UK research proves need for ultra-clean air in operating theatres to prevent infections

The Avidicare Opragon System is based on scientific validation

Avidicare has been working with an evidence-based approach to develop ultra-clean ventilation systems that help healthcare work towards zero infections since 2007. A key feature is to ensure very low levels of bacteria in the air during on-going surgery. A recent study from the UK (Bone Joint J 2018;100-B:1264-9.) contributes by validating the basic claim concerning the relation between airborne bacteria levels and deep surgical site infections.

 Deep infection was identified as a serious complication in the earliest days of total hip arthroplasty. It was identified that airborne contamination in conventional operating theatres was the major contributing factor. As progress was made in improving the engineering of operating theatres, airborne contamination was reduced. Detailed studies were carried out relating airborne contamination to deep infection rates.


Ultra-clean air in the OR lowers risk of SSI

Avidicare has made thousands of bacteria measurements during on-going surgery and also observed reduced SSI levels in operating theaters with low colony forming unit levels (CFU). This reduction was especially true for ORs that used the Avidicare Opragon system to establish ultra-clean air conditions in the whole OR. The UK research study showed that ultra-clean air conditions significantly reduced the risk of deep infection rates.

In a trial conducted by the United Kingdom Medical Research Council (MRC), it was found that the use of ultra-clean air (UCA) operating theatres was associated with a significant reduction in deep infection rates. Deep infection rates were further reduced by the use of a body exhaust system.

The MRC trial also included a detailed microbiology study, which confirmed the relationship between airborne contamination and deep infection rates.


A future with increasing infection rates

The increase in infection rates seems to be getting worse and deteriorate for the future.

Recent observational evidence from joint registries has shown that in contemporary practice, infection rates remain a problem, and may be getting worse. Registry observations have also called into question the value of “laminar air flow” operating theatres.

This trend was also indicated by a recent study published in The Lancet that we commented on our blog:


A continued need for Ultra-clean air in operating theathers

The UK study concludes that there is a valid and continued need for ultra-clean air in operating rooms to prevent deep surgical infections.

 Observational evidence from joint registries provides very limited evidence on the efficacy of UCA operating theatres. Although there have been some changes in surgical practice in recent years, the conclusions of the MRC trial remain valid, and the use of UCA is essential in preventing deep infection.


The Avidicare Opragon can support infection prevention
Avidicare works with the mission “Towards Zero Infections” which summarises our aim to eliminate the risk of Surgical Site Infections (SSI) within the healthcare system. The Avidicare Opragon system has a scientifically proven capability to lower airbone bacteria levels during surgery, and with antibiotics being less and less effective, this capability will increase in importance. Since when antibiotics fail to treat the infection, it will be more important than ever that the bacteria do not enter the wound in the first place. It is also important to combine ultra-clean air with modern hygienic protocol and antibiotics. 

Please access the complete scientific article here:


New German DIN-standard drives higher costs - Opragon a solution

The most recent version of the DIN standard 1946-4: 2018 requires hospitals to do a positioning analysis in order to determine the size of the clean zone that will be needed for surgery. Previous such analyses resulted in too large clean zones for current LAF ventilation systems, which meant that the staff had to work in a smaller zone than they actually required. This is not allowed anymore. Thus, very large LAF systems (i.e. 4.3x4.3m with more than 15.000 m3/h) are anticipated. This will be very expensive. An option is the smaller, cost-effective and proven Opragon system, which has been scientifically proven to make the whole OR ultra-clean.

Read a background article here (in German): DIN article

Expert Interview - Opragon impressions

Burkhard Schlautmann about his experiences with OR ventilation systems and his impression of Opragon

“Traditional Laminar AirFlow is a technology that is highly standardized and only leaves a small space for new ideas. It is therefore not suitable for innovative rethinking. “

Burkhard Schlautmann has recently joined Avidicare. He has a lot of experience with OR ventilation systems. Due to his past as an OR- and anaesthesia caregiver, Mr. Schlautmann knows exactly the daily working life of OR personnel and the high ventilation system requirements. As a founding member of Hybeta GmbH, he contributed his experiences, his great interest in medical technology and his training as a specialist for hospital hygiene to the company and extended his knowledge with technical content. For many years, Mr. Schlautmann accompanied the installation of many hundreds of German Laminar AirFlow systems (LAF) and he was able to deal extensively with this technology.

