Association between air changes and airborne microbial contamination in operating rooms

Background: Control of airborne microbial contamination is important in operating rooms (ORs). To keep airborne contamination low, guidelines should highlight the importance of air turnover. The aims of the study were: (1) to verify the association between air turnover and airborne contamination in ORs; and (2) to identify a statistical relationship between air turnover and airborne microbial contamination. Methods: A cross sectional study was carried out from November 2014 to July 2017 in the teaching Hospital of Siena. Nineteen ORs (14 with turbulent and 5 with laminar flow ventilation) were surveyed a total of 59 times under operating conditions. Air samples were collected with an air sampler. Petri dishes, incubated at 36 °C for 48 h, were used to quantify colony forming units in the samples (CFU). The data was transformed to evaluate several statistically significant nonlinear associations between air turnover, quantified as air changes per hour (ACH) and CFU per cubic meter of air (p < 0.05). Results: A log-linear regression model provided the best fit between ACH and CFU for laminar (p = 0.013; R2 = 0.3911) and turbulent flow systems (p = 0.002; R2 = 0.3443). The corresponding model was: ln(CFU) = (a − b*ACH), where the regression parameters were estimated at a = 4.02 and b = 0.037 for laminar flow and a = 5.24 and b = 0.067 for turbulent flow. Conclusions: Italian guidelines indicate microbial load limits of 20 and 180 CFU/m3 for operating rooms with laminar and turbulent flow ventilation, respectively. The model allowed us to evaluate the minimum number of ACHs to keep CFU within these limits. Ad hoc measurements in other environments can be used to calibrate the relationship between ACH and CFU.