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Tenue au bloc opératoire · de personnels au bloc opératoire et utilisation de dispositifs...
Transcript of Tenue au bloc opératoire · de personnels au bloc opératoire et utilisation de dispositifs...
Tenue vestimentaire
Bloc opératoire
LS Aho Glélé
CHU Dijon
2018
Tenue vestimentaire
A l’hôpital, en général
UNIFORM. JHI, 2007
RESULTS: No statistically significant differences were found in bacterial
or methicillin-resistant Staphylococcus aureus contamination of
physicians’ white coats compared with newly laundered short-sleeved
uniforms or in contamination of the skin at the wrists of physicians
wearing either garment. Colony counts of newly laundered uniforms were
essentially zero, but after 3 hours of wear they were nearly 50% of those
counted at 8 hours.
Burden M. et al., 2011
Tenue vestimentaire
Au bloc opératoire
Tenue de bloc « surgical scrubs »
• « Tenue destinée et ayant démontré son efficacité à réduire la contamination de la plaie opératoire par les squames porteurs d’agents infectieux provenant de la personne habillée de cette tenue via l’air de la salle d’opération, réduisant ainsi les risques d’infection de la plaie. »
• Norme EN 13795
• Cf. Homme et desquamation
Aspects socio-psychologiques et
anthropologiques
“Conclusions:
The doctors’ appearance is of importance to patients and their
relatives, but they view many other attributes as more important
than how we choose to dress.
While not specifically addressing the role of doctors clothing in the
transmission of infection, our results do support the preference of
patients for ‘bare below the elbows’ workplace attire”
Hee HI et al., 2014
Summary
In this study, we aimed to evaluate the bacterial contamination of surgical
scrub suits worn outside the operating theatre.
We randomised 16 anaesthetists on separate occasions into one of 3
groups: restricted to the operating theatre only; theatre and surgical wards;
and theatre and departmental office. For each group, sample fabric pieces
attached to the chest, waist and hip areas of each suit were removed at 150
min intervals between 08:30 and 16:00 on the day of study, and sent for
microbiological assessment.
Mean bacterial counts increased significantly over the course of the
working day (p = 0.036), and were lower in the chest compared to the hip
(p = 0.007) and waist areas (p = 0.016). The mean (SD) bacterial counts,
expressed as colony-forming units per cm2 at 16:00 on the day of study,
were 25.2 (43.5) for those restricted to theatre and 18.5 (25.9) and 17.9
(31.0) for those allowed out to visit the ward and office, respectively (p =
0.370).
We conclude that visits to ward and office did not significantly increase
bacterial contamination of scrub suits.
Hee HI et al., 2014
Hee HI et al., 2014
Salassa TE et al., 2014
Tour de France
Recommandations
Recommandations non « gradées »
Recommandations non « gradées »
Recommandations « gradées »
Tour du monde Recommandations
Recommandations non « gradées »
“Conclusions: Further consideration and better trials are
required to determine the impact of different theatre clothing on
SSI rates”
McHugh, 2014
• “Recommendations
• Surgical scrubs should be clean and made of tightly woven material.
• However, there is little research evidence to demonstrate that wearing surgical attire outside the theatre and returning to the theatre without changing into clean theatre suits increases SSI rates.
• In addition, there are no convincing studies demonstrating a relationship between the use of covering apparel and the prevention of infection…”
Gonzalo Bearman et al.
Healthcare Personnel Attire in Non-Operating Room Settings
SHEA, 2014
• As the SHEA workgroup on HCP attire, we recommend the following:
• Appropriately designed studies should be funded and performed to better define the relationship between HCP attire and HAIs.
• Until such studies are reported, priority should be placed on evidence-based measures to prevent HAIs (e.g. hand hygiene, appropriate device insertion and care, isolation of patients with communicable diseases, environmental disinfection).
• The following specific approaches to practice related to HCP attire may be considered by individual facilities; however, in institutions that wish to pursue these practices, measures should be voluntary and accompanied by a well-organized communication and education effort directed at both HCP and patients.
Tour du monde des recommandations
Recommandations « gradées »
Tour du monde des recommandations
Pays Sociétés savantes /
Agences
Année Recommandation tenue
USA CDC 1999 Néant
Royaume Uni NICE 2008 Staff theatre wear
1.2.5 All staff should wear specific non-sterile
theatre wear in all areas where operations are
undertaken.
Staff leaving the operating area
1.2.6 Staff wearing non-sterile theatre wear
should keep their movements in and out of the
operating area to a minimum.
France SF2H 2013 Néant
USA SHEA/IDSA/APIC
/AHA/Joint
Commission
2014 Néant
OMS OMS 2016 Néant
CDC, 2017
• Pas de recommandation concernant l’air dans
le corps du texte
– Abordé via l’orthopédie, dans les annexes des
recommandations…
• Il est noté à ce sujet : «No recommendation/unresolved
issue) »
– Berríos-Torres et al. 2017
American College of Surgeons and Surgical
Infection Society, 2017
• Ban et al. 2017
• Ventilation abordée de manière indirecte
• Dans paragraphe concernant facteurs de risque de survenue d’ISO – Au même titre que augmentation des mouvements
de personnels au bloc opératoire et utilisation de dispositifs médicaux stériles
• Référence mise en exergue = recommandations SHEA/IDSA de 2014 (Anderson et al. 2014)
– Ventilation, là aussi, abordée dans paragraphe concernant les facteurs de risque d’ISO
» Avec un niveau de preuve le plus bas possible (III, en accord avec GRADE)
American College of Surgeons and Surgical
Infection Society, 2017
• Ban et al. 2017
• Ventilation abordée de manière indirecte
• Dans celui relatif à la casaque à usage unique vs en réutilisable (en tissu…).
– Il est fait mention, en l’absence de données cliniques probantes, de l’étude de Owers (Owers et al. 2004)
• Mettant en évidence des oreilles non protégées par une casque comme une source possible de contamination bactérienne (en termes de colonies bactériennes) sous flux laminaire
Localement
• CLIN ou sous-commission CME et/ou EOH
– Etudie tenue vestimentaire et textile
– Propose à la direction
• Qualité/ Quantité des vêtements ; masques ; gants ;
coiffes
• Recommandations pour la circulation des personnels
secteurs à hauts risques infectieux
» 100 recommandations pour la
surveillance et la prévention des
infections nosocomiales- 1999
Source : cclin se-2008
Preuves
• « Ce qui est affirmé sans preuve, peut être
réfuté sans preuve » – Euclide de Mégare