Correlation of airborne bacteria in the operating room with surgical wound contamination and surgical site infection: a systematic review.

BACKGROUND

The impact of operating room air quality on the risk of surgical site infection (SSI) is a topic of debate. This systematic review explores correlation between intra-operative air contamination during clean surgery and (i) wound contamination, and (ii) the incidence of SSI.

METHODS

Medline, EMBASE and the Cochrane Library were searched for original articles that investigated correlation between intra-operative airborne bacteria and either intra-operative wound contamination or the incidence of SSI in clean surgery. Three reviewers screened retrieved articles independently for eligibility, using Rayyan, and assessed quality and risk of bias using the Integrated Quality Criteria for the Review of Multiple Study Designs methodology. A narrative synthesis of the heterogenous data was performed following the Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline.

RESULTS

Thirteen publications encompassing 11 studies (total 18,694 patients) were included. Eight studies focused on wound contamination, two of which showed significant correlation with intra-operative air contamination. Five studies examined the incidence of SSI, three of which showed significant correlation with air contamination and one of which showed significant correlation with the ventilation system.

CONCLUSION

Most studies on correlation between air quality and wound contamination exhibited significant variations and were likely underpowered. However, one study with over 3000 wound samples found significant correlation between wound contamination and air quality. Despite the limited and diverse studies on air contamination and the incidence of SSI, there appears to be correlation. However, more well-powered studies are needed to understand the impact of contamination levels <100 colony-forming units/m3 on wound contamination and the incidence of SSI.