| 1. |
- Aganovic, A., et al.
(author)
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Ventilation design conditions associated with airborne bacteria levels within the wound area during surgical procedures: a systematic review
- 2021
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In: Journal of Hospital Infection. - : Elsevier BV. - 0195-6701 .- 1532-2939. ; 113, s. 85-95
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Research review (peer-reviewed)abstract
- Background: Without confirmation of the ventilation design conditions (typology and airflow rate), the common practice of identifying unidirectional airflow (UDAF) systems as equivalent to ultra-clean air ventilation systems may be misleading, but also any claims about the ineffectiveness of UDAF systems should be doubted. The aim of this review was to assess and compare ventilation system design conditions for which ultra-clean air (mean <10 cfu/m ) within 50 cm from the wound has been reported. Six medical databases were systematically searched to identify and select studies reporting intraoperative airborne levels expressed as cfu/m close to the wound site, and ventilation system design conditions. Available data on confounding factors such as the number of persons present in the operating room, number of door openings, and clothing material were also included. Predictors for achieving mean airborne bacteria levels within <10 cfu/m were identified using a penalized multivariate logistic regression model. Twelve studies met the eligibility criteria and were included for analysis. UDAF systems considered had significantly higher air volume flows compared with turbulent ventilation (TV) systems considered. Ultra-clean environments were reported in all UDAF-ventilated (N = 7) rooms compared with four of 11 operating rooms equipped with TV. On multivariate analysis, the total number of air exchange rates (P=0.019; odds ratio (OR) 95% confidence interval (CI): 0.66–0.96) and type of clothing material (P=0.031; OR 95% CI: 0.01–0.71) were significantly associated with achieving mean levels of airborne bacteria <10 cfu/m . High-volume UDAF systems complying with DIN 1946-4:2008 standards for the airflow rate and ceiling diffuser size unconditionally achieve ultra-clean air close to the wound site. In conclusion, the studied articles demonstrate that high-volume UDAF systems perform as ultra-clean air systems and are superior to TV systems in reducing airborne bacteria levels close to the wound site. 3 3 3 3
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| 2. |
- Blomgren, Per-Ola
(author)
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Clean work, the pursuit of increased adherence to hand hygiene routines : a descriptive study
- 2022
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Licentiate thesis (other academic/artistic)abstract
- Healthcare-associated infections (HAI) are a problem in health care worldwide. In Sweden 7-8% of all patients treated in hospital suffer from an adverse event of varying severity, of which approximately 60,000 from a HAI. Proper hand hygiene is considered the single most important measure to reduce HAI. Despite the importance, adherence to correct hand hygiene routines are lacking among healthcare workers (HCWs). The World Health Organizations (WHO) multimodal promotion strategy promotes areas that need to be addressed in order to change the behaviour of individual HCWs to optimise adherence to hand hygiene and to improve patient safety. These areas include feedback, education, reminders at the workplace and institutional safety climate. The overall aim of this study was to examine the possibility of adherence to hand hygiene routines and to explore factors that might influence the HCWs adherence. The study used a descriptive research design made through qualitative method, with focus group interviews, and quantitative method, using a questionnaire survey. Eight focus group interviews were conducted with assistant nurses (n=18), nurses (n=15) and physicians (n=5) and analysed with abductive qualitative content analysis. The questionnaire survey was answered by nurses (n=84) and nursing students in their first semester (n=71) and last semester (n=46) and the data was statistically analysed.The main findings show that there are barriers to hand hygiene adherence and measures to improve these. HCWs highlighted discrepancies regarding how the organisation was supposed to give feedback and how it actually was at the workplace and expressed needs for more direct feedback to improve adherence. The study also found that hygienic knowledge gaps exists among nurses and nursing students regarding causes of HAI and how the risk of contamination of patients and HCWs can be minimized among others. Students at the beginning of the education had a lower level of knowledge than last semester students and registered nurses. The last semester students tended to have the highest level of hand hygiene knowledge. In conclusion, the key areas presented by WHO’s multimodal promotion strategy to improve adherence all lack the appropriate measures, in some extent. The use of an electronic reminder system could give the means to improve a behaviour as long as the individual integrity is protected and development of curriculums for nursing students and continuing education of nurses is needed to further develop and maintaining knowledge.
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| 3. |
- Blomgren, Per-Ola, 1986-, et al.
