Does a mobile laminar airflow screen reduce bacterial contamination in the operating room? A numerical study using computational fluid dynamics technique

BACKGROUND: Air-borne bacteria in the operating room (OR) may contaminate the surgical wound, either by direct sedimentation from the air or indirectly, by contaminated sterile instruments. Reduced air contamination can be achieved with an efficient ventilation system. The current study assesses the additive effect of a mobile laminar airflow (MLAF) unit on the microbiological air quality in an OR supplied with turbulent-mixing air ventilation. METHODS: A recently designed OR in NKS (Nya Karolinska Sjukhuset, Stockholm, Sweden) was the physical model for this study. Simulation was made with MLAF units adjacent to the operating table and the instrument tables, in addition to conventional turbulent-mixing ventilation. The evaluation used numerical calculation by computational fluid dynamics (CFD). Sedimentation rates (CFU/m(2)/h) were calculated above the operating table and two instrument tables, and in the periphery of the OR. Bacterial air contamination (CFU/m(3)) was simulated above the surgical and instrument tables with and without the MLAF unit. RESULTS: The counts of airborne and sedimenting, bacteria-carrying particles downstream of the surgical team were reduced to an acceptable level for orthopedic/implant surgery when the MLAF units were added to conventional OR ventilation. No significant differences in mean sedimentation rates were found in the periphery of the OR. CONCLUSIONS: The MLAF screen unit can be a suitable option when the main OR ventilation system is unable to reduce the level of microbial contamination to an acceptable level for orthopedic implant surgery. However, MLAF effect is limited to an area within 1 m from the screen. Increasing air velocity from the MLAF above 0.4 m/s does not increase the impact area.