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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
Summary
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.
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