Summary of audit

All elective orthopaedic units in the United Kingdom are encouraged to participate in this study. The audit is focused on ultra clean air (UCA) theatres used for joint replacement surgery in the UK.

The audit is supported by the President of the British Orthopaedic Association and the Chief Medical Advisor at the UK Health Security Agency (UKHSA). It is designed to review the microbiological quality of the air in UCA theatres, with the long term objective of reducing deep infection rates.

The audit has been peer reviewed by microbiologists from the National Infection Teams Collaborative for Audit and Research (NITCAR), which is a trainee led system supported by the British Infection Association.

The NITCAR audits are designed to be trainee run, so there will be one or two trainee leads (Trauma and orthopaedic or microbiology/infectious diseases trainee) at each hospital site.

The audit uses a settle plate based technique. The necessary packs of microbiology plates will need to be ordered by the orthopaedic department using local clinical audit funding. Packs of 10 plates, which can be peeled apart for easy dispensing onto surgical instrument trolleys have been developed by Cherwell labs. Detailed methodology for the study is available in an “how to do it “document.

Data from each arthroplasty case will be recorded on a paper data collection form in theatre, this will be bundled with the settle plates and sent to the microbiology lab for culture.

The colony count per plate will be documented by the microbiology laboratory. Documentation of bacterial species is encouraged, but not essential.

The microbiology laboratory will enter the data from each operation onto a purpose designed database for eventual analysis.

What’s involved?

Click here for how to run the audit locally (“how to do it”)

Click here for Theatre form used

Click here for the full audit Protocol

How to sign up?

Each participating site will be asked to complete a single electronic registration form to take part in this study (

The participating team should comprise a named supervising consultant (Trauma and orthopaedic or microbiology/infectious diseases) and up to two trainees (Trauma and orthopaedic or microbiology/infectious diseases).

The participating team will be responsible for case identification, recruitment and data collection.

Centres participating in this study can send the above documents to their local site along with any necessary local requirements to run an audit.

For questions about the audit, please email: Please also drop us an email if you have any comments on the practicalities of the audit, for example if there are additional types of theatre clothing that are in use.