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This study aimed at assessing the air quality in operating
room of Pediatric Surgery department, Ain Shams
University; developing and implementing a surveillance system
to decrease surgical site infections (SSIs) rates and assessment
of the effectiveness of electronic air filtration (A novel air
filtration device) in improving air quality in operating rooms
Poor ISO classification of pediatric surgery OR could be
attributed to the old central air conditioning system and flowing
of air in an uncontrolled manner in addition to direction
changes, in spite of the fact that there is HEPA filter installed.
But after intervention with GENANO device, the operation
room moved up to (ISO 6) which is a breakthrough despite the
fact that we weren’t able to connect all operating theatre air
inlets with Genano filtration devices, so the Genano system
could not work with its full capacity.
Hospital environmental control procedures can be an
effective support in reducing health care associated infections.
This study was divided into 2 phases, Phase I: Descriptive
study: assessment of air quality in operating rooms at pediatric
surgical hospital, the evaluated air quality indices were:
suspended particulate matter, culture media and microbial
identification of bacteria and fungi using active and passive air
sampling. Phase II: Interventional study for improving air
quality by new electronic air decontamination unit (Genano® 4500). After intervention the operation room moved up from
(ISO 8) to (ISO 6) there is a highly statistical significant
difference between particulate matter count before and after
intervention also there is significant difference in active
bacterial sampling and fungi sampling before and after
applying electronic filtration device where fungal colony count
dropped significantly to zero. All virulent bacterial species as
E.Coli, klebsiellaspecies and Pseudomonas Aeroginosa.
disappeared from sample with few micrococci and bacillus
species were preset in few samples.
This study revealed that 25.8% only of health care
workers had good knowledge about Air Quality in operating
rooms and 67.7% of them had poor knowledge, 76.7% of
health care workers had good attitude about Air Quality in
operating rooms and zero% of them had poor attitude.
(77.4%) agreed that Air quality is one the factors that
shares in SSI prevention and (76.7%) of HCWs agreed that
Adequate Air Quality can help decrease SSI
This study involved 321 surgical procedures. A
prospective surveillance study was done on pediatric patients
undergoing elective and emergency general surgical operations.
The incidence rate of SSI during the surveillance period among
all studied cases was 78\321 (24%) cases developed SSI in this
study participants’ characteristics in both control and
intervention group was matched and didn’t show any difference regarding Age, Sex or presence of any
chronic illness. That allowed fair comparison.
Both intervention and control group undergone major
surgical producers from April 2017 to March 2018, done at
pediatric surgery department with GIT procedures was the
leading procedure (65.1 %) (for example appendectomy,
colostomy formation or closure)followed by kidney and
urologic procedure (14%) e.g. pelvi-uretric obstruction
procedures, Hernia repair (7.8%).
There is highly significance difference between control
and intervention group regarding discharge room after surgery
with (p value=0.000) with 49.9% admitted to intensive care in
intervention group in comparison to 19.6% in control group and
despite this difference you will find that the rate of SSI was
lower in the intervention group and a significant difference
regarding Indication of surgery (p value=0.023) but, duration of
operation (p value=0.025), which was higher in intervention
group (2.99 hrs) and although it has longer duration of
exposure it yielded less SSI.
Also a highly significance difference between control
and intervention group regarding surgical site infection
presence (p value=0.008) which decreased significantly after
intervention. It’s a main finding in this study proving that the
intervention helped in decreasing SSI with both group matched
in characteristics and operating rooms with the only changed variable in the electronic air filtration device, results suggest
the importance of environmental and surface contamination
control to prevent SSI.
The risk factors significantly associated with presence of
SSI were discharge room after surgery, surgical wound class,
duration of surgery, chronic illness presence. There was
significant association in occurrence of postoperative SSI in
patients with prolonged surgery lasting three hours or longer
than those who had shorter surgery time in our work.