Ultraviolet radiation and the control of airborne contamination in the operating room

doi:10.1016/0195-6701(94)90088-4

Journal of Hospital Infection

Volume 28, Issue 4, December 1994, Pages 245-248

https://doi.org/10.1016/0195-6701(94)90088-4 Get rights and content

Abstract

Ultraviolet irradiation has been employed in operating rooms for more than half a century in attempts to reduce airborne bacterial contamination. Safety considerations have limited its intensity to 25–30 μw cm⁻² and at this level no more than a fourfold reduction has resulted. In recent studies intensities up to 300 μw cm⁻² have been used without untoward effects, and, at the highest intensity, contamination as low as that obtained with ultraclean air ventilation systems was obtained. However this was only achieved in an operating room where the level of airborne contamination before the introduction of the radiation was already much lower (around one-fifth) than that usually observed, and the reduction attributable to the radiation was still only about 12-fold.

References (16)

OM Lidwell et al.
Airborne contamination of wound in joint replacement operations: the relationship to sepsis rates
J Hosp Infect
(1983)
OM Lidwell
Sir John Charnley, Surgeon (1911–1982): the control of infection after total joint replacement
J Hosp Infect
(1993)
M Berg-Perier et al.
Ultraviolet radiation and ultra-clean air enclosures in operating rooms
J Arthroplasty
(1992)
W Whyte et al.
An investigation of occlusive polyester surgical clothing
J Hosp Infect
(1990)
WF Wells et al.
Measurement of sanitary ventilation
Am J Public Health
(1938)
National Academy of Sciences
Postoperative wound infections: Influence of ultraviolet irradiation of the operating room
Ann Surg Suppl
(1964)
JD Lowell et al.
Ultraviolet irradiation and laminar air flow during total joint replacement
AS Carlson et al.
Ultraviolet radiation and air contamination during total hip replacement
J Hosp Infect
(1986)

There are more references available in the full text version of this article.

Cited by (49)