(author)
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Hand hygiene knowledge among nurses and nursing students : a descriptive cross-sectional comparative survey using the WHO's "Hand Hygiene Knowledge Questionnaire"
- 2024
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In: Infection Prevention in Practice. - : Elsevier. - 2590-0889. ; 6:2
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Journal article (peer-reviewed)abstract
- AimTo determine the level of knowledge and explore the difference of hand hygiene between nursing students and nurses.BackgroundAnnually, 3.8 million people in Europe acquire healthcare-associated infections, highlighting the importance of hand hygiene. Despite WHO's emphasis on the fact that greater hand hygiene knowledge correlates with improved hand hygiene compliance, several studies have shown knowledge gaps among nurses and nursing students regarding hand hygiene.DesignDescriptive cross-sectional comparative survey.MethodsA version of the WHO “Hand Hygiene Knowledge Questionnaire”, translated into Swedish, was used for data collection among nursing students in the first and last semester, and registered nurses from a university and associated hospital. Data were analyzed by descriptive statistics, and comparison between groups with Fisher's exact test, one-way ANOVA, and post-hoc tests (Pairwise Z-Tests, Tukey HSD).ResultsThe survey, conducted between December 2020 and January 2021, received responses from 201 participants, including 71 first semester students, 46 last semester students and 84 registered nurses, showing moderate (55.7% [50–74% correct answers]) to good (43.8% [75–100% correct answers]) knowledge levels. First-semester students scored lower (17.0 ± 2.1) than last-semester students (18.8 ± 1.8) and registered nurses (18.3 ± 2.1) out of 25 questions.DiscussionIt is necessary for all groups to receive proper education on hand hygiene knowledge and to have an educational program that does not separate the groups but combines them with continuing education, since the students will someday be influencing future hand hygiene knowledge as a peer, together with the nurse.
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| 4. |
- Blomgren, Per-Ola, et al.
(author)
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Healthcare workers' perceptions and acceptance of an electronic reminder system for hand hygiene
- 2021
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In: Journal of Hospital Infection. - : Elsevier. - 0195-6701 .- 1532-2939. ; 108, s. 197-204
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Journal article (peer-reviewed)abstract
- Background:Healthcare-associated infections (HCAIs) have a large negative impact onmorbidity, mortality, and quality of life. Approximately 9% of all patients hospitalized inSweden suffer from HCAI. Hand hygiene plays a key role and is considered the single mostimportant measure to reduce HCAI. The hospital organization works actively to reduceHCAI. Implementing electronic systems to remind and/or notify healthcare workers raisesawareness of and adherence to hand hygiene. However, there is a paucity of studiesaddressing individuals’ perceptions of having such a system and how the organizationworks.Aim:To investigate healthcare workers’ perceptions of infection prevention in thehealthcare organization and perceptions and acceptance of an electronic reminder systemthat encourages good hand hygiene.Methods:Qualitative descriptive design with data collected in eight focus group inter-views including assistant nurses, nurses, and physicians (N¼38). Content analysis wasapplied and data were related to the Theory of Planned Behaviour.Findings:Healthcare workers perceive lack of feedback from the hospital organizationand are positive towards an electronic reminder system to increase adherence to handhygiene. The electronic reminder system should not register data at an individual levelsince it could be used as an instrument for control by the management that could bestressful for staff.Conclusion:In general, there is positive acceptance of the electronic reminder system,and the respondents perceived it as having the ability to change behaviour. However, theconcept has to be further developed to protect the individual’s integrity and needs to beused with feedback on a group level
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| 5. |
- Granqvist, Karin, 1974, et al.
(author)
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Learning to interact with new technology: Health care workers’ experiences of using a monitoring system for assessing hand hygiene – a grounded theory study
- 2022
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In: American Journal of Infection Control. - : Elsevier BV. - 0196-6553 .- 1527-3296. ; 50:6, s. 651-656
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Journal article (peer-reviewed)abstract
- Background: Recently, innovative technologies for hand hygiene (HH) monitoring have been developed to improve HH adherence in health care. This study explored health care workers’ experiences of using an electronic monitoring system to assess HH adherence. Methods: An electronic monitoring system with digital feedback was installed on a surgical ward and interviews with health care workers using the system (n = 17) were conducted. The data were analyzed according to grounded theory by Strauss and Corbin. Results: Health care workers’ experiences were expressed in terms of having trust in the monitoring system, requesting system functionality and ease of use and becoming aware of one's own performance. This resulted in the core category of learning to interact with new technology, summarized as the main strategy when using an electronic monitoring system in clinical settings. The system with digital feedback improved the awareness of HH and individual feedback was preferable to group feedback. Conclusions: Being involved in using and managing a technical innovation for assessing HH adherence in health care is a process of formulating a strategy for learning to interact with new technology. The importance of inviting health care workers to participate in the co-design of technical innovations is crucial, as it creates both trust in the innovation per se and trust in the process of learning how to use it.
