Prevent Surgical Site Infections in Neurosurgery

The Operio Sterile Air Flow unit filters the ambient air through a highly purifying H 14 Hepa filter with an efficiency of over 99.9%, which eliminates bacteria and micro-organisms (including coronavirus covid 19) by over 99.9%!

Surgical site infections (SSIs) may be devastating for the patient and they carry high economic costs. Studies of SSI after neurosurgery report an incidence of 1-11%. Patients undergoing neurosurgery are exposed to several factors which can predispose to a surgical-site infection (SSI). Infections in the postcraniotomy period are of particular interest for neurosurgeons and include a wide spectrum of entities namely superficial and deep wound infection, meningitis, empyema and abscess, and bone flap infection. In particular, those that require reoperation and prolong length of stay can have a significant negative impact on hospital care, on financial cost, and on the patient himself. Once the infection enters the bloodstream and the cerebrospinal fluid especially in susceptible patients and in areas with high antimicrobial resistance, the situation becomes more complex as prognosis of neurosurgical patients can worsen significantly.

White AND Al.1 documented that 70% of germs in surgical wounds are carried by instruments. It is precisely the instruments that, by transporting the micro-organisms inside the wound, deeply into the organism, promote germ settlement and infection development.

Operio focused laminar flow device creates a strictly aseptic area in just a few seconds, and protects the operating field and the surgical instruments – which are often left open for hours in neurosurgery – against contamination.

The most important measure against surgical site infections  is to consistently maintain the highest hygiene standards already during surgery. To minimise the intraoperative transmission of bacteria, laminar airflow ceilings (TAV ceilings) are used in many hospitals to fend off bacteria. However, in the vast majority of operating theatres the existing supply-air ceilings are far too small to also cover the instrument preparation area. A protective, sterile  zone for both the instruments and the operating field  is pratically never achieved.

The use of antibiotics has been an essential component for the prevention of SSIs over the past decades. However, the reliance on antibiotic prophylaxis cannot continue due to the increasing incidence of antibiotic-resistance. Bisht et al.  reported that nearly 70% of the bacteria that cause hospital infections are resistant to at least one antibiotic agent. Nowadays it has been widely accepted that infection-prone surgeries should not be taken in the environment with airborne bacteria concentration higher than 10 colony-forming units per cubic meter (CFU/m).

Various studies have made it very clear that instruments in an conventional operating room ( ISO 7)  and instruments prepared outside the air supply  ceiling of a laminar air flow system (ISO 5)  will become contaminated after a short time. The longer the operation lasts, the higher will be the risk of instrument contamination and thus of infection.(Thomas Benen1, Frank Wille1*, Lüder Clausdorff2, The influence of different ventilation systems on microbiological instrument cleanliness Hyg Med 2013; 38-4).

The Karolinska Hospital case study.

The mobile laminar flow unit successfully reduces CFU (colony-forming units) during neurosurgery, bringing the environment to ultra-clean air levels.

Active air sampling has been performed during 45 neurosurgery procedures, 26 with conventional ventilation, and 19 with additional mobile laminar flow units (MLAF).

A total of 233 agar samples were collected.

The majority of procedures were intracranial, and included brain tumours, aneurysms, cavernomas, cranioplasty, shunt implant and deep brain stimulation.

By comparing the mobile laminar flow unit operating theatre samples with the conventional ventilation operating theatre ones, significant differences in the number of CFU were found, both near the surgical site and on the instruments table2.


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Benefits:

up to 95% more “sterility” for the operating area and instruments

up to 95% more “sterility” for the operating area and instruments

upgrade of existing operating rooms  quickly and cost-effectively

upgrade of existing operating rooms quickly and cost-effectively

mobile-no installation work required

mobile-no installation work required

eliminates bacteria and micro-organisms (including coronavirus covid 19) by over 99.9%

eliminates bacteria and micro-organisms (including coronavirus covid 19) by over 99.9%

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