Salut à tous.
Après avoir eu le temps de lire les études proposées par julien99, je reprends ce message.
julien99 a écrit : 04 sept. 2020, 22:26
https://www.infectiologie.com/UserFiles ... AT-eb-.pdf
Après 1537 opérations réalisées avec des masques, le taux d’infection des plaies était de 4.7 % , tandis qu’après 1551 opérations réalisées sans masque, le taux d’infection des plaies était de 3.7 %.
Efficacité
– Peu d’éléments factuels mais rationnel pour efficacité des dispositifs
– Observance au port du masque et rapidité intervention = facteurs clés
– L’hygiène des mains apparaît plus efficace que le masque…
– Rôle de la transmission par contact
Les chiffres indiqués, et présentés de façon qui ne correspond pas au
lien donné, proviennent de l'étude de Tunevall, 1991 :
Postoperative Wound Infections and Surgical Face Masks: A Controlled Study ; que dit-elle (c'est moi qui souligne) ?
En 1991, Tunevall a écrit :Registration method
[...]
2. Patient not informed or consent not given, or not included because of increased risk of infection (synthetic graft to be inserted or hematologic disease)--not to be included in the
study.
3. Number of persons, if any, wearing a face mask during an "unmasked" operation, and the reason for this (common cold or allergic rhinitis). [...]
During 1,551 operations, masks were not worn, except on 277 occasions when they were worn by 1 or 2 persons because of a common cold or an allergic rhinitis.
[...]
Clinical results
[...]
In all, during the 115 weeks, a total of 184 (4.6%) postoperative wound infections were recorded after 3,967 operations. Of these infections, 56 belonged to the group of 879 operations (56/879 = 6.4%) not included in the study because of increased risk of infection (n = 199), lack of patient consent (n = 243), or lack of information to the patient because of senility or acute states (n = 437).
Of the remaining 3,088 operations, a total of 699 were acute and 2,389 were elective.
[...]
18 % d’un ou deux porteurs de masques dans les équipes non masquées (pour rhume ou allergie) ;
30 % d’infections non retenues, dont celles d'un groupe à risque accrue ;
Plus des trois quarts représentent des interventions programmées, et peu de chirurgie « lourde » sur 18 types d'interventions.
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Toujours dans le lien de julien99, on cite une
étude interrompue pour cause... d'infections dans le groupe non masqué, et l'étude de
Webster, 2001 (c'est moi qui souligne) :
Le titre de ce papier :
Use of face masks by non-scrubbed operating room staff: a randomized controlled trial ; la conclusion du résumé : «
Surgical site infection rates did not increase when non-scrubbed operating room personnel did not wear a face mask. »
Participants and setting
[...] Only non-scrubbed staff, including anaethetists, were asked to comply with the random assignement. The only exclusions were surgeries where it was considered necessary for all staff to wear masks, for example if the patient was infected with an airborne bacteria. Apart from the intervention, no attempt was made to modify normal practice; masks were not standardised for the study.
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Titre :
Do Anaesthetists Need to Wear Surgical Masks in the Operating Theatre? A Literature Review with EvidenceBased Recommendations ; que lisons-nous (c'est moi qui souligne) ?
Orr16 Mitchell11 and Tunevall’s24 studies represent levels of evidence of level III-3, level III-2 and level II respectively. These studies provide sound scientifically-based evidence that, in the setting of a modern operating theatre with laminar flow/steriflow systems, surgical masks should no longer be considered mandatory for anaesthetists and non-scrub staff during most surgical procedures. [...]
RECOMMENDED GUIDELINES FOR THE USE OF FACE MASKS BY ANAESTHETISTS IN THE OPERATING THEATRE
Guideline One*
During any surgery other than surgery identified in Guideline 2:
• Surgical mask to be worn by scrub team.
• Surgical masks NOT required by other OR staff.
Guideline Two*
Masks with eye protection or visor mask protection should be worn during
• implant insertion surgery
• during the use of surgical power tools.
• trauma management (*Assuming that theatre air conditioning meets Australian Standards and that standard infection control and transmission-based precautions apply.)
*
Moralité : toujours lire et analyser les études qui semblent appuyer une
croyance conviction...
Le sommeil de la raison engendre des monstres. Francisco de Goya.
praedicator veridicus, inquisitor intrepidus, doctor egregius
