An overview of the studies on microbial air contamination in operating theatres and related issues over time: a useful tool for a multidisciplinary approach
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Keywords
Microbial air contamination, operating theatres, air sampling, ventilation, behaviour, airflow
Abstract
Background and aim
Surgical site infection (SSI) is a major complication following surgery associated with increased morbidity and mortality, as well as increased health and not health costs. A variety of factors affect airborne contamination in operating theatres (OT). Following the Medical Research Council study showing a correlation between microbial air contamination and SSI incidence in prosthetic joint surgery ultraclean OTs have been recommended for this type of surgery, while OTs supplied by turbulent airflow plants are recommended for other types of surgery. The aim of this study was to illustrate the studies on this topic.
Methods
Scopus was considered for articles published until January 2023 on OTs and air contamination in article title or abstract or keywords. Many issues were deepened: “microbial”, “bacterial”, “fungi”, “viruses”, “surgical site/wound infection”, “monitoring/sampling”, “air changes”, “behaviour”, “door openings”, “particles”, turbulent flow”, “unidirectional flow”.
Results
Total papers published were 907 and 249 papers faced monitoring/sampling. A total of 313 papers investigated airborne bacterial contamination and 63 papers investigated fungal air contamination. There were 218 papers that have evaluated particle contamination in OTs. Many other issues were deepened.
Conclusions
This study shows a picture of the studies on biological air contamination in OTs and related issues over time. We think that the results of our study will provide a useful tool to increase awareness towards a better sharing of aims, approaches, and results, above all in the interest of the patients, but also of the health services of the different countries. (www.actabiomedica.it)
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References
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3. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999 Apr;27(2):97-132.
4. Kapadia BH, McElroy MJ, Issa K, Johnson AJ, Bozic KJ, Mont MA. The economic impact of periprosthetic infections following total knee arthroplasty at a specialized tertiary-care center. J Arthroplasty. 2014 May;29(5):929-32. doi: 10.1016/j.arth.2013.09.017.
5. Charnley J: Postoperative infection after total hip replacement with special reference to air contamination in the operating room. Clin Orthop 87: 167-187, 1972
6. Dharan S, Pittet D. Environmental controls in operating theatre. J Hosp Infect 2002;51:79e84.22. Editorial. Air sampling in operating theatres. J Hosp Infect 1984;5:1e2.
7. Whyte W. (2015) The effect of mechanical ventilation and clothing on airborne microbes and wound sepsis in hospital operating rooms, Part 1. Clean Air and Containment Review, 22, pp. 4-11.
8. Evans RP. Current concepts for clean air and total joint arthroplasty: laminar airflow and ultraviolet radiation: a systematic review. Clin Orthop Relat Res. 2011 Apr;469(4):945-53. doi: 10.1007/s11999-010-1688-7.
9. Centers for Disease Control and Prevention (CDC). Guidelines for environmental infection control in health-care facilities. Atlanta, GA: U.S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC); 2003.
10. Berríos-Torres SI, Umscheid CA, Bratzler DW et al. for the Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection. JAMA Surg. 2017;152(8):784-791. doi:10.1001/jamasurg.2017.0904 7.
11. Global guidelines for the prevention of surgical site infection World Health Organization – 2016.
12. Uckay I, Harbarth S, Peter R, Lew D, Hoffmeyer P, Pittet D. Preventing surgical site infection. Exp Rev Anti Infect Ther 2010;8:657e670.
13. Parvizi J, Barnes S, Shohat N, Edmiston CE. Environment of care: Is it time to reassess microbial contamination of the operating room air as a risk factor for surgical site infection in total joint arthroplasty? American Journal of Infection Control 2017;45(11):1267-1272. doi.org/10.1016/j.ajic.2017.06.027.
14. Reichman DE, Greenberg JA. Reducing surgical site infections: a review. Rev Obstet Gynecol. 2009 Fall;2(4):212-21.
15. Barimani B, Ahangar P, Nandra R, Porter K. The WHO surgical safety checklist: a review of outcomes and implementation strategies. Perioper Care Oper Room Manag 2020;21, 100117.
16. Whyte W. Hodgson R. Tinkler J. The importance of airborne bacterial contamination of wounds. J. Hosp. Infect. 1982, 3, 123–135.
