Hygienic Inspections of Ventilation Systems Under Resting Conditions (According to DIN 1946-4:1999-03) - A Retrospective Assessment

Abstract

Hygienic and microbiologically sterile air quality is essential for successful guideline-based work in operating theatres. To ensure clean air and to reduce contamination during surgery, ventilation systems are indispensable. Ventilation systems should be especially designed to keep the number of particles and germs under statutory limits. Therefore, they must be operated to recognised standards of good practice and be periodically inspected and maintained. The objective of this study was to prove, through the analysis of observation outside surgery time (rest condition), the effects of ventilation systems on air quality in a medical facility. Measurements were taken in 34 operating theatres annually over a period of ten years outside surgery time (resting condition) but with the air ventilation system operating under full load. 29 operating theatres were provided with laminar air flow and five theatres with turbulent air flow systems. In each operating theatre, air cleanliness was analysed by measuring the amount of airborne particles and airborne germs. Measuring points were determined 10 mm beneath the supply-air ceiling in the centre of the operating theatre and at one position outside the supply-air ceiling. The number of airborne particles at the supply-air ceiling was between 0/m³ and 4,441/m³ of air and, as such, the limiting factor was never exceeded. However, airborne germ measurements of between 0 CFU/m³ and 200 CFU/m³ (CFU: colony forming units) demonstrated that the limiting factor for this criterion was exceeded in 10.9% of occasions. In general, the values in the middle of the room were higher than at the supply-air ceiling. There were significant differences (p < 0.001) between the values at the supply-air ceiling, the surgery table and the values outside the supply-air ceiling. The results show the positive impact of ventilation systems on the air cleanliness in operating theatres. However, laminar airflow systems seem to create cleaner air than conventional ventilation systems. The size of the supply-air ceiling plays an important role in the prevention of the contamination of the staff, the surgical field, the instrument table and the patient. However, the effect on surgical site infections has not been verified. Improved measuring methods should be considered.