Influence of laminar airflow on prosthetic joint infections: a systematic review

Background: Many hospitals use ultraclean ventilation (UVC), also known as laminar airflow systems (LAF), in their operating rooms to decrease rates of surgical site infections (SSIs). However, the evidence for these systems is limited and the additional expenses for LAF are substantial. Aim: To determine the effectiveness of LAF to decrease SSI rates following hip and knee prosthesis. Methods: Systematic review of cohort studies investigating the influence of LAF on SSIs following hip and knee prosthesis published during the last 10 years. Findings: Four cohort studies using the endpoint severe SSI following knee prosthesis and four studies following hip prosthesis were included. No individual study showed a significant benefit for LAF following knee prosthesis but one small study showed a significant benefit following hip prosthesis. However, one individual study showed significantly higher severe SSI rates following knee prosthesis and three studies significantly higher SSI rates following hip prosthesis under LAF conditions. The summary odds ratio was 1.36 (95% confidence interval: 1.06-1.74) for knee prosthesis and 1.71 (1.21-2.41) for hip prosthesis. Conclusions: It would be a waste of resources to establish new operating rooms with LAF, and questionable as to whether LAF systems in existing operating rooms should be replaced by conventional ventilation systems. (C) 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.