Building Simulation

, Volume 7, Issue 3, pp 277–287 | Cite as

Ultra clean ventilation system performance relating to airborne infections in operating theatres using CFD modelling

  • Gearoid P. LydonEmail author
  • Derek B. Ingham
  • Monjur M. Mourshed
Research Article Indoor/Outdoor Airflow and Air Quality


Preventing airborne infections during a surgical procedure is of paramount importance for effective and economical delivery of care, as well as for health and well-being of patients. Ultra clean ventilation (UCV) systems are commonly used in operating theatres, in particular for orthopaedic surgery because of the higher risk of infection from exposed deep wounds. This research, investigates the airflow pattern of a UCV based operating theatre using computational fluid dynamics (CFD). The effects of the opening and closing of doors in two pressurisation scenarios (0 and 20 Pa) with the surrounding spaces at various inlet and door inflow velocities are investigated. The UCV system operates effectively in the positive pressure (20 Pa) scenario but fails when there is no pressure difference between the operating theatre and surrounding areas. The implications of the research findings are discussed in the context of design guidance and the operation of the airflow system.


operating theatre airborne infection ventilation CFD 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Allen P, Reynolds DA (1978). Clean air operating environments. British Journal of Hospital Medicine, 20: 591–598.Google Scholar
  2. Bennett MD, Brachman MD (1986). Hospital Infections, 2nd edn. Boston: Little, Brown and Company.Google Scholar
  3. Blowers R, Crew B (1960). Ventilation of operating theatres. Journal of Hygiene, 58: 427–448.CrossRefGoogle Scholar
  4. Brohus H, Hyldig M, Kamper S, Vachek UM (2008). Influence of disturbances on bacteria level in an operating room. Paper presented at 11th International Conference on Indoor Air Quality and Climate, Copenhagen, Denmark.Google Scholar
  5. Brown AR, Taylor GJ, Gregg PJ (1996). Air contamination during skin preparation and draping in joint replacement surgery. The Journal of Bone and Joint Surgery (British Volume), 78: 92–94.Google Scholar
  6. CFX (2001). CFX 5.1. Flow solver user guide. Oxfordshire, UK: Harwell Laboratory.Google Scholar
  7. Charnley J (1964). A clean-air operating enclosure. British Journal of Surgery, 51: 202–205.CrossRefGoogle Scholar
  8. Chen Q (1995). Comparison of different k-ɛ models for indoor airflow computations. Numerical Heat Transfer, Part B, 28: 353–369.CrossRefGoogle Scholar
  9. Choi JI, Edwards JR (2008). Large-eddy simulation of human-induced contaminant transport in room compartments. Indoor Air, 18: 233–249.CrossRefGoogle Scholar
  10. Choi JI, Edwards JR (2012). Large eddy simulation and zonal modeling of human-induced contaminant transport. Indoor Air, 22: 77–87.CrossRefGoogle Scholar
  11. Chow TT, Yang XY (2003). Performance of ventilation system in a non-standard operating room. Building and Environment, 38: 1401–1411.CrossRefGoogle Scholar
  12. Cook MJ, Lomas KJ (1998). Buoyancy-driven displacement ventilation flows: Evaluation of two eddy viscosity turbulence models for prediction. Building Services Engineering Research and Technology, 19:15–21.CrossRefGoogle Scholar
  13. Finlayson EU, Gadgil AJ, Thatcher TL, Sextro RG (2004). Pollutant dispersion in a large indoor space. Part 2: Computational fluid dynamics predictions and comparison with a scale model experiment for isothermal flow. Indoor Air, 14: 272–283.CrossRefGoogle Scholar
  14. Hambraeus A (1988). Aerobiology in the operating room-A review. Journal of Hospital Infection, 11(Supplement 1): 68–76.CrossRefGoogle Scholar
  15. Hirsch C (1991). Numerical Computation of Internal and External Flows, Volume 1. New York: John Wiley & Sons.Google Scholar
  16. Hoffman PN, Williams J, Stacey A, Bennett AM, Ridgway GL, Dobson C, Fraser I, Humphreys H (2002). Microbiological commissioning and monitoring of operating theatre suites. Journal of Hospital Infection, 52: 1–28.CrossRefGoogle Scholar
  17. Lidwell OM, Elson RA, Lowbury EJL (1987). Ultra-clean air and antibiotics for prevention of postoperative infection. A multicenter study of 8052 joint replacement operations. Acta Orthopaedica Scandinavica, 58: 4–13.CrossRefGoogle Scholar
  18. Lidwell OM, Lowbury EJL, Whyte W, Blowers R, Stanley SJ, Lowe D (1982). Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomized study. British Medical Journal, 285:10–14.CrossRefGoogle Scholar
  19. MacDonald DA (1995). The infected joint replacement: Prevention, diagnosis and treatment. Current Orthopaedics, 9: 21–27.CrossRefGoogle Scholar
  20. National Health Service Estates (1994). Health Technical Memorandum 2025: Ventilation in Healthcare Premises. London: HMSO.Google Scholar
  21. Plowman RM, Graves N, Roberts JA (1997). Hospital Acquired Infection. London: Office of Health Economics.Google Scholar
  22. Thorsuage J (1982). Air velocity fluctuations in the occupied zone of ventilated spaces. ASHRAE Transactions, 88(2): 753–754.Google Scholar
  23. Tinker JA, Roberts D (1998). Indoor air quality and infection problems in operating theatres. Paper presented at EPIC 1998, Lyon, France.Google Scholar
  24. Whyte W, Hambraeus A, Laurell G (1992). The relative importance of the routes and sources of wound contamination during general surgery, II Airborne. Journal of Hospital Infection, 22: 41–54.CrossRefGoogle Scholar
  25. Whyte W, Hambraeus A, Laurell G and Hoborn J (1991). The relative importance of routes and sources of wound contamination during general surgery, I Non-airborne. Journal of Hospital Infection, 18: 93–107.CrossRefGoogle Scholar
  26. Whyte W, Hodgson R, Tinkler J (1982). The importance of airborne bacterial contamination of wounds. Journal of Hospital Infection, 3: 123–135.CrossRefGoogle Scholar
  27. Whyte W, Lidwell OM, Lowbury EJL, Blowers R (1983). Suggested bacteriological standards for air in ultraclean operating rooms. Journal of Hospital Infection, 4: 133–139.CrossRefGoogle Scholar
  28. Yakhot V, Orszag SA, Thangam S, Gatski TB, Speziale CG (1992) Development of turbulence models for shear flows by a double expansion technique. Physics of Fluids A, 4: 1510–1520.CrossRefzbMATHMathSciNetGoogle Scholar
  29. Zoon W, Loomans M (2011). Testing the effectiveness of operating room ventilation with regard to removal of airborne bacteria. Building and Environment, 46: 2570–2577.CrossRefGoogle Scholar

Copyright information

© Tsinghua University Press and Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Gearoid P. Lydon
    • 1
    • 2
    Email author
  • Derek B. Ingham
    • 1
  • Monjur M. Mourshed
    • 3
  1. 1.Centre for Computational Fluid DynamicsUniversity of LeedsLeedsUK
  2. 2.IRUSE, Department of Civil EngineeringUniversity College CorkCorkIreland
  3. 3.School of EngineeringCardiff UniversityWalesUK

Personalised recommendations