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Ultraviolet lighting in OR significantly reduces total joint arthroplasty infection risk
Total joint procedures performed with laminar airflow had 3.1 times greater odds of infection than those performed with ultraviolet lighting.
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Using ultraviolet lighting during total joint replacement procedures, particularly total knee replacement, can significantly lower the risk of infection compared to using laminar airflow, according to a study by researchers in Indiana.
Merrill A. Ritter, MD, and colleagues at St. Francis Hospital in Mooresville reviewed all cases of infection that occurred after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in patients treated by a single surgeon at their center from July 1986 to July 2005. The researchers compared the rates of infection before and after implementing the use of ultraviolet lighting in the operating room (OR) in September 1991.
Before September 1991, all THA and TKA procedures were performed using laminar airflow only. After that time, the surgeon used ultraviolet lighting exclusively, according to the study, published in the American edition of Journal of Bone and Joint Surgery.
The study included data for 5,980 total joint arthroplasty procedures performed in 3,846 patients. Of these, 4,909 procedures were performed using ultraviolet lighting only and 1,071 were performed using laminar airflow.
The ultraviolet lighting group included 1,519 THAs and 3,390 TKAs. The laminar airflow group included 390 THAs and 681 TKAs.
At 5.2 years mean follow-up, deep infections had developed in 47 cases (0.79%) overall. However, the infection rate was significantly higher among patients treated using laminar airflow.
Infection developed in 19 of the 1,071 cases treated using laminar airflow, or 1.77%, and in 28 of the 4,909 cases treated using ultraviolet lighting, or 0.57% (P<.0001), according to the study.
Although not significant, the overall infection rate associated with THA decreased from 1.03% to 0.72% after initiating the use of ultraviolet lighting.
However, infection rates significantly decreased among TKA patients, from 2.2% using laminar airflow to 0.5% using ultraviolet lighting (P<.0001), the authors reported.
"The odds of infection were 3.1 times greater for all joint procedures performed without ultraviolet lighting as compared with those performed with ultraviolet lighting (P<.0001)," they wrote.
In particular, the odds of infection among TKA cases were 4.5 times higher for procedures performed using laminar airflow vs. ultraviolet lighting (P<.0001).
For THA cases, the odds of infection were 1.4 times higher when using laminar airflow; "however, this finding was not significant (P=.5407)," the authors wrote.
For more information:
- Ritter MA, Olberding EM, Malinzak RA. Ultraviolet lighting during orthopaedic surgery and the rate of infection. J Bone Joint Surg Am. 2007;89A:1935-1940.