17. Fard RF, Aali R. Airborne antibiotic resistant bacteria: hospital indoor air pollution and the challenge of nosocomial infection. J Environ Health Sustain Dev. 2019;4:859-861.
18. Shahroudi P, Aarabi A. Quality improvement through lean A3 method for foot traffic in operating room. Perioperative Care and Operating Room Management 2021;23, 100155.
19. Cao G, Pedersen C, Zhang Y, et al. Can clothing systems and human activity in operating rooms with mixed flow ventilation systems help achieve the ultraclean air requirement (≤10 CFU/m3) during orthopaedic surgeries? J Hosp Infect. 2022 Feb;120:110-116. doi: 10.1016/j.jhin.2021.11.005.
20. Pasquarella C, Balocco C, Colucci ME et al. The Influence of Surgical Staff Behavior on Air Quality in a Conventionally Ventilated Operating Theatre during a Simulated Arthroplasty: A Case Study at the University Hospital of Parma. Int J Environ Res Public Health. 2020 Jan 10;17(2):452. doi: 10.3390/ijerph17020452.
21. Spagnolo AM, Ottria G, Amicizia D, Perdelli F, Cristina ML. Operating theatre quality and prevention of surgical site infections. J Prev Med Hyg 2013;54:131-137.
22. Bhattacharya A, Ghahramani A, Mousavi E. The effect of door opening on air-mixing in a positively pressurized room: Implications for operating room air management during the COVID outbreak. J Build. Eng. 2021;44:102900.
23. Lidwell OM, Lowbury EJ, Whyte W, Blowers R, Stanley SJ, Lowe D. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. Br Med J (Clin Res Ed). 1982 Jul 3;285(6334):10-4. doi: 10.1136/bmj.285.6334.10.
24. DIN 1946-4:2008 Ventilation and Air Conditioning - Part 4: Ventilation in Buildings and Rooms of Health Care.
25. Aganovic A, Cao G, Fecer T, et al. Ventilation design conditions associated with airborne bacteria levels within the wound area during surgical procedures: a systematic review. J Hosp Infect. 2021 Jul;113:85-95. doi: 10.1016/j.jhin.2021.04.022.
26. Knudsen RJ, Knudsen SMN, Nymark T, et al. Laminar airflow decreases microbial air contamination compared with turbulent ventilated operating theatres during live total joint arthroplasty: a nationwide survey. J Hosp Infect. 2021 Jul;113:65-70. doi: 10.1016/j.jhin.2021.04.019.
27. Whyte W, Lytsy B. Ultraclean air systems and the claim that laminar airflow systems fail to prevent deep infections after total joint arthroplasty. J Hosp Infect. 2019 Sep;103(1):e9-e15. doi: 10.1016/j.jhin.2019.04.021.
28. Pasquarella C, Barchitta M, D'Alessandro D. et al. Heating, ventilation and air conditioning (HVAC) system, microbial air contamination and surgical site infection in hip and knee arthroplasties: the GISIO-SItI Ischia study. Ann Ig. 2018 Sep-Oct;30(5 Supple 2):22-35. doi: 10.7416/ai.2018.2248.
29. Agodi A, Auxilia F, Barchitta M. et al. Italian Study Group of Hospital Hygiene. Operating theatre ventilation systems and microbial air contamination in total joint replacement surgery: results of the GISIO-ISChIA study. J Hosp Infect. 2015 Jul;90(3):213-9. doi: 10.1016/j.jhin.2015.02.014.
30. Pasquarella, C., Agodi, A., Auxilia, F. et al. Air quality in the operating theatre: a perspective. Aerobiologia 36, 113–117 (2020). https://doi.org/10.1007/s10453-019-09584-018.
31. Aganovic A. Airflow distribution for minimizing human exposure to airborne contaminants in healthcare facilities Trondheim, Norwegian University of Science and Technology (2019).
32. Hb+ Die Spitäler der Schweiz. Klassifizierung und technisce Anfordungen an Spita¨lraume. Bern; 2007.
33. NHS Estates. Health technical memorandum 2025. Ventilation in healthcare premises. Part 3. Validation and verification. London:National Health Service; 1994.