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| 6. |
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| 7. |
- Lindblad, Marie, et al.
(author)
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Infection control measures to stop the spread of sequence type 15 OXA-23-producing Acinetobacter baumannii in a Swedish Burn Center
- 2022
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In: Burns. - : Elsevier. - 0305-4179 .- 1879-1409. ; 48:8, s. 1940-1949
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To describe the course of the outbreak and infection control measures to stop the spread of sequence type 15 OXA-23-producing Acinetobacter baumannii in the Burn Center of Uppsala University Hospital, between November 2014 and the end of April 2015.METHODS: Compliance with hand hygiene, dress code, and cleaning routines were reviewed, the ward's environment was systematically investigated to identify potential environmental sources. Sampling routines for A. baumannii, from patients and environment, were established, and the epidemiological relationship was analysed for all carbapenem-resistant A. baumannii isolates using arbitrarily primed polymerase chain reaction (AP-PCR) and pulsed-field gel electrophoresis (PFGE).RESULTS: A total of 54 patients were treated at the burn intensive care unit during the studied, approximately five months period, and an OXA-23-producing A. baumannii was isolated from nine patients (9/54, 17%), whereof two died (2/9, 22.2%). All isolates shared identical PFGE-genotype patterns and belonged to sequence type 15; AP-PCR was eligible for prompt epidemiological investigations.CONCLUSIONS: Higher awareness and increased compliance with hand hygiene and dress code as well as intensified cleaning protocols of the environment and equipment were successfully established and likely to have led to stop the spread of sequence type 15 OXA-23-producing Acinetobacter baumannii.
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| 8. |
- Lytsy, Birgitta, 1968-, et al.
(author)
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Comparison of Six Methods for Epidemiological Typing of Escherichia coli Producing Extended-Spectrum Beta-Lactamase during a Suspected Outbreak
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Other publication (other academic/artistic)abstract
- During a suspected outbreak of Escherichia coli producing extended-spectrum beta-lactamase (ESBL) at Uppsala University Hospital 2005-2007, different typing methods were applied to examine their usefulness in a sharp situation. Included methods were antibiogram-based typing, PhenePlate (PhP) system, pulsed-field gel electrophoresis (PFGE), repetitive sequence-based (rep)-PCR (Diversilab), arbitrarily primed (AP)-PCR, and characterization of integrons. A PCR assay was used to define the O25b-ST131 clone, and nosocomial transmission was explored with a locally developed tracing tool. Of the 253 analyzed isolates, 70% harboured CTX-M group 1 enzymes and 19% CTX-X-M group 9 enzymes. Integrons with integrated gene cassettes were detected in 47% of the isolates and 77% were of class 1. One restriction fragment length polymorphism (RFLP) type predominated (n=48), and it was in 40% of the cases associated with the O25b-ST131 clone. Fifty-five (22%) of all isolates were PCR positive for this clone, of which the PhP-system identified 49%. Fifty isolates were further analyzed. Most methods had difficulties with recognizing the O25b-ST131 clone. Rep-PCR identified 100%, PFGE 86%, AP-PCR 68%, PCR-RFLP of integrons 39% and antibiogram types 32% of the PCR positive isolates. Epidemiological data supported a nosocomial transmission in a limited number of cases, suggesting an endemic rather than an epidemic situation. In conclusion, the genetic complexity of ESBL-producing E. coli has become a challenge for any microbiology laboratory. Although the defining O25b-ST131 PCR assay was the most efficient method to identify this epidemic clone, PCR methods cannot be applied on genetically uncharacterized E. coli strains. To rely on a single epidemiological typing method to identify strains or mobile genetic elements with epidemic potential might be insufficient.
