With the onus on healthcare providers and their staff to protect patients against all elements of 'avoidable harm' perhaps never greater, Gwen Walker, a highly experienced infection prevention control nurse specialist, and David Williams, MD of Approved Air, who has 30 years' experience in validation and verification of ventilation and ultraclean ventilation systems, examine changing requirements for, and trends in, operating theatre ventilation. Validation and verification reporting on such vital HVAC equipment should not, they argue, merely be viewed as a 'tick-box exercise'; it should instead 'comprehensively inform key stakeholders, and ultimately form part of clinical governance, thus protecting those ultimately named responsible for organisation-wide safety at Trust board level'.