Correlation of airborne bacteria in the operating room with surgical wound contamination and surgical site infection: a systematic review.

Background: The impact of operating room air quality on the risk of surgical site infection (SSI) is debated. This systematic review explores the correlation between intraoperative air contamination during clean surgery and 1) wound contamination, and 2) SSI incidence.

Methods: Medline, EMBASE, and Cochrane Library were searched for original articles that correlate intraoperative airborne bacteria with either intraoperative wound contamination or SSI incidence in clean surgery. Three reviewers independently screened retrieved articles for eligibility, using the Rayyan software, and assessed quality and risk of bias using the Integrated Quality Criteria for the Review of Multiple Study Designs methodology. A narrative synthesis, of the heterogenous data, was performed following the Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline.

Results: Thirteen publications encompassing 11 studies, and in total 18,694 patients, were included. Eight studies focused on wound contamination, with two showing a significant correlation with intraoperative air contamination. Five studies examined the incidence of SSIs, with three showing a significant correlation with air contamination and a fourth with the ventilation system.

Conclusion: Most studies on the correlation between air quality and wound contamination exhibited significant variations and were likely underpowered. However, one study with over 3,000 wound samples found a significant correlation between wound contamination and air quality. Despite the limited and diverse studies on air contamination and SSI incidence, there appears to be a correlation. However, to understand the impact of contamination levels below 100 colony-forming units/m³ on wound contamination and SSI, more well-powered studies are needed.