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STERILIZATION OF THE AIR IN THE OPERATING ROOM WITH BACTERICIDAL RADIATION: RESULTS FROM NOV. 1, 1938 TO NOV. 1, 1939, WITH A FURTHER REPORT AS TO SAFETY OF PATIENTS AND PERSONNEL

STERILIZATION OF THE AIR IN THE OPERATING ROOM WITH BACTERICIDAL RADIATION: RESULTS FROM NOV. 1,... Abstract As interest in the use of ultraviolet rays of certain wavelengths as an agent for killing micro-organisms in the air, particularly in the operating room, has become more widespread, the questions most frequently asked have concerned the results obtained by its use and the possible danger to the patient and to the operating room personnel. Since probably I have had the greatest experience with this recent addition to surgical technic as a routine in all large clean operative procedures, a further report of my experience and results may be of interest and value in this field. The first operation on a patient in the Duke Hospital in a field of ultraviolet radiation was performed on Jan. 15, 1936. A preliminary report1 based on several years' study of viable bacteria in the air, showing how they can be reduced by air conditioning and almost eliminated by radiation, was made after References 1. Hart, D.: Operation Room Infections: Control of Air-Borne Pathogenic Organisms, with Particular Reference to the Use of Special Bactericidal Radiant Energy; Preliminary Report , Arch. Surg. 34:874-896 ( (May) ) 1937.Crossref 2. Hart, D.: Sterilization of the Air in the Operating Room by Special Bactericidal Radiant Energy , J. Thoracic Surg. 6:45-81 ( (Oct.) ) 1936. 3. Hart, D.; Devine, J. W., and Martin, D. W.: Bactericidal and Fungicidal Effect of Ultraviolet Radiation: Use of a Special Unit for Sterilizing the Air in the Operating Room , Arch. Surg. 38:806-815 ( (May) ) 1939.Crossref 4. Hart, D., and Sanger, P. W.: Effect on Wound Healing of Bactericidal Ultraviolet Radiation from a Special Unit: Experimental Study , Arch. Surg. 38:797-805 ( (May) ) 1939.Crossref 5. The Westinghouse Electric and Manufacturing Company have supplied all radiation equipment. 6. There were probably other deaths from operating room infections in clean wounds in the other surgical services. A complete analysis is being made and will be published. 7. During this period 1 patient, on whom a craniotomy was performed without bactericidal radiation for an inoperable glioma when the only room equipped for radiation was in use for a laminectomy, died of meningitis (hemolytic Staphylococcus aureus). This was the only death during this period from an operating room infection in a clean incision in the general, thoracic and neurologic surgical services. All the 23,216 records have not been reviewed, and there may have been some deaths from operating room infections in other services, in which radiation was not used. These are being reviewed, and the results will be published. 8. Hart, D.: Sterilization of the Air in the Operating Room by Bactericidal Radiant Energy: Results in Over Eight Hundred Operations , Arch. Surg. 37:956-972 ( (Dec.) ) 1938.Crossref 9. Hart, D., and Upchurch, S. E.: Postoperative Temperature Reactions: Reductions Obtained by Sterilizing the Air with Bactericidal Radiant Energy; Seasonal Variations , Ann. Surg. 110:291-306 ( (Aug.) ) 1939.Crossref 10. Hart, D.: Sterilization of the Air in the Operating Room with Bactericidal Radiation , J. Thoracic Surg. 7:525-535 ( (June) ) 1938. 11. Hart and others.3 Hart and Sanger.4 12. Kraissl, C. J.; Cimiotti, J. G., and Meleney, F. L.: Considerations in the Use of Ultraviolet Radiation in Operating Rooms , Ann. Surg. 111:161-185 ( (Feb.) ) 1940.Crossref 13. All the intensities given are the actual measurements without any obstruction to the rays. During use in an operation it is estimated that from 15 to 25 per cent or more of the radiation is kept from the region of the wound by shading. Any tissue not on a flat exposed surface would receive less than half of. the intensities given by measurements made without any obstruction. 14. All operations performed with bactericidal radiation have been reported with the exception of a consecutive block from the fall of 1937 to Nov. 1, 1938. This group has not been reported on, and so the records have not been reread in a search for slight infections which may not have been entered on the diagnosis when the patient was discharged. 15. I consider that this wound infection was hematogenous and secondary to the pneumonia. During this twelve month period there were 2 other infections following operation (cesarean section and appendectomy) performed without bactericidal radiation, and these infections were considered by me to have been hematogenous and secondary to pneumonia. A brief résumé of these cases follows: An appendectomy for acute appendicitis (appendix unruptured) was performed on Sept. 4, 1939. On the second postoperative day there was bilateral bronchopneumonia. Sputum for culture could not be obtained. On the sixth day the incision was well healed, with no infection. On the seventh day there was pericarditis, with fluid in the right side of the chest. On the sixteenth day the incision was well healed. On the twenty-fourth day there was an abscess in the neck. On the twenty-fifth day an abscess developed at each venipuncture wound. There were abscesses also on the back, arms and neck. On the thirty-fifth day there was an abscess in the abdominal wall, involving the incision. On the forty-second day the temperature was normal and remained down for the remainder of the course in the hospital. On the sixty-seventh day the patient was discharged, recovered. The patient was treated with sulfapyridine to the seventeenth postoperative day. The leukocyte count dropped to 1,950 per cubic millimeter by the twenty-third day. Staphylococcus antitoxin, 300,000 units, was given between the twenty-fifth and the twenty-eighth postoperative day. On the twenty-eighth day the leukocyte count was 12,850 per cubic millimeter, and by the thirty-second it was up to 20,800. All blood cultures were sterile. The urine did not become infected, and no sputum could be obtained for culture. All other cultures showed a pure growth of the hemolytic Staph. aureus. The temperature remained normal after the forty-second postoperative day. A cesarean section was performed without bactericidal radiation on Nov. 1, 1938. On the third day following operation the patient had pneumonia. The hemolytic Staph. aureus was grown on culture of the sputum. On the tenth day the urine was infected with the Staph. aureus (hemolysis not noted). The first evidence of wound infection was noted on the sixteenth day. Cultures showed the hemolytic Staph. aureus. The patient recovered. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