34. Health Technical Memorandum 03-01. Specialised ventilation for healthcare premises. Norwich: TSU; 2007.
35. Health Technical Memorandum 03-01 Specialised ventilation for healthcare buildings. 2021.
36. ISPESL. Linee guida per la definizione degli standard di sicurezza e di igiene ambientale dei reparti operatori. Rome: ISPESL; 1999.
37. ISPESL. Linee Guida sugli Standard di Sicurezza e di Igiene del Lavoro nel Reparto Operatorio. Rome: ISPESL; 2009.
38. Hoffman PN, Williams J, Stacey A, et al. Microbiological commissioning and monitoring of operating theatre suites. J Hosp Infect 2002;52:1e28.
39. Societé Française d’hygiène hospitalière. La qualité´ de l’air au bloc opératoire. Recommandations d’experts. GR-AIR; 2004
40. NFS 90-351 Établissement de Santé - Salles Propres et Environnements Maîtrisés Apparentés - Exigences Relatives pour la Maîtrise de la Contamination Aéroportée 2013.
41. SF2H, SFMM. Risque infectieux fongique et travaux en établissement de santé (2011).
42. SF2H. Qualité de l’air au bloc opératoire et autres secteurs interventionnels. Hygiène (2015).
43. UNI EN 17141:2021 – Camere bianche ed ambienti controllati associati; Controllo della biocontaminazione.
44. Surveillance microbiologique de l’environnement dans les établissements de santé. Guide de bonnes pratiques – CCLIN Sud-Ouest – 2016.
45. Carroll GT, Kirschman DL. Discrete room pressure drops predict door openings and contamination levels in the operating room setting. Perioperative Care and Operating Room Management 2022; 29, 100291.
46. D'Orazio A, D'Alessandro D. Air bio-contamination control in hospital environment by UV-C rays and HEPA filters in HVAC systems. Ann Ig. 2020 Sep-Oct;32(5):449-461. doi: 10.7416/ai.2020.2369
47. Barnewall RE, Bischoff WE. Removal of SARS-CoV-2 bioaerosols using ultraviolet air filtration. Infect Control Hosp Epidemiol. 2021 Aug;42(8):1014-1015. doi: 10.1017/ice.2021.103
48. Popovic M, Beathe JC, Gbaje E, Sharp M, Memtsoudis SG. Effect of portable negative pressure units on expelled aerosols in the operating room environment. Reg Anesth Pain Med. 2022;47:426–429. https://doi.org/10.1136/rapm-2022-103489.
49. Carroll GT, Kirschman DL. A portable negative pressure unit reduces bone cement fumes in a simulated operating room. Sci Rep. 2022;12:1–6. https://doi.org/10.1038/s41598-022-16227-x, 11890.
50. Colella Y, Valente AS, Rossano L, Trunfio TA, Fiorillo A, Improta G. A fuzzy interference system for the assessment of indoor air quality in an operating room to prevent surgical site infection. Int J Environ Res Public Health. 2022;19:3533.40.
51. Madeo M. The role of air ventilation and air sampling in reducing the incidence of surgical wound infection rates. Br J Theatre Nurs 1996;6:29e32.
52. Pasquarella C. Microbial control of the environment in the operating theatre. Ann Ig 2009;21(Suppl. 1):9e16.
53. Pasquarella C, Albertini R, Dall’Aglio P, et al. Air microbial sampling: the state of the art. Ig San Pubb 2008;64:79e120.
54. Birgand G, Saliou P, Lucet JC. Influence of staff behavior on infectious risk in operating rooms: what is the evidence? Infect Control Hosp Epidemiol. 2015 Jan;36(1):93-106. doi: 10.1017/ice.2014.9.
55. Eickhoff TC. Microbiological sampling. Hospitals 1970;44:86e87.24. Eickhoff TC. Airborne nosocomial infection; a contemporary perspective. Infect Control Hosp Epidemiol 1994;15:663e672.
56. Faure O, Fricker-Hidalgo H, Lebeau B, Mallaret MR, Ambroise-Thomas P, Grillot R. Eight-year surveillance of environmental fungal contamination in hospital operating rooms and haematological units. J Hosp Infect 2002;50:155e160.
