Modern airflow ventilation systems in OT fails to reduce the post surgery infection rate: Study

A new study published in The New England Journal of Medicine Evidence showed that the post-surgery infection marker (PSIM) rate during orthopedic surgery was not decreased by the installation of wall-mounted plasma air purifiers in contemporary operating rooms with conventional, moderate airflow ventilation systems.

The total estimated incidence of surgical site infections (SSI) following orthopedic surgery is between 1% and 4%, even with clean operating rooms (ORs), surface sterilization, and medicines. Therefore, it is crucial to prevent SSIs. There is a chance of postoperative infection because airflow in the operating room might disperse airborne particles.

These airborne particles, which are mostly emitted into the surrounding air of the operating room by the surgical team members and the patient, comprise dust, textile fibers, skin scales, and breathing aerosols. They are packed with live bacteria, including Staphylococcus aureus. Modern ventilation systems have had modest effectiveness in lowering SSI rates, despite their considerable cost and resource requirements. Thus, this study was set to determine whether SSI rates following orthopedic surgery may be decreased by using a cheap air filter.

This research enrolled all patients receiving orthopedic surgery throughout the study period in a multicenter trial that was conducted worldwide. While the control group had surgery in operating rooms with the identical air purifiers that were not in use, the intervention group had surgery in operating rooms with active Novaerus NV800 air purifiers.

As a PSIM, a customized composite outcome based on registry information for prescription antibiotics, diagnoses, and surgical procedures, the primary end objective was SSI within 12 weeks after surgery. The primary outcome was assessed using logistic regression.

Out of the 40,547 patients who were examined, 20,678 were in the control group and 19,869 were in the intervention group. The innovation group's PSIM rate was 9.2%, whereas the control group's was 9.4%. The intervention group's odds ratio was 0.98 (95% CI 0.91 to 1.05). This result was true for several subgroups according to ventilation modes, hospital levels, and diagnoses.

Overall, in the current operating rooms with typical, moderate airflow ventilation systems, adding wall-mounted plasma air purifiers did not diminish the PSIM rate following orthopedic surgery.

Source:

Persson, A., Atroshi, I., Tyszkiewicz, T., Hailer, N. P., Lazarinis, S., Eisler, T., Brismar, H., Mukka, S., Kernell, P.-J., Mohaddes, M., Sköldenberg, O., & Gordon, M. (2025). Effect of plasma air purifiers on infection rates in orthopedic surgery. NEJM Evidence, 4(4), EVIDoa2400289. https://doi.org/10.1056/EVIDoa2400289