The Road to Cleaner OR Air

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A wide array of whole-room disinfection options and air filtration systems can help purify your surgical environment.

The jury is out on how big of a role airborne contaminants play when it comes to causing surgical site infections. There is general agreement that they are one of the contributors to the problem, however, which makes it a no-brainer to take advantage of the latest products to make the air quality in your operating rooms as clean as possible.

Extra assurance

There’s no shortage of options for surgery centers that want to make their top priority of good OR air quality align with the daily realities at their facilities. From ultraviolet robots to integrated lighting systems, misting devices and portable air purification-filtration systems, facilities have multiple options to keep microorganisms at bay.

“These things provide an added layer of protection and some assurance to facilities that they’re doing everything they can to prevent or reduce surgical-site and hospital-acquired infections,” says Luci Perri, RN, BSN, MSN, MPH, CIC, FAPIC, CSPDT, owner and president of Infection Control Results, a consulting company in Charlotte, N.C.

Robotic assistance. UV light systems on wheels, called UV robots, are the most commonly used technology in operating rooms to fight infections, says Suraj S. Soudagar, MS, MBA, LEED, principal at IMEG Corp., an Illinois-based medical equipment engineering and design firm.

“They’re effective and, depending on the power of the model, can kill 99.9% of the germs that the UV light they throw out come into contact with,” says Mr. Soudagar. The devices can cost from approximately $25,000 to $47,000 per unit. The portable, plug-and-play devices can easily be rolled from room to room. Ms. Perri notes that the robots disinfect what is in the direct line of sight of the device, which is why it automatically moves throughout the room during the hours-long treatment that takes place overnight.

The FDA has created a new medical device category that allows companies that make ultraviolet robots to market themselves as products that reduce microbial loads in healthcare settings. To date, one company has qualified for a marketing authorization that the new FDA category allows for. Essentially, the federal regulatory agency has said that UV robots designed to clean surgical spaces do indeed reduce the amount of bacteria in procedure rooms, ORs and surgical suites. The new category was created last fall and other UV robot companies are working to get the federal clearance to market themselves as companies that can help ASCs and HOPDs to reduce SSIs and HAIs.

Cleaner Air
CLEAR THE AIR Modern HVAC systems and portable purifiers filter airborne pathogens from your ORs to minimize the spread of infections.

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 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.

“UVGI systems can be operated 24/7 because it’s safe for people to be in the OR when they’re running,” notes Ms. Perri. “No one can be in the room while the UV robot is in there.”

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 and the 405nm tech that disinfects it.

“Some versions of these products also can use an occupancy sensor so it can turn itself on when no one is in the room,” adds Mr. Soudagar.

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.

Don’t Forget the ABCs of Superior Infection Prevention

Manual cleaning can keep your patients extremely safe from infection: If your staff has the time to perform it properly; if they clean according to guidelines; if they’ve been recently trained and haven’t become complacent; and if they don’t make any number of errors humans can invariably make when they’re in a hurry. UV robots, air purifiers and devices with smoke evacuation features can help as well — if facilities have them.

That’s a lot of “ifs,” which is why the basics of infection prevention should always be foundational practices in surgery centers, says Frank Edward Myers, MA, CIC, FAPIC, director of infection prevention and clinical epidemiology at University of California San Diego Health.

For example, chlorhexidine gluconate baths by patients for a few days before their procedures is likely at least as effective in preventing methicillin resistant Staphylococcus aureus (MRSA) because many patients arrive with their own flora and essentially infect themselves when the MRSA migrates into the surgical wound, notes Mr. Myers.

“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.”

—Adam Taylor

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. The treatments can take an hour or more to complete, depending on the size of your OR suite.

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.

These tools help tell your story that you’re doing everything you can to reduce SSIs and HAIs.
—Suraj S. Soudagar, MS, MBA, LEED

Mr. Myers suggests asking vendors for peer-reviewed data about the effectiveness of their products in reducing SSIs before making a purchase.

“Are having all these things absolutely necessary? No,” says Mr. Soudagar. “But they are nice to have and are effective extra measures to take, so they make sense to purchase if you can afford them.” OSM

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