You can’t see them, but they’re there. Minute traces of airborne dust particles, skin cells and microbes are swirling around the sterile field, waiting to touch down on instruments, surfaces, implants and surgical wounds. Our research has shown that numerous bacteria move throughout the OR air, even in the presence of an adequate ventilation system (HVAC) with laminar flow. The amount of airborne particulate in the OR air is directly correlated to the number of people in the room during a case — it’s estimated that 30% of surgical team members are carriers of Staphylococcus aureus. When staff members move into and out of the OR during surgery, they interrupt laminar airflow, which increases the risk of airborne contaminants reaching the sterile field. Laminar flow is also disrupted when its currents hit stationary objects around the surgical table.

Current standards for OR air quality are based on engineering requirements for air flow and ventilation. They do not address specific evidence-based criteria for the quantitative reduction of viable microbial aerosols. So how do you measure and manage potentially infectious aerosols in the OR air?

There are no practical ways. Perhaps that’s why infection preventionists often focus on contact contamination, aseptic technique, the shedding of skin flora from surgical team members and patients, surface disinfection and hand hygiene in their efforts to reduce contamination risks in the OR.

That’s certainly understandable. But we now have access to sophisticated data that clearly show airborne contamination is occurring in the OR. There is also an increasing body of clinical evidence documenting that airborne microbial populations can contaminate the surgical wound and increase the risk of post-op infection, especially during joint replacement cases. Our own studies have shown that airborne gram-positive bacteria were present within 1 meter of the surgical wound in an OR with optimal laminar flow and regular air exchanges (osmag.net/N4hAZv). Numerous other studies have linked airborne contamination to orthopedic SSIs.

There are many barriers to improving infection control practices, including a lack of administration support for embracing evidence-based risk-reduction technologies. The reasons for this reluctance vary from facility to facility, but cost and a failure to understand how these innovative technologies can be successfully integrated into a risk-reduction strategy are leading factors. That needs to change, especially as increasing numbers of complex procedures shift to the outpatient setting.

Sophisticated data clearly show airborne contamination is occurring in the OR.

For example, orthopedic surgeons will be replacing about 4.5 million total joints a year by 2030. Experts estimate that implant infections will occur in 2% of the cases. It will conservatively cost between $6 billion and $9 billion a year to manage and treat those adverse events.

We need to take an evidence-based approach to lowering risks of post-op infections. The use of UV-C to reduce airborne microbial contamination in the OR represents but one component of a future risk-reduction strategy that needs to involve both patients and healthcare professionals. Surgeons, OR personnel and infection preventionists will lead the way, but it’s the surgical administrators who green light investments in effective solutions for improving surgical patient outcomes. OSM