Zusammenfassung
Postoperative Wundinfektionen stellen eine relevante Komplikation invasiver Eingriffe dar. Aktuelle europaweit erhobene Prävalenzdaten zeigen für die aus Deutschland teilnehmenden Krankenhäuser (n = 132), dass die postoperative Wundinfektion mit 24,3 % die häufigste nosokomiale Infektionsentität bildet. Dies entspricht einer Punktprävalenz von 1,31 %. Es wird angenommen, dass bei Ausschöpfung sämtlicher infektionspräventiver Maßnahmen etwa 25–33 % aller nosokomialen Infektionen vermeidbar sind. Neuere Untersuchungen deuten darauf hin, dass dieser Anteil für einzelne Infektionsentitäten noch höher sein könnte. Infektionsprävention lässt sich in allgemeine Maßnahmen, die für die Vorbeugung in vielen Bereichen und für viele Infektionsentitäten gültig sind, sowie in spezifische Maßnahmen, bezogen auf krankenhausspezifische Gegebenheiten bzw. eine Infektionsentität, einteilen. Im Folgenden werden verschiedene Hygienemaßnahmen bzw. Empfehlungen hinsichtlich ihrer Zuordnung vorgestellt.
Abstract
Postoperative wound infections represent a relevant complication of invasive interventions. Current European prevalence data show that for participating hospitals from Germany (n = 132) surgical site infections represent the most commonly occurring nosocomial infection with 24.3 %. This corresponds to a point prevalence of 1.31 %. It is assumed that approximately 25–33 % of all infections acquired in hospital could be prevented if all possible precautions would be taken. Recent studies have indicated that this rate might be even higher for individual infection entities. Infection control measures can be divided into general measures, which are valid for prevention in many fields and for many infection entities and into specific precautions related to hospital-specific circumstances or specific infection entities. In this article the various hygiene measures and recommendations are presented with respect to the level of evidence.
Literatur
Akca O, Podolsky A, Eisenhuber E et al (1999) Comparable postoperative pulmonary atelectasis in patients given 30 % or 80 % oxygen during and 2 hours after colon resection. Anesthesiology 91:991–998
Anderson DJ, Podgorny K, Berrios-Torres SI et al (2014) Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 35:605–627
Anderson DJ, Podgorny K, Berrios-Torres SI et al (2014) Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 35(Suppl 2):66–88
Andrzejowski J, Hoyle J, Eapen G et al (2008) Effect of prewarming on post-induction core temperature and the incidence of inadvertent perioperative hypothermia in patients undergoing general anaesthesia. Br J Anaesth 101:627–631
Ata A, Lee J, Bestle SL et al (2010) Postoperative hyperglycemia and surgical site infection in general surgery patients. Arch Surg 145:858–864
Behnke M, Hansen S, Leistner R et al (2013) Nosokomiale Infektionen und Antibiotika-Anwendung: Zweite nationale Prävalenzstudie in Deutschland. Dtsch Arztebl 110:627–633
Belda FJ, Aguilera L, Garcia AJ De La et al (2005) Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. JAMA 294:2035–2042
Bock M, Muller J, Bach A et al (1998) Effects of preinduction and intraoperative warming during major laparotomy. Br J Anaesth 80:159–163
Bode LG, Kluytmans JA, Wertheim HF et al (2010) Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 362:9–17
Bodi M, Ardanuy C, Olona M et al (2001) Therapy of ventilator-associated pneumonia: the Tarragona strategy. Clin Microbiol Infect 7:32–33
Brandes IF, Jipp M, Popov AF et al (2011) Intensified thermal management for patients undergoing transcatheter aortic valve implantation (TAVI). J Cardiothorac Surg 6:117
Bratzler DW, Dellinger EP, Olsen KM et al (2013) Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 70:195–283
Bräuer A, Russo M, Nickel EA et al (2015) Anwendungsrealität des perioperativen Wärmemanagements in Deutschland – Ergebnisse einer Online-Umfrage. Anästh Intensivmed 56:287–297
