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Mobile laminar airflow units in ophthalmic surgery: a review of the experience to date
First Author: Y. Abdallah UK
Co Author(s): P. Gounder S. Madge
Surgical site infections (SSIs) are particularly devastating in the field of ophthalmology. A sterile field is usually achieved in part by incorporation of immobile laminar flow filtered air ventilation units into theatre ceilings, which is appropriate for most surgeries. In ophthalmology, the surgical site is comparatively smaller; This literature review explores whether the smaller surgical site presents an opportunity for smaller mobile laminar airflow (MLAF) units as a more cost-effective and flexible solution to surgical field sterility by critically appraising and summarizing the existing body of literature relating to adoption of these devices in ophthalmological surgery.
This literature review appraises and summarizes studies exploring the efficacy of MLAF systems in ophthalmology.
A variety of keywords including ﾑmobile laminar airflowﾒ and ﾑbacterial contaminationﾒ were used to search Pubmed, Medline, EMBASE and Cochrane Database of Controlled Trials databases. The preliminary search returned 294 articles. These were reviewed by title and abstract to select for studies investigating the efficacy of MLAF units within ophthalmological settings. This yielded three studies. The search and selection were conducted by two independent reviewers and any discrepancies resolved by a third author. In addition, further unpublished data was sought by contacting companies manufacturing these units. This yielded one additional study which was critically appraised and added to the review.
Three studies explored the efficacy of the MLAF units in the setting of intravitreal injections in a clean room while one explored the patientsﾒ experiences. The studies had a similar methodology; the surgical site and, in one study, the instrument table were supplied by air from the MLAF unit with subsequent particulate and bacteria sampling. The studies found the units effective in producing ultraclean air with a significantly lowered number of colony-forming units (under 10 CFU/m3). Patient experience while operating in a clean room with MLAF units was found to be no less positive compared to operating theatres.
Mobile laminar airflow units are an innovative solution to providing ultraclean air in surgical disciplines. In ophthalmology, the surgical field is much smaller than other disciplines which appears to allow safe adoption of these devices thereby reducing the cost of operations and enabling flexibility with regards to the operating venue: this may prove critical in the midst of COVID-19 disruptions. However, the paucity of sufficiently powered high-quality randomized controlled trials to assess the efficacy of mobile laminar airflow units in ophthalmology necessitates further trials to support their use.
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