Ventilation systems are the primary way of eliminating airborne pathogenic particles in an operating room (OR). However, such systems can be complex due to factors such as different surgical instruments, diverse room sizes, various staff counts, types of clothing used, different surgical types and duration, medications, and patient conditions. OR ventilation should provide a thermally comfortable environment for the surgical staff team members while preventing the patient from suffering from any extreme hypothermia. Many technical, logistical, and ethical implications need to be considered in the early stage of designing a ventilation system for an OR. Years of research and a significant number of publications have highlighted the controversy and disagreement among infection specialists, design engineers, and ventilation experts in this context. This review article aims to provide a good understanding of OR ventilation systems in the context of air quality and infection control from existing research and provide multidimensional insights for appropriate design and operation of the OR. To this end, we have conducted a systematic review of the literature, covering 253 articles in this context. Systematic review and meta-analyses were used to map the evidence and identify research gaps in the existing clinical, practical, and engineering knowledge. The present study is categorized into six research focuses: ventilation system, thermal comfort, staff work practice and obstacles, door operation and passage, air cleaning technology, emission rate, and clothing systems. In the conclusion, we summarize the key limitations of the existing studies and insights for future research direction.

Increasing antibiotic resistance in humans during the last decades converts the surgical site infections as one of the main concerns in health-care system. The ventilation systems are considered as the main tool to provide clean air in operating rooms. Although laminar air flow ventilation systems are among the most common system for operating rooms, the number of surgical staff, surgical lamps and door openings can affect the performance of the ventilation system.The main goal of this study is to numerically investigate whether a fan-mounted surgical lamp can reduce the level of bacteria carrying particles within the surgical zone of an operating room with the laminar airflow ventilation system. In this regards, two types of surgical lamps were considered: a closed-shape lamp and a fan-mounted lamp. Computational Fluid Dynamics simulations were applied to map the airflow patterns and bacteria carrying particles. The simulated results showed that the lamp with fan resolved the problem of the low-velocity area under the closed-shape lamp and the contamination level reduced successfully to an acceptable level.