Prevention of Projectile and Aerosol Contamination During Pulsatile Lavage Irrigation Using a Wound Irrigation Bag
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Pulsatile lavage is a high-pressure wound irrigation system commonly used in operating rooms and wound care facilities. The system consists of a battery-powered device which delivers a pressurized sterile crystalloid solution to the wound bed at usually no greater than 15 psi. The device administers a fluid stream to the wound surface and has a built-in suction tube that concurrently removes the fluid as it is dispensed. A small circular shield is attached to the nozzle of the device, which serves to decrease gross splash when placed in contact with the wound bed. Tubing connects the device to a sterile irrigation fluid bag and a suction pump with a collection canister. Proper technique requires close proximity of the device’s suction tip with the wound bed at all times during irrigation. This can be difficult to achieve when used on wounds with irregular contours. For example, sacral decubitis ulcers present a challenge with their jagged irregular surfaces. Often the vacuum seal is broken leading to splashing and contamination from fluid droplets.
The risk of exposure to bloodborne pathogens for surgical personnel is well established in the literature.1,2 The risk of percutaneous injury and contact via mucous membranes, conjunctiva, or non-intact skin has also been described.3–6 High pressure irrigation is associated with a particularly high incidence of contamination from fluid dispersing around the wound.4 Facial contamination of personnel resulting from droplets during pulse lavage irrigation has also been reported.7 Adequate barrier protection during the course of the pulsatile lavage is important in decreasing the risk of human immunodeficiency virus (HIV), hepatitis B virus, and multi-drug resistant bacterial exposure.8,9 The literature describes a few innovative methods of decreasing projectile and aerosolized emissions in the operating room.1,4,8,10 Each of these methods requires the placement of holes in a bag in order to insert the pulse lavage device and suction tubing.
The authors evaluated an easy and convenient method of decreasing projectile contamination in the operating room and protecting personnel from exposure while using pulse lavage. The Wound Irrigation Bag© (Pulse Care Medical LLC, North Andover, Mass) is a sterile plastic self-sealing system, which consists of a bag with 2 compartments connected by a conduit. The irrigation compartment has a 1-way valved sleeve that permits the pulsatile lavage device to enter but restricts any fluid or splatter from leaking out. Any fluid runoff from the irrigation compartment flows by gravity through the conduit into the collection compartment where it is contained for disposal (Figure 1). This study compared the amount of aerosol and projectile contamination that occurs during pulse lavage with and without the WIB. No previous study has shown objective evidence of decreased operating room contamination and reduced risk of exposure to personnel performing pulse lavage.
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