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INTRODUCTION The prevention of postoperative wound sepsis has long been a topic of prime concern to surgeons. With the recent advent of total-joint replacement and the use of methyl methacrylate, the orthopedic surgeon has become increasingly concerned with prevention of sepsis. It was the purpose of the steering committee to isolate and ex- plore a controversial and crucial aspect of surgical antisepsis. Charnley (1969) found that the establishment of an operating room environment with markedly reduced airborne bacterial content was associated with a significant reduction in postoperative total-hip arthroplasty infection rates. Whether this favorable result was effected by air filtration alone or whether it was also attributable to improved barrier techniques, more attention to aseptic techniques, or a multiplicity of other improvements in technique has remained unanswered. Clean air in the operating room is frequently discussed and often poorly understood. Its implications for capital investment costs are large and there are several techniques for cleaning air. Because of the potential significance of reduced operating room airborne bacterial content to reduced postoperative sepsis rates, the Committee on Prosthetics Research and Development convened a multidisciplinary workshop to discuss this subject. In their planning sessions, the Steering Committee on the Control of Operating Room Airborne Bacteria discussed many subjects which might in- fluence postoperative sepsis rates. These included host resistance, pre- and postoperative antibiotic therapy, skin preparation, surgical technique, tissue toilet, instrument sterilization, and quality control of commercially steril- ized materials used in the operation. The committee also agreed that endoge- nous infections and the prophylactic or therapeutic treatment of infection would be recognized, but not examined in these discussions. Finally, it was agreed that the direct contamination of clean wounds was not a matter for this workshop, except as it was a reflection of failures of barrier techniques used to prevent contaminating the air. Convening a conference to discuss the entire totality of the problem seemed impossible, yet the urgency to resolve the "clean air" aspect of the problem was evident. Therefore, it was decided
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that this workshop would be particularly devoted to a review of the current knowledge of the origins and pathways by which airborne bacteria contaminate clean wounds. The committee developed the following objectives to provide a general framework for the workshop: 1. to summarize the current state of knowledge on airborne contamination of clean wounds; 2. to tabulate available techniques for estimating the cleanliness or contamination of the air; 3. to list methods that can lower the contamination of the air; 4. to assess, on the basis of available data, the effective- ness of the techniques for controlling operating room airborne contamination and further investigate the adequacy of systems currently used to decontaminate operating room air; and 5. to publish the workshop proceedings. Such a publication would include recommendations on the effectiveness of sampling and decontamination techniques if the data presented were adequate to support and validate such recommendations. The report also would include recom- mendations and priorities for future studies on air- borne bacteria in operating rooms.