 "Through the many years with German LAF technology, I have gained a comprehensive knowledge of the weak points and limits of technology," he says. This is the reason why he is now a member of Avidicare. "In addition, I had to realize that for many years nothing has changed with the DIN standard 1946-4 and the standard is to blame for the fact that there is hardly any innovation in OR ventilation systems," he explained further. The traditional industry has a great influence on the DIN standard and significantly determines its changes. A disappointed fact, because LAF technology only allows a small space for new ideas and is therefore not suitable for innovative rethinking. Mr. Schlautmann was able to get to know and experience the innovative and effective TCAF technology (temperature-controlled airflow) for himself and he is so convinced of Opragon that he wants to help Avidicare gain a foothold in Germany.

But what must change? On one hand, improving bureaucracy and politics is needed but not enough to drive a change. "On the other hand, the people who control the development of the DIN norm earn their money on LAF systems," Schlautmann notes. This is just not right. To be clear, this is particularly evident from the latest adaptation of the standard which, for example only mentions a protected zone of a fixed – and square – size of 3.20 m x 3.20 m.

Although other systems (such as Opragon) do not require a protected zone, this example often serves as a standard because many authorities blindly rely on the DIN norm. For this reason, scientific facts are important to argue for the use of alternative systems such as Opragon. “I would like to help Avidicare and Opragon to have a larger base in Germany," Schlautmann continued, so that the research can be shared, and reliable results achieved.

As an expert for the established LAF technology, Mr. Schlautmann is familiar with the weak points of these systems. Opragon offers hospitals many benefits compared to ventilation systems with TAF technology. Mr. Schlautmann is most impressed by the fact that the whole operating theatre is ultra-clean and no "classic" protected zone is necessary due to the TCAF technology. Thus, the patient is also better and more effectively protected. As a former OR caregiver, the best possible patient protection is always close to his heart. "This is the main reason why I can honestly recommend the TCAF technique," says Schlautmann.

Based on his experiences in the operating theatre and expert for LAF systems, he can assess the advantages of Opragon differently: for example, there is a high risk of failure with LAF systems, which can already be identified during installation and can only be remedied by extensive subsequent improvements. "Opragon has about the same price as a ventilation system with LAF technology, but offers more benefits and better patient protection," explains Schlautmann. As he spents a lot of time in operating theatres, he claims "with certain confidence that he had felt no temperature difference and no draughts" when he was in an OR with the Opragon system. In addition, the Opragon's TCAF technology provides much more freedom of movement. By eliminating the protected zone, the OR staff can focus on the work on the patient. LAF systems, on the other hand, require constant monitoring of the protected zone, the patient and the instruments.

In conclusion, Mr. Schlautmann tells us that he finally feels that he has arrived at Avidicare. "It's no longer a matter of installing technology and selling systems, but of focusing on the well-being of patients and the innovative development of patient protection," he added. The safety of the patient is Avidicare's top priority and this is fully in harmony with his personal beliefs. "Not only because of my experience, but also because of my time with LAF systems, I believe in the technology of the TCAF and Opragon."

AORN Report - OR of the Future with Opragon

This week Avidicare was part of the “OR of the Future” at the AORN conference in Nashville, TN, USA.

AORN is the Association of periOperative Registered Nurses. Every year, their annual conference is held to support the development of OR nurses and to present the best equipment and tools for surgery in the US. The conference was staged in Nashville TN with almost 6000 attendees.

OR of the future 

This year, AORN wanted to show the latest innovations that are available already today. Carefully selected medical equipment suppliers joined in one joint booth to showcase the latest walls, lamps, tables, software, VR tools and imaging equipment. Avidicare was invited to show its Opragon ventilation system and joined this centerpiece of the expo along with leading suppliers such as Getinge and Siemens.


