Sliding doors: how does their opening affect particulate matter levels in operating theatres?
DOI:
https://doi.org/10.3396/ijic.v18.22156Keywords:
particulate matter, operating rooms, controlled environment, ventilation, laminar flow, turbulent flowAbstract
Background: Operating theatres (OTs) have adequate conditions to perform safe operations and to prevent surgical site infections (SSIs). Opening doors can compromise these situations. Measurement of particulate contamination is a crucial point to check the effectiveness of preventive measures in the OTs. We analysed how opening the doors interact with particulate contamination in different designs of OTs.
Methods: Between January and February 2020, a cross-sectional study was conducted in five different types of OTs of a teaching hospital in Siena. Two (OTs 1 and 2) had laminar flows, with 58 and 55 air changes/h, respectively. Three had turbulent flows: OT3 (18 air changes/h, with four inlets from the ceiling), OT4 (16 air changes/h, airflow directed from one wall to the opposite one and the main door laterally to the flow) and OT5 (23 air changes/h and airflow from the ceiling plenum). Particulate matter (PM) measurements were carried out at seven different locations in each OT, alternating two conditions: 1) doors closed and 2) opening/closing the main door twice per minute. For each spot, in each condition, we recorded for several minutes the following parameters: particles (>0.3, >0.5, >1, >3, >5 and >10 µm), room temperature (RT), relative humidity (RH) and airflow velocity (AS). International Organization for Standardization (ISO) class for PM > 0.5 µm was calculated. Comparison with the Wilcoxon signed-rank test was made using Stata 16 (StataCorp LLC, College Station, TX, USA).
Results: All five OTs had differential pressure, but all fell to 0 at door opening; negligible changes were detected on microclimatic parameters although they may be affected by different types of airflows and design. Even though the variations in the turbulent flow rooms were broader and different, there were no changes in ISO class particle classification, given the already very high initial particulate levels. In laminar flow rooms, with a better ISO classification, the variations were smaller but sufficient to worsen the class.
Conclusions: When opening the doors, the PM levels in OTs are influenced by different ventilation systems and room design. Different ventilation systems and the design of OTs influence particulate levels during door opening. Particulate variations in the laminar flows studied were smaller than in the turbulent flows, which, although lower in performance in our study, can be just as effective; however, as the heterogeneous construction and logistic characteristics of OTs result in significant variations in PMs, further research is needed to determine the actual effect of airflow on the SSI rate.
Downloads
References
European Centre for Disease Control. Healthcare-associated infections: surgical site infections – annual epidemiological report for 2017. Stockholm: European Centre for Disease Prevention and Control; 2019. Available from: https://www.ecdc.europa.eu/en/publications-data/healthcare-associated-infections-surgical-site-infections-annual-1 [cited 18 June 2020].
Badia JM, Casey AL, Petrosillo N, Hudson PM, Mitchell SA, Crosby C. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect 2017 May; 96(1): 1–15. doi: 10.1016/j.jhin.2017.03.004
World Health Organization. Global guidelines for the prevention of surgical site infection, second edition. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536404/ [cited 6 July 2020].
Decree of the President of the Republic of 14 January 1997 – approval of the act of address and co-ordination to the regions and autonomous provinces on the subject of minimum structural, technological and organisational requirements for the exercise of healthcare activities by public and private structures. G.U. n. 42 of 20 February 1997 – ordinary supplement. Available from: https://www.gazzettaufficiale.it/eli/id/1997/02/20/097A1165/sg [cited 21 February 2022].
Istituto Superiore Per La Prevenzione E La Sicurezza Del Lavoro (Ispesl) – guidelines on standards of safety and hygiene at work in the operating ward; translated from ‘Linee Guida Sugli Standard Di Sicurezza E Di Igiene Del Lavoro Nel Reparto Operatorio’. ISPESL; 2009. Available from: https://www.inail.it/cs/internet/docs/linee-guida-igiene-reparto-operatorio.pdf?section=attivita [cited 15 February 2022].