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| 9. |
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| 10. |
- Lytsy, Birgitta, 1968-
(author)
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Enterobacteriaceae Producing Extended-Spectrum Beta-Lactamases : Aspects of Detection, Epidemiology and Control
- 2010
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Doctoral thesis (other academic/artistic)abstract
- Enterobacteriaceae belong to the normal enteric flora in humans and may cause infections. Escherichia coli is the leading urinary tract pathogen with septicaemic potential, whereas Klebsiella pneumoniae causes opportunistic infections and often outbreaks in hospital settings. Beta-lactams are the first choice for treatment of infections caused by Enterobacteriaceae, and might be destroyed by extended-spectrum beta-lactamases, ESBLs. ESBLs hydrolyse all beta-lactams except cephamycin and carbapenems, and constitute a large heterogeneous group of enzymes with different origins. The phenotypic and molecular characteristics of a K. pneumoniae strain causing a major outbreak at Uppsala University Hospital between 2005 and 2008 were described. The strain was multiresistant and produced CTM-M-15, a common ESBL type in Europe. Due to the lack of obvious epidemiological links between patients, a case-control study was performed, which identified risk factors for the acquisition of the outbreak strain in urine cultures. The complex chain of transmission facilitated by patient overcrowding and the interventions applied to curb the outbreak, was revealed in the subsequent study. In the final study, the genetic background of the observed increase in ESBL-producing E. coli isolates during the K. pneumoniae outbreak was explored. The utility of six typing methods in epidemiological investigations of a local outbreak with ESBL-producing E. coli was compared. The increase of ESBL-producing E. coli isolates was not secondary to the K. pneumoniae outbreak. Twentytwo per cent belonged to the epidemic O25b-ST131 clone and only a limited number of infections were caused by nosocomial transmission. ESBL-producing Enterobacteriaceae are a challenge to clinical microbiology laboratories and infection control teams. To investigate their dissemination, typing methods need to be continuously adapted to the current situation. Proper hand disinfection and structural key problems such as over-crowding, under-staffing, lack of single rooms and bathrooms must be adressed to limit transmission.
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| 11. |
- Lytsy, Birgitta, 1968-, et al.
(author)
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Evaluating the effect of Novarerus NV800 air purifier units during orthopaedic surgery to reduce bioburden in the air
- 2022
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In: Journal of Hospital Infection. - : Elsevier BV. - 0195-6701 .- 1532-2939. ; 130, s. 108-111
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Journal article (peer-reviewed)abstract
- Background: A locally installed air purifier unit (Novaerus Protect 800) has been shown to reduce the air bioburden in an intensive care unit and the incidence of healthcare-associated infections. Aim: To explore whether this type of air purifying unit could reduce bacterial concentrations in the air of an operating room (OR) during orthopaedic surgery, thereby reducing the risk of surgical site infections. Methods: In this prospective experimental study, undertaken in 2018, three air purifying units were installed in an OR in a Swedish hospital in 2018. The air was actively sampled during 11 operations by a slit-to-slit agar impactor with the air purifying units either switched on or switched off. Air movements were visualized with the aid of smoke in mock-up studies. Findings: No significant difference in bacterial concentrations in air was found between the two conditions (air purifying units switched off or on) (P=0.54). Air movements around and above the surgical wound were disordered and resembled those of dilution mixing air. Conclusion: The three air purifying units installed in the OR did not reduce the airborne bacterial levels in the critical zone during orthopaedic surgery.
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| 12. |
- Lytsy, Birgitta, 1968-, et al.
(author)
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Hygienic interventions to decrease deep sternal wound infections following coronary artery bypass grafting
- 2015
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In: Journal of Hospital Infection. - : Elsevier BV. - 0195-6701 .- 1532-2939. ; 91:4, s. 326-331
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Journal article (peer-reviewed)abstract
- BACKGROUND: The department of Cardiothoracic Surgery at Uppsala University Hospital has 25 beds in one to four patient rooms and an operating suite consisting of five operating rooms with ultraclean air. Around 700 open heart (250 isolated coronary artery bypass grafting, CABG) operations are performed annually. In 2009, the numbers of deep sternal wound infections (DSWIs) increased to unacceptable rates despite existing hygienic guidelines.AIM: To show how root cause analysis (RCA) followed by quality improvement interventions reduced the rate of DSWI after CABG surgery.METHODS: Only isolated CABG patients requiring surgical revision due to DSWI were included. Swabs and tissue biopsies were taken during surgical revision and analysed with standard methods. DSWIs were registered prospectively according to US Centers for Disease Control and Prevention definitions. RCA for infection was performed between September 2009 and April 2010. Interventions based on results of the RCA and on nationally recommended practices were concluded in April 2010, and thought to have taken full effect by July 1st, 2010. Air was actively sampled at ≤0.5m from the sternal incision.FINDINGS: DSWI incidence rates per CABG operations decreased from 5.1% pre intervention to 0.9% post intervention. Wound cultures pre intervention grew Staphylococcus aureus 27.1% and coagulase negative staphylococcus (CoNS) 47.1%, post intervention S. aureus 23.1% and CoNS 30.8%. Air counts did not exceed 5cfu/m(3).CONCLUSION: When the aetiology of an error is multifactorial, RCA engaging both the medical professions and the infection control team is a potential tool to map causes leading to adverse events such as healthcare-associated infections. A systematic quality improvement intervention based on the RCA may reduce the number of deep sternal wound infections after CABG surgery.
