THE IMPACT OF SURGICAL HELMET SYSTEMS ON PERIOPERATIVE INFECTIONS IN ARTHROPLASTY
THE IMPACT OF SURGICAL HELMET SYSTEMS ON PERIOPERATIVE INFECTIONS IN ARTHROPLASTY

Summary/Abstract: Background: Total joint arthroplasty (TJA) is the gold standard for treating end-stage osteoarthritis. However, periprosthetic joint infection (PJI) remains a severe complication associated with considerable morbidity. To reduce infection risk, protective systems such as Body Exhaust Suits (BES) and Surgical Helmet Systems (SHS) have been introduced. Despite their widespread use, concerns persist regarding the effectiveness of SHS due to positive-pressure airflow and the lack of exhaust filtration.Aim of the study: To evaluate whether SHS improve or compromise perioperative sterility and infection prevention in arthroplasty, with a focus on contamination rates and PJI incidence.Material and methods: The analyzed literature was selected from publications identified through searches of the PubMed, Cochrane Library, and Informit databases using the keywords “surgical helmet,” “infection,” “contamination,” and “arthroplasty.” Studies published within the last 20 years that assessed SHS or BES in TJA and reported contamination or infection outcomes were included. Of the 176 identified articles, 31 were selected for further analysis.Results: Contamination was primarily caused by staphylococci, including Staphylococcus epidermidis, S. hominis, and S. saprophyticus, as well as Micrococcus luteus, Bacillus spp., and Burkholderia cepacia, all of which are capable of biofilm formation and pose a risk for The use of SHS was frequently associated with contamination, including glove contamination rates of 12–18.3%, helmet surface contamination of up to 13.5%, and at least one positive culture in 40.8% of cases. Commonly identified organisms included S. epidermidis, S. hominis, S. saprophyticus, Micrococcus luteus, Bacillus spp., and Burkholderia cepacia, all capable of biofilm formation. Early activation of the helmet fan before gowning increased particle dispersion, whereas delayed activation reduced immediate spread but did not prevent subsequent contamination. SHS airflow was also shown to disrupt laminar airflow in the operating room. BES demonstrated superior control of airborne contamination. Registry data suggested a reduction in PJI rates only in total knee arthroplasty, with no observed benefit in other joint procedures.Conclusions: SHS provide improved comfort for the surgeon; however, they are less effective than BES in controlling microbial spread. Optimization of fan activation timing, enhancement of cleaning protocols, and refinement of airflow design are essential to improve the safety of SHS use in arthroplasty.

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