Jason M Jennings, Todd M Miner, Roseann M Johnson, Aviva K Pollet, Anna C Brady, Douglas A Dennis

Am J Infect Control. 2021 Oct 2; S0196-6553(21)00640-4
doi: 10.1016/j.ajic.2021.09.020

Summary by Farideh Najafi, MD

Many modifiable and nonmodifiable risk factors increase infection rates after joint arthroplasty surgeries. One of the important modifiable risk factors is the operating room (OR) environment. The air in the operating room acts as a vehicle for pathogens and there is a significant association between number of colony forming units (CFUs) in the environment and surgical site infection (SSI) incidence. Ultraviolet (UV) light can reduce postoperative infectious complications by decreasing the number of CFUs.

Jennings et al., assessed the effect of a UV-LED device on the amount of back table contamination in the operating room (OR) through a prospective randomized study in April 2019. In this study, either a real or a sham UV-LED device was placed on the OR back table. During the study period, a total of 96 soy agar petri plates were collected (eight plates per OR, four operating rooms, three different days). The number of CFUs formed on each plate was recorded after 48 hours of incubation. In addition, the number of door openings prior plate removal from the OR was collected.

The authors reported a statistically significant difference in total CFUs between the real vs. sham devices. There was a positive correlation between the number of door openings and the number of CFUs. Of the 57 surgical cases being performed at the time of plate removal, eight were revision surgeries for the following reasons: three knee instability (all sham), one knee allergy (sham), one hip metallosis (sham), one deep infection after TKA (sham), one superficial infection after TKA (UV-C) and one arthrofibrosis (UV-C).

The authors concluded that a UV-LED may reduce back table contamination in the operating room, potentially decreasing joint infection rates. However, the study did not explore the relationship between reduced CFU counts and subsequent development of periprosthetic joint infection (PJI). Furthermore, the study did not compare UV-LED vs. traditional UV light, determine pathogen types, or assess the compatibility of UV irradiation with objects placed on the back table.

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