Bischoff P, Kubilay NZ, Allegranzi B, Egger M, Gastmeier P. Effect of laminar airflow ventilation on surgical site infections: a systematic review and meta-analysis. Lancet Infect Dis 2017; 17(5): 553–61. doi: 10.1016/S1473-3099(17)30059-2
Davis ED, Zmistowski B, Abboud J, Namdari S. Cost effectiveness of laminar flow systems for total shoulder arthroplasty: filtering money from the OR? Arch Bone Jt Surg 2020 1; 8(1): 38–43.
Birgand G, Toupet G, Rukly S, Antoniotti G, Deschamps M-N, Lepelletier D, et al. Air contamination for predicting wound contamination in clean surgery: a large multicenter study. Am J Infect Control 2015; 43(5): 516–21. doi: 10.1016/j.ajic.2015.01.026
Vonci N, De Marco MF, Grasso A, Spataro G, Cevenini G, Messina G. Association between air changes and airborne microbial contamination in operating rooms. J Infect Public Health 2019 Dec; 12(6): 827–30. doi: 10.1016/j.jiph.2019.05.010
Gormley T, Markel TA, Jones H, Greeley D, Ostojic J, Clarke JH, et al. Cost-benefit analysis of different air change rates in an operating room environment. Am J Infect Control 2017 Dec 1; 45(12): 1318–23. doi: 10.1016/j.ajic.2017.07.024
Sadrizadeh S, Pantelic J, Sherman M, Clark J, Abouali O. Airborne particle dispersion to an operating room environment during sliding and hinged door opening. J Infect Public Health 2018; 11(5): 631–5. doi: 10.1016/j.jiph.2018.02.007
Weiser MC, Shemesh S, Chen DD, Bronson MJ, Moucha CS. The effect of door opening on positive pressure and airflow in operating rooms. J Am Acad Orthop Surg 2018; 26(5): e105–13. doi: 10.5435/JAAOS-D-16-00891
Smith EB, Raphael IJ, Maltenfort MG, Honsawek S, Dolan K, Younkins EA. The effect of laminar air flow and door openings on operating room contamination. J Arthroplasty 2013; 28(9): 1482–5. doi: 10.1016/j.arth.2013.06.012
Messina G, Spataro G, Catarsi L, Francesca De Marco M, Grasso A, Cevenini G, et al. A mobile device reducing airborne particulate can improve air quality. AIMS Public Health 2020; 7(3): 469–77. doi: 10.3934/publichealth.2020038
International Organization for Standardization (ISO). International Standard ISO 14644-1:1999. Cleanrooms and associated controlled environments – Part 1: classification of air cleanliness. Geneva, Switzerland; 1999 (revised in 2015)
International Organization for Standardization (ISO). International Standard ISO 14644-3:2005. Cleanrooms and associated controlled environments – Part 3: test methods. Geneva, Switzerland; 2005 (revised in 2019)
International Organization for Standardization (ISO). International Standard ISO 14644-4:2001. Cleanrooms and associated controlled environments – Part 4: design, construction and start-up; Geneva, Switzerland; 2001
Rezapoor M, Alvand A, Jacek E, Paziuk T, Maltenfort MG, Parvizi J. Operating room traffic increases aerosolized particles and compromises the air quality: a simulated study. J Arthroplasty 2018; 33(3): 851–5. doi: 10.1016/j.arth.2017.10.012
Scaltriti S, Cencetti S, Rovesti S, Marchesi I, Bargellini A, Borella P. Risk factors for particulate and microbial contamination of air in operating theatres. J Hosp Infect 2007 Aug; 66(4): 320–6. doi: 10.1016/j.jhin.2007.05.019
Hendiger J, Chludzińska M, Ziętek P. Influence of the pressure difference and door swing on heavy contaminants migration between rooms. PLoS One 2016; 11(5): e0155159. doi: 10.1371/journal.pone.0155159
Mitchell NJ, Evans DS, Kerr A. Reduction of skin bacteria in theatre air with comfortable, non-woven disposable clothing for operating-theatre staff. Br Med J 1978; 1(6114): 696–8. doi: 10.1136/bmj.1.6114.696
Published
How to Cite
Issue
Section
License
Authors retain copyright of their work, with first publication rights granted to IJIC. Read the full Copyright- and Licensing Statement.
