Infection prevention
These reductions were sustained throughout procedural phases when personnel activity and door-opening frequency were highest, suggesting that active recirculation effectively counters the episodic contamination spikes attributable to intraoperative behavioural factors. Technologically, contemporary systems
such as continuous-flow recirculation devices incorporating multi-stage filtration – including carbon-based pre-filtration for volatile organic compound removal, an internal UV-C photolytic chamber, and a downstream HEPA barrier – offer a comprehensive approach to intraoperative air treatment. Such devices address not only infectious bioaerosols but also surgical smoke plume, bone cement fumes, and waste anaesthetic gas volatiles, constituents of occupational health relevance given evidence that perioperative nurses experience twice the
population-prevalence rate of chronic respiratory conditions.18
Platforms additionally equipped
with continuous particulate and environmental sensors enable real-time surveillance of room air quality, generating data streams that can be cross-referenced during SSI root cause analyses – a capability explicitly endorsed by the Association of peri-Operative Registered Nurses (AORN) in Recommendation 9.5.3 of its updated Guideline for Sterile Technique.19
Integration into perioperative infection prevention bundles The clinical rationale for continuous air decontamination is most compelling when understood within the conceptual framework of a bundled SSI prevention strategy. Bundles derive their efficacy from the additive and synergistic effects of individual interventions that together reduce the cumulative probability
The WHO’s 2016 Global Guidelines for the Prevention of Surgical Site Infection explicitly identified ventilation and environmental management as areas warranting ongoing investigation and investment.
of pathogen delivery to the surgical wound.4 Airborne contamination reduction addresses a distinct and incompletely mitigated pathway that is not targeted by antibiotic prophylaxis, skin antisepsis, or sterile draping alone. The World Health Organization’s 2016 Global Guidelines for the Prevention of Surgical Site Infection explicitly identified ventilation and environmental management as areas warranting ongoing investigation and investment, noting that available evidence supports the maintenance of positive pressure ventilation with high-efficiency filtration in operating theatres.20
While the WHO stopped
short of recommending specific supplemental technologies pending larger controlled trials, the mechanistic rationale and available clinical data are sufficient to support institutional adoption as part of a risk-reduction strategy, particularly in high-volume orthopedic, cardiac, and implant- based procedures where SSI consequences are most severe. Operational integration of portable air decontamination systems presents several practical advantages. Units designed according to human-factors engineering principles operate autonomously without requiring staff intervention, function without modification to existing HVAC infrastructure, and have been
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w.arxada.com July 2026 I
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