57. Fox C, Whyte A. Theatre air sampling e ignorance is bliss. J Hosp Infect 1995;30:80e82.
58. Fox C, Whyte A. Theatre air sampling e once a year is not enough. J Hosp Infect 1996;32:319e320.
59. French MLV, Eitzen HE, Ritter MA, Leland DS. Environmental control of microbial contamination in the operating room. In:Hunt TK, editor. Wound healing and wound infection. New York:Appleton-Century-Crofts; 1980. p. 254e261.
60. Friberg B, Friberg S, Burman LG. Inconsistent correlation between aerobic bacterial surface and air counts in operating rooms with ultraclean laminar air flows: proposal of a new bacteriological standard for surface contamination. J Hosp Infect 1999;42:287e293.
61. Groschel DH. Air sampling in hospitals. Ann N Y Acad Sci 1980;353:230e239.
62. Humphreys H, Taylor EW. Hospital Infection Society Working Party on Infection Control and Operating Theatres. Operating theatre ventilation standards and the risk of postoperative infection. J Hosp Infect 2002;50:85e90.
63. Jowitt D, Morris AJ. The questionable value of microbiological sampling when commissioning new operating theatres. J Hosp Infect 2005;59:267e268.
64. Pitzurra M, Savino A, Pasquarella C. Microbiological environment monitoring (MEM)]. Ann Ig. 1997 Nov-Dec;9(6):439-54.
65. Pasquarella C, Pitzurra O, Savino A. The index of microbial air contamination. J Hosp Infect 2000;46:241e256.
66. Pasquarella C, Vitali P, Saccani E. et al. Microbial air monitoring in operating theatres: experience at the University Hospital of Parma. J Hosp Infect. 2012 May;81(1):50-7. doi: 10.1016/j.jhin.2012.01.007
67. Albertini R, Veronesi L, Colucci ME, Pasquarella C. The scenario of the studies on ragweed (Ambrosia Sp.) and related issues from its beginning to today: a useful tool for future goals in a one health approach. Acta Biomed. 2022 Oct 26;93(5):e2022324. doi: 10.23750/abm.v93i5.13771
68. Falagas ME, Pitsouni EI, Malietzis GA, Pappas G. Comparison of PubMed, Scopus, Web of Science, and Google Scholar: strengths and weaknesses. FASEB J. 2008 Feb;22(2):338-42. doi: 10.1096/fj.07-9492LSF.
69. D’Amico A, Fara GM. The need to develop a multidisciplinary expertise for the microbiological safety of operating theatres Ann Ig 2016; 28: 379-380 doi:10.7416/ai.2016.2119
2. Badia JM, Casey AL, Petrosillo N, Hudson PM, Mitchell SA, Crosby C. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect. 2017 May;96(1):1-15. doi: 10.1016/j.jhin.2017.03.004.
3. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999 Apr;27(2):97-132.
4. Kapadia BH, McElroy MJ, Issa K, Johnson AJ, Bozic KJ, Mont MA. The economic impact of periprosthetic infections following total knee arthroplasty at a specialized tertiary-care center. J Arthroplasty. 2014 May;29(5):929-32. doi: 10.1016/j.arth.2013.09.017.
5. Charnley J: Postoperative infection after total hip replacement with special reference to air contamination in the operating room. Clin Orthop 87: 167-187, 1972
6. Dharan S, Pittet D. Environmental controls in operating theatre. J Hosp Infect 2002;51:79e84.22. Editorial. Air sampling in operating theatres. J Hosp Infect 1984;5:1e2.
7. Whyte W. (2015) The effect of mechanical ventilation and clothing on airborne microbes and wound sepsis in hospital operating rooms, Part 1. Clean Air and Containment Review, 22, pp. 4-11.
8. Evans RP. Current concepts for clean air and total joint arthroplasty: laminar airflow and ultraviolet radiation: a systematic review. Clin Orthop Relat Res. 2011 Apr;469(4):945-53. doi: 10.1007/s11999-010-1688-7.
9. Centers for Disease Control and Prevention (CDC). Guidelines for environmental infection control in health-care facilities. Atlanta, GA: U.S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC); 2003.
