Air Supply in Operating Theatres - The German View

Air supply in operating theatres the
German view
Differences and similarities in infection prevention in

European countries
Berlin
26.06.2015
Frank Wille, HYBETA GmbH, Mnster, Germany
Knowing more. Thinking ahead.
Surgical site infections
SSI are the most frequent hospital infection in Germany

(ca. 225.000) (Gastmeier, Dtsch med Wochenschr. 2008; 133(21))
reasons are multicausal
30 % 55 % der SSI are avoidable
(Gastmeier, Dtsch med Wochenschr. 2010; 135 (3), DGKH Hygiene-Tipp (02/2012))
Influence of the air is an unsolved question in Germany

(rki; Epidemiologisches Bulletin 04/2010)
Modern Surgery in Germany | Slide 2 Dr. Frank Wille | HYBETA GmbH | www.hybeta.com
Surgical site infections - reasons
Endogenous factors (90 %)

Microbiological colonization within the wound area (95 %)
Microbiological colonization outside the wound area (5 %)
Exogenous factors (10%)
surgical staff and ventilation (99 %)
environment (1%)
(Swissnoso Bulletin, Postoperative Wundinfektionen: eine bersicht, 03/1996)
KRINKO-Guideline: Prevention of SSI
Tasks of the ventilation system
removal of
thermal load
external loads
removal of
micro-organisms
internal loads
removal of harmful substances
Source: Dr. Peter Lderitz
Technical standard
DIN 1946-4: 1963/1978/1989/1999

E-VDI 2167: 2004
E-DIN 1946-4: 2005
E-DIN 1946-4: 2007
DIN 1946-4:2008-12
VDI 2167-1: 2007
Hygienic requirements of the ventilation system
depend on kind of surgery
The requirements depending on:
Implantation of extraneous material
Size of the wound area
Time of surgery
Blood circulation
Room classes according to DIN 1946-4
Room classes
OR: Room class Ia
Total endoprothetic, transplantations, thorax surgery
OR: Room class Ib
common surgery, colon, micro invasive surgery
Room class II
All peripheral rooms
Room class Ia
3-stage supply-air filtration

(F7/ F9 ventilation unit) and terminal HEPA filters (H13)
Plenum-type laminar-airflow-style diffusers
Size: 3.2 m x 3.2 m
Supply-air velocities LAF: 0.22 0.25 m*s-1
Outdoor air flow rate min. 1,200 m3/ h,
Whole amount of air : 9,000 10,000 m3/ h
Positive pressure
Room class Ia
Diferential flow
Supply-air diffuser is the same

Air volume flow is the same
Supply-air velocities in the center is faster then in the
boundaries
Center: 0.40 m*s-1, boundaries: 0.20 m*s-1
Smaller lee areas behind lamps
Diferential flow
Poor ventilation
Good ventilation
Room class Ib
3-stage supply-air filtration

(F7/ F9 ventilation unit) and terminal HEPA filters (H13)
Small supply-air diffusers or simple filter outlets
Turbulent air distribution
Outdoor air flow rate min. 1.200 m/h
Whole amount of air : 3,000 4,000 m3/ h
Positive pressure
Room class Ib
Room class II
2-stage supply-air filtration (F7/F9)

Filter outlets or overspill air from theatre
Turbulent air distribution
Outdoor air flow 40 m/ person
All peripheral rooms in the surgical suite belong to
room class II
Room class II: intervention room
Influence of different ventilation systems upon the
contamination of medical device
Turbulent
ventilation
under laminar-airflow outside the LAF

Results
Benen T., Wille F, Clausdorff, L Influence of different ventilation systems upon the contamination of medical device. HygMed 2013; 38-4:
overnight shutdown of the ventilation
system in the OR
Ventilation runs 24 h, 365 d per year and costs a lot of energy
DIN 1946-4: 2008 for the peripheral rooms possible
point 6.9: shutdown room class II possible
roomclass I: reversal of positiv pressure should be avoided
OENORM H 6020: 2007
point 5.9.1: shutdown for OR-ventilation possible
default: lead time from 30 min before the start of use
Hygienic review of overnight shutdown
no patients in the OR no risk

no stuff in the OR no risk
nobody in the OR no comfort requirements
entry of particles and germs during the out of the use
time is low
by lead time the sufficient purging of the room is ensured
Conclusions
Ventilation is just one part to avoid surgical site infections

The importance of the ventilation system in infection control is
unsure but cannot be denied
German standard: DIN 1946-4: 2008
3 room classes: Ia LAF, Ib turbulent for OR, II normal rooms
Intersurgical contamination of medical devices depends on
the ventilation system
Overnight shutdown of the ventilation is possible
Thank you for your attention!
Any questions?
HYBETA GmbH | Head Office

Nevinghoff 20| 48147 Mnster
T +49 (0)251 2851-0 | F +49 (0)251 2851-129
Info@hybeta.com | www.hybeta.com
Knowing more. Thinking ahead.

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Air supply in operating theatres the

Differences and similarities in infection prevention in

SSI are the most frequent hospital infection in Germany

Influence of the air is an unsolved question in Germany

Endogenous factors (90 %)

Source: Dr. Peter Lderitz

DIN 1946-4: 1963/1978/1989/1999

3-stage supply-air filtration

Supply-air diffuser is the same

3-stage supply-air filtration

2-stage supply-air filtration (F7/F9)

under laminar-airflow outside the LAF

no patients in the OR no risk

Ventilation is just one part to avoid surgical site infections

HYBETA GmbH | Head Office

Knowing more. Thinking ahead.

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