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Updated: Feb 27, 2026
Whole-Body Nanoparticle Aerosol Inhalation Exposures
Published on: May 7, 2013
Factors contributing to airborne particle dispersal in the operating room
Chieko Noguchi1, Hironobu Koseki2, Hidehiko Horiuchi1
1Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Background:
Surgical-site infections due to intraoperative contamination are chiefly ascribable to airborne particles carrying microorganisms. The purpose of this study is to identify the actions that increase the number of airborne particles in the operating room.
Methods:
Two surgeons and two surgical nurses performed three patterns of physical movements to mimic intraoperative actions, such as preparing the instrument table, gowning and donning/doffing gloves, and preparing for total knee arthroplasty. The generation and behavior of airborne particles were filmed using a fine particle visualization system, and the number of airborne particles in 2.83 m3 of air was counted using a laser particle counter. Each action was repeated five times, and the particle measurements were evaluated through one-way analysis of variance multiple comparison tests followed by Tukey-Kramer and Bonferroni-Dunn multiple comparison tests for post hoc analysis. Statistical significance was defined as a P value ≤ .01.
Results:
A large number of airborne particles were observed while unfolding the surgical gown, removing gloves, and putting the arms through the sleeves of the gown. Although numerous airborne particles were observed while applying the stockinet and putting on large drapes for preparation of total knee arthroplasty, fewer particles (0.3-2.0 μm in size) were detected at the level of the operating table under laminar airflow compared to actions performed in a non-ventilated preoperative room (P < .01).
Conclusions:
The results of this study suggest that surgical staff should avoid unnecessary actions that produce a large number of airborne particles near a sterile area and that laminar airflow has the potential to reduce the incidence of bacterial contamination.
Insights
Surgical staff actions like unfolding gowns and removing gloves significantly increase airborne particles. Minimizing these movements and using laminar airflow can reduce contamination and surgical-site infections.
Area of Science:
- Surgical hygiene and operating room contamination control.
- Microbiology and particle physics in healthcare settings.
Background:
- Surgical-site infections (SSIs) are often caused by microorganisms in airborne particles during surgery.
- Understanding sources of intraoperative airborne contamination is crucial for infection prevention.
Purpose of the Study:
- To identify specific surgical staff actions that generate the most airborne particles in the operating room.
- To quantify the impact of different movements on particle generation.
Main Methods:
- Simulated surgical tasks were performed by surgeons and nurses.
- Airborne particle generation was visualized and quantified using particle visualization systems and laser particle counters.
- Statistical analysis (ANOVA, Tukey-Kramer, Bonferroni-Dunn) was used to determine significance (P ≤ .01).
Main Results:
- Unfolding surgical gowns and removing gloves generated substantial airborne particles.
- Applying stockinets and drapes for procedures like total knee arthroplasty also increased particle counts.
- Laminar airflow at the operating table reduced particle detection compared to non-ventilated areas.
Conclusions:
- Surgical staff should minimize actions that create airborne particles near sterile fields.
- Laminar airflow demonstrates potential in reducing bacterial contamination and SSIs.
- Further research into optimizing operating room protocols for particle reduction is warranted.
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