Ultraclean air and antibiotics for prevention of postoperative infection. A multicenter study of 8,052 joint replacement operations.

To determine the value of ultraclean air in operating rooms, 8,052 operations for total hip- or knee-joint replacement were followed up for 1-4 years. For operations done in ultraclean air, bacterial contamination of the wound, deep joint sepsis, and major wound sepsis were substantially less than for operations done in conventionally ventilated rooms. Sepsis was also less frequent when prophylactic antibiotics had been given. The two precautions acted independently so that the incidence of sepsis after operation in ultraclean air and with antibiotics was much less than that when either was used alone. Wound sepsis was associated with an enhanced risk of joint sepsis. Staphylococcus aureus was the commonest joint pathogen, but infections with other organisms, often considered to be of low pathogenicity, were almost as numerous. Most S. aureus infections were traced to sources in the operating room.