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The Role of Particulate Matter in Surgical Site Infection Pathogenesis: A Scoping Review

Divya Kewalramani1, Justin Benton1, Tyler Loftus2

  • 1Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

The Journal of Hospital Infection
|July 13, 2026
PubMed
Abstract

Insights

Operating room particulate matter (PM) is linked to surgical site infections (SSIs). Current measurements are indirect, highlighting a need for dynamic, size-specific PM monitoring to prevent SSIs.

Area of Science:

  • Environmental Health
  • Infectious Disease Epidemiology
  • Surgical Safety

Background:

  • Surgical site infections (SSIs) are a significant cause of patient morbidity, prolonged hospital stays, and increased healthcare expenses.
  • Airborne particulate matter (PM) is implicated as a carrier of bacterial contamination within the operating room (OR) sterile field.
  • Understanding the link between OR PM and SSIs is critical for improving patient outcomes.

Purpose of the Study:

  • To conduct a scoping review of evidence associating operating room (OR) particulate matter (PM) with surgical site infections (SSIs).
  • To identify current methodologies for assessing OR PM and their relationship with SSI development.
  • To highlight gaps in knowledge and suggest future research directions for effective SSI prevention strategies.

Main Methods:

  • A comprehensive scoping review was performed across major databases (PubMed®, Embase, Scopus, CINAHL).
  • Studies investigating OR particulate matter, microbial load, ventilation, and SSIs were included.
  • Eligible studies underwent quantitative and qualitative analysis, with 21 studies meeting the inclusion criteria.

Main Results:

  • Only 14.3% of studies directly measured PM; 85.7% used indirect indicators like ventilation systems (81.0%) or microbial air load (4.8%).
  • Significant heterogeneity was observed in particle size resolution, temporal and spatial characteristics, and viable versus total PM measurements.
  • Current methods for assessing OR airborne contaminants show poor correlation with pathogen exposure at the surgical site.

Conclusions:

  • Particulate matter (PM) is a plausible and modifiable factor contributing to SSI development.
  • Existing room-level air quality metrics do not adequately reflect biologically relevant pathogen exposure.
  • Developing dynamic, size-discriminatory PM measurement is essential for objective SSI risk assessment and targeted environmental interventions.
Keywords:
Airborne ContaminationMicrobial LoadOperating Room Air QualityParticle MonitoringParticulate MatterSurgical Site InfectionVentilation Systems

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