The Role of Particulate Matter in Surgical Site Infection Pathogenesis: A Scoping Review.

OBJECTIVE

This scoping review examines relevant evidence to understand the associations between operating room (OpR) PM and SSI.

SUMMARY BACKGROUND DATA: Surgical site infections (SSIs), a substantial cause of postoperative morbidity, lead to prolonged hospitalization and increased healthcare cost. Studies have demonstrated airborne particulate matter (PM) to be a vector of exogenous bacterial contamination of the sterile field.

METHODS

A scoping review across PubMed®, Embase, Scopus, and CINAHL databases for eligible studies including OR particulate matter, microbial load, ventilation, and SSI was performed. Non-English and non-human studies were excluded. Among 1,681 records, 21 met inclusion criteria - reporting 51 independent comparisons. Quantitative and qualitative analyses were performed.

RESULTS

Three (14.3%) studies employed direct PM measurement, whereas 18 studies (85.7%) used indirect proxy indicators such as ventilation system characteristics (n=17, 81.0%) and microbial air load (n=1, 4.8%). Substantial heterogeneity was demonstrated across four exposure domains: (1) particle size resolution, (2) temporal resolution, (3) spatial characteristics, (4) viable vs total PM.

CONCLUSION

PM is a biologically plausible, modifiable contributor to SSI development. Current approaches optimize room-level air metrics that correlate poorly with biologically relevant pathogen exposure at the surgical field. Dynamic, size-discriminatory measurement of PM remains a crucial gap essential to establish objective markers of SSI risk, thereby enabling the development and implementation of targeted, actionable environmental interventions for SSI prevention.