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The air flow control systems compared were a variable air volume (VAV Box) and a Venturi type air valve (Venturi). Both VAV Box and Venturi were challenged with the release of controlled contaminants, Baker’s yeast, S. cerevisiae (microbes) and tracer gas, sulfur hexafluoride (SF6), at a point of origin in the adjacent hallway. During each simulation, the initial room air flow control system was set at 3 ACH with the doors closed to simulate the unoccupied mode. To transition to occupied mode, the doors were opened and closed as the patient entered the room and the air changes increased to 6 ACH. A Code Blue simulation was initiated and the control systems entered procedure mode by increasing the air changes to 15 ACH and creating positive pressure to the corridor. Doors were opened and closed to simulate entry of additional support staff. Finally, at the conclusion of the procedure, the room returned to occupied mode at 6 ACH with neutral pressure. This study demonstrates that a properly designed and engineered procedure ready ICU room reduces the necessity to move critically ill patients to operating rooms by changing the room’s environment to mimic the protective environment of a procedure room quickly and effectively. The Venturi valve system outperformed the more conventional VAV Box by transitioning and stabilizing more quickly which provided better protection from contaminants in the hallway. https://images.squarespace-cdn.com/content/v1/59f2c82149fc2b47edda6da7/1572403585365-FY4IIXU9GUKZAF8YF3M5/Screen+Shot+2019-10-29+at+10.46.02+PM.png Expertise and Research - EQI Method to Compare Air Delivery Methods in Three Functional ORs During Dynamic Simulated Surgical Procedures In this study, the OnSite team employed the EQI method to compare three OR air delivery concepts with respect to airborne particles, microbial loads, air velocity, temperature and CO2 levels, within the sterile field and outside the sterile zone at the instrument table. Two newly constructed ORs were compared to each other (AirFrame SLD to MDA) and to an older OR (4TD). The two new ORs were identical with respect to construction materials, HVAC units, dimensions (55 M2), air change rates (26ACH), pressurization (min. 10 pa), HEPA filtration, return grille placement (4 low wall), surgical table and equipment placement. Both ORs had been actively used for surgery for approximately three months prior to testing. The two ORs differed only in the air delivery method. The AirFrame, was constructed as a 9 diffuser, contiguous ceiling air distribution system, a concept based on semiconductor clean room technology, in which blockages to air flow from boom mounts and gaps between filters, had been minimized. The MDA was constructed as a conventional array of multiple diffusers (MDA) in the ceiling separated by non-air delivery hard ceiling surfaces with booms mounted between the diffusers. The MDA had 6 diffusers and the longitudinal axis of the array was perpendicular to the longitudinal axis of the surgical table. The older OR, 4TD, was 6.9 Pa positive to the anesthetic bay, HEPA filtered with four 4-way throw diffusers (4TD) in the ceiling and two low wall returns. The 4TD room did not have air distribution over the surgical table/sterile field as per ASHRAE 170 but did have air distribution outside the sterile field over the back, instrument table, though the coverage was not unidirectional, downward. The EQI study took place in January 2018 in Sydney, Australia. Based on this study, the SLD resulted in a significantly cleaner airborne environment, with respect to microbes and CO2, within the sterile field, on the surgical table, as compared to the array of diffusers in the ceiling. SLD and MDA both provided a cleaner environment than the 4TD OR. The SLD also had a significantly higher velocity at the sterile field than the MDA. Both SLD and MDA had cleaner environments with higher air velocity within the sterile field than their respective back tables, outside the sterile zone. Wagner et al., AJIC Jan 2018 https://images.squarespace-cdn.com/content/v1/59f2c82149fc2b47edda6da7/1519073392970-DMP5NMRFRVBD4QWRET8N/Methodology+for+analyzing+environmental+quality+indicators+in+a+dynamic+operating+room+environment Expertise and Research - Methodology for analyzing environmental quality indicators in a dynamic operating room environment Background: Sufficient quantities of quality air and controlled, unidirectional flow are important elements in providing a safe building environment for operating rooms. Methods: To make dynamic assessments of an operating room environment, a validated method of testing the multiple factors influencing the air quality in health care settings needed to be constructed. These include the following: temperature, humidity, particle load, number of microbial contaminants, pressurization, air velocity, and air distribution. The team developed the name environmental quality indicators (EQIs) to describe the overall air quality based on the actual measurements of these properties taken during the mock surgical procedures. These indicators were measured at 3 different hospitals during mock surgical procedures to simulate actual operating room conditions. EQIs included microbial assessments at the operating table and the back instrument table and real-time analysis of particle counts at 9 different defined locations in the operating suites. Air velocities were measured at the face of the supply diffusers, at the sterile field, at the back table, and at a return grille. Results: The testing protocol provided consistent and comparable measurements of air quality indicators between institutions. At 20 air changes per hour (ACH), and an average temperature of 66.3°F, the median of the microbial contaminants for the 3 operating room sites ranged from 3-22 colony forming units (CFU)/m3 at the sterile field and 5-27 CFU/m3 at the back table. At 20 ACH, the median levels of the 0.5-μm particles at the 3 sites were 85,079, 85,325, and 912,232 in particles per cubic meter, with a predictable increase in particle load in the non–high-efficiency particulate air-filtered operating room site. Using a comparison with cleanroom standards, the microbial and particle counts in all 3 operating rooms were equivalent to International Organization for Standardization classifications 7 and 8 during the mock surgical procedures. Conclusions: The EQI protocol was measurable and repeatable and therefore can be safely used to evaluate air quality within the health care environment to provide guidance for operational practices and regulatory requirements. © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. https://images.squarespace-cdn.com/content/v1/59f2c82149fc2b47edda6da7/1519073521405-U8LBZ7CH5ZFI094HZI48/Cost-benefit+analysis+of+different+air+change+rates+in+an+operating+room+environment Expertise and Research - Cost-benefit analysis of different air change rates in an operating room environment Background: Hospitals face growing pressure to meet the dual but often competing goals of providing a safe environment while controlling operating costs. Evidence-based data are needed to provide insight for facility management practices to support these goals. Methods: The quality of the air in 3 operating rooms was measured at different ventilation rates. The energy cost to provide the heating, ventilation, and air conditioning to the rooms was estimated to provide a cost-benefit comparison of the effectiveness of different ventilation rates currently used in the health care industry. Results: Simply increasing air change rates in the operating rooms tested did not necessarily provide an overall cleaner environment, but did substantially increase energy consumption and costs. Additionally, and unexpectedly, significant differences in microbial load and air velocity were detected between the sterile fields and back instrument tables. Conclusions: Increasing the ventilation rates in operating rooms in an effort to improve clinical outcomes and potentially reduce surgical site infections does not necessarily provide cleaner air, but does typically increase operating costs. Efficient distribution or management of the air can improve quality indicators and potentially reduce the number of air changes required. Measurable environmental quality indicators could be used in lieu of or in addition to air change rate requirements to optimize cost and quality for an operating room and other critical environments. © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. https://images.squarespace-cdn.com/content/v1/59f2c82149fc2b47edda6da7/1519073763756-D5XMBCGF7UGQ1LSXQUQG/Hats+and+Sleeves%3A+A+Study+of+Different+Operating+Room+Headgear+Assessed+by+Environmental+Quality+Indicators Expertise and Research - Hats: A Study of Different Operating Room Headgear Assessed by Environmental Quality Indicators Background: The effectiveness of operating room headgear in preventing airborne contamination has been called into question. We hypothesized that bouffant style hats would be as effective in preventing bacterial and particulate contamination in the operating room compared with disposable or cloth skull caps, and bouffant style hats would have similar permeability, particle penetration, and porosity compared with skull caps. Study Design: Disposable bouffant and skull cap hats and newly laundered cloth skull caps were tested. A mock surgical procedure was used in a dynamic operating room environment. Airborne particulate and microbial contaminants were sampled. Hat fabric was tested for permeability, particle transmission, and pore sizes. Results: No significant differences were observed between disposable bouffant and disposable skull caps with regard to particle or actively sampled microbial contamination. However, when compared with disposable skull caps, disposable bouffant hats did have significantly higher microbial shed at the sterile field, as measured by passive settle plate analysis (p < 0.05). When compared with cloth skull caps, disposable bouffants yielded higher levels of 0.5 mm and 1.0 mm particles and significantly higher microbial shed detected with passive analysis. Fabric assessment determined that disposable bouffant hats had larger average and maximum pore sizes compared with cloth skull caps, and were significantly more permeable than either disposable or cloth skull caps. Conclusions: Disposable bouffant hats had greater permeability, penetration, and greater microbial shed, as assessed by passive microbial analysis compared with disposable skull caps. When compared with cloth skull caps, disposable bouffants yielded greater permeability, greater particulate contamination, and greater passive microbial shed. Disposable style bouffant hats should not be considered superior to skull caps in preventing airborne contamination in the operating room. J Am Coll Surg 2017;225:573e581. © 2017 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.) https://images.squarespace-cdn.com/content/v1/59f2c82149fc2b47edda6da7/1520919906090-0PTIAT1RPFZ3JPXCYN8N/shutterstock_368021759_sm.jpg Expertise and Research - Sleeves: A Study of Different Operating Room Gear Assessed by Environmental Quality Indicators Background: The use of long sleeves by non-scrubbed personnel in the operating room has been called into question.We hypothesized that wearing long sleeves and gloves, compared with having bare arms without gloves, while applying the skin preparation solution would decrease particulate and microbial contamination. Methods: A mock patient skin prep was performed in 3 different operating rooms. A long-sleeved gown and gloves, or bare arms, were used to perform the procedure. Particle counters were used to assess airborne particulate contamination, and active and passive microbial assessment was achieved through air samplers and settle plate analysis. Data were compared with Student’s t-test or Mann-Whitney U, and P < .05 was considered to be significant. Results: Operating room B demonstrated decreased 5.0- μm particle sizes with the use of sleeves, while operating rooms A and C showed decreased total microbes only with the use of sleeves. Despite there being no difference in the average number of total microbes for all operating rooms assessed, the use of sleeves specifically appeared to decrease the shed of Micrococcus sp. Conclusion: The use of long sleeves and gloves while applying the skin preparation solution decreased particulate and microbial shedding in several of the operating rooms tested. Although long sleeves may not be necessary for all operating room personnel, they may decrease airborne contamination while the skin prep is applied, which may lead to decreased surgical site infections. © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. 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