10. Berríos-Torres SI, Umscheid CA, Bratzler DW et al. for the Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection. JAMA Surg. 2017;152(8):784-791. doi:10.1001/jamasurg.2017.0904 7.
11. Global guidelines for the prevention of surgical site infection World Health Organization – 2016.
12. Uckay I, Harbarth S, Peter R, Lew D, Hoffmeyer P, Pittet D. Preventing surgical site infection. Exp Rev Anti Infect Ther 2010;8:657e670.
13. Parvizi J, Barnes S, Shohat N, Edmiston CE. Environment of care: Is it time to reassess microbial contamination of the operating room air as a risk factor for surgical site infection in total joint arthroplasty? American Journal of Infection Control 2017;45(11):1267-1272. doi.org/10.1016/j.ajic.2017.06.027.
14. Reichman DE, Greenberg JA. Reducing surgical site infections: a review. Rev Obstet Gynecol. 2009 Fall;2(4):212-21.
15. Barimani B, Ahangar P, Nandra R, Porter K. The WHO surgical safety checklist: a review of outcomes and implementation strategies. Perioper Care Oper Room Manag 2020;21, 100117.
16. Whyte W. Hodgson R. Tinkler J. The importance of airborne bacterial contamination of wounds. J. Hosp. Infect. 1982, 3, 123–135.
17. Fard RF, Aali R. Airborne antibiotic resistant bacteria: hospital indoor air pollution and the challenge of nosocomial infection. J Environ Health Sustain Dev. 2019;4:859-861.
18. Shahroudi P, Aarabi A. Quality improvement through lean A3 method for foot traffic in operating room. Perioperative Care and Operating Room Management 2021;23, 100155.
19. Cao G, Pedersen C, Zhang Y, et al. Can clothing systems and human activity in operating rooms with mixed flow ventilation systems help achieve the ultraclean air requirement (≤10 CFU/m3) during orthopaedic surgeries? J Hosp Infect. 2022 Feb;120:110-116. doi: 10.1016/j.jhin.2021.11.005.
20. Pasquarella C, Balocco C, Colucci ME et al. The Influence of Surgical Staff Behavior on Air Quality in a Conventionally Ventilated Operating Theatre during a Simulated Arthroplasty: A Case Study at the University Hospital of Parma. Int J Environ Res Public Health. 2020 Jan 10;17(2):452. doi: 10.3390/ijerph17020452.
21. Spagnolo AM, Ottria G, Amicizia D, Perdelli F, Cristina ML. Operating theatre quality and prevention of surgical site infections. J Prev Med Hyg 2013;54:131-137.
22. Bhattacharya A, Ghahramani A, Mousavi E. The effect of door opening on air-mixing in a positively pressurized room: Implications for operating room air management during the COVID outbreak. J Build. Eng. 2021;44:102900.
23. Lidwell OM, Lowbury EJ, Whyte W, Blowers R, Stanley SJ, Lowe D. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. Br Med J (Clin Res Ed). 1982 Jul 3;285(6334):10-4. doi: 10.1136/bmj.285.6334.10.
24. DIN 1946-4:2008 Ventilation and Air Conditioning - Part 4: Ventilation in Buildings and Rooms of Health Care.
25. Aganovic A, Cao G, Fecer T, et al. Ventilation design conditions associated with airborne bacteria levels within the wound area during surgical procedures: a systematic review. J Hosp Infect. 2021 Jul;113:85-95. doi: 10.1016/j.jhin.2021.04.022.
26. Knudsen RJ, Knudsen SMN, Nymark T, et al. Laminar airflow decreases microbial air contamination compared with turbulent ventilated operating theatres during live total joint arthroplasty: a nationwide survey. J Hosp Infect. 2021 Jul;113:65-70. doi: 10.1016/j.jhin.2021.04.019.
27. Whyte W, Lytsy B. Ultraclean air systems and the claim that laminar airflow systems fail to prevent deep infections after total joint arthroplasty. J Hosp Infect. 2019 Sep;103(1):e9-e15. doi: 10.1016/j.jhin.2019.04.021.
28. Pasquarella C, Barchitta M, D'Alessandro D. et al. Heating, ventilation and air conditioning (HVAC) system, microbial air contamination and surgical site infection in hip and knee arthroplasties: the GISIO-SItI Ischia study. Ann Ig. 2018 Sep-Oct;30(5 Supple 2):22-35. doi: 10.7416/ai.2018.2248.
