Kramer A, Külpmann R, Wille F, Christiansen B, Exner M, Kohlmann T, Heidecke C D, Lippert H, Oldhafer K, Schilling M, Below H, Harnoss J C, Assadian O
Universität Greifswald, Institut für Hygiene und Umweltmedizin, Walther-Rathenau-Strasse49a, 17489 Greifswald, Deutschland.
Zentralbl Chir. 2010 Feb;135(1):11-7. doi: 10.1055/s-0029-1224721. Epub 2009 Dec 3.
Surgical teams need to breathe air that is conducive to their health. An adequate exchange of air ensures oxygen supply, the ventilation of humidity, smells, toxic substances, especially narcotic gases and surgical smoke, pathogens and particles. With regard to the infection risk, DIN 1946 / 4 -differentiates between operation theaters with the highest demand for clean air (operation room class I a), operation theatres with a high demand (operation room class I b) and rooms within the operation theatres without special requirements, meaning that the microbial load in the air is close to or equal to that of normal in-room air quality (room class II). For an operation room class I a, ventilation that displaces the used air is necessary, while a regular ventilation is sufficient for operation room class I b. Because of ambiguous -results in previous studies, the necessity to define a -class I a for operation rooms is being questioned. Therefore, this review focuses on the analysis of the existing publications with respect to this -question. The result of this analysis indicates that so far there is only one surgical procedure, the -implantation of hip endoprosthetics, for which a preventive effect on SSI of a class I a ventilation (displacement of the used air) is documented. One recent study, reviewed critically here, -showed opposite results, but lacks methodological clarity. Thus, it is concluded that evidence for the requirement of operation room classes can only be derived from risk assessment (infection risk by surgical intervention, extent of possible damages), but not from epidemiological studies. Risk assessment must be based on the following criteria: size and depth of the operation field, -duration of the procedure, vascular perfusion of the wound, implantation of alloplastic material and general risk of the patient for an infection. From an infection preventive point of view, no class I a "displacement ventilation" is necessary for small surgical procedures for which the RKI recommends only a procedure room, and for surgical procedures for which a risk evaluation indicates that the air in the operation theater can be equal to normal air.
手术团队需要呼吸有利于他们健康的空气。充足的空气交换可确保氧气供应、湿度、气味、有毒物质（尤其是麻醉气体和手术烟雾）、病原体和颗粒的排出。关于感染风险，德国工业标准DIN 1946 / 4将对清洁空气有最高要求的手术室（手术室I a级）、有高要求的手术室（手术室I b级）和手术室中无特殊要求的房间区分开来，这意味着空气中的微生物负荷接近或等同于正常室内空气质量（房间II级）。对于手术室I a级，需要采用排出用过空气的通风方式，而对于手术室I b级，常规通风就足够了。由于先前研究结果不明确，为手术室定义I a级的必要性受到质疑。因此，本综述着重分析关于这个问题的现有出版物。该分析结果表明，到目前为止，仅有一项外科手术，即髋关节假体植入术，记录了I a级通风（排出用过的空气）对手术部位感染有预防作用。一项近期研究（在此进行批判性回顾）显示了相反的结果，但在方法上缺乏清晰度。因此，得出的结论是，手术室等级要求的证据只能来自风险评估（手术干预的感染风险、可能损害的程度），而不是来自流行病学研究。风险评估必须基于以下标准：手术区域的大小和深度、手术持续时间、伤口的血管灌注、异体材料的植入以及患者感染的总体风险。从感染预防的角度来看，对于德国罗伯特·科赫研究所仅建议设置手术间的小型外科手术，以及风险评估表明手术室内空气可等同于正常空气的外科手术，无需I a级“置换通风”。
