POSI-red - Reduksjon av postoperative sårinfeksjoner gjennom utvikling av XR-verktøy

Infections in wounds following surgeries (Postoperative Surgical Site Infections (POSI)) is a significant problem both in Norway and worldwide. In 2018, the rate of infections following various procedures ranged from 1.6 to 13.4 percent, according to the Norwegian Institute of Public Health. In Sweden, 1,500 patients die each year due to postoperative infections (Swedish National Board of Health and Welfare). The human body emits 10,000 particles every minute, and 10 percent of these can contain bacteria. Even with protective clothing, medical personnel can release airborne particles that may fall into the surgical wound and cause POSI. There is also a risk of contact and droplet transmission. In addition to the consequences for individual patients, POSI has several negative impacts on society and healthcare systems: - High costs due to longer hospital stays, the need for reoperations, and reduced workforce participation by patients - Increased need for antibiotics, which in turn raises the risk of developing resistance According to the WHO, 50 percent of postoperative wound infections will be antibiotic-resistant in the near future. The aim of the research project POSIred is to contribute to sustainable societal development and economic benefits by reducing the risk of postoperative wound infections in hospitals. This aligns with the UN's Sustainable Development Goal No. 3, which aims to ensure good health and promote well-being for everyone at all ages. The vision is to nearly eliminate the risk of postoperative surgical site infections caused by airborne transmission, through the development of an "Extended Reality" (XR) tool. XR is a technology that combines reality with virtual elements. The tool visualizes all ventilation solutions in the operating room and provides insight into how airflows and particle distribution are affected by the movements of healthcare personnel during operations. By making particles and ventilation flows in the operating room visible, the XR tool will increase the understanding of how different ventilation solutions, as well as the behavior of surgical personnel, affect the risk of POSI. This facilitates the assessment of different ventilation strategies to reduce the incidence of wound infections and improve patient safety. A full-scale operating room laboratory has been established at NTNU as part of the project. The laboratory is equipped with 10 particle counters measuring concentrations at critical locations in the operating room. Additionally, it includes temperature sensors, humidity sensors, and six stereo cameras with GPUs that record movements of surgical staff. This data is sent to a separate computer that combines movements from all angles to create a 3D representation of personnel in the room. Dynamic computational fluid dynamics (CFD)-simulations were conducted, incorporating medical staff movements. Previous studies have primarily performed stationary CFD simulations of airflow in operating rooms without considering how flow patterns are affected by time and staff movements. The dynamic simulations are executed using powerful computers leveraging parallel processing technology. The NTNU laboratory is equipped with two different ventilation solutions – laminar airflow ventilation (LAF) and mixing ventilation (MV). Measurements have been conducted under both stationary scenarios with mannequins and dynamic scenarios with real people performing simulated operations. Findings from stationary measurements have been published in Ashrae Journal. Results from dynamic measurements are in development and will be published in an international scientific journal. Results from stationary particle measurements show a clear difference between ventilation solutions. The particle concentration at the surgical site was measured to about 60 times higher with MV than with LAF. However, results from dynamic simulations are less conclusive as they are significantly influenced by staff movements, such as arm and body motions near the surgical site. Further dynamic measurements around the surgical site will be conducted after the project's formal conclusion.

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Postoperative sårinfeksjoner (POSI) er et stort problem i Norge og resten av verden. Folkehelseinstituttets årsrapport for 2018 viste at insidensandelen for postoperative sårinfeksjon varierte mellom fra 1,6-13,4 % avhengig av type operasjon. POSI bidrar til store kostnader for samfunnet både gjennom flere liggedøgn, økt behov for reoperasjon og mindre deltagelse i arbeidslivet. Høy forekomst av POSI øker behovet for antibiotika, både forebyggende og til behandling, noe som igjen øker risiko for resistensutvikling. Ifølge Verdens helseorganisasjon (WHO) vil 50 % av postoperative sårinfeksjoner være antibiotikaresistente i nær fremtid. Menneskekroppen gir fra seg 10 000 partikler per minutt, der 10% av disse inneholder bakterier. Selv om det medisinske personellet bruker beskyttelsesklær vil de avgi partikler som kan holde seg svevende i luften og falle ned i operasjonssåret. Slik luftbåren smitte, i tillegg til kontaktsmitte og dråpesmitte, kan forårsake POSI. Målet med dette prosjektet er at disse partiklene og ventilasjonsstrømningene synliggjøres gjennom å bygge opp et visualiseringsverktøy (XR-verktøy). For å utvikle XR-verktøyet skal det først logges både hånd- og kroppsbevegelser i et fullskala laboratorium. Deretter skal det gjennomføres komplekse dynamiske simuleringer der bevegelsene til det medisinske fagpersonellet inkluderes. XR-verktøyet skal benyttes til å øke forståelsen av samspillet mellom helsepersonellets bevegelser og ulike ventilasjonsløsninger i operasjonsrommet for å redusere POSI.