29. Agodi A, Auxilia F, Barchitta M. et al. Italian Study Group of Hospital Hygiene. Operating theatre ventilation systems and microbial air contamination in total joint replacement surgery: results of the GISIO-ISChIA study. J Hosp Infect. 2015 Jul;90(3):213-9. doi: 10.1016/j.jhin.2015.02.014.
30. Pasquarella, C., Agodi, A., Auxilia, F. et al. Air quality in the operating theatre: a perspective. Aerobiologia 36, 113–117 (2020). https://doi.org/10.1007/s10453-019-09584-018.
31. Aganovic A. Airflow distribution for minimizing human exposure to airborne contaminants in healthcare facilities Trondheim, Norwegian University of Science and Technology (2019).
32. Hb+ Die Spitäler der Schweiz. Klassifizierung und technisce Anfordungen an Spita¨lraume. Bern; 2007.
33. NHS Estates. Health technical memorandum 2025. Ventilation in healthcare premises. Part 3. Validation and verification. London:National Health Service; 1994.
34. Health Technical Memorandum 03-01. Specialised ventilation for healthcare premises. Norwich: TSU; 2007.
35. Health Technical Memorandum 03-01 Specialised ventilation for healthcare buildings. 2021.
36. ISPESL. Linee guida per la definizione degli standard di sicurezza e di igiene ambientale dei reparti operatori. Rome: ISPESL; 1999.
37. ISPESL. Linee Guida sugli Standard di Sicurezza e di Igiene del Lavoro nel Reparto Operatorio. Rome: ISPESL; 2009.
38. Hoffman PN, Williams J, Stacey A, et al. Microbiological commissioning and monitoring of operating theatre suites. J Hosp Infect 2002;52:1e28.
39. Societé Française d’hygiène hospitalière. La qualité´ de l’air au bloc opératoire. Recommandations d’experts. GR-AIR; 2004
40. NFS 90-351 Établissement de Santé - Salles Propres et Environnements Maîtrisés Apparentés - Exigences Relatives pour la Maîtrise de la Contamination Aéroportée 2013.
41. SF2H, SFMM. Risque infectieux fongique et travaux en établissement de santé (2011).
42. SF2H. Qualité de l’air au bloc opératoire et autres secteurs interventionnels. Hygiène (2015).
43. UNI EN 17141:2021 – Camere bianche ed ambienti controllati associati; Controllo della biocontaminazione.
44. Surveillance microbiologique de l’environnement dans les établissements de santé. Guide de bonnes pratiques – CCLIN Sud-Ouest – 2016.
45. Carroll GT, Kirschman DL. Discrete room pressure drops predict door openings and contamination levels in the operating room setting. Perioperative Care and Operating Room Management 2022; 29, 100291.
46. D'Orazio A, D'Alessandro D. Air bio-contamination control in hospital environment by UV-C rays and HEPA filters in HVAC systems. Ann Ig. 2020 Sep-Oct;32(5):449-461. doi: 10.7416/ai.2020.2369
47. Barnewall RE, Bischoff WE. Removal of SARS-CoV-2 bioaerosols using ultraviolet air filtration. Infect Control Hosp Epidemiol. 2021 Aug;42(8):1014-1015. doi: 10.1017/ice.2021.103
48. Popovic M, Beathe JC, Gbaje E, Sharp M, Memtsoudis SG. Effect of portable negative pressure units on expelled aerosols in the operating room environment. Reg Anesth Pain Med. 2022;47:426–429. https://doi.org/10.1136/rapm-2022-103489.
49. Carroll GT, Kirschman DL. A portable negative pressure unit reduces bone cement fumes in a simulated operating room. Sci Rep. 2022;12:1–6. https://doi.org/10.1038/s41598-022-16227-x, 11890.
50. Colella Y, Valente AS, Rossano L, Trunfio TA, Fiorillo A, Improta G. A fuzzy interference system for the assessment of indoor air quality in an operating room to prevent surgical site infection. Int J Environ Res Public Health. 2022;19:3533.40.
