Importance of air quality and related factors in the prevention of infection in orthopaedic implant surgery

The list of geographical areas with which cases of viral haemorrhagic fever have been associated is so extensive and the ACDP’s definition of ‘moderate risk’ so inclusive that an urgent review and revision of the guidelines is essential.

Abstract

The list of geographical areas with which cases of viral haemorrhagic fever have been associated is so extensive and the ACDP’s definition of ‘moderate risk’ so inclusive that a significant proportion of patients being investigated for malaria in the community are likely to fall into the ‘moderate risk’ group for viral haemorrhagic fever. According to the guidelines, unless a thin blood film confirms a diagnosis of malaria in such patients, all other laboratory tests should be deferred or performed in a high security infectious disease laboratory. Moreover, the Consultant in Communicable Disease Control should be notified and arrangements made to admit the patient to a designated high security infectious diseases unit (either Coppetts Wood Hospital, London or Newcastle General Hospital, Newcastle upon Tyne) or to intermediate isolation facilities. Special transportation must be arranged, usually through the ambulance service as an ambulance category III removal. This example highlights the difficulties presented by the guidelines in their current form, and yet they continue to be promoted by the ACDP and the Health and Safety Executive as illustrating good practice. We therefore agree with Bignardi that an urgent review and revision of the guidelines is essential.