Breier AC, Brandt C, Sohr D et al (2011) Laminar airflow ceiling size: no impact on infection rates following hip and knee prosthesis. Infect Control Hosp Epidemiol 32:1097–1102
Brunkhorst FM, Engel C, Bloos F et al (2008) Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 358:125–139
Brunskill SJ, Millette SL, Shokoohi A et al (2015) Red blood cell transfusion for people undergoing hip fracture surgery. Cochrane Database Syst Rev 4:CD009699
Houlden R, Capes S, Canadian Diabetes Association Clinical Practice Guidelines Expert C, - (2013) In-hospital management of diabetes. Clin Pract 37(Suppl 1):77–81
Coburn M, Schiff JH, Bause H et al (2016) Qualitätsindikatoren Anästhesiologie 2015. Anästh Intensivmed : (in press)
Crolla RM, Van Der LL, Veen EJ et al (2012) Reduction of surgical site infections after implementation of a bundle of care. PLoS ONE 7:e44599
Brito PV De, Clark AM, Galvao CM (2013) A systematic review on the effectiveness of prewarming to prevent perioperative hypothermia. J Clin Nurs 22:906–918
Dellinger RP, Levy MM, Rhodes A et al (2013) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 41:580–637
Desai SP, Henry LL, Holmes SD et al (2012) Strict versus liberal target range for perioperative glucose in patients undergoing coronary artery bypass grafting: a prospective randomized controlled trial. J Thorac Cardiovasc Surg 143:318–325
Edmark L, Kostova-Aherdan K, Enlund M et al (2003) Optimal oxygen concentration during induction of general anesthesia. Anesthesiology 98:28–33
Fischer D, Geisen C, Steffen B et al (2014) Patient Blood Management – Der Patient im Krankenhaus. Anasthesiol Intensivmed Notfallmed Schmerzther 49:256–264
Fossum S, Hays J, Henson MM (2001) A comparison study on the effects of prewarming patients in the outpatient surgery setting. J Perianesth Nurs 16:187–194
Frank SM, Fleisher LA, Breslow MJ et al (1997) Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 277:1127–1134
Furnary AP, Zerr KJ, Grunkemeier GL et al (1999) Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg 67:352–360
Gastmeier P, Geffers C (2008) Nosokomiale Infektionen in Deutschland: Wie viele gibt es wirklich? Dtsch Med Wochenschr 133:1111–1115
Gastmeier P, Breier AC, Brandt C (2012) Influence of laminar airflow on prosthetic joint infections: a systematic review. J Hosp Infect 81:73–78
Glance LG, Dick AW, Mukamel DB et al (2011) Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology 114:283–292
Greif R, Akca O, Horn EP et al (2000) Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. N Engl J Med 342:161–167
Ho VP, Stein SL, Trencheva K et al (2011) Differing risk factors for incisional and organ/space surgical site infections following abdominal colorectal surgery. Dis Colon Rectum 54:818–825
Hopf HW (2007) Is it time to retire high-concentration nitrous oxide? Anesthesiology 107:200–201
Hopf HW, Hunt TK, West JM et al (1997) Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg 132:997–1004
Hovaguimian F, Lysakowski C, Elia N et al (2013) Effect of intraoperative high inspired oxygen fraction on surgical site infection, postoperative nausea and vomiting, and pulmonary function: systematic review and meta-analysis of randomized controlled trials. Anesthesiology 119:303–316
Jonsson K, Jensen JA, Goodson WH 3rd (1987) Assessment of perfusion in postoperative patients using tissue oxygen measurements. Br J Surg 74:263–267
Joyce CJ, Baker AB, Kennedy RR (1993) Gas uptake from an unventilated area of lung: computer model of absorption atelectasis. J Appl Physiol 1985(74):1107–1116
Krediet AC, Kalkman CJ, Bonten MJ et al (2011) Hand-hygiene practices in the operating theatre: an observational study. Br J Anaesth 107:553–558
Kurz A, Sessler DI, Lenhardt R (1996) Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 334:1209–1215
Latham R, Lancaster AD, Covington JF et al (2001) The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients. Infect Control Hosp Epidemiol 22:607–612
