History points to future needs

You can go way back in time when you want to describe the background to why the development of preventative measures against infections in conjunction with operations is important. We can discuss the situation for those who were forced to have an operation in a time when incantations were the most “effective” measure against post-operative infections. Or we can discuss the discoveries and  steps which actually took the development a couple of steps forward, such as when Louis Pasteur discovered that bacteria spread infection or when Joseph Lister introduced disinfection of skin, suture material and wounds. Many are those scientists who have added to this development. But let us focus on the modern development of preventative measures against exogen transmission of infection on operating theatres, focusing especially on ventilation.

With this in focus we also find many names of people who have contributed to the development of modern ventilation systems in operating theatres. The most famous person, who most probably has had the greatest influence on change during the last 50 years, is Sir John Charnley.

Operations in a ”box” lowered the infection frequency

Sir John Charnley (he was knighted in 1977, for amongst other things, his work for better air quality in operating theatres) had developed his hip prosthesis which meant a great improvement for patients in need of an artificial hip joint. It was in this connection he discovered that many of the patients got post-operative infections which nullified the good results from the actual operation. This led to him in 1964 developing a ”box” with a parallel air flow with filtered air. In order to assure that there was a parallel down flowing air stream without bacteria carrying particles which could contaminate the parallel flowing area he gave the box rigid outer walls that stopped just above the floor, to enable air evacuation. Sir John did 5,800 hip operations in this box and without antibiotikaprofylax he was able to lower the post-operative infection rate from around 7% to 0.5%.

Sir John Charnley meant that the box was the reason behind the greater part of this evident infection reduction. A minor part of the reduction was explained by the simultaneous use of new airtight operation gowns with air suction plus new work routines.

Sir John’s box did indeed have a good effect on the frequency of post-operative infections but did also have its drawbacks; the mobility of the staff was decreased, face masks steamed up and communication between the members of the team was made more difficult due to the face masks.