STERILIZATION OF THE AIR IN THE OPERATING ROOM WITH BACTERICIDAL RADIATION: RESULTS FROM NOV. 1, 1938 TO NOV. 1, 1939, WITH A FURTHER REPORT AS TO SAFETY OF PATIENTS AND PERSONNEL

HART, DERYL
Archives of Surgery , Volume 41 (2) – Aug 1, 1940
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References (11)

Publisher
American Medical Association
Copyright
Copyright © 1940 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1940.01210020130014
Publisher site
See Article on Publisher Site

Abstract

Abstract As interest in the use of ultraviolet rays of certain wavelengths as an agent for killing micro-organisms in the air, particularly in the operating room, has become more widespread, the questions most frequently asked have concerned the results obtained by its use and the possible danger to the patient and to the operating room personnel. Since probably I have had the greatest experience with this recent addition to surgical technic as a routine in all large clean operative procedures, a further report of my experience and results may be of interest and value in this field. The first operation on a patient in the Duke Hospital in a field of ultraviolet radiation was performed on Jan. 15, 1936. A preliminary report1 based on several years' study of viable bacteria in the air, showing how they can be reduced by air conditioning and almost eliminated by radiation, was made after References 1. Hart, D.: Operation Room Infections: Control of Air-Borne Pathogenic Organisms, with Particular Reference to the Use of Special Bactericidal Radiant Energy; Preliminary Report , Arch. Surg. 34:874-896 ( (May) ) 1937.Crossref 2. Hart, D.: Sterilization of the Air in the Operating Room by Special Bactericidal Radiant Energy , J. Thoracic Surg. 6:45-81 ( (Oct.) ) 1936. 3. Hart, D.; Devine, J. W., and Martin, D. W.: Bactericidal and Fungicidal Effect of Ultraviolet Radiation: Use of a Special Unit for Sterilizing the Air in the Operating Room , Arch. Surg. 38:806-815 ( (May) ) 1939.Crossref 4. Hart, D., and Sanger, P. W.: Effect on Wound Healing of Bactericidal Ultraviolet Radiation from a Special Unit: Experimental Study , Arch. Surg. 38:797-805 ( (May) ) 1939.Crossref 5. The Westinghouse Electric and Manufacturing Company have supplied all radiation equipment. 6. There were probably other deaths from operating room infections in clean wounds in the other surgical services. A complete analysis is being made and will be published. 7. During this period 1 patient, on whom a craniotomy was performed without bactericidal radiation for an inoperable glioma when the only room equipped for radiation was in use for a laminectomy, died of meningitis (hemolytic Staphylococcus aureus). This was the only death during this period from an operating room infection in a clean incision in the general, thoracic and neurologic surgical services. All the 23,216 records have not been reviewed, and there may have been some deaths from operating room infections in other services, in which radiation was not used. These are being reviewed, and the results will be published. 8. Hart, D.: Sterilization of the Air in the Operating Room by Bactericidal Radiant Energy: Results in Over Eight Hundred Operations , Arch. Surg. 37:956-972 ( (Dec.) ) 1938.Crossref 9. Hart, D., and Upchurch, S. E.: Postoperative Temperature Reactions: Reductions Obtained by Sterilizing the Air with Bactericidal Radiant Energy; Seasonal Variations , Ann. Surg. 110:291-306 ( (Aug.) ) 1939.Crossref 10. Hart, D.: Sterilization of the Air in the Operating Room with Bactericidal Radiation , J. Thoracic Surg. 7:525-535 ( (June) ) 1938. 