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