The effectiveness of the surgical helmet system in reducing infection and contamination in arthroplasty procedures: An integrative review

Background: Peri-prosthetic joint infections are a serious complication of primary arthroplasty procedures. While surgical helmet systems are commonly used, limited guidelines exist to support their effectiveness in preventing infection. Aim: This integrative review aims to synthesise relevant literature on the role of the surgical helmet system in arthroplasty procedures. Design: An integrative review process was undertaken. Method: A literature search was conducted for primary literature in PubMed, Scopus and ESBCO using the keywords ‘surgical helmet’ AND ‘contamination OR infection’ AND NOT ‘COVID’. Studies involving COVID-19 were excluded. Of the 44 retrieved studies, 13 met the inclusion criteria after removing duplicates and reviewing titles. This included one randomised controlled trial, six quasi-experimental studies, five observational analytical studies, and oneobservational descriptive study. The quality of the literature was assessed using EQUATOR network (Enhancing QUAlity and Transparency Of health Research network) guidelines. Findings: Findings indicate that the use of the surgical helmet system is associated with lower infection rates in arthroplasty procedures when compared to standard surgical attire. Additionally, the literature explores techniques to further reduce contamination rates with the surgical helmet system, including wrapping the glove–gown interface, treating the sterilesurgical helmet system hood as unsterile, delaying fan activation, running the fan for three minutes before entering the operating room, covering the back of the surgical gown and having a non-sterile team member apply the sterile surgical helmet system hood. Conclusion: The use of a surgical helmet system in arthroplasty procedures reduces infection rates compared to standard surgical attire. This integrative review highlights the importance of implementing additional practices to reduce intra-operative contamination rates when using the surgical helmet system. Further research is needed to strengthen the findings from thisintegrative review.