51. Madeo M. The role of air ventilation and air sampling in reducing the incidence of surgical wound infection rates. Br J Theatre Nurs 1996;6:29e32.
52. Pasquarella C. Microbial control of the environment in the operating theatre. Ann Ig 2009;21(Suppl. 1):9e16.
53. Pasquarella C, Albertini R, Dall’Aglio P, et al. Air microbial sampling: the state of the art. Ig San Pubb 2008;64:79e120.
54. Birgand G, Saliou P, Lucet JC. Influence of staff behavior on infectious risk in operating rooms: what is the evidence? Infect Control Hosp Epidemiol. 2015 Jan;36(1):93-106. doi: 10.1017/ice.2014.9.
55. Eickhoff TC. Microbiological sampling. Hospitals 1970;44:86e87.24. Eickhoff TC. Airborne nosocomial infection; a contemporary perspective. Infect Control Hosp Epidemiol 1994;15:663e672.
56. Faure O, Fricker-Hidalgo H, Lebeau B, Mallaret MR, Ambroise-Thomas P, Grillot R. Eight-year surveillance of environmental fungal contamination in hospital operating rooms and haematological units. J Hosp Infect 2002;50:155e160.
57. Fox C, Whyte A. Theatre air sampling e ignorance is bliss. J Hosp Infect 1995;30:80e82.
58. Fox C, Whyte A. Theatre air sampling e once a year is not enough. J Hosp Infect 1996;32:319e320.
59. French MLV, Eitzen HE, Ritter MA, Leland DS. Environmental control of microbial contamination in the operating room. In:Hunt TK, editor. Wound healing and wound infection. New York:Appleton-Century-Crofts; 1980. p. 254e261.
60. Friberg B, Friberg S, Burman LG. Inconsistent correlation between aerobic bacterial surface and air counts in operating rooms with ultraclean laminar air flows: proposal of a new bacteriological standard for surface contamination. J Hosp Infect 1999;42:287e293.
61. Groschel DH. Air sampling in hospitals. Ann N Y Acad Sci 1980;353:230e239.
62. Humphreys H, Taylor EW. Hospital Infection Society Working Party on Infection Control and Operating Theatres. Operating theatre ventilation standards and the risk of postoperative infection. J Hosp Infect 2002;50:85e90.
63. Jowitt D, Morris AJ. The questionable value of microbiological sampling when commissioning new operating theatres. J Hosp Infect 2005;59:267e268.
64. Pitzurra M, Savino A, Pasquarella C. Microbiological environment monitoring (MEM)]. Ann Ig. 1997 Nov-Dec;9(6):439-54.
65. Pasquarella C, Pitzurra O, Savino A. The index of microbial air contamination. J Hosp Infect 2000;46:241e256.
66. Pasquarella C, Vitali P, Saccani E. et al. Microbial air monitoring in operating theatres: experience at the University Hospital of Parma. J Hosp Infect. 2012 May;81(1):50-7. doi: 10.1016/j.jhin.2012.01.007
67. Albertini R, Veronesi L, Colucci ME, Pasquarella C. The scenario of the studies on ragweed (Ambrosia Sp.) and related issues from its beginning to today: a useful tool for future goals in a one health approach. Acta Biomed. 2022 Oct 26;93(5):e2022324. doi: 10.23750/abm.v93i5.13771
68. Falagas ME, Pitsouni EI, Malietzis GA, Pappas G. Comparison of PubMed, Scopus, Web of Science, and Google Scholar: strengths and weaknesses. FASEB J. 2008 Feb;22(2):338-42. doi: 10.1096/fj.07-9492LSF.
69. D’Amico A, Fara GM. The need to develop a multidisciplinary expertise for the microbiological safety of operating theatres Ann Ig 2016; 28: 379-380 doi:10.7416/ai.2016.2119
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Albertini R, Coluccia A, Colucci ME, Zoni R, Affanni P, Veronesi L, Pasquarella C. An overview of the studies on microbial air contamination in operating theatres and related issues over time: a useful tool for a multidisciplinary approach. Acta Biomed [Internet]. [cited 2023 May 29];94(S3):e2023149. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/14507
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Supplement: Public Health Challenges in The Post-Pandemic Era
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.