Lazar HL, Mcdonnell M, Chipkin SR et al (2009) The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. Ann Thorac Surg 87:663–669
Leaper D, Ousey K (2015) Evidence update on prevention of surgical site infection. Curr Opin Infect Dis 28:158–163
Lidwell OM, Elson RA, Lowbury EJ et al (1987) Ultraclean air and antibiotics for prevention of postoperative infection. A multicenter study of 8,052 joint replacement operations. Acta Orthop Scand 58:4–13
Lidwell OM, Lowbury EJ, Whyte W et al (1984) Infection and sepsis after operations for total hip or knee-joint replacement: influence of ultraclean air, prophylactic antibiotics and other factors. J Hyg (Lond) 93:505–529
Longmate AG, Ellis KS, Boyle L et al (2011) Elimination of central-venous-catheter-related bloodstream infections from the intensive care unit. BMJ Qual Saf 20:174–180
Marschall J, Mermel LA, Fakih M et al (2014) Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 35(Suppl 2):89–107
Mauermann WJ, Nemergut EC (2006) The anesthesiologist’s role in the prevention of surgical site infections. Anesthesiology 105:413–421 (quiz 439–440)
Mchugh SM, Hill AD, Humphreys H (2015) Laminar airflow and the prevention of surgical site infection. More harm than good? Surgeon 13:52–58
Meier J, Meininger D, Zacharowski K (2012) Patient blood management: from blood-sparing techniques to the rationale use of blood products. Curr Opin Anaesthesiol 25:48–49
Melling AC, Ali B, Scott EM et al (2001) Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial. Lancet 358:876–880
Meyhoff CS, Wetterslev J, Jorgensen LN et al (2009) Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial. JAMA 302:1543–1550
Moghissi ES, Korytkowski MT, Dinardo M et al (2009) American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care 32:1119–1131
Myles PS, Leslie K, Chan MT et al (2007) Avoidance of nitrous oxide for patients undergoing major surgery: a randomized controlled trial. Anesthesiology 107:221–231
Park C, Hsu C, Neelakanta G et al (2009) Severe intraoperative hyperglycemia is independently associated with surgical site infection after liver transplantation. Transplantation 87:1031–1036
Pryor KO, Fahey TJ 3rd, Lien CA (2004) Surgical site infection and the routine use of perioperative hyperoxia in a general surgical population: a randomized controlled trial. JAMA 291:79–87
Rahn H, Farhi LE (1963) Gaseous environment and atelectasis. Fed Proc 22:1035–1041
Rajagopalan S, Mascha E, Na J et al (2008) The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology 108:71–77
Richards JE, Hutchinson J, Mukherjee K et al (2014) Stress hyperglycemia and surgical site infection in stable nondiabetic adults with orthopedic injuries. J Trauma Acute Care Surg 76:1070–1075
Robert-Koch-Institut (2007) Prävention postoperativer Infektionen im Operationsgebiet – Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 50:377–393
Robert-Koch-Institut (2010) Kategorien in der Richtlinie für Krankenhaushygiene und Infektionsprävention 1999, 2010 Die Kategorien in der Richtlinie für Krankenhaushygiene und Infektionsprävention – Aktualisierung der Definitionen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 53:754–756
Robert-Koch-Institut (2010) Sentinel-Krankenhaus-Surveillance – Pandemische Influenza A/H1N1 Krankenhaus Surveillance (PIKS): Erste Ergebnisse. Epidemiol Bull 2010:31–34
Rohde JM, Dimcheff DE, Blumberg N et al (2014) Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis. JAMA 311:1317–1326
Rothen HU, Sporre B, Engberg G et al (1995) Influence of gas composition on recurrence of atelectasis after a reexpansion maneuver during general anesthesia. Anesthesiology 82:832–842
Scheithauer S, Eitner F, Hafner H et al (2013) Long-term sustainability of hand hygiene improvements in the hemodialysis setting. Infection 41:675–680
Scheithauer S, Eitner F, Mankartz J et al (2012) Improving hand hygiene compliance rates in the haemodialysis setting: more than just more hand rubs. Nephrol Dial Transplant 27:766–770
