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Effect of Plasma Air Purifiers on Infection Rates in Orthopedic Surgery

Persson, Anders ; Atroshi, Isam LU ; Tyszkiewicz, Thomas ; Hailer, Nils P. ; Lazarinis, Stergios ; Eisler, Thomas ; Brismar, Harald ; Mukka, Sebastian LU ; Kernell, Per Juan and Mohaddes, Maziar LU , et al. (2025) In NEJM Evidence 4(4).
Abstract

BACKGROUND Surgical site infection (SSI) following orthopedic surgery impacts patient outcomes. Airborne transmission is one potential route of infection. Despite their high cost and resource demands, modern ventilation systems have shown limited efficacy in reducing SSI rates. This trial investigated the effectiveness of a low-cost air purifier in reducing SSI rates after orthopedic surgery. METHODS In a nationwide, multicenter, double-blind, cluster-randomized crossover, placebo-controlled superiority trial, we included all patients undergoing orthopedic surgery during the trial period. The intervention group underwent surgery in operating rooms with active Novaerus NV800 air purifiers, while the control group underwent surgery in... (More)

BACKGROUND Surgical site infection (SSI) following orthopedic surgery impacts patient outcomes. Airborne transmission is one potential route of infection. Despite their high cost and resource demands, modern ventilation systems have shown limited efficacy in reducing SSI rates. This trial investigated the effectiveness of a low-cost air purifier in reducing SSI rates after orthopedic surgery. METHODS In a nationwide, multicenter, double-blind, cluster-randomized crossover, placebo-controlled superiority trial, we included all patients undergoing orthopedic surgery during the trial period. The intervention group underwent surgery in operating rooms with active Novaerus NV800 air purifiers, while the control group underwent surgery in operating rooms with the same air purifiers that were inactive. The primary end point was SSI within 12 weeks post surgery, defined as a postsurgery infection marker (PSIM), a custom composite outcome based on registry codes for prescribed antibiotics, diagnoses, and surgical procedures. Logistic regression was performed to evaluate the primary outcome. RESULTS Of the 40,547 patients analyzed, 19,869 were in the intervention group and 20,678 in the control group. The PSIM rate was 9.2% in the intervention group, and 9.4% in the control group, with an odds ratio of 0.98 (95% confidence interval, 0.91 to 1.05) for the intervention group. This finding remained consistent across various subgroups based on diagnoses, hospital levels, and ventilation types. CONCLUSIONS In modern operating rooms equipped with standard, midrange airflow ventilation systems, the addition of wall-mounted plasma air purifiers did not reduce the PSIM rate after orthopedic surgery. (Funded by the Swedish Research Council; grant number, 2017-00198; ClinicalTrials.gov number, NCT02695368.)

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publication status
published
subject
in
NEJM Evidence
volume
4
issue
4
publisher
Massachusetts Medical Society
external identifiers
  • scopus:105024593838
  • pmid:40130977
ISSN
2766-5526
DOI
10.1056/EVIDoa2400289
language
English
LU publication?
yes
id
7c715244-bd26-428f-a571-ea42230d8e74
date added to LUP
2026-02-13 14:25:20
date last changed
2026-02-14 03:00:02
@article{7c715244-bd26-428f-a571-ea42230d8e74,
  abstract     = {{<p>BACKGROUND Surgical site infection (SSI) following orthopedic surgery impacts patient outcomes. Airborne transmission is one potential route of infection. Despite their high cost and resource demands, modern ventilation systems have shown limited efficacy in reducing SSI rates. This trial investigated the effectiveness of a low-cost air purifier in reducing SSI rates after orthopedic surgery. METHODS In a nationwide, multicenter, double-blind, cluster-randomized crossover, placebo-controlled superiority trial, we included all patients undergoing orthopedic surgery during the trial period. The intervention group underwent surgery in operating rooms with active Novaerus NV800 air purifiers, while the control group underwent surgery in operating rooms with the same air purifiers that were inactive. The primary end point was SSI within 12 weeks post surgery, defined as a postsurgery infection marker (PSIM), a custom composite outcome based on registry codes for prescribed antibiotics, diagnoses, and surgical procedures. Logistic regression was performed to evaluate the primary outcome. RESULTS Of the 40,547 patients analyzed, 19,869 were in the intervention group and 20,678 in the control group. The PSIM rate was 9.2% in the intervention group, and 9.4% in the control group, with an odds ratio of 0.98 (95% confidence interval, 0.91 to 1.05) for the intervention group. This finding remained consistent across various subgroups based on diagnoses, hospital levels, and ventilation types. CONCLUSIONS In modern operating rooms equipped with standard, midrange airflow ventilation systems, the addition of wall-mounted plasma air purifiers did not reduce the PSIM rate after orthopedic surgery. (Funded by the Swedish Research Council; grant number, 2017-00198; ClinicalTrials.gov number, NCT02695368.)</p>}},
  author       = {{Persson, Anders and Atroshi, Isam and Tyszkiewicz, Thomas and Hailer, Nils P. and Lazarinis, Stergios and Eisler, Thomas and Brismar, Harald and Mukka, Sebastian and Kernell, Per Juan and Mohaddes, Maziar and Sköldenberg, Olof and Gordon, Max}},
  issn         = {{2766-5526}},
  language     = {{eng}},
  number       = {{4}},
  publisher    = {{Massachusetts Medical Society}},
  series       = {{NEJM Evidence}},
  title        = {{Effect of Plasma Air Purifiers on Infection Rates in Orthopedic Surgery}},
  url          = {{http://dx.doi.org/10.1056/EVIDoa2400289}},
  doi          = {{10.1056/EVIDoa2400289}},
  volume       = {{4}},
  year         = {{2025}},
}