Hostname: page-component-848d4c4894-hfldf Total loading time: 0 Render date: 2024-05-01T02:32:11.167Z Has data issue: false hasContentIssue false
  • English
  • Français

Shutting Down Operating Theater Ventilation When the Theater Is Not in Use: Infection Control and Environmental Aspects

Published online by Cambridge University Press:  02 January 2015

Markus Dettenkofer ,
M. Scherrer ,
V. Hoch ,
H. Glaser ,
G. Schwarzer ,
J. Zentner  and
F. D. Daschner
Markus Dettenkofer*
Affiliation:
Institute of Environmental Medicine and Hospital Epidemiology, Freiburg University Hospital, Freiburg, Germany
M. Scherrer
Affiliation:
Institute of Environmental Medicine and Hospital Epidemiology, Freiburg University Hospital, Freiburg, Germany
V. Hoch
Affiliation:
Institute of Environmental Medicine and Hospital Epidemiology, Freiburg University Hospital, Freiburg, Germany
H. Glaser
Affiliation:
Hospital Engineering Department, Freiburg University Hospital, Freiburg, Germany
G. Schwarzer
Affiliation:
Institute of Medical Biometry and Medical Informatics, Freiburg University Hospital, Freiburg, Germany
J. Zentner
Affiliation:
Department of Neurosurgery, Freiburg University Hospital, Freiburg, Germany
F. D. Daschner
Affiliation:
Institute of Environmental Medicine and Hospital Epidemiology, Freiburg University Hospital, Freiburg, Germany
*
Institute of Environmental Medicine and Hospital Epidemiology, Hugstetter Str. 55, 79106 Freiburg, Germany
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

In hospital operating rooms (ORs), specially conditioned air is supplied to protect patients from airborne agents that may cause infections. This study investigated whether it is hygienically safe to shut down the air supply at night if measures are taken to ensure a timely restart before surgery is performed.

Design:

Experimental study.

Setting:

Neurosurgical OR of a German university hospital.

Methods:

The ventilation system was switched off and restarted after 10 hours. Particles suspended in the air near the operating table were counted, OR temperature was measured, and settle plates were exposed and incubated.

Results:

In 13 investigations, a median of 1.3 × 104 particles 0.5 μm/m3 or greater (range, 5.8 × 103 to 1.1 × 105) were documented immediately after restart in the morning. After 10 minutes and subsequently, no test showed a particle count exceeding the threshold limit of 1.0 × 104 particles 0.5 μm/m3 or greater recommended by the German Society of Hygiene and Microbiology. Only a few colony-forming units (CFU) were detected per settle plate (median, 0 CFU/60 cm2; range, 0 to 8) and OR temperatures quickly reached normal levels.

Conclusions:

Shutting down OR ventilation during off-duty periods does not appear to result in an unacceptably high particle count or microbial contamination of the OR air shortly after the system is restarted. Because substantial energy and cost savings are likely, this should be considered in hygienically safe heating, ventilation, and air conditioning systems. However, normal ventilation should be established at least 30 minutes before surgical activity.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 8 , August 2003 , pp. 596 - 600
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Humphreys, H. Infection control team in the operating room: separating aspiration from reality. J Hosp Infect 1999;42:265–267.CrossRefGoogle ScholarPubMed
2.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR, the Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999;20:247–280.CrossRefGoogle ScholarPubMed
3.Roy, M-C. The operating theater: a special environmental area. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. Baltimore: Williams & Wilkins; 1997:516–538.Google Scholar
4.Wong, ES. Surgical site infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia: Iippincott, Williams & Wilkins; 1999:189–210.Google Scholar
5.Deutsches Institut für Normung. DIN 1946-4: Raumlufttechnische Anlagen in Krankenhäusern [HVAC Systems in Hospitals]. Berlin: Beuth-Verlag; 1999.Google Scholar
6.Babb, JR, Lynam, P, Ayliffe, GAJ. Risk of airborne transmission in an operating theatre containing four ultraclean air units. J Hosp Infect 1995;31:159–168.CrossRefGoogle Scholar
7.Robert Koch Institut. Anforderungen der hygiene bei Operationen und anderen invasiven eingriffen [Hygiene requirements during surgery and other invasive procedures]. Bundesgesundheitsblatt 2000;43:644–648. Available at www.rki.de/GESUND/HYGIENE/HYGIENE.htm.CrossRefGoogle Scholar
8.Gosden, PE, MacGowan, AP, Bannister, GC. Importance of air quality and related factors in the prevention of infection in orthopaedic implant surgery. J Hosp Infect 1998;39:173–180.CrossRefGoogle ScholarPubMed
9.Humphreys, H, Taylor, EW. Operating theatre ventilation standards and the risk of postoperative infection. J Hosp Infect 2002;50:85–90.CrossRefGoogle ScholarPubMed
10.Lidwell, OM, Elson, RA, Lowbury, EJ, et al.Ultraclean air and antibiotics for prevention of postoperative infection: a multicenter study of 8,052 joint replacement operations. Acta Orthop Scand 1987;58:4–13.CrossRefGoogle Scholar
11.Hoffman, PN, Williams, J, Stacey, A, et al.Microbiological commissioning and monitoring of operating theatre suites. J Hosp Infect 2002;52:1–28.CrossRefGoogle ScholarPubMed
12.Deutsches Institut für Normung. DIN EN DIN 1822-1 Schwebstoffilter (HEPA und ULPA) Teil 1: Klassifikation, Leistungsprüfung, Kennzeichnung [German Standards Institute, HEPA Filters]. Berlin: Beuth-Verlag; 1998.Google Scholar
13.Deutsche Gesellschaft für Hygiene und Mikrobiologie (DGHM), Kommission für Krankenhaus-und Praxishygiene. Hygienische Abnahmeprüfung und Hygienische Kontrollen nach DIN 1946 Teil 4 Raumlufttechnische Anlagen in Krankenhäusern [German Society for Hygiene and Microbiology. Hygiene approval and Standards according to DIN 1946, part 4: HVAC systems in hospitals]. Kranketthaushygiene und Infektionsverhütung 1989;11:239–241.Google Scholar
14.Bischoff, WE, Kindermann, A, Sander, U, Sander, J. Comparison of air supply ceilings (ceilings with supporting flow outlets) with laminar air flow ceilings in operating theatres of the A type (DIN 1946 Part 4) during operations. Zentralblatt für Hygiene und Umweltmedizin 1995;198:84–95.Google Scholar
15.Hartung, J. Statistik, 9th ed. Munich: Oldenbourg; 1993:163.Google Scholar
16.Friberg, B, Friberg, S, Burman, LG. Correlation between surface and air counts of particles carrying aerobic bacteria in operating rooms with turbulent ventilation: an experimental study. J Hosp Infect 1999;42:61–68.CrossRefGoogle ScholarPubMed
17.Daschner, FD, Dettenkofer, M. Protecting the patient and the environment: new aspects and challenges in hospital infection control. J Hosp Infect 1997;36:7–15.CrossRefGoogle ScholarPubMed
18.Dettenkofer, M, Kümmerer, K, Schuster, A, et al.Environmental auditing in hospitals: first results in a university hospital. Environ Manage 2000;25:105–113.CrossRefGoogle ScholarPubMed
19.Hambraeus, A, Aerobiology in the operating room: a review. J Hosp Infect 1988;11(suppl):68–76.CrossRefGoogle ScholarPubMed
20.Austrian Standards Institute. OENORM H 6020-2: Lüftungstechnische Anlagen in Krankenanstalten: Betrieb, Instandhaltung, Technische und Hygienische Kontrollen [HVAC Systems in Hospitals: Operation, Maintenance and Hygienic Controls]. Vienna: Österreichisches Normungsinstitut; 2000.Google Scholar
21.Fridkin, SK, Kremer, FB, Bland, LA, Padhye, A, McNeil, MM, Jarvis, WR, Acremonium kiliense endophthalmitis that occurred after cataract extraction in an ambulatory surgical center and was traced to an environmental reservoir. Clin Infect Dis 1996;22:222–227.CrossRefGoogle Scholar
22.Department of Health, National Health Service Estates. Ventilation in Healthcare Premises: Health Technical Memorandum no. 2025 (4 vol.). London: Her Majesty's Stationery Office; 1994.Google Scholar
23.American Institute of Architects. Draft Guidelines for Design and Construction of Hospital and Health Care Facilities. Washington, DC: American Institute of Architects. Available at www.eeicommunications.com/aia.Google Scholar