11. Hart and others.3 Hart and Sanger.4 12. Kraissl, C. J.; Cimiotti, J. G., and Meleney, F. L.: Considerations in the Use of Ultraviolet Radiation in Operating Rooms , Ann. Surg. 111:161-185 ( (Feb.) ) 1940.Crossref 13. All the intensities given are the actual measurements without any obstruction to the rays. During use in an operation it is estimated that from 15 to 25 per cent or more of the radiation is kept from the region of the wound by shading. Any tissue not on a flat exposed surface would receive less than half of. the intensities given by measurements made without any obstruction. 14. All operations performed with bactericidal radiation have been reported with the exception of a consecutive block from the fall of 1937 to Nov. 1, 1938. This group has not been reported on, and so the records have not been reread in a search for slight infections which may not have been entered on the diagnosis when the patient was discharged. 15. I consider that this wound infection was hematogenous and secondary to the pneumonia. During this twelve month period there were 2 other infections following operation (cesarean section and appendectomy) performed without bactericidal radiation, and these infections were considered by me to have been hematogenous and secondary to pneumonia. A brief résumé of these cases follows: An appendectomy for acute appendicitis (appendix unruptured) was performed on Sept. 4, 1939. On the second postoperative day there was bilateral bronchopneumonia. Sputum for culture could not be obtained. On the sixth day the incision was well healed, with no infection. On the seventh day there was pericarditis, with fluid in the right side of the chest. On the sixteenth day the incision was well healed. On the twenty-fourth day there was an abscess in the neck. On the twenty-fifth day an abscess developed at each venipuncture wound. There were abscesses also on the back, arms and neck. On the thirty-fifth day there was an abscess in the abdominal wall, involving the incision. On the forty-second day the temperature was normal and remained down for the remainder of the course in the hospital. On the sixty-seventh day the patient was discharged, recovered. The patient was treated with sulfapyridine to the seventeenth postoperative day. The leukocyte count dropped to 1,950 per cubic millimeter by the twenty-third day. Staphylococcus antitoxin, 300,000 units, was given between the twenty-fifth and the twenty-eighth postoperative day. On the twenty-eighth day the leukocyte count was 12,850 per cubic millimeter, and by the thirty-second it was up to 20,800. All blood cultures were sterile. The urine did not become infected, and no sputum could be obtained for culture. All other cultures showed a pure growth of the hemolytic Staph. aureus. The temperature remained normal after the forty-second postoperative day. A cesarean section was performed without bactericidal radiation on Nov. 1, 1938. On the third day following operation the patient had pneumonia. The hemolytic Staph. aureus was grown on culture of the sputum. On the tenth day the urine was infected with the Staph. aureus (hemolysis not noted). The first evidence of wound infection was noted on the sixteenth day. Cultures showed the hemolytic Staph. aureus. The patient recovered.

Journal

Archives of Surgery – American Medical Association

Published: Aug 1, 1940

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