Carbon dioxide insufflation deflects airborne particles from an open surgical wound model

• Published in: The Journal of hospital infection Vol. 95; no. 1; pp. 112 - 117
• Main Authors: Kokhanenko, P, Papotti, G, Cater, J.E, Lynch, A.C, van der Linden, J.A, Spence, C.J.T
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.01.2017
• Subjects: Carbon Dioxide - administration & dosage; Flow visualization; Humans; Infection; Infectious Disease; Insufflation; Medical device; Medicin och hälsovetenskap; Particulate Matter - analysis; Surgical site infection; Surgical Wound Infection - prevention & control; Treatment Outcome; Infection; Flow visualization; Surgical site infection; Medical device
• ISSN: 0195-6701; 1532-2939; 1532-2939
• DOI: 10.1016/j.jhin.2016.11.006

Summary Background Surgical site infections remain a significant burden on healthcare systems and may benefit from new countermeasures. Aim To assess the merits of open surgical wound CO2 insufflation via a gas diffuser to reduce airborne contamination, and to determine the distribution of CO2 in and over a wound. Methods An experimental approach with engineers and clinical researchers was employed to measure the gas flow pattern and motion of airborne particles in a model of an open surgical wound in a simulated theatre setting. Laser-illuminated flow visualizations were performed and the degree of protection was quantified by collecting and characterizing particles deposited in and outside the wound cavity. Findings The average number of particles entering the wound with a diameter of <5 μm was reduced 1000-fold with 10 L/min CO2 insufflation. Larger and heavier particles had a greater penetration potential and were reduced by a factor of 20. The degree of protection was found to be unaffected by exaggerated movements of hands in and out of the wound cavity. The steady-state CO2 concentration within the majority of the wound cavity was >95% and diminished rapidly above the wound to an atmospheric level (∼0%) at a height of 25 mm. Conclusion Airborne particles were deflected from entering the wound by the CO2 in the cavity akin to a protective barrier. Insufflation of CO2 may be an effective means of reducing intraoperative infection rates in open surgeries.