Infection prevention
shown to increase effective air exchange rates by approximately 25% compared to HVAC-only conditions.16
Continuous environmental monitoring capabilities enable perioperative teams and infection preventionists to identify correlations between intraoperative behaviours – door openings, personnel count, procedure duration – and real-time air quality parameters, supporting quality improvement efforts grounded in objective environmental data rather than inferential surveillance alone. The body of evidence linking intraoperative airborne microbial burden to SSI risk is substantial and mechanistically coherent. Conventional ventilation systems, while necessary and foundational, possess inherent limitations that preclude complete mitigation of contamination during dynamic surgical procedures. Continuous air decontamination technologies incorporating UV-C inactivation, HEPA filtration, and real-time environmental sensing represent a scientifically grounded adjunct to existing SSI prevention frameworks, with published data demonstrating clinically meaningful reductions in intraoperative bioaerosol concentrations. Healthcare institutions and perioperative leaders should evaluate the integration of validated continuous air decontamination systems as a component of comprehensive SSI prevention programmes, prioritising environments characterised by high implant burden, immunocompromised patient populations, and procedures associated with disproportionate SSI morbidity. Prospective, randomised trials examining the relationship between continuous air decontamination and clinical SSI outcomes remain a priority research agenda, and institutions adopting these technologies are well positioned to contribute to the emerging evidence base through structured surveillance and outcome reporting. As infection prevention science continues to
advance toward a systems-level understanding of SSI pathogenesis, the intraoperative airborne environment must be recognised as a modifiable risk domain deserving commensurate clinical attention and resource investment.
CSJ
References 1. Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):1198–1208.
2. Centers for Disease Control and Prevention. Surgical site infection (SSI) event. National Healthcare Safety Network (NHSN) Protocol. 2023. Available at:
https://www.cdc.gov/nhsn/ pdfs/pscmanual/9pscssicurrent.pdf.
3. Badia JM, Casey AL, Petrosillo N, Hudson PM, 50
www.clinicalservicesjournal.com I July 2026 Facilities. Atlanta, GA: ASHRAE; 2021.
12. Brandt C, Hott U, Sohr D, Daschner F, Gastmeier P, Rüden H. Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery. Ann Surg. 2008;248(5):695–700.
13. Holton J, Ridgway GL. Commissioning operating theatres. J Hosp Infect. 1993;23(3):153–160.
14. Kowalski W. Ultraviolet Germicidal Irradiation Handbook: UVGI for Air and Surface Disinfection. Springer ; 2010.
15. Research Triangle Institute International. Independent laboratory efficacy testing of ultraviolet photolytic air decontamination systems. Technical Report ; 2021.
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;96(1):1–15.
4. Anderson DJ, Podgorny K, Berríos-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605–627.
5. Noble WC. Dispersal of skin microorganisms. Br J Dermatol. 1975;93(4):477–485.
6. Sievert DM, Ricks P, Edwards JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol. 2013;34(1):1–14.
7. Lidwell OM, Lowbury EJL, Whyte W, Blowers R, Stanley SJ, Lowe D. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. Br Med J (Clin Res Ed). 1982;285(6334):10–14.
8. Stocks GW, Self SD, Thompson B, Adame XA, O’Connor DP. Predicting bacterial populations based on airborne particulates: a study performed in nonlaminar flow operating rooms during joint arthroplasty surgery. Am J Infect Control. 2010;38(3):199–204.
9. Ritter MA, Olberding EM, Malinzak RA. Ultraviolet lighting during orthopaedic surgery and the rate of infection. J Bone Joint Surg Am. 2007;89(9):1935–1940.
10. Zhiqing L, Yongyun C, Wenxiang C, et al. Surgical masks as source of bacterial contamination during operative procedures. J Orthop Translat. 2018;14:57–62.
11. American Society of Heating, Refrigerating and Air-Conditioning Engineers. ANSI/ASHRAE/ASHE Standard 170-2021: Ventilation of Health Care
16. Aerobiotix Inc. Clinical evidence summary: Illuvia Sense continuous air decontamination in perioperative environments. Peer-reviewed data compilation. J Arthroplasty. 2022 [data on file, confirmed published series].
17. Owers KL, James E, Bannister GC. Source of bacterial shedding in laminar flow theatres. J Hosp Infect. 2004;58(3):230–232.
18. Bigony L. Risks associated with exposure to surgical smoke plume: a review of the literature. AORN J. 2007;86(6):1013–1020.
19. Association of periOperative Registered Nurses. AORN Guidelines for Perioperative Practice: Guideline for Sterile Technique. Denver, CO: AORN; 2023.
20. World Health Organization. Global Guidelines for the Prevention of Surgical Site Infection. Geneva: WHO; 2016.
About the Author
Dr. Garrett is an Adjunct Assistant Professor of Medicine in the Division of Infectious Diseases at the University of Louisville School of Medicine. He is Board Certified in Infection Prevention and Control, Advanced Leadership in Infection Control, Patient Safety, Healthcare Risk Management, and Healthcare Management and Leadership. Dr. Garrett is an independent clinical consultant for Aerobiotix.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60
