No-sweat surgery helps keep those bugs at bay

By MARTIN JOHNSTON

Sweaty surgeons may need to wear sealed "space suits" to protect their patients from infection after the discovery by Auckland Hospital specialists that bacterial counts in theatre more than double when surgeons perspire.

The study on the effect of surgeons' sweat found an average of 3.3 colonies of bacteria in theatre for each surgeon in a mock-up 30-minute hip-replacement operation.

The 10 male surgeons then worked up a sweat on an exercycle, scrubbed, gowned and gloved up afresh, and spent another 30 minutes in the theatre, holding a 1kg weight.

An average of 6.9 colonies were found after this "sweating phase," including staphylococcus epidermidis. Around 2 per cent of patients undergoing hip joint replacements suffer serious infections, most often from certain organisms found on the skin such as staphylococcus epidermidis and staphylococcus aureus.

The bacteria in the study could have come off the surgeons, from sweat droplets or skin flakes from their foreheads, or by seepage through their hoods or masks.

One of the authors, clinical microbiologist Dr David Holland, said: "It's quite disastrous if you get an infection in an artificial hip joint."

It could mean weeks in hospital on antibiotics and re-replacement of the joint.

Operations where foreign material, like an artificial joint, was inserted posed a greater risk of infection than other surgery.

To deal with sweat, the article, published in the latest Australian and New Zealand Journal of Surgery, suggests:

Lowering the operating room temperature and keeping the patient warm in a special blanket that uses hot air.

Dressing the surgeon in an impermeable "helmet exhaust suit."

South Auckland Health's head of orthopaedic surgery, Dr Garnet Tregonning, said the disposable "space suits," which cost up to $400 each, had been used in New Zealand, but he disliked them. Infection rates could be lowered almost as much in other ways.



Newer theatres had ultra-clean air, and at Middlemore Hospital theatre doors were locked during operations to limit the risk of infection. Joint cement loaded with antibiotics was used in risky patients.

Dr Tregonning said orthopaedic surgery was a hot business, but theatre gowns were now impermeable, keeping any sweat inside. Only the area around the eyes was exposed, although some surgeons wore masks that covered this.