Diagnosis and Treatment; Volume 1, Number 1
This activity is supported by an educational grant from Genentech, Inc.
k119
0.75
CME
0.75
AAPA
45
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$0
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PSYCHIATRY
JOURNAL
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Metabolic Syndrome Across Psychiatric Disorders: August 2020
AKH Inc., Advancing Knowledge in Healthcare and Psychiatric Annals
Psychiatric Annals
3.00
CME
180
MINS
$30
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Sight-saving Therapeutics for the Treatment of Neovascular Age-related Macular Degeneration
This activity is supported by an educational grant from Allergan, Inc.
namd cme
1.00
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1.00
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1
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Mitigating Lack of Response to Antidepressant Therapy in Major Depressive Disorder: A Game On! Challenge
This activity is supported by an educational grant from Takeda Pharmaceuticals U.S.A., Inc. and Lundbeck.
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0.50
ABIM MOC
30
MINS
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PULMONOLOGY
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New Horizons in Idiopathic Pulmonary Fibrosis: The Era of Antifibrotic Therapy
This activity is supported by an independent educational grant from Genentech.
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45
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OPHTHALMOLOGY
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Retina360: Advances in the Management of Retinal Diseases; Volume 1, Number 1
This activity is supported by independent medical education grants from Genentech, Inc.; Novartis Pharmaceuticals Corporation; and Regeneron Pharmaceuticals, Inc.
Retina360: Advances in the Management of Retinal Diseases
1.25
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1.25
ABO MOC
75
MINS
$0
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VIDEO
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Improving Adult Vaccine Confidence: A GameOn! Challenge
This activity is supported by an educational grant from Merck & Co., Inc.
Improving Adult Vaccine Confidence: A GameOn! Challenge
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utpatient Orthopedic Rehabilitation Inhaled nitric oxide at higher dose shows benefit in pulmonary hypertension, fibrotic ILD
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Pulsed, inhaled nitric oxide at a higher dose was safe and well tolerated, and resulted in improvements in physical activity and other outcomes in patients at risk for pulmonary hypertension-associated fibrotic interstitial lung disease.
A new study evaluated safety and efficacy of pulsed, inhaled nitric oxide (Bellerophon Therapeutics) at a dose of 45 µg/kg of ideal body weight per hour.
Source: Adobe Stock.
“Inhaled nitric oxide is a proven vasodilator and has recently been shown to benefit physical activity in a placebo-controlled trial of patients with fibrotic ILD when used at a dose of 30 µg/kg ideal body weight per hour for 2 months. The objective of this current trial was to explore the safety and efficacy of a higher dose — 45 µg/kg ideal body weight per hour — for a longer period of 4 months,” Steven D. Nathan, MD, director of the Advanced Lung Disease Program and Lung Transplant Program at Inova Fairfax Hospital in Virginia, said during a prerecorded presentation during the American Thoracic Society Virtual meeting.
The randomized, double-blind, placebo-controlled study enrolled patients at risk for pulmonary hypertension associated with pulmonary fibrosis on background oxygen therapy. Patients were randomly assigned to inhaled nitric oxide 45 µg/kg of ideal body weight per hour (n = 30) or placebo (n = 14) for 4 months. The researchers monitored changes in activity levels via a wrist-worn medical grade activity monitor.
The primary endpoint was placebo-corrected change from baseline to 4 months in moderate to vigorous physical activity, which represents activities of daily living, such as walking, climbing stairs and yardwork, Nathan said. Additional outcomes included patient-reported outcomes of the St. George’s Respiratory Questionnaire and the University of California San Diego Shortness of Breath Questionnaire.
Researchers reported a statistically significant placebo-corrected benefit of 14 minutes per day in moderate to vigorous physical activity among the patients assigned inhaled nitric (P = .02). Results also showed a 7% benefit in overall activity with inhaled nitric oxide compared with placebo. Moreover, for both activity parameters, Nathan noted that while the inhaled nitric oxide treatment group remained stable, the placebo group deteriorated.
Nathan also reported clinically significant changes in the University of San Diego Shortness of Breath Questionnaire (4.8 points) and the St. George’s Respiratory Questionnaire Total (3.3), Activity (4.8) and Impact (5.7) domain scores. Again, over the study period, patients assigned inhaled nitric oxide remained stable, while the placebo group deteriorated.
The researchers also conducted an anchoring analysis between moderate to vigorous physical activity and the Activity domain in the St. George’s Respiratory Questionnaire, which established an estimated minimally important difference of approximately 5 minutes per day for moderate to vigorous physical activity, Nathan said.
Pulsed, inhaled nitric oxide at the higher dose was well tolerated, with fewer severe adverse events observed compared with the placebo group (10% vs. 21.4%). The overall incidence of adverse events was low and balanced between the two groups. No deaths were reported during the treatment period, according to the results.
The new data confirm the previously reported results with inhaled nitric oxide at a lower concentration, according to the researchers.
“The inhaled nitric oxide 45 µg/kg ideal body weight per hour dose was safe and well tolerated and is currently being studied in a large registrational, phase 3, placebo-controlled clinical trial in patients with fibrosing ILD,” Nathan said.
Effect of a Clean Surgical Airflow Layer on the Incidence of Infection in Total Hip Arthroplasty
Lucas K. Routh, MD; Nancy L. Parks, MS; Jeanine M. Gargiulo, Pa-C; William G. Hamilton, MD
Orthopedics. https://doi.org/10.3928/01477447-20200721-13
Posted August 6, 2020
ABSTRACT
FULL TEXT
FIGURES/TABLES
REFERENCES
VIEW PDF
Abstract
The Center for Health Design estimates that more than 30% of surgical site infections are caused by airborne pathogens. A device that creates a localized clean air field directly adjacent to and surrounding the incision site is meant to shield a surgical site from particulate in the operating room. The purpose of this study was to determine whether the routine use of this device would reduce the rate of infection following total hip arthroplasty (THA). The authors conducted a retrospective review of primary THA cases performed with and without the airflow device. Since July 2013, a total of 1093 primary THA cases were performed with the device at the authors' institution. The incidence of wound dehiscence and deep infection was compared with that of 1171 THA cases performed prior to July 2013 without the airflow device. There were no significant differences between the study groups regarding average patient age, sex, body mass index, or diagnosis. In the airflow group, there were 7 (0.64%) deep infections and 5 (0.46%) cases of wound dehiscence that required a return to the operating room for irrigation and wound revision. In the control group, there were 7 (0.60%) cases of deep infection and 4 (0.34%) wound revisions. The groups were not significantly different in the rates of infection (P=1.0) or wound revision (P=.75). Both groups had a very low incidence of infection and wound revision, with rates below 1%. Despite compelling bench data showing a dramatic reduction of particle load in the wound, the use of the airflow device did not reduce the clinical rate of infection over a large number of cases. [Orthopedics. 2020;43(x):xx–xx.]
Authors
The authors are from Anderson Orthopaedic Research Institute, Alexandria, Virginia.
Dr Routh, Ms Parks, and Ms Gargiulo have no relevant financial relationships to disclose. Dr Hamilton is a paid consultant for and receives royalties from DePuy and Total Joint Orthopaedics.
Correspondence should be addressed to: Nancy L. Parks, MS, PO Box 7088, Alexandria, VA 22307 ( [email protected]).
