Environmental hygiene in the operating room: cleanliness, godliness, and reality.

Cleanliness becomes more important when godliness is unlikely (P.J. O’Rourke). “Environment” is defined by the New Oxford American Dictionary as “the surroundings or conditions in which a person lives or operates,” whereas hygiene is defined as “conditions or practices conducive to maintaining health and preventing disease, especially through cleanliness.” Cleanliness is the state of being free from imperfections, dirt, and pollution. Although achieving true cleanliness in the operating room (OR)—that is, being free from imperfections and contamination— may be as difficult to achieve as godliness, there is growing evidence in the literature to guide our efforts. For the OR, the environment is comprised of the people (OR staff and patient), the space, and the equipment (Fig. 1). The complex interactions that exist between these elements define how clean and safe the environment is.