Centre for Clinical Research, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany.
Department of Trauma and Orthopaedic Surgery, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany.
Syst Rev. 2019 Jan 9;8(1):16. doi: 10.1186/s13643-018-0937-9.
Architectural division of aseptic and septic operating theatres is a distinct structural feature of surgical departments in Germany. Internationally, hygienists and microbiologists mainly recommend functional separation (i.e. aseptic procedures first) without calling for separate operating floors and rooms. However, patients with severe musculoskeletal infections (e.g. joint empyema, spondylodiscitis, deep implant-associated infections) may benefit from the permanent availability of septic operating capacities without delay caused by an ongoing aseptic surgical program. A systematic literature review on the influence of a structural separation of septic and aseptic operating theatres on process and/or outcome quality has not yet been conducted.
Systematic literature search in PubMed MEDLINE, Ovid Embase, CINAHL and the Cochrane Library, screening of referenced citations, and assessment of grey literature.
A total of 572 articles were found through the systematic literature search. No head-to-head studies (neither randomised, quasi-randomised nor observational) were identified which examined the impact of structural separation of septic and aseptic operating theatres on process and/or outcome quality.
This review did not identify evidence in favour nor against architectural separation of septic or aseptic operating theatre. Specifically, there is no evidence of a harmful effect of architectural separation. Unless prospective studies, ideally randomised trials, will be available, it is unjustified to call for abolishing established hospital structures. Future investigations must address patient-centered endpoints, surgical site infections, process quality and hospital economy.
PROSPERO (International prospective register of systematic reviews): CRD42018086568.
无菌和感染手术室的建筑分区是德国外科部门的一个显著结构特征。在国际上，卫生学家和微生物学家主要推荐功能分离（即先进行无菌程序），而不要求单独的手术室楼层和房间。然而，患有严重肌肉骨骼感染（如关节积脓、脊椎骨髓炎、深部植入物相关感染）的患者可能会受益于永久性提供感染手术室，而不会因正在进行的无菌手术计划而导致延迟。目前尚未对无菌和感染手术室的结构分离对过程和/或结果质量的影响进行系统的文献回顾。
在 PubMed MEDLINE、Ovid Embase、CINAHL 和 Cochrane 图书馆进行系统文献检索，筛选参考文献，并评估灰色文献。
通过系统文献检索共发现 572 篇文章。未发现头对头研究（既没有随机、准随机也没有观察性研究），这些研究检查了无菌和感染手术室结构分离对过程和/或结果质量的影响。
本综述没有发现支持或反对无菌或感染手术室建筑分离的证据。具体来说，没有建筑分离有害影响的证据。除非有前瞻性研究，理想情况下是随机试验，否则没有理由要求取消既定的医院结构。未来的研究必须解决以患者为中心的终点、手术部位感染、过程质量和医院经济问题。
PROSPERO（国际系统评价前瞻性登记库）：CRD42018086568。
