Survey of operating theatre ventilation facilities for minimally invasive surgery in Great Britain and Northern Ireland: Current practice and considerations for the future

Increasing use of minimally invasive surgery (MIS) and other invasive procedures has raised the question of what ventilation facilities are appropriate for such procedures to prevent infection. The Hospital Infection Society (HIS) Working Party on Infection Control in Operating Theatres undertook a survey of practice in Great Britain and Northern Ireland on the ventilation facilities provided for a variety of MIS and other procedures. Five hundred and fifty questionnaires were forwarded to HIS members, and 186 (39%) replies were received. Fifty-eight percent were from district general hospitals (DGHs). Designated theatres for orthopaedic surgery (although not necessarily ultraclean ventilated theatres) were available in more than 80% of hospitals, with approximately 50% of hospitals having designated theatres for a variety of other surgical subspecialities. Approximately two-thirds of urological procedures were performed in conventionally ventilated operating theatres. Most radiological procedures were performed in non-ventilated theatres or treatment rooms. In around half of the DGHs and university/referral hospitals, orthopaedic MIS procedures such as arthroscopy were performed in ultraclean ventilated theatres. This survey revealed considerable variation in the use of conventionally ventilated theatres and ultraclean ventilated theatres. In particular, many radiological and anaesthetic procedures are performed in treatment rooms or ventilated rooms with less than 20 air changes per hour. Whilst it is not clear whether this is acceptable practice given current knowledge, large-scale clinical trials to determine what standards of ventilation are appropriate to minimize infection for these types of procedures would be difficult to conduct. Research is needed on the relative risk of airborne infection for a variety of procedures, including whether all prosthetic implant procedures should be carried out in ultraclean ventilated theatres, as infection associated with implants is often of airborne origin and of considerable clinical significance.