SSI/HAI is a dominating theme

The OR nurses and medical equipment suppliers have an increasing awareness around the SSI/HAI challenges in general and airborne bacteria as a leading origin of SSI in particular. This is in line with current research and the evidence generated by Avidicare’s bacteria measurements during surgery. The conclusions are well documented in scientific publications both in terms of the efficiency of the Opragon as well as expected outcomes.

 Several projects in the US are now considering Opragon to ensure ultraclean conditions in their ORs while securing a much larger clean zone than current laminar airflow systems as well as fantastic staff comfort.

Learn more on our scientific support by requesting our “reference to literature”, or let us help by drawing a solution for your next project. Welcome to contact Peter Hojerback.

Opragon selected for OR of the Future at AORN

Experience Opragon in the “OR of the Future” at AORN (Booth 2514) along with selected leading suppliers including Getinge Maquet.

Changes in technology and new scientific findings in clinical practice are redefining perioperative care and the OR surgical suite – and nurses must be ready. Walk through a full-sized OR for hands-on experience with several new technologies. See how more efficient use of space, interoperability, and equipment accessibility are impacting clinical practice, workflows and OR design.

Learn more here:

(Photo Flevo Hospital, Copyright Hanne van der Woude)

AMR kills 33,000 Europeans every year (Lancet)

Anti-microbial resistance (AMR) is a clear and present danger

The rise of AMR has been accelerating the past years. This has been proven by many research studies and governmental Initiatives. A recent article published in The Lancet on November 5th 2018 states that as many 33 000 Europeans die every year from AMR related bacterial infections. This elevates the disease burden to be on par with the combined deaths of influenza, tuberculosis and HIV/AIDS. 

The study furthermore states that a majority of the infections and deaths are associated with the healthcare system, which is a major challenge for public health. 

"We estimated that 63,5% (426 277 of 671 689) of cases of infections with antibiotic-resistant bacteria were associated with health care, resulting in 72,4% (23 976 of 33 110) of attributable deaths and 74,9% (127 of 180) of DALYs* per 100 000 population. This finding suggests that the health effects of infections with antibiotic-resistant bacteria predominantly occur in hospitals and other health-care settings.”

Learn more about the report here:

Less bacteria in the air means less risk for infections - Opragon case

The new Lancet article is only one in a long line of studies that point to the importance of ultra-clean air in operating rooms as a means of reducing the risk of Surgical Site Infections (SSIs), since high bacteria levels in the air during surgery is one of the leading causes of SSIs. (

Avidicare works with the mission “Towards Zero Infections” which summarises our aim to eliminate the risk of Surgical Site Infections (SSI) within the healthcare system. The Avidicare Opragon system has a scientifically proven capability to lower airbone bacteria levels during surgery, and with antibiotics being less and less effective, this capability will increase in importance. Since when antibiotics fail to treat the infection, it will be more important than ever that the bacteria do not enter the wound in the first place. It is also important to combine ultra-clean air with modern hygenic protocol and antibiotics.

Learn more on how Avidicare can help you fight SSI and join us in our mission on  

*Disability Adjusted Life Years - DALY

First clinical Avidicare Opragon installation in Potsdam, Germany

First clinical Avidicare Opragon installation in Potsdam, Germany

The Oberlinklinik in Potsdam launched the first two of four Avidicare Opragon systems on October 15th 2018. This is another great example of a collaboration to reduce bacteria levels during surgery with leading orthopaedic clinics in Northern Europe. 

This successful launch is part of the greater ongoing Avidicare expansion in the DACH and Benelux regions respectively  where Sint Maartens Klinik in Nijmegen and Clinica Luganese Moncucco, Lugano, Switzerland are two additional examples. 

