All procedures that were performed before the installation of the ultraviolet lighting used horizontal laminar airflow, whereas all procedures that were performed after that date used ultraviolet lighting without laminar airflow. Factors associated with the rate of infection were analyzed.
Results: Over a nineteen-year period, forty-seven infections occurred following 5980 joint replacements. The infection rate without ultraviolet lighting was 1.77%, and the infection rate with ultraviolet lighting was 0.57% (p < 0.0001).
The odds of infection were 3.1 times greater for procedures performed without ultraviolet lighting (and with laminar airflow) as compared with those performed with only ultraviolet lighting (p < 0.0001).
The infection rate associated with total hip replacement decreased from 1.03% to 0.72% (p = 0.5407), and the infection rate associated with total knee replacement decreased from 2.20% to 0.50% (p < 0.0001). Revision surgery, previous infection, age, total body mass index, use of cement, disease, and diagnosis were not associated with an elevated infection rate.
Conclusion: When appropriate safety precautions are taken, ultraviolet lighting appears to be an effective way to lower the risk of infection in the operating room during total joint replacement surgery.
Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence. postoperative wound infection following total joint replacement is a complication that is dreaded by surgeons and patients alike.
Much emphasis has been placed on decreasing infection rates in order to ensure a more successful operative outcome. Reduced infection rates have been associated with controlling for various environmental factors in the operating room with a great variety of means, including systemic antibiotics (1-3), laminar airflow (1,2), antibiotic-loaded bone cement (3,4), and ultraviolet lighting (5-11). Contamination most often occurs as a result of bacteria that are emitted from the various surgical personnel in and around the operating room (12).