Surgery outcomes are multifactorial, encompassing various clinical, patient-specific, and environmental elements. Surgery is the number one energy-intensive field in healthcare, but it is not as well known that environmental factors also impact surgery and surgical outcomes [1]. Environmental factors including the role of air quality, laminar flow, temperature, and noise levels all play a role in shaping surgery outcomes and must be incorporated into the framework of patient safety and recovery perioperatively.
Recent studies have explored the correlation between environmental control and surgical site infections (SSIs) [2]. Laminar flow of ultraclean air along with high-efficiency particulate absorbing filters (HEPA) have been shown to create a more sterile surgical field and help prevent SSI development [3]. Further, advances in surgical sterilization, UV radiation, air renewal, humidity control, temperature control, and air pressure control have contributed to the reduction in SSI incidence. When evaluating environmental biosafety across hospitals, one study found a large volume of fungi contamination, which was thought to be related to inadequate maintenance of the air conditioning systems or noncompliance with procedural norms, such as opening and closing the door between the operating room and outer hospital environment [2,4]. Thus, it is important to emphasize the role of air filtration, ventilation design, and overall air quality management in preventing microbial contamination. As surgical site infections negatively impact surgery outcomes, hospital-wide procedural protocols must be emphasized to maintain stringent environmental control within the surgical setting and operating rooms.
Temperature management within the operating room has also been identified as a critical environmental factor influencing patient comfort, complications, recovery rates, and overall outcomes related to surgery. The Surgical Care Improvement Project (SCIP) states body temperature control as a measure to reduce incidence of post-surgical events such as hospital-acquired infections, deep venous thrombosis, and other cardiovascular events [5]. The SCIP measure states that patients undergoing surgery greater or equal to 60 minutes should either be actively warmed or have a body temperature greater or equal to 36 degrees Celsius within 30 minutes before to 15 minutes after anesthesia end time. One study found that compliance with this measure was associated with a decreased incidence of hospital-acquired infections, ischemic-cardiovascular events, mortality, and hospital length of stay [5]. It is important to note that temperature can influence both the physiological and psychological aspects of a surgical patients’ care. Thus, hospitals should stress the significance of following SCIP temperature measures to enhance overall patient outcomes.
The influence of noise levels on clinician performance during surgery is another environmental factor with implications for surgical outcomes. Higher noise levels have been shown to negatively impact surgical performance, team communication and overall patient outcomes and have been studied in various surgical fields including orthopedics, neurosurgery, and urology [6]. A range of studies have shown noise pollution in the operating rooms is often above the threshold of hospital standards [7]. Thus, multidisciplinary strategies and protocols for noise reduction in the operating room are necessary to optimize the surgical environment.
Overall, there has been a large recent body of evidence demonstrating how environmental factors can significantly contribute to surgery outcomes. By focusing on significant factors like air quality, temperature regulation, and noise pollution, healthcare institutions can implement targeted interventions to enhance patient safety and recovery.
References
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2. Alfonso-Sanchez JL, Martinez IM, Martín-Moreno JM, González RS, Botía F. Analyzing the risk factors influencing surgical site infections: the site of environmental factors. Can J Surg. 2017 Jun;60(3):155-161. doi: 10.1503/cjs.017916. PMID: 28234221; PMCID: PMC5453757.
3. Smyth ET, Humphreys H, Stacey A, et al. Survey of operating ventilation facilities for minimally invasive surgery in Great Britain and Northern Ireland: current practice and considerations for the future. J Hosp Infect. 2005;61:112–22.
4. Scaltriti S, Cencetti S, Rovesti S, et al. Risk factors for particulate and microbial contamination of air in operating theatres. J Hosp Infect. 2007;66:320–6.
5. Andrew V. Scott, Jerry L. Stonemetz, Jack O. Wasey, Daniel J. Johnson, Richard J. Rivers, Colleen G. Koch, Steven M. Frank; Compliance with Surgical Care Improvement Project for Body Temperature Management (SCIP Inf-10) Is Associated with Improved Clinical Outcomes. Anesthesiology 2015; 123:116–125
6. Sampieri, G., Namavarian, A., Levin, M. et al. Noise in Otolaryngology – Head and Neck Surgery operating rooms: a systematic review. J of Otolaryngol – Head & Neck Surg 50, 8 (2021).
7. Giv MD, Sani KG, Alizadeh M, Valinejadi A, Majdabadi HA. Evaluation of noise pollution level in the operating rooms of hospitals: A study in Iran. Interv Med Appl Sci. 2017 Jun;9(2):61-66. doi: 10.1556/1646.9.2017.2.15. PMID: 28932499; PMCID: PMC5598129.