Mapping the knowledge pattern of ultraviolet germicidal irradiation for cleaner indoor air through the lens of bibliometrics
2023, Journal of Cleaner Production
Due to the global outbreak of infectious diseases over the years, airborne pathogen removal from the indoor environment has become a critical issue. Ultraviolet germicidal irradiation (UVGI) has been adopted as a strategic solution, and its implementation shows the enormous potential of inactivating airborne infectious pathogens. Despite extensive research, some critical research areas or gaps remain unidentified, while at the same time, few studies highlight the knowledge trend for UVGI air disinfection research necessary to guide investigators and practitioners. The purpose of this paper is to provide a thorough and objective analysis of UVGI research areas using bibliometric analysis. The available international standard known as the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) was followed for conducting this review. A comprehensive search covering the publication year up to December 2021 using Web of Science (WoS), Scopus, and PubMed databases was conducted. Also, the selection of studies, extraction of data, and assessments of risk of bias were also carried out. The characteristics and results of selected studies in evidence graphs, pie charts, network maps, and tables were presented and discussed. A total of 210 UVGI air disinfection-related publications were identified and reviewed. Based on the keyword co-occurrence analysis, document and direct citation analysis, 112 research keywords (see Table A1), and 6 core research journals were identified. Further, the results show that 3 countries and 7 organizational collaborators are at the centre of UVGI research. Based on the clustering analysis and comprehensive analysis of the findings, the research domain was developed, which grouped UVGI research into four themes. These findings are highly important for the advancement of UVGI. This paper provides a significant contribution by showing the knowledge pattern needed to facilitate further research and applications for both academia and industry stakeholders to improve indoor air quality.
Control of bioaerosols, biosafety, and biosecurity
2023, Aeromicrobiology
This chapter explores the various physical and chemical methods employed in the control of bioaerosols in the microbiological and biomedical laboratory. The basic scientific principles behind the various methods and the techniques are given due consideration. The central role of proper control measures is emphasized as an important part of routine laboratory operations. Biosafety and biosecurity are explored as two interlinked but distinct concepts in laboratory practice. Good laboratory practices, biosafety cabinets and biosafety levels, and risk assessment are explored along with biosecurity principles and components. Bioterrorism, biocrimes, and biological warfare are treated as areas of concerns for airborne microorganism laboratory as well as challenges that depend on aerosolization and air dispersal.
Many Common Pathogens are Present in the Operative Room Air During Surgery
2022, Journal of Arthroplasty
The main objective of this study was to assess the sanitary measures of operating theaters using next-generation sequencing.
Air was sampled from the operating room for the whole duration of 10 surgical days of “clean” (no infection cases) procedures (6 hip/knee arthroplasty and 4 spine cases). Controls consisted of samples at the beginning of the day (1 hour before the surgery started) and at the end of the day after terminal cleaning. One additional control sample, consisting of a culture swab that was opened and exposed to the air for 5 seconds, was collected at each time point. All samples were sent for next-generation sequencing analysis (16S rRNA sequencing) for bacterial identification.
Overall, 306 samples were collected (159 controls and 147 experimental). Microbial DNA was detected in only 1 control sample, while 18 (12.2%) experimental samples were positive for microbial DNA. The most common organisms retrieved were Escherichia coli (6/18, 30%), Cutibacterium acnes (3/18, 15%), and Pseudomonas aeruginosa (2/18, 11.1%). There was no difference in positive samples between arthroplasty and spine cases (P > .05).
Microbial organisms are not uncommonly present in the operating room air during hip and knee arthroplasties and spine procedures.
Wind of change: Better air for microbial environmental control
2022, Case Studies in Chemical and Environmental Engineering
The COVID19 epidemic highlighted the importance of air in the transmission of pathogens. Air disinfection is one of the key points to reduce the risk of transmission both in the health sector and in public, civil and industrial environments. All bacteria and viruses tested to date can be inactivated by UV-C rays. Laboratory tested UV-C systems are increasingly popular and proposed as effective technologies for air purification; few studies have evaluated their performance in populated indoor environments. The aim of this investigation was to evaluate the effectiveness of a UV-C disinfection system for air in a real working context.
This experimental study was conducted between December 2020 and February 2021 in an office of the Department of Molecular and Developmental Medicine of the University of Siena, Italy. A pre-final version air purifier (Cleaning Air T12), capable of treating 210 m³/h of air, was first tested for its ability to filter particulates and reduce microbial air contamination in the absence of people. Subsequently, the experiments were conducted in the presence of 3–5 subjects who worked for several hours in an office. During the tests, microbiological samples of air were collected in real time, switching the system on and off periodically. Air samples were collected and incubated on Petri dishes at 36 °C and 22 °C. Statistical analysis was performed with Stata 16 software assuming a significance level of 95%. An interpolating model was identified to describe the dynamics of contamination reduction when the device operates.
Preliminary tests showed a significant 62.5% reduction in Colony-Forming Units (CFUs) with 36 °C incubation. Reductions in the particulate component were also observed. In the main test, comparison of CFU data, between the device-on phase (90 min) and the subsequent device-off phase (60 min), showed statistically significant increase (p = 0.001) of environmental contamination passing from a mean of 86.6 (65.8–107.4) to 171.1 (143.9–198.3) CFU/m³, that is a rise of about 100%. The interpolating model exhibited a good fit of CFU reduction trend with the device on.
The system, which mainly uses UV-C lamps for disinfection, was able to significantly reduce environmental and human contamination in real time. Experimental tests have shown that as soon as the device is switched off, after at least half an hour of operation, the healthiness of the air decreases drastically within 10 minutes, bringing the airborne microbial contamination (induced by the presence of operators in the environment) to levels even higher than 150% of the last value with the device on. Re-engineering strategies for system improvement were also discussed.
Recent advances in sterilization and disinfection technology: A review
2022, Chemosphere
Citation Excerpt :
Inexpedient high irradiation levels are required for the sterilization of medical and pharmaceutical products (Morris, 1972; Reybrouck, 1992). UV radiation is not used in sterilization techniques but it finds some applications in disinfection techniques like, generation of pyrogen free water, disinfection of drinking water, mostly important in air disinfection (Linden et al., 2019; Vinge et al., 2021; Szeto et al., 2020; Lidwell, 1994) and in the cabinet considered for the disinfection of hazard microorganism (Reed, 2010). UV radiation are effective for the air filtration but not a solution for the air sterilization.
Sterilization and disinfection of pollutants and microorganisms have been extensively studied in order to address the problem of environmental contamination, which is a crucial issue for public health and economics. Various form of hazardous materials/pollutants including microorganisms and harmful gases are released into the environment that enter into the human body either through inhalation, adsorption or ingestion. The human death rate rises due to various respiratory ailments, strokes, lung cancer, and heart disorders related with these pollutants. Hence, it is essential to control the environmental pollution by applying economical and effective sterilization and disinfections techniques to save life. In general, numerous forms of traditional physical and chemical sterilization and disinfection treatments, such as dry and moist heat, radiation, filtration, ethylene oxide, ozone, hydrogen peroxide, etc. are known along with advanced techniques. In this review we summarized both advanced and conventional techniques of sterilization and disinfection along with their uses and mode of action. This review gives the knowledge about the advantages, disadvantages of both the methods comparatively. Despite, the effective solution given by the advanced sterilization and disinfection technology, joint technologies of sterilization and disinfection has proven to be more effective innovation to protect the indoor and outdoor environments.
Hypochlorous Acid: A Review
2020, Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
Currently, the US Environmental Protection Agency has recommended numerous disinfectants against COVID-19 including hypochlorous acid (HOCl).11 The mechanism of disinfection involves the destroying of the cell wall of microbes or viruses, allowing the disinfectant to destroy or inactivate them.12-27 This article focuses on HOCl.
The surgeon needs to have an inexpensive, available, nontoxic, and practical disinfectant that is effective in sanitizing against the COVID-19 (Coronavirus Disease 2019) virus. The purpose of this article was to review the evidence for using hypochlorous acid in the office setting on a daily basis. The method used to assemble recommendations was a review of the literature including evidence for this solution when used in different locations and industries other than the oral-maxillofacial clinic facility. The results indicate that this material can be used with a high predictability for disinfecting against the COVID-19 (Coronavirus Disease 2019) virus.

View all citing articles on Scopus

View full text

Leading articleUltraviolet radiation and the control of airborne contamination in the operating room

Abstract

J Hosp Infect

J Hosp Infect

J Arthroplasty

J Hosp Infect

Measurement of sanitary ventilation

Am J Public Health

Postoperative wound infections: Influence of ultraviolet irradiation of the operating room

Ann Surg Suppl

Ultraviolet irradiation and laminar air flow during total joint replacement

Ultraviolet radiation and air contamination during total hip replacement

J Hosp Infect

Leading article
Ultraviolet radiation and the control of airborne contamination in the operating room