When making a decision on the operating room air handling installation and type of air supply system, it is relevant to know the expenditures of the different air handling installations and air supply systems. The aim of this study was to determine the capital and operational expenditures of air handling installations equipped with an ultra-clean or with a conventional system. To compare the technical requirements of Dutch air handling installations with European standards and guidelines, and evaluate the costs of surgical site infections in comparison with the capital expenditures. This study fills a gap in knowledge, detailed technical information and costs of air handling installations and air supply systems from multiple completed projects of 24 hospitals were collected, analyzed and compared. Per OR capital expenditures increase by €62,491 to €139,018 when an air handling installation with an ultra-clean system is compared to a conventional system, which is 3%–7% of the total construction costs of a completely new OR department. The yearly increase in operational expenditures per OR with an ultra-clean system compared to a conventional system was €673 to €1,896. The capital and operational expenditures of air handling installations with an ultra-clean system are higher than those with a conventional system. The technical specifications of the ORs studied in the Netherlands correspond to European standards and guidelines. When the impact on patient suffering and costs associated with surgical site infections are weighed against the investment required for an air handling installation with an ultra-clean system, it is worth considering.