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Infektionsrisk och tidpunkt för uppdukning av instrument på operationssal
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Postoperativa infektioner är idag den tredje vanligaste formen av vårdrelaterade infektioner efter urinvägsinfektioner och pneumonier. Detta medför kostnader för hälso- och sjukvården och lidande för enskilda patienter. Det är önskvärt att minska antalet postoperativa sårinfektioner och det finns ett flertal metoder för att göra detta, såsom handtvätt och luftflöde i operationssalar.
Bland rutiner inför operationer ingår uppdukning av de instrument som behövs under operationen. Detta kan utföras antingen innan eller efter patienten kommer in på operationssalen. Ju längre tid instrumenten ligger uppdukade, desto mer ökar risken att de kontamineras. Å andra sidan är fler personer i rörelse när patienten kommit in, vilket i sig också ökar risken för kontaminering.
Vanligt är att man dukar upp instrumenten i förväg och täcker med steril operationsduk. Nackdelen då är att operationssalen inte utnyttjas effektivt vilket också medför ökade kostnader.
Fråga till SBU:s upplysningstjänst
Vilken evidens finns för att instrument ska dukas upp innan patienten förs in på operationssal?
Upplysningstjänstens svar
Upplysningstjänsten har gjort en litteratursökning som genererade 4 393 referenser. Alla abstrakt genomlästes och 54 bedömdes potentiellt relevanta.Av dessa lästes 54 i fulltext. Vi har inte identifierat några studier av omedelbart intresse för frågeställningen. Däremot identifierades sju artiklar som möjligen skulle kunna vara av intresse [1-7]. Observera att vi inte har bedömt kvaliteten på rapporterna.
Detta är SBU:s upplysningstjänsts svar på en avgränsad medicinsk fråga. Observera att det kan ha tillkommit nya studier efter litteratursökningsdatum: 2012-05-31.
Referenser
- Recommended practices for maintaining a sterile field. AORN journal 2006;83:402-4, 07-10, 13-6.
- Dalstrom DJ, Venkatarayappa I, Manternach AL, Palcic MS, Heyse BA, Prayson MJ. Time-dependent contamination of opened sterile operating-room trays. The Journal of bone and joint surgery. American volume 2008;90:1022-5.
- Hopper WR, Moss R. Common breaks in sterile technique: clinical perspectives and perioperative implications. AORN journal 2010;91:350-64; quiz 65-7.
- Howard JL, Hanssen AD. Principles of a clean operating room environment. The Journal of arthroplasty 2007;22:6-11.
- Tartari E, Mamo J. Pre-educational intervention survey of healthcare practitioners' compliance with infection prevention measures in cardiothoracic surgery: low compliance but internationally comparable surgical site infection rate. The Journal of hospital infection 2011;77:348-51.
- Thiele RH, Huffmyer JL, Nemergut EC. The "six sigma approach" to the operating room environment and infection. Best practice & research. Clinical anaesthesiology 2008;22:537-52.
- Woodhead K, Taylor EW, Bannister G, Chesworth T, Hoffman P, Humphreys H. Behaviours and rituals in the operating theatre. A report from the Hospital Infection Society Working Party on Infection Control in Operating Theatres. The Journal of hospital infection 2002;51:241-55.
