An evaluation of the environmental factors that impact on operating room air quality and the risk for development of surgical site infections.

Ms Karen Mckenna1, Ms  Anastasia  Hutchinson2, Mrs Mal Butler1

1Mercy Health, Heidelberg, Australia, 2Deakin University, Center for Quality & Patient Safety Research, Melbourne, Australia


Surgical site infections (SSIs) have substantial impacts on patient outcomes and are associated with increased healthcare costs. A scoping review identified two areas for infection prevention associated with SSIs. Preoperative screening and optimisation of patient risk factors, and intraoperative interventions that included surgical technique, prophylactic antibiotics and adherence to infection prevention practices.


An integrative review was completed focusing on behavioural factors that may affect air quality, surface contamination and microbial load in the operating room (OR). The aims of this integrative review were: (1) to evaluate evidence for the impact of surgical attire on air quality & surface contamination and (2) to evaluate the evidence that increased foot traffic has negative impacts on air quality and SSI rates.


The integrative approach was chosen as included studies used a wide range of research designs. The study population was patients undergoing joint replacement surgery. The intervention/exposure included studies evaluating: OR foot traffic and choice of surgical attire. Outcome measures were: Air Quality in the OR, staff compliance with guidelines and staff behaviour change.


This integrative review found that increased foot traffic and OR door openings have a negative impact on OR air quality. Cloth or disposable skull caps result in lower rates of particle shedding than disposable bouffant hats. Quality Improvement interventions had a limited impact on staff behaviour change.


There is limited research available evaluating the impact of staff behaviour on SSI rates with most recommendations for practice based on expert opinion.


Karen McKenna is the Group Manager for Infection Prevention & Control at Mercy Health Victoria. She has worked in  Infection Prevention and Control and surgical surveillance since 2009, in both the public and private healthcare systems in Australia and the Middle East.

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