Effectiveness of architectural separation of septic and aseptic operating theatres for improving process quality and patient outcomes: a systematic review

Abstract

BackgroundArchitectural 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.MethodsSystematic literature search in PubMed MEDLINE, Ovid Embase, CINAHL and the Cochrane Library, screening of referenced citations, and assessment of grey literature.ResultsA 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.ConclusionsThis 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.Systematic review registrationPROSPERO (International prospective register of systematic reviews): CRD42018086568.Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0937-9) contains supplementary material, which is available to authorized users.

Sustainable Healthcare to Provide Quality Care in the Surgical Industry in the United Kingdom

“…Only one study discussed business services, mortality, and morbidity. There is significant duplication of data among the researched studies on mortality, morbidity, and business services [1,3,[5][6][7][8][9][10][11][12][13][14][15][16][17].…”

Guideline for Design and Maintenance of the Surgical Suite

“…A perioperative nurse should participate in the creation of documents associated with a design project, including the functional program that informs stakeholders (eg, construction personnel) and communicates specifics related to the functional and operational requirements of a new, major, or minor renovation project 1 . The updated guideline now includes more information related to what should be included in the functional program (eg, security requirements, anticipated volume of procedures) and highlights that, when a perioperative nurse contributes to the creation of a functional program, they should include considerations for current and future perioperative needs, including patient population, infection prevention, features to improve productivity, disciplines served, possible expansions, and anticipated technology needs 1,3‐5 …”

“…1 The updated guideline now includes more information related to what should be included in the functional program (eg, security requirements, anticipated volume of procedures) and highlights that, when a perioperative nurse contributes to the creation of a functional program, they should include considerations for current and future perioperative needs, including patient population, infection prevention, features to improve productivity, disciplines served, possible expansions, and anticipated technology needs. 1,[3][4][5] Additional information was added to the recommendation that the interdisciplinary team should create and maintain a safety risk assessment (SRA) for construction projects that begins early in planning and continues throughout the project. 1 Miner indicated that the SRA is a collection of elevated risks that are identified from several different assessments (eg, patient handling and mobility, fall prevention, medication safety, security risk) and potential solutions, all of which are compiled in a living document that should be updated as the design project progresses.…”

Evaluasi Penggunaan Surgical Safety Checklist terhadap Kematian Pasien setelah Laparotomi Darurat di Kamar Operasi

“…Pembedahan atau operasi merupakan segala tindakan yang menggunakan cara invasif yang dilakukan untuk mendiagnosa, mengobati penyakit, injury atau deformitas tubuh umumnya dilakukan dengan pembuatan sayatan yang dapat menimbulkan perubahan fisiologis tubuh dan mempengaruhi organ tubuh lainnya (Scholz et al, 2019). Berdasarkan data yang diperoleh dari World Health Organization (WHO) jumlah pasien dengan tindakan operasi mencapai angka peningkatan yang signifikan dari tahun ke tahun.…”