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| 13. |
- Lytsy, Birgitta, 1968-, et al.
(author)
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Source strength as a measurement to define the ability of clean air suits to reduce airborne contamination in operating rooms
- 2022
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In: Journal of Hospital Infection. - : Elsevier BV. - 0195-6701 .- 1532-2939. ; 119, s. 9-15
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Journal article (peer-reviewed)abstract
- Background: Surgical site infections after total hip and knee replacement are linked to the quality of the operating room (OR) air. Applying tight occlusive clothing, effective ventilation and correct working methods are key concepts to obtain low bacterial concentrations in the OR air. The dry penetration test referred to in European standard EN 13795-2:2019 is a screening method for materials used in surgical clothing. Source strength, defined as the dispersal of bacteria-carrying particles from persons during activity, is a functional test of clothing systems and has been calculated in a dispersal chamber and in ORs. Results from both tests can be used when comparing surgical clothing systems. Aim: This study relates results of dry penetration tests to source strength values for five surgical clothing systems available on the Swedish market. Methods: Experimental data are reported on the function of these products, expressed as source strength calculated from results in a dispersal chamber and in ORs during orthopaedic operations. Findings: All materials tested with dry penetration ≤50 colony-forming units (cfu) had source strength values <3 cfu/s for one person in the dispersal chamber, whereas the material of one product when laundered >50 times had source strength in the dispersal chamber of up to 8 cfu/s. Conclusion: The dry penetration test could predict the performance of clean air suits of the same design, but more studies are needed to obtain a more valid correlation. Requirements of source strength should be included in standards.
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| 14. |
- Lytsy, Birgitta, 1968-, et al.
(author)
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Time to review the gold standard for genotyping vancomycin-resistant enterococci in epidemiology : Comparing whole-genome sequencing with PFGE and MLST in three suspected outbreaks in Sweden during 2013–2015
- 2017
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In: Infection, Genetics and Evolution. - : Elsevier BV. - 1567-1348 .- 1567-7257. ; 54, s. 74-80
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Journal article (peer-reviewed)abstract
- Vancomycin-resistant enterococci (VRE) are a challenge to the health-care system regarding transmission rate and treatment of infections. VRE outbreaks have to be controlled from the first cases which means that appropriate and sensitive genotyping methods are needed.The aim of this study was to investigate the applicability of whole genome sequencing based analysis compared to Pulsed-Field Gel Electrophoresis (PFGE) and Multi-Locus Sequence Typing (MLST) in epidemiological investigations as well as the development of a user friendly method for daily laboratory use.Out of 14,000 VRE - screening samples, a total of 60 isolates positive for either vanA or vanB gene were isolated of which 38 were from patients with epidemiological links from three suspected outbreaks at Uppsala University Hospital. The isolates were genotypically characterised with PFGE, MLST, and WGS based core genome Average Nucleotide Identity analysis (cgANI). PFGE was compared to WGS and MLST regarding reliability, resolution, and applicability capacity.The PFGE analysis of the 38 isolates confirmed the epidemiological investigation that three outbreaks had occurred but gave an unclear picture for the largest cluster. The WGS analysis could clearly distinguish six ANI clusters for those 38 isolates.As result of the comparison of the investigated methods, we recommend WGS-ANI analysis for epidemiological issues with VRE. The recommended threshold for Enterococcus faecium VRE outbreak strain delineation with core genome based ANI is 98.5%.All referred sequences of this study are available from the NCBI BioProject number PRJNA301929.
