The Importance of Clean OR Air

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The science supports getting assistance for manual cleaning protocols in operating rooms and leaning on technology to purify the air.

While the jury may still be deliberating on how effective some whole-room disinfection and/or air purification systems are in reducing healthcare-associated infections, promising evidence is adding up that they do.

Research-backed

For example, a 2021 study by the Environment, Exposure Science and Risk Assessment Center (ESRAC) at the University of Arizona in Tucson found that whole-room disinfection technologies demonstrated significant reductions with a broad array of pathogens, including the highly resistant Clostridium difficile spores. C-diff is a real issue in acute-care settings and is being watched closely by infection prevention professionals in ambulatory settings as well.

“We found that the use of whole-room atomized disinfection with terminal cleaning protocols lowered manual labor times, improved disinfection outcomes and eliminated the transfer of bacterial pathogens to uncontaminated surfaces in healthcare environments,” says Kelly A. Reynolds, MSPH, PhD, director of ESRAC.

Purchasing such systems, which can be pricey, is reasonable even without a mountain of evidence as to their efficacy because, chances are, facilities will achieve a return on their investment, says J. Darell Hicks, BA, CHESP, CMIP, owner of Safe, Clean and Disinfected, a Missouri-based infection control company.

Hydrogen-Peroxide-Fogger
STAY AWAY One considersation when searching for whole room systems: Whether staff can be in the room when in use.

“You certainly achieve a cost avoidance if you do prevent infections from happening, and there’s evidence to show that less than 50% of terminally cleaned rooms actually get disinfected,” says Mr. Hicks. “That fact alone, to me, shows me there is a place for these systems in OR environments.” With all the high-tech help, it’s crucial to not slack on manual cleaning. Even if you know automated whole-room systems don’t replace between-case cleaning by nurses and overnight cleaning by environmental services, it’s important to not get complacent about manual-cleaning protocols after the purchase of an effective complement.

“Whole-room disinfection systems can be a valuable adjunct to routine disinfection and room turnover procedures. It does require leadership support for the staff training and utilization of those systems,” says Marie H. Wilson, MSN, RN, CIC, FAPIC, chair of the Association for Professionals in Infection Control and Epidemiology’s Communications Committee and an infection preventionist at Fred Hutchinson Cancer Center in Seattle. “It also requires auditing, just like any other cleaning verification that we do for performance, to ensure they’re being used properly, consistently and only as an adjunct that’s not taking place of the routine.”

TECHNOLOGY
Finding the Right System

When it comes to determining the right whole room or air-purification technology, facilities have options. Here are the major types of technology on the market:

• Robotic assistance. UV light systems on wheels, called UV robots, are the most commonly used technology used in operating rooms to fight infections. The portable, plug-and-lay devices can easily be rolled from room to room.

• Purification systems in surgical lighting. These systems can protect patients, staff and visitors from airborne bacteria, viruses and mold throughout the building. The specifics of different overhead systems vary, but they do their work essentially by providing ultraviolet germicidal irradiation (UVGI) technology placed out of sight behind traditional ceiling lights. In addition to improving air quality, the circulating fans in the system also reduce pathogens from settling on surfaces. Tucked behind ceiling lights and panels, the systems also save precious space that large portable floor models do not.

• 405nm technology. This alternative to UV lighting systems also allows for around-the-clock environmental disinfection of the air and surfaces in ORs. The bulb emits a mixture of traditional LED lighting that illuminates the room as well as the 405nm tech that disinfects it.

• Hydrogen peroxide fogging. Misting systems that produce airborne hydrogen peroxide cover every inch of a sealed OR, even those spaces that are especially hard to reach during manual cleaning. The dry mist they produce doesn’t damage any equipment from saturating it and the devices are small, extremely portable and require a minimal amount of training to operate. They’re also significantly less expensive than a UV robot. No one can be in the room when the machine is in use; HVAC vents must be sealed; and the operation should be monitored to make sure the hydrogen peroxide isn’t escaping from the room being treated.

• Air purification systems. Some industrial-grade negative pressure “portable” units can be as large as a refrigerator with multi-stages that include pre-filters, a HEPA filter and chemical filter than can process 100% of the air in an OR in less than five minutes. Traditional laminar airflow HVAC systems also work well, and there are new temperature-controlled airflow systems that create less turbulence when the air hits the OR floor, so airborne particulates are less likely to be disturbed and potentially flow above the sterile surgical field.

—Outpatient Surgery Editors

Ambulatory facilities who would be prime candidates for whole-room disinfection methods include those who have suboptimal SSI rates or those that have done risk assessments and found their manual cleaning practices to be insufficient, says Nancy Havill, MT(ASCP), MHA, CIC, an infection prevention manager at Yale New Haven Health System in Connecticut.

Hydrogen peroxide misting machines, UV robots, UV lighting systems and other disinfection products are effective but different and Ms. Havill advises that facilities educate themselves about each of them to see which one is the best fit for you. Cleaning OR air by using laminar airflow, thermal-controlled or high-level HEPA filtration systems also work well.

Just as disinfection systems don’t change the rules for manual cleaning, those in ASCs shouldn’t forget to follow the ABCs of infection prevention, reminds Frank Edward Myers, MA, CIC, FAPIC, director of infection prevention and clinical epidemiology at University of California San Diego Health.

“Of prime importance in ambulatory surgery centers is making sure: One, the patient is properly bathed; two, your instruments have been effectively sterilized; and three, the patient understands correct postoperative care,” says Mr. Myers. “Those to me must always be done properly and done well as facilities also consider investing in devices to clean the environment.”

Mr. Hicks says the additional efforts to back up manual cleaning practices are more important than ever. “With healthcare’s staffing shortages and other challenges, the human element of our efforts isn’t getting any better,” he says. “We have to do something that is more of a belt-and-suspenders approach.”

Dr. Reynolds agrees, saying successful cleaning protocols should be standardized and multimodal. “By adding a whole-room disinfection system to your infection prevention arsenal and using it properly and regularly, you provide extra assurance that the risk to your patients and staff of contracting a healthcare-associated infection will be reduced,” she says.

There are also nonclinical benefits to buying a whole-room disinfection system, says Suraj S. Soudagar, MS, MBA, LEED, principal at IMEG Corp., an Illinois-based medical equipment and engineering firm.

“They are nice to have and are effective extra measures to take, so they make sense to purchase if you can afford them,” he says. “These tools also help from a marketing perspective to tell your story, which includes that you’re doing everything you can to reduce SSIs and HAIs.” OSM

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