Scheithauer S, Kamerseder V, Petersen P et al (2013) Improving hand hygiene compliance in the emergency department: getting to the point. BMC Infect Dis 13:367
Scheithauer S, Rosarius A, Rex S et al (2013) Improving hand hygiene compliance in the anesthesia working room work area: More than just more hand rubs. Am J Infect Control 41:1001–1006
Schmied H, Kurz A, Sessler DI et al (1996) Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet 347:289–292
Schmied H, Schiferer A, Sessler DI et al (1998) The effects of red-cell scavenging, hemodilution, and active warming on allogenic blood requirements in patients undergoing hip or knee arthroplasty. Anesth Analg 86:387–391
Schweizer ML, Chiang HY, Septimus E et al (2015) Association of a bundled intervention with surgical site infections among patients undergoing cardiac, hip, or knee surgery. JAMA 313:2162–2171
Sessler DI (2006) Non-pharmacologic prevention of surgical wound infection. Anesthesiol Clin 24:279–297
Shander A, Van Aken H, Colomina MJ et al (2012) Patient blood management in Europe. Br J Anaesth 109:55–68
Swenne CL, Lindholm C, Borowiec J et al (2005) Peri-operative glucose control and development of surgical wound infections in patients undergoing coronary artery bypass graft. J Hosp Infect 61:201–212
The_Joint_Commission (2015) Specifications Manual for National Hospital Inpatient Quality Measures – The Surgical Improvement Project (SCIP. http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures.aspx;. Zugegriffen: 5. Nov. 2015
Thibon P, Borgey F, Boutreux S et al (2012) Effect of perioperative oxygen supplementation on 30-day surgical site infection rate in abdominal, gynecologic, and breast surgery: the ISO 2 randomized controlled trial. Anesthesiology 117:504–511
Togioka B, Galvagno S, Sumida S et al (2012) The role of perioperative high inspired oxygen therapy in reducing surgical site infection: a meta-analysis. Anesth Analg 114:334–342
Torossian A, Bein B, Bräuer A et al (2014) S3 Leitlinie: Vermeidung von perioperativer Hypothermie 2014. http://www.awmf.org/uploads/tx_szleitlinien/001-018l_S3_Vermeidung_perioperativer_Hypothermie_2014-05.pdf. Zugegriffen: 16. Jan. 2015
Trick WE, Scheckler WE, Tokars JI et al (2000) Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting. J Thorac Cardiovasc Surg 119:108–114
Vanni SM, Braz JR, Modolo NS et al (2003) Preoperative combined with intraoperative skin-surface warming avoids hypothermia caused by general anesthesia and surgery. J Clin Anesth 15:119–125
Waeschle RM, Russo SG, Sliwa B et al (2015) Perioperatives Wärmemanagement in Abhängigkeit von der Krankenhausgröße in Deutschland. Anaesthesist 64:612–622
Webster J, Osborne S (2015) Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev 2015(2):CD004985
World Health Organization (2010) The World Health Assembly. Resolution on availability, safety and quality of blood safety and quality of blood products. http://www.who.int/bloodsafety/transfusion_services/self_sufficiency/en/. Zugegriffen: 31. Jan. 2016
World Health Organization (Who) (2009) WHO Guidelines on Hand Hygiene in Health Care – First Global Patient Safety Challenge – Clean Care is Safe Care
Zerr KJ, Furnary AP, Grunkemeier GL et al (1997) Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg 63:356–361
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
S. Scheithauer, T. Artelt, M. Bauer und R.M. Waeschle geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
Rights and permissions
About this article
Cite this article
Scheithauer, S., Artelt, T., Bauer, M. et al. Prävention der postoperativen Wundinfektion. Anaesthesist 65, 328–336 (2016). https://doi.org/10.1007/s00101-016-0169-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00101-016-0169-0
Schlüsselwörter
- Postoperative Komplikationen
- Nosokomiale Infektionen
- Krankenhaushygiene
- Patientenversorgungsbündel
- Evidenzbasierte Medizin