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Air quality in the operating theatre: a perspective

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Abstract

Operating theatres are among the hospital’s most risky environments as far as infections are concerned. Surgical site infection is a serious complication of surgery, associated with increased morbidity, mortality and costs. The ambient air of the operating theatre represents an important vehicle of micro-organisms causing surgical site infection, in particular in clean operations. The aim of this paper is to give a brief historical excursus of the milestones of the prevention of airborne surgical site infections. The debated issue on the use of unidirectional airflow ventilation system is presented. Some national recommendations for threshold air microbial contamination values are reported, and the need for a European standard on air quality to provide a safe operating theatre environment for surgical patients is underlined.

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References

  • AFNOR NORMALISATION. (2013). NF S90-351 – Établissements de santé – Zones à environment maîtrisé – Exigences relatives à la maîtrisé de la contamination aéroportée. Afnor, p. 68.

  • Bischoff, P., Kunilay, N. Z., Allegranzi, B., Egger, M., & Gastmeier, P. (2017). Effect of laminar airflow ventilation on surgical site infections: A systematic review and meta-analysis. The Lancet Infectious Diseases,17, 553–561.

    Article  Google Scholar 

  • Brandt, C., Hott, U., Sohr, D., Daschner, F., Gastmeier, P., & Ruden, H. (2008). Operating room ventilation with with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery. Annals of Surgery,248, 695–700.

    Article  Google Scholar 

  • Charnley, J. (1964). A sterile-air operating enclosure. The British Journal of Surgery,51, 195–202.

    Article  CAS  Google Scholar 

  • Charnley, J. (1972). Postoperative infection after total hip replacement with special reference to air contamination in the operating room. Clinical Orthopaedics and Related Research,87, 167–187.

    Article  CAS  Google Scholar 

  • European Centre for Disease Prevention and Control. (2013). Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. Sthockholm: ECDC.

    Google Scholar 

  • Friberg, B., Friberg, S., & Burman, L. G. (1999). Inconsistent correlation between aerobic bacterial surface and air counts in operating rooms with ultraclean laminar air flows: proposal of a new bacteriological standard for surface contamination. Journal Hospital Infection,42, 287–293.

    Article  CAS  Google Scholar 

  • German Society of Hospital Hygiene (DGKH). (2018). Air quality in the Operating Room: Surgical Site Infections, HVAC Systems and Discipline.

  • H+ Die Spitäler der Schweiz. (2007). Klassifizierung und technishe Anfordungen an Spitälraume. Bern.

  • Health Technical Memorandum 2025. (1994). Ventilation in healthcare premises. Part 3. Validation and verification. London: National Health Service.

    Google Scholar 

  • Health Technical Memorandum 03-01. (2007). Specialised ventilation for healthcare premises. Norwich: TSU.

    Google Scholar 

  • Istituto Superiore per la Previdenza e la Sicurezza sul Lavoro, ISPESL, National Institute for Occupational Safety and Prevention). (1999). Linee Guida sugli Standard di Sicurezza e di Igiene del Lavoro nel Reparto Operatorio. ISPESL; rev. 2009.

  • Lidwell, O.M. (1988). Air, antibiotics and sepsis in replacements joints. Journal of Hospital Infection, 11(Suppl. C), 18–40.

    Article  Google Scholar 

  • Lidwell, O. M., Lowbury, E. J. L., Whyte, W., Blowers, R., Stanley, S. J., & Lowe, D. (1982). Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. British Medical Journal,285, 10–14.

    Article  CAS  Google Scholar 

  • Lister, J. B. (1909). Collected papers. Oxford: Clarendon Press.

    Google Scholar 

  • Lowbury, E. J. L., & Lidwell, O. M. (1978). Multi-hospital trial on the use of ultraclean air systems in orthopaedic operating rooms to reduce infection: preliminary communication. Journal of the Royal Society of Medicine,71, 800–806.

    Article  CAS  Google Scholar 

  • Noble, W. C. (1975). Dispersal of skin organisms. British Journal of Dermatology,1975(93), 477–485.

    Article  Google Scholar 

  • Pasquarella, C., Barchitta, M., D’Alessandro, D., Cristina, M. L., Mura, I., Nobile, M., et al. (2018). Heating, ventilation and air conditioning (HVAC) system, microbial air contamination and surgical site infection in hip and knee arthroplasties: the GISIO-SItI Ischia study. Annali di Igiene,30(5 Suppl 2), 22–35.

    CAS  Google Scholar 

  • Pasquarella, C., Pitzurra, O., & Savino, A. (2000). The index of microbial air contamination. Journal of Hospital Infection,46, 241–256.

    Article  CAS  Google Scholar 

  • Société Française d’Hygiène Hospitalière (SF2H). AVIS N° 2018-02/SF2H du 23 mars 2018 relatif au traitement d’air au bloc opératoire pour la prévention du risque infectieux en chirurgie.

  • Swedish Standard Institute. (2015). Mikrobiologisk renhet i operationsrum–Förebyggande av luftburen smitta–Vägledning och grundläggande krav». Stockholm: SIS.

    Google Scholar 

  • World Health Organization. (2016). Global Guidelines for the prevention of surgical site infection. Geneva, Switzerland: WHO Press.

    Google Scholar 

Download references

Acknowledgements

This paper is dedicated to the 25th anniversary of the Italian Study Group of Hospital Hygiene (GISIO) of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI).

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Correspondence to Cesira Pasquarella.

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Pasquarella, C., Agodi, A., Auxilia, F. et al. Air quality in the operating theatre: a perspective. Aerobiologia 36, 113–117 (2020). https://doi.org/10.1007/s10453-019-09584-0

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  • DOI: https://doi.org/10.1007/s10453-019-09584-0

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