Featured Project: measuring the air quality during an operation

Wednesday, May 26, 2021

Name: Research project on air quality of operating theaters
Goal: To gain more insight into what influences air quality during operations
Intended result: Using these new insights to achieve better and more efficient air treatment for operating theaters
Partners: Reinier de Graaf Gasthuis, TU Delft, LUMC, Medexs BV, Medical Delta Living Lab Research OR
Status: Research started

The air in an operating theater is continuously refreshed with HEPA filtered air. The idea is that this prevents infections. For many years, air treatment systems have been used to purify the air in almost every operating theater in the same way for every type of procedure. Scientists from various scientific disciplines in the Medical Delta Living Lab Research OR are investigating whether this can be done differently, better and more efficiently.

They do this by measuring the air quality, both microbiological and dust-technical, during operations. A novelty, because normally the air quality is only analyzed in such a way when an operating theater is at rest. Therefore, it is still insufficiently known what the influence on the air quality is of, for example, surgical teams walking back and forth, equipment that is in use or doors that open and close.


Jos Lans works for the company Medexs and deals with the advice and installation of air treatment systems on a daily basis. He includes this knowledge in his doctoral research, in which measurements are taken during operations and close to the patient, something that has hardly been done in this way before. The first measurements have now been carried out in the Medical Delta Living Lab Research OR in the Reinier de Graaf Gasthuis (RdGG). In the coming year, various measurements in different situations and operating rooms, including those of the LUMC, should yield new insights.

Various disciplines come together in the research. Promoters are surgeon Prof. Maarten van der Elst (RdGG / TU Delft) and technical researcher Dr. John van den Dobbelsteen (TU Delft). Both are scientific leaders of the Medical Delta Living Lab Research OR. Prof. Peter Luscuere (TU Delft) of the Faculty of Architecture and the Built Environment is also closely involved in the research as supervisor, involving all relevant aspects: technology, healthcare practices and the environment. In addition, the LUMC is involved in the research.

Patient safety

With the research, Lans hopes to gain new insights that will ultimately improve the air quality in operating theaters and thus patient safety. “The ultimate goal is to make the air in the operating rooms of the Reinier de Graaf Hospital the cleanest in The Netherlands and at the same time to help other hospitals to improve their air quality where possible,” says surgeon and professor Van der Elst.

At the same time, there is hope the research will provide more insight into the degree of effectiveness of common air treatment systems in operating theaters. From the point of view of energy saving, there may be methods of maintaining air quality with less energy. According to professor Luscuere, there is a lot of potential. “It may well be that for certain types of procedures with a low risk of infection, the ventilation knob does not have to be opened all the way in order to still achieve the necessary air quality. Continuously refreshing the air in an operating theater takes an enormous amount of energy, so that can quickly contribute to a greener OR.”

Better choices for healthcare practice

It is still the case that technology determines how the medical staff behave during an operation. For example, the position of the air supply system is important and determines where operations are performed in the room and where instruments are placed. With his research, Lans hopes to be able to demonstrate the use of this in practice.

“The air entering an operating theater is almost 100% clean, so it is interesting to measure whether and, if so, what other influences there are on air quality. Perhaps operating theaters can do with less energy consumption, or maybe a different set-up of the operating team can improve patient safety,” says Lans. “Is the method of air supply in an operating theater important, or is the amount of clean air in the OR more important? If the entire air content is refreshed every minute in the entire OR, what is the chance that there are still microparticles that cause an infection?”

These are the aspects that make the research design special, says Dr. John van den Dobbelsteen. “The question is whether the technical standards that now form the basis for air quality in operating theaters also make sense for healthcare practice. Little is known, for example, about the air quality close to a patient during an operation and which factors influence this. That makes this research special. Just like it is special that not only care, technology and industry come together in this research, but also the architectural and installation design of the operating theater is included.”

If everything goes according to plan, Lans expects to be able to draw the first conclusions from the many measurements that are taken after a year. Ultimately, the scientists hope that better choices can be made with the measurements: better choices with regard to the design, with the construction of operating rooms, with their use and with regard to energy consumption.

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