Correlation between a real-time bioparticle detection device and a traditional microbiological active air sampler monitoring air quality in an operating room during elective arthroplasty surgery: a prospective feasibility study.

Background and purpose:  The standard method for controlling operating room (OR) air quality is measuring bacteria-carrying particles per volume unit of air: colony forming units (CFU/m3). The result takes at least 2 days after sampling. Another method is real-time measurements of fluorescing bioparticles per unit volume of air (FBP/dm3). We aimed to compare simultaneous measurements of FBP/50 dm3 and CFU/m3 during ongoing arthroplasty surgery.

Methods:  18 arthroplasties were performed in a modern OR with turbulent mixed airflow ventilation. The sampling heads of a BioAerosol Monitoring System (BAMS) and a microbiological active air sampler (Sartorius MD8 Air Sampler) were placed next to each other, and 6 parallel 10-minute registrations of FBP/50 dm3 and CFU/m3 were performed for each surgery. Parallel measurements were plotted against each other, Passing-Bablok nonparametric linear regression was performed, and the Spearman correlation coefficient (r) was calculated.

Results:  The r between FBP ≥ 3 μm/50 dm3 and CFU/m3 sampled for 96 x 10-minute intervals, was 0.70 (95% confidence interval [CI] 0.57-0.79). In the 25th percentile with the lowest 10-minute FBP ≥ 3μm/50 dm3, there were no CFU measurements with ≥ 10 and 4% with ≥ 5 CFU/m3. In the 75th percentile with the highest 10-minute FBP ≥ 3 μm/50 dm3, there were 58% CFU measurements with ≥ 10 and 88% with ≥ 5 CFU/m3. The r between FBP ≥ 3 μm/50 dm3 and CFU/m3 means sampled during 18 operations was 0.87 (CI 0.68-0.95).

Conclusion:  Low FBP ≥ 3 μm/50 dm3 measured by BAMS indicates low CFU/m3; conversely, high FBP ≥ 3 μm/50 dm3 indicates high CFU/m3. Real-time measurements of FBP ≥ 3 μm/50 dm3 can be used as a supplement to CFU/m3 monitoring OR air bacterial load.