Fumigation, Gaseous Decontamination, and No-Touch Environmental Technologies in the Operating Theatre: A Narrative Review
Authors and Affiliations
- Foundation University Islamabad, Pakistan
- The Operating Room Global (TORG)
- Allied Health Sciences, Rashid Latif Khan University, Lahore, Pakistan
- Nishtar Medical University, Multan, Pakistan
- Women University, Multan, Pakistan
Corresponding author: Anas Jahangir · [email protected]
Abstract
Background: Environmental decontamination is essential for infection prevention in operating theatres (OTs), yet terminology, evidence and implementation practices vary considerably.
Objective: To review the efficacy, safety and implementation of traditional fumigation and contemporary no-touch decontamination technologies.
Methods: A structured narrative search of PubMed/MEDLINE, Scopus and Google Scholar prioritised systematic reviews and OT-specific studies. Formal risk-of-bias and GRADE assessments were not performed.
Results: Formaldehyde demonstrates broad-spectrum antimicrobial activity but presents substantial occupational health risks and prolonged environmental persistence. Vaporized hydrogen peroxide and aerosolized hydrogen peroxide are distinct technologies, with vaporized hydrogen peroxide having the strongest evidence base among gaseous approaches, although clinical findings remain variable. Ozone and chlorine dioxide demonstrate antimicrobial efficacy under laboratory conditions, but clinical evidence is limited and stringent safety measures are required. Ultraviolet-C has moderate supporting evidence as an adjunct to manual cleaning. Plasma air treatment and far-UVC require further evaluation, while photocatalytic coatings remain investigational. Clinical trials have not established a clear benefit for plasma air treatment.
Conclusion: No single technology suits all OT settings. Selection should consider efficacy, safety, cost and institutional capacity, with manual cleaning remaining fundamental and automated technologies serving as adjuncts.
Keywords: Fumigation; Operating Rooms; Communicable Disease Control; Hydrogen Peroxide; Decontamination; Ultraviolet Rays; Review.
Review at a Glance
Gaseous Technology
Vaporized hydrogen peroxide has the most developed evidence base among the gaseous approaches reviewed, but clinical findings vary.
No-Touch Adjunct
Evidence supports selected uses alongside routine manual cleaning; shadowing and dose verification are important.
Implementation Priority
Containment, exposure monitoring, validation, clearance and local regulatory requirements are central to safe use.
Technologies and Evidence Reviewed
Formaldehyde Fumigation
Historically used for broad-spectrum decontamination, but carcinogenicity, exposure hazards and lengthy aeration make routine use undesirable when safer validated alternatives are available.
Hydrogen Peroxide Systems
Vaporized hydrogen peroxide (VHP) and aerosolized or dry-mist hydrogen peroxide are distinct systems. Each requires device-specific validation, clearance procedures and evidence appropriate to its intended use.
Ozone and Chlorine Dioxide
Both demonstrate antimicrobial activity under controlled conditions, but operating-theatre clinical outcome evidence is limited. Strict containment and monitored re-entry are essential.
Ultraviolet-C and Far-UVC
Conventional UV-C can support terminal decontamination but is affected by room geometry and shadowing. Far-UVC is emerging, with safety and clinical evidence still evolving.
Plasma Air Treatment
A large clinical trial did not demonstrate benefit for its postoperative infection outcome measure; biological plausibility alone does not establish patient benefit.
Photocatalytic Coatings
These remain investigational for operating theatres, with unresolved questions about durability, real-world effectiveness and patient-centred outcomes.
Evidence note: This is a narrative review, not a systematic review. It did not perform PRISMA screening, a formal risk-of-bias assessment, GRADE appraisal or meta-analysis.
Practical Implications for Operating Theatres
Routine environmental cleaning, disinfection, ventilation and engineering controls remain the foundation of operating-theatre infection prevention. Automated technologies should be evaluated as adjuncts for defined indications rather than replacements for established practice.
Implementation decisions should account for validated efficacy, occupational safety, room configuration, staff training, equipment maintenance, total cost of ownership, downtime, documented clearance and monitoring of meaningful clinical outcomes.
Cite This Article
Publication Information
Article History
Received: 6 September 2026
Accepted: 8 October 2026
Available online: 15 October 2026
Journal and License
The Operating Room Global Journal (TORGJ)
ISSN: 3105-3262
Volume 2, Issue 4, December 2026
Pages 23–38
Creative Commons Attribution 4.0 International
Ethics and Consent
Not applicable. This narrative review used published literature and did not involve human or animal participants.
Funding and Conflicts
No funding was received. The authors declared no conflicts of interest.
Authors’ Contributions
Anas Jahangir: Conceptualization, literature search, evidence synthesis, critical analysis, manuscript drafting, review and editing.
Prof. Atia Ur Rehman: Project supervision, conceptualization and critical review of the manuscript.
Hira Khan: Conceptualization, manuscript revision and editing.
Fatima Ashraf: Project administration, review and editing.
All authors approved the final manuscript.
Data Availability
Not applicable; no new datasets were generated.
Full Text and References
The complete published review, including its comparative tables, decision-making framework, discussion, declarations and references, is available in the official PDF.