Projektgrupp
- Jan Liliemark, programchef, SBU
- Jessica Dagerhamn, projektledare, SBU
Litteratursökning
Litteratursökning till och med 2012-05-31
Databaser
PubMed via NLM, Embase via embase, The Cochrane Library, CRD, Cinahl via EBSCO
Söktermer
Söktermer | Antal ref | |
Intervention | ||
1. | "Operating Rooms"[MeshOR] "Surgical Instruments"[Mesh:NoExp] OR "Operating Room Nursing"[Mesh] OR "operating room"[Title/Abstract] OR "operating rooms"[Title/Abstract] OR "operating theatre"[Title/Abstract] OR "surgical instrument"[Title/Abstract] OR "surgical instruments"[Title/Abstract] OR ( instrument*[Title/Abstract] AND (setup[Title/Abstract] OR set-up[Title/Abstract] OR set up[Title/Abstract] OR setups[Title/Abstract] OR surgery[Title/Abstract] OR surgical[Title/Abstract] OR preparation[Title/Abstract])) | 65257 |
Utfallsmått | ||
2. | "Surgical Wound Infection"[Mesh] OR "Infection Control"[Mesh] OR "Cross Infection"[Mesh] OR "Air Microbiology/prevention and control"[Mesh] OR "Postoperative Complications"[Mesh:NoExp] OR "Equipment Contamination"[Mesh] | 364537 |
3. | "surgical site infection"[Title/Abstract] OR "surgical site infections"[Title/Abstract] OR "surgical wound infection"[Title/Abstract] OR "surgical wound infections"[Title/Abstract] OR "postoperative infection"[Title/Abstract] OR "postoperative infections"[Title/Abstract] OR "postoperative wound infection"[Title/Abstract] OR "postoperative wound infections"[Title/Abstract] OR "postoperative complication"[Title/Abstract] OR "postoperative complications"[Title/Abstract] OR "post-operative infection"[Title/Abstract] OR "post-operative infections"[Title/Abstract] OR "post-operative wound infection"[Title/Abstract] OR "post-operative wound infections"[Title/Abstract] OR "post-operative complication"[Title/Abstract] OR "post-operative complications"[Title/Abstract] OR "infection control"[Title/Abstract] OR "cross infection"[Title/Abstract] | 53936 |
4. | 2 OR 3 | 384285 |
Studietyp (RCT + SÖ) | ||
5. | "randomized controlled trial"[Title/Abstract] OR "randomized controlled trial"[Publication Type] OR "random"[Title/Abstract] OR "randomly"[Title/Abstract] OR "randomised"[Title/Abstract] OR "randomized"[Title/Abstract] OR "review"[Publication Type] OR "systematic review"[Title/Abstract] OR systematic*[Title/Abstract] OR systematic[sb] | 2 482 254 |
Final | ||
6. | 1 AND 4 AND 5 | 1255 |
Söktermer | Antal ref | |
Intervention | ||
1. | 'equipment'/exp OR 'surgical infection'/exp 'cross infection'/exp AND [embase]/lim | 18913 |
Utfallsmått | ||
2. | 'operating room'/exp OR 'surgical instrument'/ OR 'operating room personnel'/exp AND [embase]/lim | 19530 |
Final | ||
3. | 1 AND 2 | 391 |
Söktermer | Antal ref | |
Intervention | ||
1. | "Operating Rooms"[Mesh] OR "Surgical Instruments"[Mesh:NoExp] OR "Operating Room Nursing"[Mesh] OR "operating room"[Title/Abstract] OR "operating rooms"[Title/Abstract] OR "operating theatre"[Title/Abstract] OR "surgical instrument"[Title/Abstract] OR "surgical instruments"[Title/Abstract] OR ( instrument*[Title/Abstract] AND (setup[Title/Abstract] OR set-up[Title/Abstract] OR set up[Title/Abstract] OR setups[Title/Abstract] OR surgery[Title/Abstract] OR surgical[Title/Abstract] OR preparation[Title/Abstract])) | 12398 |
Utfallsmått | ||
2. | "Surgical Wound Infection"[Mesh] OR "Infection Control"[Mesh] OR "Cross Infection"[Mesh] OR "Air Microbiology/prevention and control"[Mesh] OR "Postoperative Complications"[Mesh:NoExp] | 18262 |
3. | "surgical site infection"[Title/Abstract] OR "surgical site infections"[Title/Abstract] OR "surgical wound infection"[Title/Abstract] OR "surgical wound infections"[Title/Abstract] OR "postoperative infection"[Title/Abstract] OR "postoperative infections"[Title/Abstract] OR "postoperative wound infection"[Title/Abstract] OR "postoperative wound infections"[Title/Abstract] OR "postoperative complication"[Title/Abstract] OR "postoperative complications"[Title/Abstract] OR "post-operative infection"[Title/Abstract] OR "post-operative infections"[Title/Abstract] OR "post-operative wound infection"[Title/Abstract] OR "post-operative wound infections"[Title/Abstract] OR "post-operative complication"[Title/Abstract] OR "post-operative complications"[Title/Abstract] OR "infection control"[Title/Abstract] OR "cross infection"[Title/Abstract] | 19927 |
