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Understanding Surgical Site Infections (SSI) and Airborne Particle Hazards

Surgical site infections (SSIs) are a huge source of increased morbidity, extended hospital stays, and even mortality. In the best circumstances, they involve 2% of surgeries; in the worst, as high as 33% (3). Even 2% is far too frequent—infections involving one out of fifty surgeries (i.e., 2%) would not be considered acceptable in any other industry. Several causes and risk factors contribute to SSIs, but one particularly under-addressed is the role of airborne particles. Airborne particle contamination has been well-documented since the 1950s (1) and is the basis for installing elaborate, expensive laminar airflow systems in operating rooms.

SSIs occur when microorganisms, such as bacteria, viruses, or fungi, enter the surgical site. These pathogens can originate from the patient's skin, surgical field contaminants, and the environment. Airborne particles, including dust, microorganisms, and even lint, can pose a significant risk in causing SSIs.

Activities in the operating room, such as staff movement, patient skin preparation, and even donning surgical gowns, generate airborne particles (2). These particles can be sterile initially, such as lint particles generated as the surgical team dons gowns. Clean particles that settle onto dirty surfaces, such as foot pedals, become contaminated. Routine movements in the OR, such as a surgeon moving surgical drapes with his foot to locate the bipolar forceps foot pedal, can cause these now-contaminated particles to become airborne again. They can remain suspended in the air for extended periods and be inhaled or settle on surgical wounds, increasing the likelihood of infection.

Challenges Faced by Healthcare Providers:

1. Lack of Awareness: The role of airborne particles in SSI transmission is often under-appreciated compared to other infection control measures. This lack of awareness can hinder the implementation of effective preventive strategies.

2. Invisible Threat: Airborne particles are invisible to the naked eye, making it challenging for healthcare providers to identify and mitigate their presence. This invisibility can lead to complacency and inadequate precautions.

3. Complexity of Surgical Environments: Operating rooms are complex environments with multiple potential sources of airborne particles. Maintaining optimal air quality and minimizing particle concentration requires specialized knowledge, equipment, and protocols.

To combat the risks associated with airborne particles and reduce SSIs, healthcare providers should consider implementing the following strategies:

1. Strict Adherence to Sterile Techniques: Ensuring that healthcare personnel follows proper sterile techniques during surgery, including hand hygiene, surgical attire, and equipment sterilization, can minimize the introduction of pathogens into the surgical site.

2. Environmental Controls: Implementing effective ventilation systems, including high-efficiency particulate air (HEPA) filters and laminar airflow systems, can help remove airborne particles from the operating room, reducing the risk of SSI transmission.

3. Education and Training: Increasing awareness among healthcare professionals about the role of airborne particles in SSIs and providing training on infection control practices can promote a culture of prevention and vigilance.

4. Equipment Innovation: Continuous improvement in surgical equipment and materials can help mitigate the risk of SSIs. Reducing operating time and reduced incision size result in reduced SSI risk.

5. Surveillance and Monitoring: Implementing robust surveillance systems to track SSIs and identify potential transmission sources can help healthcare providers identify areas for improvement and measure the effectiveness of infection control protocols.

6. Minimizing movement in the OR during surgery can reduce airborne contamination risk. Surgeons often step back from the operating table and use their feet to lift the drape to peer under to locate the foot pedal. Surveys have indicated that OR staff relocate the foot bipolar pedals by crawling under the operating table more than twice per case.

In conclusion, airborne contamination is a well-known cause of surgical site infections. Reducing movement in the OR reduces airborne contamination. The bipolar forceps foot pedal is an unnecessary contamination source, which BiPAD hand-switching eliminates.

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