A Better Option for Clean Air
Orthopedic surgery is carried out in two different hospitals within the Vestre Viken Hospital Trust. As part of the planning of a major renovation of existing operation theaters in 2014, the orthopedic team investigated new clean air systems.

“With inconsistent data regarding the performance of LAF (Laminar Air Flow) ceilings, we looked for alternatives in the market and found out about Toul Meditech Operio®,” said Dr. Månsson. “It became a choice between a LAF ceiling and the Toul Meditech Operio® . Toul Meditech Operio® stood out for three main reasons. Firstly, there was good and consistent data published on its performance. Both preclinical and subclinical papers. Secondly, it appealed because it gives us better control of the clean air in the operation, that can be focused on the surgery site and on the instrument table. And the last point that was relevant was cost. On life-cycle cost, the Operio® offers savings.”

Infection Control System
The Toul Meditech Operio® has become a part of the Hospital’s infection control system.
“We have a very efficient or effective infection control program and have reduced the risk of many infections through this,” remarked Dr. Månsson. “It's hard to say which part has contributed to what in a complex system, but we have been able to achieve a relatively low incidence of circo synovial infection in the context of joint replacement that is class leading on a global scale. That, of course, is the main benefit of the Toul Meditech Operio®. It is part of a very good system.”

Since 2015, the Vestre Viken Hospital has used the Toul Meditech for more than 5,000 joint replacements and over 3,000 spinal surgeries, as well as other surgeries. It is now used for all joint replacements and spinal surgeries.

No Downtime
Firstly, the system was used it in the Vestre Viken’s minor hospital. While the main operation suite in this hospital was renovated in December 2019, the Toul Meditech Operio® enabled joint replacement surgery to be continued in the day surgery unit.

“Without the Toul Meditech Operio® , that would not have been possible, because that was an old (20 years old) day surgery unit, which was originally designed for non-ultraclean surgery” said Dr. Månsson. “With the Toul system, we were confident that we had a clean air system that we could employ to utilize all the space that we had.”

Adopting New Technology
Within a short space of time, the Toul Meditech® was easily integrated into the surgical processes of the orthopedic department.

“With Toul Meditech Operio®, you do have to look through your processes. You have to ensure that the nurses and surgeons that use the system really know and understand it,” emphasized Dr. Månsson. “However, if you accept it and learn how to use it, you can
maintain good efficiency, but you need to adapt it to your work level, or adapt your work-level to that kind of equipment.”

COVID-19 Pandemic
The COVID-19 pandemic has had an impact Norway, although so far not as severely as some other countries.

“Considering the effects of the pandemic on the world in general, we have a huge backlog on elective surgeries on a global scale And of course, every technology that can reduce the risk of major surgery complications helps capacity in this context,” said Dr. Månsson. “Some orthopedic conditions already require enormous amounts of resources to treat, with long surgeries, and long stays at the hospital, but one of the biggest cause of waste in the healthcare environment is major complications, as well as over overtreatment, So everything we can do to reduce complications will free up capacity to address that backlog. I think it's extremely important that during the post-pandemic period we consider that we look at infection control and learn as much as possible from the pandemic experience. Infection control must be regarded as an essential system. And in infection control with regards to surgery, I would predict surgery with the Toul Meditech Operio®, can be a cost-efficient part of that.”

Dr. Lukas Månsson
Dr. Lukas Månsson is the Chief of Services for the Department of Orthopedic Surgery and Emergency Medicine at the Vestre Viken Hospital, Drammen, Norway. He is also an orthopedic surgeon, mainly in hip, shoulder and trauma surgery.

Dr. Månsson has worked at the Hospital for 16 years. He has worked as an orthopedic surgeon at several different hospitals before that, in both Norway and Sweden.

En partikelmätare användes för att mäta partiklar när Operio var påslaget jämfört med avslaget. Resultaten visar på 0 partiklar/m3 av storlek 0,3 och 0,5 μm inom 2 minuter efter det att aggregatet har slagits på, och därmed uppfylls ISO klass 5.

Rapporten är på italienska men är översatt till engelska här.

Toul Meditechs produkter, som Operio och SteriStay, har HEPA filter av klass 14 vilka har en effektivitet på minst 99.995 % filtrering av partiklar i storleksordningen mindre än 0,18 µm. Operio och SteriStay har en luftflödeshastighet på 400 m3/t och MPPS (Most Penetrating Particle Size) är 0,145 µm vid den hastigheten. Se kurvan nedan:

Kurvan visar att virus vid en storlek på 0,05-0,15 µm kan fångas upp effektivt av filtret. Coronaviruset har en partikelstorlek på ungefär 0,1 µm. Dessutom cirkuleras luften flera gånger genom filtret allt eftersom luftaggregatet är påslaget och på så sätt minskas även partiklarna successivt hela tiden då de fångas upp i HEPA-filtret.

Förutom övriga rutiner för att förhindra kontaminering, är användningen av Operio och SteriStay tillsammans med sterilskyddet mycket effektivt att använda för att filtrera virus i storleksordningen 0,05-0,15 µm och kan därför rekommenderas att använda som ett skydd i kampen mot att sprida Coronaviruset i hälso- och sjukvårdsmiljön.

Infektionsstatistik från Drammen i Norge visar att infektionsfrekvensen var 0.3% vid 645 knäimplantat och 0% för 646 höftimplantat. Infektionsfrekvensen innan användning av Operio och SteriStay var c:a 1,5%.