Journal Article

EPOS trial: the effect of air filtration through a plasma chamber on the incidence of surgical site infection in orthopaedic surgery: a study protocol of a randomised, double-blind, placebo-controlled trial

Eisler, Thomas, Mukka, Sebastian, Lazarinis, Stergios, Mohaddes, Maziar, Persson, Anders, Hailer, Nils, Brismar, Harald, Atroshi, Isam, Kernell, Per-Juan, Tyszkiewicz, Thomas, Gordon, Max, Sköldenberg, Olof

2022

Overview

IntroductionThere is controversy regarding the importance of air-transmitted infections for surgical site infections (SSIs) after orthopaedic surgery. Research has been hindered by both the inability in blinding the exposure, and by the need for recruiting large enough cohorts. The aim of this study is to investigate whether using a new form of air purifier using plasma air purification (PAP) in operating rooms (ORs) lowers the SSI rate or not.Methods and analysisMulticentre, double-blind, cluster-randomised, placebo-controlled trial conducted at seven hospitals in 2017–2022. All patients that undergo orthopaedic surgery for minimum 30 min are included. Intervention group: patients operated in OR with PAP devices turned on. Control group: patients operated in OR with PAP devices turned off. Randomisation: each OR will be randomised in periods of 4 weeks, 6 weeks or 8 weeks to either have the devices on or off. Primary outcome: any SSI postoperatively defined as a composite endpoint of any of the following: use of isoxazolylpenicillin, clindamycin or rifampicin for 2 days or more, International Classification of Diseases codes or Nordic Medico-Statistical Committee codes indicating postoperative infection. In a second step, we will perform a chart review on those patients with positive indicators of SSI to further validate the outcome. Secondary outcomes are described in the Methods section. Power: we assume an SSI rate of 2%, an SSI reduction rate of 25% and we need approximately 45 000 patients to attain a power of 80% at a significance level of 0.05.Ethics and disseminationThe study is approved by the Swedish Ethical Review Authority. The interim analysis results from the study will be presented only to the researchers involved unless the study thereafter is interrupted for whatever reason. Publication in a medical journal will be presented after inclusion of the last patient.Trial registration numberNCT02695368.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: adult / adult orthopaedics / air and air related phenomena / air conditioning / Air flow / airborne infection / airborne transmission / Antibiotics / clindamycin / clinical article / Clinical Medicine / clinical trial protocol / Clinical trials / controlled study / double blind procedure / Double-Blind Method / Double-blind studies / female / hip / hospital readmission / Hospitals / human / Humans / Incidence / infection control / infection rate / Infectious Diseases / Infectious Medicine / Infektionsmedicin / International Classification of Diseases / Intervention / isoxazolylpenicillin / Kirurgi / Klinisk medicin / Knee / length of stay / male / Medical and Health Sciences / Medicin och hälsovetenskap / multicenter study / Nosocomial infections / orthopaedic & trauma surgery / Orthopaedics / Orthopedic Procedures - adverse effects / orthopedic surgery / Orthopedics / Ortopedi / Pathogens / penicillin derivative / Plasma / plasma air purification / prescription / randomized controlled trial / Randomized Controlled Trials as Topic / reoperation / rifampicin / room ventilation / Surgeons / Surgery / surgical infection / Surgical site infections / Surgical Wound Infection - epidemiology / Surgical Wound Infection - prevention & control / Sweden / total hip replacement / unclassified drug / Ventilation