Integration of Air and Surface Disinfection in the Operating Theatre Environment: Protocol Development
A Holistic Approach to Operating Theatre Hygiene
During surgical procedures, the patient’s tissues are exposed to the external environment in their most vulnerable state. At this point, the pathogen load in the environment is a variable that directly affects the success of the operation. Whilst air purification and surface disinfection are typically treated as two separate processes in traditional methods, modern medicine has demonstrated the interdependence of these two elements. The settling of airborne particles onto surfaces (sedimentation) or the contamination of the air by surface activity (aerolisation) explains why disinfection must be managed through an ‘integrated’ protocol.
Surgical site infection prevention strategies must be built upon a traceable and standardised protocol that covers every square centimetre and every cubic metre of air in the operating theatre.
I. The Microbiological Bridge Between Air and Surfaces
Microorganisms are not static in the operating theatre environment. Airflow, staff movement and the moisture generated during surgical procedures facilitate the transfer of pathogens.
A. Transition from Air to Surface: Particle Settling
When operating theatre air disinfection is inadequate, airborne Staphylococcus aureus or Aspergillus spores settle onto the surgical table, instrument trays, or directly onto the incision site due to the force of gravity. This means that, no matter how clean the surfaces are, airborne contamination can contaminate the surface within seconds.
B. Surface-to-Air Transmission: The Turbulence Effect
Incorrectly applied surface cleaning methods (such as dry sweeping or inappropriate wiping techniques) stir up dust and microorganisms from the surface into the air. The only way to break this ‘re-contamination’ cycle is to apply air and surface disinfection simultaneously or in a complementary sequence.
II. Operating Theatre Air Disinfection Technologies and Protocols
Operating theatre air is responsible for approximately 30% of surgical site infections. Therefore, maintaining the microbiological quality of the air is a cornerstone of the protocol.
- HEPA Filtration and Positive Pressure: HVAC systems in operating theatres filter the majority of the air. However, staff entry and the opening of doors can momentarily compromise this system.
- Hydrogen Peroxide Fogging: The hydrogen peroxide-based cold fogging method (e.g. Detrosan Air) is effective in disinfecting surfaces, including hard-to-reach areas, by dispersing throughout the room. With its broad-spectrum and sporicidal action, it contributes to a high level of environmental hygiene.
- Continuous Air Disinfection: Some modern units incorporate UV-C or plasma technologies that sanitise the air without disturbing staff, even whilst operations are ongoing.
III. Disinfection of Critical Surfaces: Standard Operating Procedures
The operating theatre surface protocol should be tiered according to the area’s risk level. “High-touch surfaces” are the points most frequently touched by the surgical team and the patient.
A. Identification of High-Touch Areas
The protocol should prioritise the following areas:
- Operating table and controls
- Anaesthesia machine and monitor buttons
- Lighting handles and medical gas panels
- Door handles and computer keyboards
B. Product Selection and Material Compatibility
Operating theatre equipment is highly expensive and features sensitive optical/electronic components. The rapid surface disinfectants in the Detro Healthcare product range ensure rapid circulation between operations with a short contact time (30–60 seconds); their corrosion-preventing properties help preserve the lifespan of the equipment. Choices based on alcohol, quaternary ammonium or hydrogen peroxide must be incorporated into the protocol according to the surface material’s properties.
IV. Surgical Site Infection (SSI) Prevention and Financial Impact
SSI is not merely a health issue but also a significant financial burden and reputational risk for hospital management.
- Additional Costs: The treatment cost for a surgical patient who develops an infection is 3–4 times higher than for a normal patient. Additional antibiotic use, revision surgeries and dressing costs place a strain on the hospital budget.
- Length of Stay: CAE extends the hospital stay by an average of 7–10 days. This results in inefficient use of bed capacity.
- Legal Liability: An updated and implemented integrated disinfection protocol is the strongest evidence that the hospital has achieved ‘full compliance with medical standards’ in the event of a potential infection case.
V. Steps for Developing an Integrated Protocol
A roadmap for a successful protocol for infection control committees and responsible physicians:
- Risk Mapping: Identify high-, medium- and low-risk areas within the operating theatre (e.g. the operating field vs. semi-sterile corridors).
- Product Consolidation: To avoid confusion, select biocidal-licensed products that complement each other for both air and surface disinfection.
- Creating a Timetable: Define specific times for inter-case cleaning, end-of-day disinfection and weekly deep-cleaning procedures.
- Traceability and Validation: Maintain digital or manual records of the procedures carried out. Periodically validate the protocol’s success by taking swab samples (ATP testing) from surfaces and microbiological samples from the air.
- Staff Training: The success of the protocol depends on everyone, from cleaning staff to surgeons, being fully familiar with the process.
Detro Healthcare: Operating Theatres of the Future
In operating theatre hygiene, treating air and surfaces as separate issues is like leaving a link missing in the chain. At Detro Healthcare, our comprehensive solutions are based on advanced technological formulations that purify the air of pathogens whilst protecting surfaces. We are here to support you in your goal of preventing surgical site infections with our science-based protocols and innovative products. Quality in healthcare begins with the correct integration of disinfection.
Frequently Asked Questions
1. How often should fogging be carried out for operating theatre air disinfection?
It must be carried out during weekly deep disinfection processes or following high-risk (septic) cases. In routine practice, it is recommended at least once a month as part of the end-of-shift cleaning, depending on the operating theatre’s usage intensity.
2. Why is it critical for a surface disinfectant to be ‘fast-acting’?
In operating theatres, the time between cases is limited. If a disinfectant’s contact time is 15 minutes, disinfection will not be effective if staff use the surface before this time has elapsed. Short contact times of 30–60 seconds ensure safe circulation.
3. Does air disinfection replace surface cleaning?
Absolutely not. Air disinfection removes microorganisms from the air but cannot remove organic contaminants (blood, bodily fluids) adhering to surfaces. In the integrated protocol, surface cleaning and disinfection are carried out first, followed by air disinfection to complete the process.
4. What role does disinfection play in preventing surgical site infections?
Surgical site infections are multifactorial (patient resistance, surgical technique, etc.), but environmental hygiene and instrument sterilisation account for approximately 40–60% of these preventable infections. The elimination of environment-borne pathogens minimises this proportion.
5. Are alcohol-based surface disinfectants safe in the operating theatre?
Yes, but they must be used with care. Alcohol-based products dry quickly and are effective; however, they must be used in a controlled manner and in accordance with the manufacturer’s instructions on sensitive device screens or large surfaces (such as areas with a fire risk, like electrosurgical units).
6. Are Detro Healthcare products compliant with international standards?
Yes. Our products hold a Biocidal Product Authorisation from the Turkish Ministry of Health and have been tested in accredited laboratories in accordance with European Standards (EN) (EN 13727, EN 14476, etc.) and are CE certified.