4. | 2 OR 3 | 19927 |
Final | ||
5. | 1 AND 4 | CDSR: 268 CENTRAL: 1310 TA: 9 EE: 32 |
Söktermer | Antal ref | |
Intervention | ||
1. | MeSH DESCRIPTOR Operating Rooms EXPLODE ALL TREES | 46 |
2. | MeSH DESCRIPTOR Surgical Instruments EXPLODE ALL TREES | 73 |
3. | MeSH DESCRIPTOR Operating Room Nursing EXPLODE ALL TREES | 1 |
4. | ("operating room") OR ("operating rooms") OR ("surgical instrument") OR ("surgical instruments") OR ("operating theatre") | 582 |
5. | (instrument*) | 2629 |
6. | (setup) OR (set-up) OR (set up) OR (setups) OR (surgical) OR (preparation) OR (surgery) | 12921 |
7. | 5 AND 6 | 1171 |
8. | 1 OR 2 OR 3 OR 6 OR 7 | 1618 |
Utfallsmått | ||
9. | MeSH DESCRIPTOR Surgical Wound Infection EXPLODE ALL TREES | 216 |
10. | MeSH DESCRIPTOR Infection Control EXPLODE ALL TREES | 199 |
11. | MeSH DESCRIPTOR Cross Infection EXPLODE ALL TREES | 258 |
12. | MeSH DESCRIPTOR Air Microbiology EXPLODE ALL TREES | 3 |
13. | MeSH DESCRIPTOR Postoperative Complications EXPLODE ALL TREES | 1859 |
14. | ("surgical site infection") OR ("surgical site infections") OR ("surgical wound infection") OR ("surgical wound infections") | 257 |
15. | ("postoperative infection") OR ("postoperative infections") OR ("postoperative wound infection") OR ("postoperative wound infections") OR ("postoperative complication") OR ("postoperative complications") OR ("post-operative infection") OR ("post-operative infections") OR ("post-operative wound infection") OR ("post-operative wound infections") OR ("post-operative complication") OR ("post-operative complications") OR ("infection control") OR ("cross infection") | 1839 |
16. | 9 OR 10 OR 11 OR 12 OR 13 OR 14 OR 15 | 2634 |
Final | ||
17. | 8 AND 16 | 372 |
Söktermer | Antal ref | |
Intervention | ||
1. | (MH "Surgical Instruments") OR (MH "Operating Room Personnel") OR (MH "Surgery Schedule") OR (MH "Operating Rooms") OR (MH "Surgical Equipment and Supplies") OR (MH "Perioperative Nursing") | 16943 |
2. | TX "operating room" OR TX "operating rooms" OR TX "surgical instrument" OR TX "surgical instruments" OR TX "operating theatre" | 22145 |
3. | TX instrument* | 134277 |
4. | TX setup OR TX set-up OR TX set up OR TX setups OR TX surgical OR TX preparation OR TX surgery | 376752 |
5. | 3 AND 4 | 40600 |
6. | 1 OR 2 OR 5 | 66039 |
Utfall | ||
7. | (MH "Surgical Wound Infection") OR (MH "Infection Control") OR (MH "Cross Infection") OR (MH "Infection Control (Saba CCC)") OR (MH "Infection Risk (Saba CCC)") OR (MH "Infection Control (Iowa NIC)") OR (MH "Infection Protection (Iowa NIC)") OR (MH "Air Microbiology/PC") OR (MH "Postoperative Complications") OR (MH "Surgical Recovery Delay (Saba CCC)") | 43199 |
8. | TX "surgical site infection" OR TX "surgical site infections" OR TX "surgical wound infection" OR TX "surgical wound infections" OR TX "postoperative infection" OR TX "postoperative wound infection" OR TX "postoperative infections" OR TX "postoperative wound infections" OR TX "infection control" OR TX "cross infection" OR TX "postoperative complication" OR TX "postoperative complications" OR TX "post-operative infection" OR TX "post-operative wound infection" OR TX "post-operative infections" OR TX "post-operative wound infections" OR TX "post-operative complication" OR TX "post-operative complications" | 62853 |
9. | 7 OR 8 | 62854 |
Final | ||
10. | 6 AND 9 Limiters - Peer Reviewed; Exclude MEDLINE records; Publication Type: Clinical Trial, Meta Analysis, Practice Guidelines, Randomized Controlled Trial, Review, Systematic Review |
141 |