> Hello everybody,
> Can I ask all Arthroplasty surgeons please
>
> Do you routinely use Charnley Hood?
> Is there any published suggestive evidence?
>
> Thanks
>
> Siten Roy
> Orthopaedic Consultant & Clinical Director
> Sandwell & City hospitals
> Birmingham, UK
>
______________________________________________________________________________________________
Colchester. Trauma including implant surgery done in non laminar flow.
Elective laminar flow and some use funny headgear and suits but most don't.
The evidence is contradictory and the stuff showing laminar flow
reduces infection is flawed and historic ( before decent plenium ventilation)
Have recently done a study looking at infection rate for trauma
surgery in laminar flow v conventional plenium (all elective is done in laminar flow so you can't compare)
Not published yet but about a million operations.
Trauma operations done in laminar flow Theatres have a higher
infection rate including hip hemiarthroplasty.
I doubt if the laminar flow is responsible for a higher infection
rate, hospitals that changed from plenium to laminar didn't alter rate of infection
Bottom line. It doesn't matter.
Sent from my iPhone
> On 18 Jun 2015, at 21:36, "'FARNDON MARK (RCD) ORTHOPAEDIC
CONSULTANT' mark.farndon@hdft.nhs.uk [orthodirectors]" <orthodirectors@yahoogroups.com> wrote:
>
> Laminar flow for all arthroplasty (elective and trauma) and major
cases in Harrogate.
> No hoods used.
>
> Mark.
>
> On 18 Jun 2015, at 20:05, David Gidden
dgidden@aol.com<mailto:dgidden@aol.com> [orthodirectors] <orthodirectors@yahoogroups.com<mailto:orthodirectors@yahoogroups.com>> wrote:
>
>
>
> Not used at all in Northampton, laminar flow only for all trauma
and elective surgery.
> David Gidden
>
> Sent from my iPad
At the Royal Orthopaedic Hospital, Birmingham we have been doing quite a lot of work on the use of body exhausts and personal protection helmets. We have carried out conventional settle plate
studies during surgery and also, for the first time anywhere, we have placed settle plates on the instrument trolleys in defined positions within the clean zone of an ultra clean canopy. We have
also been working with Public Health England at the Porton Down laboratory, where there is a very large clean room which we have been using for testing conventional theatre clothing and body
exhausts. We have also been collaborating with Cranfield University who are experts at the laser imaging of airflow.
The bottom line is that if you use a body exhaust properly with a down flow ultra clean enclosure you can get to a situation where there is almost zero bacterial contamination on the instrument
trolleys. We found that when one member of the team (the scrub nurse) was using a battery helmet the bacterial count on the trays was quite significantly worse.
The study will be presented at the British hip Society this week and it is being got ready for publication.
The other work that we have done is on the use of cosmetics skin exfoliants and creams by operating theatre staff, which has a dramatic effect on the bacterial a account. This work is also being
readied for publication at the moment.
There are a number of papers in the literature which expressed doubt about the use of ultra clean enclosures but my view is that, as Mike Reid has commented, that there is no problem with the
clean-air itself. The problem is how people behave within the clean air enclosure. There is a paper in the literature by Brandt C et al Ann Surg 2008 which shows that, in Germany, there is
no advantage to using clean air systems for joint replacement. The difficulty with this pap er is that in both the clean air group and the non-clean air group the infection rates are both
strikingly worse than those which we achieve in Birmingham, and are doubtless achieved in other major centres.
I can't prove it yet but my suspicion would be that the best possible arrangement is a body exhaust combined with appropriate skincare regimes. This is the arrangement that I use for my
practice, with its high numbers of rheumatoid patients. In the real life trauma situation body exhausts are probably not practical since the colon surgery trained theatre staff would not know how
to put them on! In these circumstances I think that it is unlikely that a battery-powered hood will be of any benefit to the patient.
Andrew Thomas o
>
> On 18 Jun 2015, at 18:51, "'Alex Acornley'
acornal@doctors.org.uk<mailto:acornal@doctors.org.uk> [orthodirectors]" <orthodirectors@yahoogroups.com<mailto:orthodirectors@yahoogroups.com>> wrote:
>
>
> All primary and revision arthroplasty done for last 5½ years at
my unit with Stryker T5 hoods (including all trauma arthroplasty) but no exhaust system.
