Starting with the air handling unit, new features concerning energy efficient air treatment in combination with optimisation of required space were presented. Strategic concepts for the supply of one or more operating suites with a modular based air handling system were discussed. The operating theatre ceiling itself, as a major part of the whole integrated system, is no longer a simple air outlet: additional functions have been added in so-called media-bridges, so that it has changed towards a medical apparatus serving as a daily tool for the physicians and the operating staff. Last and not least, the servicing of the whole system has become an integral part of the facility management with remote access to the main functions and controls. The results are understood to be the basis for a discussion with specialists from medical and hygienic disciplines as well as with technically orientated people representing the hospital and building-engineering.