Taking Aim at the ‘Dirty Doughnut’ In ORs

Proper ventilation can greatly reduce the environmental strain on operating rooms. However, there’s no one-size-fits all solution.

Back when David Kirschman, MD, worked as a neurosurgeon, he’d sometimes see particles floating in the air under the operating room lights, the way anybody might see dust in their homes at certain times of the day in the spears of illumination coming through a window. Kirschman didn’t like what he saw because he knew that those floating particles had the potential to contaminate everything in an OR: surfaces, instruments, clinicians, and, most alarmingly, the patient being operated on.

Flash forward some 20 years, and Kirschman is the founder and CEO of Aerobiotix, which manufactures the FDA-approved and peer-reviewed Illuvia system, made specifically to keep those pathogens at bay. Those studies have shown that the Illuvia system reduces airborne contamination during surgery by 50% to 70%.

Kirschman tells Infection Control Today® (ICT®) that although hospitals and operating rooms have ventilation standards that they must comply with, those standards don’t seem to help with what he refers to as the “dirty doughnut”—the area around the operating table and on the periphery of the OR. Ventilation in ORs is pretty much one-size-fits-all, he says.

“That [the dirty doughnut] is where the contamination occurs,” Kirschman tells ICT®. “You have a very high particulate level, a very high bacterial level and viral level in this outer part of the room.”

COVID-19 came as a shock to many hospital systems, and its effects will be felt for years to come. “Health care is changing very rapidly,” says Kirschman. “It’s getting crowded. It’s getting dirty. There are new pathogens all the time, like SARS-CoV-2, but also drug-resistant bacteria. Hospitals that are trying to cram more and more services into smaller and smaller time and space.

That puts environmental strain on ORs—strain that infection preventionists (IPs) need to be mindful of. Kirschman notes that Aerobiotix has been a strategic partner with the Association for Professionals in Infection Control and Epidemiology for years.

“Infection preventionists understand that air quality is a hugely important vector for infection in a hospital, whether it’s bacterial, whether it’s viral, whether it's Legionella,” says Kirschman. “A huge chunk of the infections that occur travel through the air at one point or another, either directly or through an aerosol. That’s something that infection preventionists are thinking more about.”

The cost of installing the Illuvia system should pay for itself fairly quickly. “Hospital administrators are very much dollars-and-cents folks,” says Kirschman. “You have to show that what you’re doing will benefit them financially and benefit the hospital financially in the long run. We concentrate mostly on surgical site infections. There are very significant costs associated with those.”