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| 15. |
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| 16. |
- Pasquarella, Cesira, et al.
(author)
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Air quality in the operating theatre : a perspective
- 2020
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In: Aerobiologia. - : Springer Science and Business Media LLC. - 0393-5965 .- 1573-3025. ; 36:1, s. 113-117
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Journal article (peer-reviewed)abstract
- Operating theatres are among the hospital's most risky environments as far as infections are concerned. Surgical site infection is a serious complication of surgery, associated with increased morbidity, mortality and costs. The ambient air of the operating theatre represents an important vehicle of micro-organisms causing surgical site infection, in particular in clean operations. The aim of this paper is to give a brief historical excursus of the milestones of the prevention of airborne surgical site infections. The debated issue on the use of unidirectional airflow ventilation system is presented. Some national recommendations for threshold air microbial contamination values are reported, and the need for a European standard on air quality to provide a safe operating theatre environment for surgical patients is underlined.
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| 17. |
- Ransjö, Ulrika, et al.
(author)
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Hospital outbreak control requires joint efforts from hospital management, microbiology and infection control
- 2010
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In: Journal of Hospital Infection. - Amsterdam : Elsevier. - 0195-6701 .- 1532-2939. ; 76:1, s. 26-31
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Journal article (peer-reviewed)abstract
- An outbreak of multidrug-resistant Klebsiella pneumoniae producing the extended-spectrum beta-lactamase CTX-M-15 affected 247 mainly elderly patients in more than 30 wards in a 1000-bedded Swedish teaching hospital between May 2005 and August 2007. A manual search of the hospital administrative records for possible contacts between cases in wards and outpatient settings revealed a complex chain of transmission. Faecal screening identified twice as many cases as cultures from clinical samples. Transmission occurred by direct and indirect patient-to-patient contact, facilitated by patient overcrowding. Interventions included formation of a steering group with economic power, increased bed numbers, better compliance with alcohol hand disinfection and hospital dress code, better hand hygiene for patients and improved cleaning. The cost of the interventions was estimated to be €3 million. Special infection control policies were not necessary, but resources were needed to make existing policies possible to follow, and for educational efforts to improve compliance.
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| 18. |
- Schönning, Caroline, et al.
(author)
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Legionellosis acquired through a dental unit : a case study
- 2017
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In: Journal of Hospital Infection. - : Elsevier BV. - 0195-6701 .- 1532-2939. ; 96:1, s. 89-92
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Journal article (peer-reviewed)abstract
- In 2012, an elderly immunocompromised man died from legionellosis at a hospital in Uppsala, Sweden. The patient had visited a dental ward at the hospital during the incubation period. Legionella spp. at a concentration of 2000 colony-forming units/L were isolated from the cupfiller outlet providing water for oral rinsing. Isolates from the patient and the dental unit were Legionella pneumophila serogroup 1, subgroup Knoxville and ST9. Pulsed-field gel electrophoresis and whole-genome sequencing strongly suggested that the isolates were of common origin. This report presents one of few documented cases of legionellosis acquired through a dental unit.
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| 19. |
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| 20. |
- Whyte, W., et al.
(author)
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Ultraclean air systems and the claim that laminar airflow systems fail to prevent deep infections after total joint arthroplasty
- 2019
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In: Journal of Hospital Infection. - : W B SAUNDERS CO LTD. - 0195-6701 .- 1532-2939. ; 103:1, s. E9-E15
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Research review (peer-reviewed)abstract
- The World Health Organization published guidelines in 2016 for preventing surgical site infections. The guidelines contained a conditional recommendation that laminar airflow (LAF) ventilation systems should not be used to reduce the risk of infection after total joint arthroplasty (TJA). This recommendation was largely based on a systematic review and meta-analysis of information from hospital infection surveillance registries. The recommendation contradicts information published in earlier major studies carried out by Charnley and the UK Medical Research Council (MRC). The first aim of this article is to revisit and explain the MRC study, and reply to criticisms of it. The second aim is to suggest reasons why some recent studies have failed to demonstrate that ultraclean air (UCA) systems reduce deep joint infection after TJA. It demonstrates that if a UCA system establishes average airborne concentrations of microbe-carrying particles (MCPs) <10/m(3), and preferably <1/m(3), then deep joint infection after TJA will be lower than in conventionally ventilated operating theatres.
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