The Oberlinklinik launch event was featured in the Potsdam TV network "Hallo Potsdam” please see link below:

Please learn more on the Avidicare Opragon system on

Nov 23 - Join Opragon Workshop in Oberlinklinik, Potsdam

Endlich ist es soweit, die neuen Operationssäle im Oberlinhaus sind in Betrieb. Wir möchten Sie herzlich zum Avidicare Workshop in Potsdam am 23. November einladen. Dort erwarten Sie interessante Vorträge und die einzigartige Möglichkeit das innovative Opragon-System von Avidicare in einem Operationssaal zu erleben. Wir freuen uns darüber, dass wir führende Experten für die Vorträge des Workshops gewinnen konnten. Die Themen der Vorträge entnehmen Sie bitte dem Save-the-Date Flyer (DOWNLOAD).

Die Teilnehmerzahl für die Besichtigung des Opragon ist allerdings begrenzt, daher bitte ich Sie, mich zeitnah via zu kontaktieren, um Ihre Einladung zu bestätigen.

Research confirms benefits of Opragon compared to LAF and mixing ventilation

The Royal Institute of Technology in Stockholm (KTH) has investigated the new Temperature controlled AirFlow (TAF) being used in the Opragon® operating room ventilation and compared it with the two conventional technologies (LAF and TMA). The super-computer based numerical simulations confirmed that Opragon creates ultra-clean conditions in the whole operating room using significantly less air than LAF. TMA could not maintain ultra-clean levels. It also showed that only increasing the airflow rate (ACH) was not efficient to improve the removal of bacteria. Access the report here, or mail for a copy of the article:

Getting the hospital you deserve

The Dutch health-care magazine FMT has interviewed key stakeholders at the leading orthopedic clinic SMK, who share the story of the integrated ORs from Avidicare and Optimus.

That Opragon has been chosen for an orthopedic hospital is an outstanding choice. It was mainly guided by the positive experiences of Swedish hospitals. Koen Defoort, orthopedic surgeon at SMK: "We went to see Opragon in Swedish hospitals in which implantations are being carried out on a large scale. The experiences were unanimously positive with low infection rates. What further convinced us were the bacteriological measurements - and not with particle counts. The results were very favorable. We already have low infection rates (1-1.5%) and we are convinced that these can certainly be achieved in the new ORs and may be improved somewhat.”

Prof Mark van Houdenhoven, chairman of the executive board at SMK, concludes: "We are working very hard with a lot of people, our position is that every hospital gets the hospital that it deserves." To learn more, check this link.

Blog - Superbugs are changing healthcare

Airborne bacteria is a main source of the feared Surgical Site Infection (SSI). They cause many deaths and suffering that also consumes health care resources that could have been used better. Today, healthcare relies on curing infections using antibiotics, but as superbugs resistant to drugs are rapidly becoming more common, we need to redesign how care is given. Prevention will become much more important, which in the case of SSIs means investing in innovations such as ultra-clean air systems that prevent the bacteria from entering the wounds in the first place.

Tags: Airborne bacteria, SSI, AMR, Ultra-clean air during surgery, Opragon, Avidicare, SVT, American Journal of Infection Control

Anti-microbial resistance is a growing health risk today and in the future

The current development of AMR is growing into a global worry. The current levels of SSIs are kept to somewhere between 1-5% with the use of antibiotics during and after surgery. The long-term challenge is that antibiotics are experiencing reduced or completely lost effectiveness due to superbugs. They are bacteria that cannot be killed by antibiotics.

In fact, the Swedish national television recently ran a special report on SSIs that pointed to the importance of antibiotics:

”The WHO estimates that ten million people die every year as a result of bacterial infections that antibiotics can’t kill. 25 000 of them live in Europe. Approximately 400 of them are Swedes, according to the Swedish National board of health and welfare” (, 2018)

It is also important to note that antibiotics are not only essential for fighting infections but also crucial for enabling certain treatments, including cancer.

”(…) antibiotics is crucial in the healthcare system, not only for treating infections, it is also a pre-requisite for a successful outcome of many different treatments and surgeries, such as chemotherapy.” (, 2018)

The special report pointed to the risk of performing surgery at all on patients that are infected with superbugs.

