Assessment of operating room airflow using air particle counts and direct observation of door openings

Am J Infect Control. 2017 May 1;45(5):477-482. doi: 10.1016/j.ajic.2016.12.018. Epub 2017 Feb 13.


Background: The role of the operating room (OR) environment has been thought to contribute to surgical site infection rates. The quality of OR air, disruption of airflow, and other factors may increase contamination risks. We measured air particulate counts (APCs) to determine if they increased in relation to traffic, door opening, and other common activities.

Methods: During 1 week, we recorded APCs in 5-minute intervals and movement of health care workers. Trained observers recorded information about traffic, door openings, job title of the opener, and the reason for opening.

Results: At least 1 OR door was open during 47% of all readings. There were 13.4 door openings per hour during cases. Door opening rates ranged from 0.19-0.28 per minute. During this time, a total of 660 air measurements were obtained. The mean APCs were 9,238 particles (95% confidence interval [CI], 5,494- 12,982) at baseline and 14,292 particles (95% CI, 12,382-16,201) during surgery. Overall APCs increased 13% when either door was opened (P < .15). Larger particles that correlated to bacterial size were elevated significantly (P < .001) on door opening.

Conclusions: We observed numerous instances of verbal communication and equipment movement. Improving efficiency of communication and equipment can aid in reduction of traffic. Further study is needed to examine links between microbiologic sampling, outcome data, and particulate matter to enable study of risk factors and effects of personnel movement.

Keywords: Air quality; Infection control; Operating room; Particulate matter; Surgery; Surgical site infection.

MeSH terms

  • Air Microbiology
  • Air Movements*
  • Humans
  • Observation
  • Operating Rooms*
  • Particulate Matter


  • Particulate Matter