AIR QUALITY


Clean air, safer surgery: The case for filtration


Operating theatres are high-risk spaces and are therefore tightly controlled, and demand the highest standards of sterility. Yet one vital element of safety is too often underestimated – the air itself. Sanathoi Bachaspatimayum, Marketing & PR assistant at Smart Air UK, explores why filtration must sit alongside ventilation as a core safeguard for patients and staff.


For decades, ventilation has been at the centre of efforts to control airborne contamination in surgical settings. However, growing evidence and practical challenges have made something very clear; ventilation alone is not enough. The conversation must expand to include filtration as a fundamental pillar of indoor air quality in operating theatres. This article explores the interplay between ventilation and filtration in operating theatres, why the latter is often overlooked and how integrated solutions that are both smart and sustainable can better protect patients and staff while supporting long term operational goals.


Why clean air matters more than ever Airborne contaminants in operating theatres originate from people (staff and patients), equipment and even the air supply itself. These microscopic particles are often invisible to the naked eye but can carry bacteria, viruses and other pathogens. When they settle into open surgical sites, they can cause serious post-operative infections. Healthcare- associated infections (HCAIs) remain a critical priority for all healthcare facilities. Despite significant progress in infection control, the problem persists. According to the BMJ,1


an estimated 4.7per cent of adult inpatients in


general and teaching hospitals across England acquired an HCAI in 2016-17, costing the NHS approximately £2.1 bn.2 The consequences of HCAIs extend well beyond the financial. These infections often lead to prolonged hospital stays, the need for additional surgery, staff absences, and considerable emotional and physical strain on patients and their families. They are responsible for around 5.6 million occupied hospital bed days, 62,500 staff absences, and 22,800 patient deaths each year.2 Among the various types of HCAIs, Surgical Site Infections (SSIs) are among the most common, accounting for 15.7% of all reported cases. These infections are associated with a 34%-226% increase in treatment costs, due to prolonged hospital stays, readmissions and the need for re-operations. SSIs not only compromise patient safety and recovery but also place considerable financial strain on the NHS.3


Ventilation alone is not enough Operation theatres rely on ventilation systems like laminar airflow (LAF) or ultraclean ventilation (UVC) to reduce airborne contamination. These systems typically use directional airflow, high air change rates and built-in HEPA filters to help limit the spread of contaminants. However, the cleanest airflow is usually concentrated over the surgical site and instrument table and not the entire room.


October 2025 Health Estate Journal 125


As a result, areas outside the direct airflow zone may not receive the same level of protection.4


Ventilation systems,


even when well-designed, cannot guarantee that airborne particles and pathogens are consistently removed from every part of the room. While ventilation moves the air, it is filtration that removes harmful contaminants. Real-world factors such as staff movement, equipment placement, and ageing infrastructure can disturb the airflow patterns and allow contaminants to accumulate in areas beyond the direct ventilation zone.5


Studies have


shown that portable HEPA filtration units can significantly reduce aerosol concentrations, particularly in settings where existing systems are under strain or inconsistently maintained.6 Supplementary filtration can also play a crucial role


in improving air quality in high-risk zones that sit outside the optimal reach of built-in systems. In fact, research has found that portable air purifiers can significantly reduce airborne aerosol concentrations, even when used alongside standard ventilation. This suggests they may help lower the risk of airborne infection in healthcare settings where ventilation alone falls short of providing adequate protection.6,7 What is needed is a complimentary approach: ventilation to move air and filtration to clean it. Together, they offer a more complete solution to protect high-risk


Real-world factors such as staff movement, equipment placement, and ageing infrastructure can disturb airflow patterns.


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