In February of 2023, the University of Rochester Medical Center (URMC) opened the first phase of a new ambulatory Orthopaedics campus. With the goal of creating a world-class facility, the staff optimized every opportunity to innovate and improve upon operating room design. Over the last decade a growing body of evidence has demonstrated that conventional Laminar Air Flow (LAF) ventilation is not effective in protecting patients from the risk of airborne microbial contamination. With this in mind, facilities engineering teamed with orthopedic surgical partners to evaluate a more recent innovation in ventilation, Temperature-controlled Air Flow (TcAF). Through a temperature differential and gravity, TcAF provides robust unidirectional airflow and maintains air quality at <10 CFU/m3 throughout the entire room. Presenters will review how airborne risk factors have intensified as surgery has evolved over the decades, describe the process of evaluating this novel system, provide data on the performance of the TcAF system under dynamic conditions and how this technology complies with the requirements of the ASHRAE 170 Standard. . With the goal of creating a world-class facility, the staff optimized every opportunity to innovate and improve upon previous operating room design. Over the last decade a growing body of evidence has demonstrated that conventional Laminar Air Flow (LAF ) ventilation is not effective in protecting patients from the risk of airborne microbial contamination. With this in mind, facilities engineering teamed with orthopedic surgical partners to evaluate a more recent innovation in ventilation, Temperature-controlled Air Flow (TcAF). Through a temperature differential and gravity, TcAF provides robust unidirectional airflow and