Institute of Hygiene and Environmental Health, Charité-University Medicine Berlin, Berlin, Germany.
World Health Organization Patient Safety Program, World Health Organization, Geneva, Switzerland.
Lancet Infect Dis. 2017 May;17(5):553-561. doi: 10.1016/S1473-3099(17)30059-2. Epub 2017 Feb 17.
The role of the operating room's ventilation system in the prevention of surgical site infections (SSIs) is widely discussed, and existing guidelines do not reflect current evidence. In this context, laminar airflow ventilation was compared with conventional ventilation to assess their effectiveness in reducing the risk of SSIs.
We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and WHO regional medical databases from Jan 1, 1990, to Jan 31, 2014. We updated the search for MEDLINE for the period between Feb 1, 2014, and May 25, 2016. We included studies most relevant to our predefined question: is the use of laminar airflow in the operating room associated with the reduction of overall or deep SSI as outcomes in patients of any age undergoing surgical operations? We excluded studies not relevant to the study question, studies not in the selected languages, studies published before Jan 1, 1990, or after May 25, 2016, meeting or conference abstracts, and studies of which the full text was not available. Data were extracted by two independent investigators, with disagreements resolved through further discussion. Authors were contacted if the full-text article was not available, or if important data or information on the paper's content was absent. Studies were assessed for publication bias. Grading of recommendations assessment, development, and evaluation was used to assess the quality of the identified evidence. Meta-analyses were done with RevMan (version 5.3).
We identified 1947 records of which 12 observational studies were comparing laminar airflow ventilation with conventional turbulent ventilation in orthopaedic, abdominal, and vascular surgery. The meta-analysis of eight cohort studies showed no difference in risk for deep SSIs following total hip arthroplasty (330 146 procedures, odds ratio [OR] 1·29, 95% CI 0·98-1·71; p=0·07, I=83%). For total knee arthroplasty, the meta-analysis of six cohort studies showed no difference in risk for deep SSIs (134 368 procedures, OR 1·08, 95% CI 0·77-1·52; p=0·65, I=71%). For abdominal and open vascular surgery, the meta-analysis of three cohort studies found no difference in risk for overall SSIs (63 472 procedures, OR 0·75, 95% CI 0·43-1·33; p=0·33, I=95%).
The available evidence shows no benefit for laminar airflow compared with conventional turbulent ventilation of the operating room in reducing the risk of SSIs in total hip and knee arthroplasties, and abdominal surgery. Decision makers, medical and administrative, should not regard laminar airflow as a preventive measure to reduce the risk of SSIs. Consequently, this equipment should not be installed in new operating rooms.
None.
手术室通风系统在预防手术部位感染（SSI）方面的作用备受关注，现有指南并未反映当前的证据。在此背景下，层流通风与常规通风进行了比较，以评估它们在降低 SSI 风险方面的有效性。
我们检索了 MEDLINE、Embase、Cochrane 对照试验中心注册库和世界卫生组织区域医学数据库，检索时间为 1990 年 1 月 1 日至 2014 年 1 月 31 日。我们对 MEDLINE 的检索进行了更新，检索时间为 2014 年 2 月 1 日至 2016 年 5 月 25 日。我们纳入了与我们预先设定的问题最相关的研究：在任何年龄段接受手术的患者中，手术室使用层流是否与降低总体或深部 SSI 风险相关，作为结局指标？我们排除了与研究问题不相关、语言选择以外的研究、发表于 1990 年 1 月 1 日之前或 2016 年 5 月 25 日之后的研究、会议摘要，以及无法获取全文的研究。两名独立的调查员提取数据，如果全文不可用或论文内容的重要数据或信息缺失，我们将与作者联系。我们评估了发表偏倚。我们使用 Grading of Recommendations Assessment, Development, and Evaluation 对确定的证据质量进行评估。RevMan（版本 5.3）用于进行荟萃分析。
我们共识别出 1947 条记录，其中 12 项观察性研究比较了层流通风与骨科、腹部和血管手术中的常规紊流通风。8 项队列研究的荟萃分析显示，全髋关节置换术后深部 SSI 的风险无差异（330146 例手术，比值比 [OR] 1.29，95% CI 0.98-1.71；p=0.07，I=83%）。对于全膝关节置换术，6 项队列研究的荟萃分析显示深部 SSI 的风险无差异（134368 例手术，OR 1.08，95% CI 0.77-1.52；p=0.65，I=71%）。对于腹部和开放性血管手术，3 项队列研究的荟萃分析显示总体 SSI 的风险无差异（63472 例手术，OR 0.75，95% CI 0.43-1.33；p=0.33，I=95%）。
现有证据表明，与常规紊流手术室通风相比，层流通风在降低全髋关节和膝关节置换术以及腹部手术的 SSI 风险方面没有益处。决策者、医疗和行政人员不应将层流视为降低 SSI 风险的预防措施。因此，这种设备不应安装在新的手术室中。
无。
