Traffic flow in the operating room: an explorative and descriptive study on air quality during orthopedic trauma implant surgery

Am J Infect Control. 2012 Oct;40(8):750-5. doi: 10.1016/j.ajic.2011.09.015. Epub 2012 Jan 29.


Background: Understanding the protective potential of operating room (OR) ventilation under different conditions is crucial to optimizing the surgical environment. This study investigated the air quality, expressed as colony-forming units (CFU)/m(3), during orthopedic trauma surgery in a displacement-ventilated OR; explored how traffic flow and the number of persons present in the OR affects the air contamination rate in the vicinity of surgical wounds; and identified reasons for door openings in the OR.

Methods: Data collection, consisting of active air sampling and observations, was performed during 30 orthopedic procedures.

Results: In 52 of the 91 air samples collected (57%), the CFU/m(3) values exceeded the recommended level of <10 CFU/m(3). In addition, the data showed a strongly positive correlation between the total CFU/m(3) per operation and total traffic flow per operation (r = 0.74; P = .001; n = 24), after controlling for duration of surgery. A weaker, yet still positive correlation between CFU/m(3) and the number of persons present in the OR (r = 0.22; P = .04; n = 82) was also found. Traffic flow, number of persons present, and duration of surgery explained 68% of the variance in total CFU/m(3) (P = .001).

Conclusions: Traffic flow has a strong negative impact on the OR environment. The results of this study support interventions aimed at preventing surgical site infections by reducing traffic flow in the OR.

MeSH terms

  • Air / standards*
  • Air Microbiology*
  • Air Pollution, Indoor / adverse effects
  • Air Pollution, Indoor / prevention & control*
  • Colony Count, Microbial
  • Data Collection
  • Hospitals, University
  • Humans
  • Operating Rooms / standards*
  • Orthopedics
  • Prostheses and Implants
  • Surgical Wound Infection / prevention & control*
  • Sweden
  • Time Factors
  • Ventilation / standards
  • Wounds and Injuries / surgery