The Promise of Cleaner OR Air

Laminar air flow in an operating room is carefully designed to prevent airborne contaminants from reaching the sterile field. However, even the most perfectly constructed ORs can’t fully prevent infectious particles from landing in surgical incisions. “The biggest infection risk in the room is the flora shed by patients and providers,” says Linda L. Dickey, RN, MPH, CIC, CPHQ, FAPIC, who owns her own healthcare consulting company.

She points to the potential benefits of filtering OR air or treating it with UV-C disinfection to eliminate the airborne contaminants that increase infection risks. The technology has been around for a while, but the pandemic — as well as some recent facility design guideline changes — has added a new urgency to the debate about whether surgical facilities should invest in systems that purify the air around the surgical table. Consider some of the more exciting air purification technologies on the market to decide for yourself:

• Overhead systems. Ceiling LED light units with integrated UV-C disinfection capabilities provide uninterrupted protection against airborne pathogens. Integrated fans draw air in through a vent at one end of the light unit and into the UV-C chamber, where it’s treated before being pushed out a vent at the opposite side of the unit. Unlike whole room UV-C disinfection systems that require ORs to be empty while they’re activated and rely on maintaining a direct line of site with the surfaces being treated, air purification systems can be used safely and continuously with staff in the room.

“The benefit is that UV-C air purification is one of most effective methods for killing contaminants,” says Mike Zorich, PE, LEED, AP, principal/director of healthcare at IMEG Corp, an enginering consulting firm. “That’s been proven.”

UV-C is one of the best sources for killing contaminants.
— Mike Zorich, PE, LEED, AP

• Portable units. These mobile devices, which employ HEPA filtration and UV-C disinfection, can be wheeled directly into an OR and strategically placed in a location near the sterile field where the unit takes in and treats contaminated air. HEPA filtration and UV-C light is certainly a powerful combination, but Mr. Zorich says there is one drawback facilities don’t often consider. “These units generate a lot of noise,” he says. “In a busy OR where staff are trying to communicate, that could become an issue.” He believes, however, that as the technology evolves, upgrades made to future models will remedy the noise issue.

• Increased air exchanges. While the bulk of air purification systems incorporate UV-C, HEPA filtration, or both, a developing technology aims to eliminate particulates within the sterile field simply by increasing the number of air exchanges. “These systems provide between 80 to 90 exchanges per hour directly over the patient to reduce particulate counts within the sterile field,” says Mr. Zorich. 

As with any equipment investment, determining which air purification system is right for your facility depends on a number of factors. However, Mr. Zorich urges surgical leaders to approach air purification systems with realistic expectations about what the technology can do and, perhaps more importantly, what it cannot do. “Does this technology help reduce the risk posed by airborne contaminants? Yes,” he says. “Is it the silver bullet some facilities are looking for? In my opinion, no.” Still, he says, air purification systems can aid in breaking the chain of infection.

Mr. Zurich also points out the technology is only going to improve and evolve moving forward. If you’re interested in adding continuous air purification to your infection prevention efforts, Mr. Zorich suggests talking to prospective vendors about the future applications of their offerings. Whenever he consults with a client, he emphasizes the importance of ensuring the platforms they invest in today will be applicable tomorrow. COVID-19 has changed the current focus of infection control practices, and your facility must be outfitted to help your surgical team perform safe surgery, whether it’s preventing SSIs or dealing with another worldwide pandemic. 

You also have to factor in new and emerging guidelines regarding air distribution within the OR when determining what level of air treatment is needed in your facility. One clear example is HEPA filtration. Until recently, HEPA filters weren’t required in ORs, but that changed with updated guidance from the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), says Mr. Zorich. “ASHRAE has a big influence on healthcare design requirements, and its latest standard says HEPA filters are required within orthopedic ORs.”

In addition to working closely with potential vendors and evaluating the upfront costs of air purification systems, as well as the energy and maintenance costs associated with continuous usage of the units, involve your infection preventionists when discussing the technology’s potential benefits.

“Ultimately, facilities are considering adding air purification systems because of the SSI-prevention capabilities,” says Ms. Dickey. “That’s infection control’s area of expertise.” She suggests working with your infection preventionists to track your facility’s SSI rates, the types of infections and the specialties in which they occur to help you decide if air purification systems are worth the investment.

Finally, keep a close watch on this technology and the growing market it represents. “We’re learning more about these platforms, and the best ways to apply them,” says Mr. Zorich. “If there’s a space within the healthcare setting that’s continuing to evolve, it’s the OR.” OSM