Background: Ultraviolet lighting is an alternative to laminar
airflow in the operating room that may be as effective for lowering the number
of environmental bacteria and possibly lowering infection rates by killing the
bacteria rather than simply reducing the number at the operative site. The
purpose of the present study was to compare the infection rates following
joint replacement procedures performed by one orthopaedic surgeon with and
without the use of ultraviolet lighting.
Methods: From July 1986 to July 2005, one surgeon performed 5980
total joint replacements at one facility. In September 1991, ultraviolet
lighting was installed in the operating rooms. All procedures that were
performed before the installation of the ultraviolet lighting utilized
horizontal laminar airflow, whereas all procedures that were performed after
that date utilized ultraviolet lighting without laminar airflow. Factors
associated with the rate of infection were analyzed.
Results: Over a nineteen-year period, forty-seven infections
occurred following 5980 joint replacements. The infection rate without
ultraviolet lighting (and with laminar airflow) was 1.77%, and the infection
rate with ultraviolet lighting was 0.57% (p < 0.0001). The odds of
infection were 3.1 times greater for procedures performed without ultraviolet
lighting (and with laminar airflow) as compared with those performed with only
ultraviolet lighting (p < 0.0001). The infection rate associated with total
hip replacement decreased from 1.03% to 0.72% (p = 0.5407), and the infection
rate associated with total knee replacement decreased from 2.20% to 0.50% (p
< 0.0001). Revision surgery, previous infection, age, total body mass
index, use of cement, disease, and diagnosis were not associated with an
elevated infection rate.
Conclusion: When appropriate safety precautions are taken,
ultraviolet lighting appears to be an effective way to lower the risk of
infection in the operating room during total joint replacement surgery.
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.