”-Today we take many things for granted. To be able to get a hip replacement, for example, we might not be able to do that in the future. This is especially true if the patient carries a superbug, then we may have to refrain from at all performing the surgery." (, 2018)

The right OR ventilation system reduces airborne bacteria levels during surgery

At Avidicare we have more than ten years’ of experience from installing more than 130 OR ventilation units at leading academic hospitals in Northern Europe. We have during this period amassed a weight of scientific evidence illustrating the effectiveness of the Opragon system to create ultra-clean air conditions during surgery. This is in line with scientific recommendations, such as recently published in the Journal of Infection Control.

“Future considerations should be given to institutional investment in innovative air purification technologies as an adjunctive strategy to enhance current engineering controls in an effort to reduce the risk of Perioperative Joint Infections” (AJOIFC, 2018)

There are additional scientific articles illustrating the effectiveness of the Opragon ventilation system as well as comparison with other technologies in the market today.

Learn more about how you and your organization can reduce the risk of Surgical Site Infections on or through the linked resources below.

Further reading

There are many relevant publications that illustrate the importance of ultra-clean air during surgery to reduce the risk of infection from superbugs and AMR side effects.


The WHO information resource on antimicrobial resistance:

Swedish national broadcasting organisation

The Journal of Hospital Infection

Temperature-controlled airflow ventilation in operating rooms compared with laminar airflow and turbulent mixed airflow, M.Alsved et al, The Journal of Hospital Infection, 2018

American Journal of Infection Control

“Environment of care: Is it time to reassess microbial contamination of the operating room air as a risk factor for surgical site infection in total joint arthroplasty”, Parvizi et al, American Journal of Infection Control, 2017

Berlin Students Study Opragon

Avidicare was invited by the students from OSZIMT in Berlin to present and discuss around the Opragon system compared to traditional ventilation solutions in German operating theatres. A few of the students also had the opportunity to visit an Opragon workshop at OTH-Weiden led by Prof. Dr. med. Clemens Bulitta thus gaining more practical experience. Read their article here. And if you want to learn more as well or even make a visit, just e-mail

One in ten develops an SSI globally - 20% resistant to antibiotics

More than one in 10 (12%) patients around the world develops a surgical site infection within 30 days of gastrointestinal surgery, finds a study* of more than 12,500 people in 66 countries, published in The Lancet Infectious Diseases

Worryingly, more than one in five (22%) of these infections were resistant to the antibiotics given before surgery to ward off infections. 

“These findings begin to characterise the relationship between surgical site infections and global antimicrobial resistance,” says Dr Ewen Harrison, NIHR Unit on Global Surgery at the University of Edinburgh. 

Leading orthopedic clinic chooses Opragon

One of the best orthopedic clinics in the world, The Sint Maartenskliniek in Holland, has chosen Opragon to ensure that their patients and staff get the cleanest and most comfortable air in their six new operating and six lay-up rooms. The Opragon system allows the surgical team increased flexibility in terms of working space, which benefits both patient safety and working comfort. Read more in our press room here.

(Photo from St Jansdaal in Holland, Linda Heller)

Kids get best O.R. ventilation

Avidicare is proud to announce that it is helping the prestigious Queen Silvia’s Kids and Youth Hospital to reduce the risk for Surgical Site Infections by suppling the innovative Opragon ventilation systems to several operating and hybrid operating rooms. Learn more about the cool and futuristic hospital project here and watch their YouTube video (in Swedish).  E-mail for the press release (in Swedish).

New scientific evidence for Opragon

The respected “Journal of Hospital Infection” just published an article comparing the Opragon system to traditional OR ventilation systems. Researchers confirmed that Opragon maintains ultra-clean conditions in the whole OR using less energy and with better working conditions than Laminar Airflow Systems, while also using 28% less energy. Mixed ventilation was not able to create ultra-clean conditions. Read the paper here. (Open access will be available in November.)

The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience.