The Mölnlycke Health Care blog

What’s the big deal with clean air? Or... who wants to get stuck in bed?

By: Roger Allansson, October 27 2015Posted in: The Mölnlycke Health Care blog

Roger Allansson is a former surgery nurse who is now a clinical specialist with Mölnlycke Health Care.

It reads a bit like a song, "It's something in the air... and it's all about what you wear...". But in all seriousness, air quality, air cleanliness and what surgeons, nurses and anaesthesia staff wear to help preserve the clean air in an O.R. is one factor directly related to post-surgical outcomes.

Unfortunately, 2.6 percent of all surgical procedures are complicated by a surgical site infection (SSI), according to data from 593,000 operations. That means that at least two to three patients out of every 100 suffer from a SSI. As many as 500,000 SSI occur annually in the United States.

Each SSI is associated with approximately 7 to 10 additional postoperative days in the hospital. And that's not the worst of it: patients with an SSI have a 2 to 11 times higher risk of death, compared to surgical patients who did not acquire an SSI. SSIs are believed to account for up to USD 10 billion each year in healthcare expenditures1.

No one likes these figures, and everyone wants to explore ways to reduce these numbers and to prevent SSI.

Here's where the air, the skin and what you wear all come squarely into play.

Skin flora is released from everyone who is moving around in the operating room. Approximately 5,000 -10,000 skin scales are released every minute from each person2. Each of these scales potentially carries infection-causing microorganisms. These bacteria-carrying scales can make their way into open surgical wounds and create surgical site infections. It is not necessary to explain that patients with surgical site infections end up staying in hospital an average of 7 to 10 days longer1, which extends to even longer stays if the patient ends up with a deep tissue infection. Longer stays equal higher costs for the complete cost of care (labour/staff time, hospital stay, etc.). The important takeaway is that steps can be taken to reduce the likelihood of an SSI happening in the first place.

It is common for surgical departments to measure colony forming units (CFUs) and take action to lower the CFUs by creating ultra clean air3,4,5. One preventive measure for keeping this in check is by preventing skin scales from flying around the in O.R. Being properly attired for the O.R. contributes, and single-use, clean air suits lead the way in helping reduce CFU counts. When all staff is wearing single-use clean-air suits, air quality can improve (<10 CFU/m3) even when ordinary ventilation is used6. Clean air suits are made of a material that has low permeability, which means the suits keep the skin scales inside the suit. Ordinary scrub suits are permeable, meaning that skin scales can escape. With the right design (good cuffs to prevent escape of skin scales), impermeable material and proper donning, a clean air suit is one piece of the clean-air O.R. puzzle.

Clean air is one contributing strategy toward ensuring that a surgical patient stays in bed recovering for the standard period for his or her procedure – and not for several extra weeks or months because of an SSI.

Because – really – who wants to get stuck in bed?



  1. Anderson DJ et al. the official journal of the Society of Hospital Epidemiologists of America. 2008;29 Suppl 1:S51-61.
  2. Hoborn J. Thesis: Humans as Dispersers of Microorganisms - Dispersion Pattern and Prevention. Department of Clinical Bacteriology, Institute of Medical Microbiology, University of Göteborg, Göteborg, Sweden. 1981.
  3. Lidwell OM, et al. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. BMJ1982;285:10-14.
  4. Lidwell OM, Lowbury EJL, Whyte W. Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates. J Hosp Infect 1983;4:111-31.
  5. Lidwell OM, et al. Ultra-clean air and antibiotics for prevention of postoperative infection: a multi-center study of 8,052 joint replacement operations. Acta Orthop Scand,1987;58(1): 4-13.
  6. Tammelin A, et al. Single-use surgical clothing system for reduction of airborne bacteria in the operating room. Journal of Hospital Infection, 2013.
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The surgical and wound care environment is always changing. The Mölnlycke Health Care blog addresses topics and trends in surgery and wound care. Among these topics are efficiency, health economy, infection control and patient safety. Read more about this blog and how to comment.

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