>
> When in Sheffield on Fellowship all arthroplasty done with
Charnley necklaces with extraction/exhaust port and hood.
>
> It’s not just about infection, it’s far safer for surgeon due to
better field of vision, more comfortable operating environment due to fan and no splatters over visors/glasses onto face etc etc. I certainly wouldn’t do arthroplasty without (COI – Revision
surgeon with an interest in infection for some insane reason!!).
>
> Cheers
>
> Alex Acornley
> CD Orthopaedics
> Airedale NHS Foundation NHS Trust
Here is the abstract that raises concerns about positive pressure surgeon hoods increasing contamination around
cuffs:
Intraoperative contamination and space suits: a potential mechanism.
-
1Department of Orthopaedic Surgery, North Shore Hospital, Private Bag 93-503, Takapuna, Auckland, 0740, New Zealand, simonwyoung@gmail.com.
Abstract
The body exhaust suit (BES) of Charnley creates 'negative pressure' inside the gown using intake/outtake tubing. Modern 'space suit' (SS) systems incorporate helmet-based intake fans, which use
the hood material as a filter and create 'positive pressure' inside the gown. While early studies of BES demonstrate a clear reduction in infection rates following arthroplasty, recent clinical
data on SS use has paradoxically reported a marked increase. We hypothesized that the positive pressure inside the gown could carry air and particles via the unsealed area around the surgeon's
cuff into the operative field. We performed 12 simulated operations with the surgeons hands covered in fluorescent 0.5 micron powder that approximates the size of shedded skin squames.
Photographs under UV light and air particle counts were used to compare potential contamination rates between SS and conventional gowns using a standardised scoring system. The highest powder
migration was seen in the SS group with a score of 15.3 out of 28. No powder migration was seen in the standard gown group (p = 0.028). This study provides a plausible explanation for
the increase in infection rates seen with SS use. We recommend SS be considered for personal protection only and supplemented with sealant tape around the inner glove
Ben
Yeovil
In Crewe, all theatres, including trauma are laminar flow. Stryker Flyte hoods for all
primary, revision and trauma arthroplasty. No hoods for Hemis, DHS and IM nails for #NOF.
I agree evidence is not convincing either way hence the variation in practice. We are
in the process of standardising our practices (within limits) to minimise variation and confusion amongst staff.
Cefin
Mr Cefin Barton MB BCh, MRCS, FRCS(Tr&Orth)
Consultant Orthopaedic Surgeon
Clinical Lead in Trauma and Orthopaedics
Mid Cheshire Hospitals NHS Foundation Trust
We have been using Stryker hoods for arthroplasty surgery for a few years. I
find them comfortable but not all surgeons like them and they cost about £20 per use. They are certainly good from a personal protection point of view, but I have not seen any
evidence for reduced risk to patients.
I have heard a concern that if the pump is turned up high it might cause air to be
pumped out around the cuffs of a surgeon’s gown but don’t know if there is any evidence for this.
Ben Lankester
Yeovil
In Crewe, all theatres, including trauma are laminar flow. Stryker
Flyte hoods for all primary, revision and trauma arthroplasty. No hoods for Hemis, DHS and IM nails for #NOF.
I agree evidence is not convincing either way hence the variation in
practice. We are in the process of standardising our practices (within limits) to minimise variation and confusion amongst staff.
Cefin
Mr Cefin Barton MB BCh, MRCS,
FRCS(Tr&Orth)
Consultant Orthopaedic Surgeon
Clinical Lead in Trauma and Orthopaedics
Mid Cheshire Hospitals NHS Foundation Trust
We have been using Stryker hoods for arthroplasty surgery for a few
years. I find them comfortable but not all surgeons like them and they cost about £20 per use. They are certainly good from a personal protection point of
view, but I have not seen any evidence for reduced risk to patients.
I have heard a concern that if the pump is turned up high it might
cause air to be pumped out around the cuffs of a surgeon’s gown but don’t know if there is any evidence for this.
Ben Lankester
Yeovil
James Cook
Laminar flow all theatres – evidence comes down to expert opinion from what ive
read
Stryker hoods for revision – just because really – surgeon protection mainly –
longer surgery – blood and cement everywhere etc
