Environmental Air and Airborne Infections

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Abstract
The epidemiology of airborne (aerobic) surgical infections is discussed. The 1st phase of the study was carried out in a surgical suite which contained no environmental or traffic control systems. The 2nd phase took place within a modern operating room suite containing multiple air screens and an elaborate ventilation system utilizing HEPA type filters which provide clinically sterile air. Patients (156) underwent major procedures. The ratio of clean, clean-contaminated and dirty cases was the same in both groups. Preoperatively a nasal swab, clean voided urine (or vaginal swab) and a rectal swab were obtained on each patient. Daily nasal cultures and cultures of suspected infection sites were obtained postoperatively. Daily nasal cultures and glove sweat cultures were obtained on all personnel attending the patient. Environmental cultures of the operating room, the operating room hallway, recovery room and patients'' rooms were also taken. All samples were checked for staphylococci, streptococci, Escherichia coli, Proteus sp., Enterobacter, Klebsiella and Pseudomonas. In all, 15,000 cultures were taken during the study. The infection rate was essentially equal in both phases of the study. Environmental air only occasionally served as the source of infecting organisms. The most common source of infecting organisms in surgical infections is apparently the patient or those around him. The most common time of contamination is during the surgical procedure itself. Surgical infections can best be minimized by meticulous observation of fundamental principles of antisepsis rather than by dependence on elaborate and costly ventilation and air control systems.