Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Infect Control Hosp Epidemiol. 2024 Jul;45(7):880-889. doi: 10.1017/ice.2023.280. Epub 2024 Mar 13.
To synthesize evidence and identify gaps in the literature on environmental cleaning and disinfection in the operating room based on a human factors and systems engineering approach guided by the Systems Engineering Initiative for Patient Safety (SEIPS) model.
A systematic scoping review.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched 4 databases (ie, PubMed, EMBASE, OVID, CINAHL) for empirical studies on operating-room cleaning and disinfection. Studies were categorized based on their objectives and designs and were coded using the SEIPS model. The quality of randomized controlled trials and quasi-experimental studies with a nonequivalent groups design was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials.
In total, 40 studies were reviewed and categorized into 3 groups: observational studies examining the effectiveness of operating-room cleaning and disinfections (11 studies), observational study assessing compliance with operating-room cleaning and disinfection (1 study), and interventional studies to improve operating-room cleaning and disinfection (28 studies). The SEIPS-based analysis only identified 3 observational studies examining individual work-system components influencing the effectiveness of operating-room cleaning and disinfection. Furthermore, most interventional studies addressed single work-system components, including tools and technologies (20 studies), tasks (3 studies), and organization (3 studies). Only 2 studies implemented interventions targeting multiple work-system components.
The existing literature shows suboptimal compliance and inconsistent effectiveness of operating-room cleaning and disinfection. Improvement efforts have been largely focused on cleaning and disinfection tools and technologies and staff monitoring and training. Future research is needed (1) to systematically examine work-system factors influencing operating-room cleaning and disinfection and (2) to redesign the entire work system to optimize operating-room cleaning and disinfection.
基于患者安全系统工程倡议（SEIPS）模型，采用以人为中心和系统工程方法，综合手术室环境清洁和消毒相关文献，识别其中的空白。
系统范围综述。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，我们在 4 个数据库（即 PubMed、EMBASE、OVID、CINAHL）中搜索了关于手术室清洁和消毒的实证研究。根据研究目的和设计对研究进行分类，并使用 SEIPS 模型进行编码。使用 Cochrane 随机对照试验风险偏倚工具版本 2 评估随机对照试验和非等效组设计的准实验研究的质量。
共审查了 40 项研究，并将其分为 3 组：观察性研究，考察手术室清洁和消毒的效果（11 项研究）；观察性研究，评估手术室清洁和消毒的依从性（1 项研究）；以及改善手术室清洁和消毒的干预性研究（28 项研究）。基于 SEIPS 的分析仅确定了 3 项观察性研究，研究了影响手术室清洁和消毒效果的个别工作系统组件。此外，大多数干预性研究都针对单一工作系统组件，包括工具和技术（20 项研究）、任务（3 项研究）和组织（3 项研究）。只有 2 项研究针对多个工作系统组件实施了干预措施。
现有文献表明，手术室清洁和消毒的依从性不理想，效果不一致。改进工作主要集中在清洁和消毒工具和技术以及员工监测和培训上。未来的研究需要（1）系统地研究影响手术室清洁和消毒的工作系统因素，以及（2）重新设计整个工作系统以优化手术室清洁和消毒。
