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.
Highlights
Architectural division of aseptic and septic operating theatres is a distinct structural feature of surgical departments in Germany
Architectural separation of aseptic and septic operating theatres is a traditional structural feature of many hospitals in Germany which may be less frequently found in other European countries and surgical departments around the globe
In the qualitative part of the review, a total of 572 articles were found through the systematic literature search in PubMed Medical literature analysis and retrieval system online (MEDLINE), Ovid Excerpta medica database (Embase), CINAHL and the Cochrane Library, as well as through the identification of additional literature (Fig. 1)
Summary
Architectural division of aseptic and septic operating theatres is a distinct structural feature of surgical departments in Germany. 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. Architectural separation of aseptic and septic operating theatres is a traditional structural feature of many hospitals in Germany which may be less frequently found in other European countries and surgical departments around the globe. “separation of septic and aseptic surgical areas is obsolete” [2]. This interpretation is unjustified, as the study was not designed to compare different theatre environments in a head-to-head fashion. Emergency cases demanding immediate intervention may further interrupt schedules and postpone planned septic surgeries
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