Recommendations for Improving Environmental Biosafety in the Operating Theatre

The Agencia de Calidad Sanitaria de Andalucía (Andalucia's Sanitary Quality Agency) has published its recommendations to improve biosafety in the surgical environment, which include actions directed to increasing air and ventilation quality, as well as intrasurgery action protocols.

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ACSA offers the following recommendations in order to aid surgical and medical-surgical units to control the operating theatres’ environmental quality:

Infrastructure. Air and Ventilation

1. To know the optimal biosafety conditions of the operating theatre. In order to do that, there should be access to:

  • daily, to operating theatre records: temperature (optimal value: 18-26 ºC), relative humidity (optimal value: 40-60%) and differential pressure between operating theatres and surrounding areas (optimal value: 10 pascals);
  • monthly, to the air/hour renewal values (optimal value: 15-20);
  • to the results of the microbiological controls performed.

2. If deviations are detected, contact the relevant services (Preventive Medicine Service, Maintenance Service, etc.).

3. Record the events that occurred and establish a schedule for review and analysis. This system will allow the identification and knowledge of the causes of recurring events in order to be able to apply the relevant solutions.  

Intrasurgical Discipline

  1. Attire: surgical scrubs, footwear or clogs suitable for the operating theatre, scrub cap covering all the hair and a facial mask covering mouth and nose, which should be on before entering the operating theatre. 
  2. Hand hygiene before and after contact with the patient and their environment.
  3. Personnel traffic: limit as much as possible the number of professionals and their circulation within the operating theatre, to reduce bacterial load.
  4. Comply with the asepsis protocols implemented in the hospital.
  5. Maintain doors closed, except for personnel, patient and instrument circulation. In these cases, keep them open as short as possible.
  6. Open pass-through windows only if necessary (to deliver material).
  7. Use sterile materials in the surgical field and only handle them through methods which preserve their sterility.
  8. Design an individual responsible to supervise operating theatre cleaning and disinfection.
  9. During activity, maintain the operating theatre as tidy and clean as possible.  

Source of information:

Agencia de Calidad Sanitaria de Andalucía: Recommendation No. 35. Bioseguridad ambiental en quirófano [Internet]. Andalucia; May 2018 [query performed on September 23, 2018]. Available at #Infografía: Recomendaciones para mejorar la bioseguridad ambiental en quirófano [Internet]. Andalucia; [query performed on September 23, 2018]. Available at 



-       To decrease the number of safety incidents related to the surgical process and which represent 40% of the adverse events notified by hospitals.
-       To reduce the incidence of surgically-located infections, which represent 14% of nosocomial infections.
-       To control the environmental quality of the surgical areas.
-       To bolster the implementation of dynamic mechanisms for inquiries about the operating theatres’ state of maintenance.
-       To boost the analysis of registered events.
-       To record and control the operating theatres’ ventilation systems.
-       To detect any possible environmental biosafety issues in advance.
-       To drive the implementation of good practices in terms of environmental biosafety in areas and installations.






Published on*** 23 Sep 2018


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