Copyright 2020, SLACK Incorporated
Received: February 08, 2019
Accepted: July 22, 2019
Posted Online: August 03, 2020
10.3928/01477447-20200721-13Effect of a Clean Surgical Airflow Layer on the Incidence of Infection in Total Hip Arthroplasty
Lucas K. Routh, MD; Nancy L. Parks, MS; Jeanine M. Gargiulo, Pa-C; William G. Hamilton, MD
Orthopedics. https://doi.org/10.3928/01477447-20200721-13
Posted August 6, 2020
ABSTRACT
FULL TEXT
FIGURES/TABLES
REFERENCES
VIEW PDF
Abstract
The Center for Health Design estimates that more than 30% of surgical site infections are caused by airborne pathogens. A device that creates a localized clean air field directly adjacent to and surrounding the incision site is meant to shield a surgical site from particulate in the operating room. The purpose of this study was to determine whether the routine use of this device would reduce the rate of infection following total hip arthroplasty (THA). The authors conducted a retrospective review of primary THA cases performed with and without the airflow device. Since July 2013, a total of 1093 primary THA cases were performed with the device at the authors' institution. The incidence of wound dehiscence and deep infection was compared with that of 1171 THA cases performed prior to July 2013 without the airflow device. There were no significant differences between the study groups regarding average patient age, sex, body mass index, or diagnosis. In the airflow group, there were 7 (0.64%) deep infections and 5 (0.46%) cases of wound dehiscence that required a return to the operating room for irrigation and wound revision. In the control group, there were 7 (0.60%) cases of deep infection and 4 (0.34%) wound revisions. The groups were not significantly different in the rates of infection (P=1.0) or wound revision (P=.75). Both groups had a very low incidence of infection and wound revision, with rates below 1%. Despite compelling bench data showing a dramatic reduction of particle load in the wound, the use of the airflow device did not reduce the clinical rate of infection over a large number of cases. [Orthopedics. 2020;43(x):xx–xx.]
Authors
The authors are from Anderson Orthopaedic Research Institute, Alexandria, Virginia.
Dr Routh, Ms Parks, and Ms Gargiulo have no relevant financial relationships to disclose. Dr Hamilton is a paid consultant for and receives royalties from DePuy and Total Joint Orthopaedics.
Correspondence should be addressed to: Nancy L. Parks, MS, PO Box 7088, Alexandria, VA 22307 ( [email protected]).
Copyright 2020, SLACK Incorporated
Received: February 08, 2019
Accepted: July 22, 2019
Posted Online: August 03, 2020
10.3928/01477447-20200721-13Effect of a Clean Surgical Airflow Layer on the Incidence of Infection in Total Hip Arthroplasty
Lucas K. Routh, MD; Nancy L. Parks, MS; Jeanine M. Gargiulo, Pa-C; William G. Hamilton, MD
Orthopedics. https://doi.org/10.3928/01477447-20200721-13
Posted August 6, 2020
ABSTRACT
FULL TEXT
FIGURES/TABLES
REFERENCES
VIEW PDF
Abstract
The Center for Health Design estimates that more than 30% of surgical site infections are caused by airborne pathogens. A device that creates a localized clean air field directly adjacent to and surrounding the incision site is meant to shield a surgical site from particulate in the operating room. The purpose of this study was to determine whether the routine use of this device would reduce the rate of infection following total hip arthroplasty (THA). The authors conducted a retrospective review of primary THA cases performed with and without the airflow device. Since July 2013, a total of 1093 primary THA cases were performed with the device at the authors' institution. The incidence of wound dehiscence and deep infection was compared with that of 1171 THA cases performed prior to July 2013 without the airflow device. There were no significant differences between the study groups regarding average patient age, sex, body mass index, or diagnosis. In the airflow group, there were 7 (0.64%) deep infections and 5 (0.46%) cases of wound dehiscence that required a return to the operating room for irrigation and wound revision. In the control group, there were 7 (0.60%) cases of deep infection and 4 (0.34%) wound revisions. The groups were not significantly different in the rates of infection (P=1.0) or wound revision (P=.75). Both groups had a very low incidence of infection and wound revision, with rates below 1%. Despite compelling bench data showing a dramatic reduction of particle load in the wound, the use of the airflow device did not reduce the clinical rate of infection over a large number of cases. [Orthopedics. 2020;43(x):xx–xx.]
Authors
The authors are from Anderson Orthopaedic Research Institute, Alexandria, Virginia.
Dr Routh, Ms Parks, and Ms Gargiulo have no relevant financial relationships to disclose. Dr Hamilton is a paid consultant for and receives royalties from DePuy and Total Joint Orthopaedics.
Correspondence should be addressed to: Nancy L. Parks, MS, PO Box 7088, Alexandria, VA 22307 ( [email protected]).
Copyright 2020, SLACK Incorporated
Received: February 08, 2019
Accepted: July 22, 2019
Posted Online: August 03, 2020
10.3928/01477447-20200721-13
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