OR air not as sterile, clean as expected



Hassan T. New considerations and solutions for operating room and office sterility. Presented at: Retina World Congress; May 12-15, 2022; Fort Lauderdale, Fla.

Hassan reports consulting for SurgiCube.

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FORT LAUDERDALE, Fla. — Patient care areas, including operating rooms, might not have as clean or sterile air as most people think, according to a speaker at the Retina World Congress.

“Ventilation systems in our patient care areas are not optimized to eliminate dangerous airborne particles,” Tarek S. Hassan, MD, said. “Within the operating room air, we have multiple particles that come from droplets, skin scales, the patients, instruments, which is a potential source for surgical site infection in a lot of specialties, as well as patient, doctor and staff infections .”

Tarek S. Hassan

Hassan said conventional mixed ventilation systems in which air flows in from the ceiling and flows out at points in the upper and lower parts of the wall create diffuse turbulent air that mixes and dilutes particles throughout the room. What is needed, he said, is a downward laminar flow system that directs inflowing air from the ceiling to the lower parts of the side walls. This creates unidirectional parallel lines of air flow that sweep particles away in one direction, ideally into HEPA filters, he said.

Even in rooms that have this setup, Hassan said they routinely do not operate properly because of blocked outflow or other factors.

Hassan and colleagues conducted a study to measure baseline particle counts in several areas in their workplace, including exam rooms, the cafeteria and operating rooms. While the ORs had lower levels of larger particles than “presumed dirtier” areas, they actually had higher levels of small particles that rose after the first patient of the day.

Hassan’s team then tested the same spaces with mobile laminar air flow hoods to filter the air and saw immediate reductions in both small and large particles.

Although patient care areas are not as clean as expected, Hassan said there are pathways to improvement.

“Current technology can improve air cleanliness now,” he said. “There are new devices that can make the air in any space cleaner than your current operating room air.”

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