Total hip replacement in a laminar flow environment with special reference to deep infections.

A clean air enclosure with standard drapings was inadequate in the prevention of deep infection in total hip replacement and an overall deep infection rate of 2.2% still existed. This suggested that a sterile atmosphere under these circumstances could not ensure a bacteria-free deep wound at the end of a lengthy procedure. Additional antibiotic coverage, however, gave a deep wound infection rate of zero. A larger number of cases must be studied before final conclusions can be reached. Subsequent studies under these conditions have shown that the contamination appears to come from both patient and surgeon--principally the latter. Patient-derived organisms can be eliminated by impermeable draping. Contamination from the surgeon possibly can be eliminated only by drastic modification of conventional surgical attire.