Unfolding the risk: a pilot study of airborne contamination in the operating room during total joint arthroplasty.

BACKGROUND: As known microbial reservoirs, hospital linens thrown in the operating room (OR) can impact sterility in total joint arthroplasty, where a reduced inoculum may result in periprosthetic joint infection. Herein, we examine the effects of hospital blankets dropped or thrown in the OR on airborne bioburden and contamination. METHODS: A standardized, staged pilot study was developed employing different blanket handling practices in the OR. Airborne bioburden was compared between each of these common scenarios. Settling plates (n = 48) at varying distances from the disturbances were used to detect aerosolized organisms. Test conditions were conducted in the morning and afternoon to assess temporal changes in microbial flora. RESULTS: Of the 17 (35.4%) microorganism-positive plates, 7 (41.2%) were observed on control and 10 (58.8%) on days with dropped or thrown blankets. Positions near the airflow disturbance were 3× more likely to become contaminated compared to far positions (p = 0.03). Blankets dropped and thrown resulted in 18% more microorganisms compared to control (p = 0.59). Temporally, 58.8% (10/17) of the positive plates were observed following afternoon cases (p = 0.59). All microorganisms were gram positive, of which 93.3% were human colonizers, with Staphylococcus spp. being most common. CONCLUSIONS: This pilot study demonstrated that closer proximity to airflow disruptions negatively impacts sterility, while later time of day and dropped or thrown objects may contribute to contamination. The presented methodologies provide guidance for future studies, and the findings can help curtail OR practices by offering insights into the effects of airflow disruptions beyond the sterile field.