Operating theatre ventilation standards and the risk of postoperative infection

Some form of specialized ventilation has been a feature of operating theatres for over 60 years, and ultraclean ventilation has been shown to reduce postoperative infection after prosthetic joint surgery. However, controversy remains over the contribution of plenum (conventional) ventilation to the prevention of infection after surgery in which there is no prosthetic implant. A previous survey in Great Britain and Ireland indicated the continued use of non-ventilated theatres for minor surgery. Laparoscopic and other forms of minimally invasive surgery (MIS) have become more common in the last decade, and offer the advantages of reduced morbidity and shorter hospital stay. However, it is not clear whether such surgery requires the same standard of ventilation facilities as open surgery and, in particular, whether all MIS procedures should be performed in a plenum-ventilated theatre. Furthermore, there are many diagnostic and therapeutic procedures currently performed in cardiac and radiology departments where only natural ventilation is available. The Hospital Infection Society (HIS) Working Party on Infection Control and Operating Theatres is attempting to assess the ventilation facilities currently utilized for a wide variety of MIS procedures. This review should form the basis of future HIS guidance on minimum standards in this area.