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Cold Atmospheric Plasma Treatment and Surgical Site Infections

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Textbook of Good Clinical Practice in Cold Plasma Therapy

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Abstract

Based on an increasing understanding of the cellular and molecular effects, the clinical use of cold atmospheric plasma is constantly expanding. Surgical site infections (SSI), which are a considerable burden to both individual patients and public health system, thus appear to be a promising indication for this innovative technology. In particular, the field of antimicrobial efficacy can reference to in vivo and in vitro assured treatment success, opening up interdisciplinary approaches and potentials. While the typical causal pathogen spectrum depends on the type of surgery, several endogenous and exogenous risk factors have been identified. The chapter provides an overview of how cold atmospheric plasma could enhance existing anti-SSI prevention and therapy concepts. While there is still a need for further evidence-based research the interim evaluation demonstrates the comprehensive potential of cold atmospheric plasma in the fight against this type of healthcare-associated nosocomial infection including all medical and economic challenges.

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References

  1. Moisan M, Barbeau J, Crevier M-C, Pelletier J, Philip N, Saoudi B. Plasma sterilization. Methods and mechanisms. Pure Appl Chem. 2002;74(3):349–58.

    Article  CAS  Google Scholar 

  2. Von Woedtke T, Kramer A, Weltmann KD. Plasma sterilization: what are the conditions to meet this claim? Plasma Process Polym. 2008;5(6):534–9.

    Article  Google Scholar 

  3. Bárdos L, Baránková H. Cold atmospheric plasma: sources, processes, and applications. Thin Solid Films. 2010;518(23):6705–13.

    Article  Google Scholar 

  4. Bekeschus S, Schmidt A, Weltmann K-D, von Woedtke T. The plasma jet kINPen–A powerful tool for wound healing. Clin Plasma Med. 2016;4(1):19–28.

    Article  Google Scholar 

  5. Conrads H, Schmidt M. Plasma generation and plasma sources. Plasma Sources Sci Technol. 2000;9(4):441.

    Article  CAS  Google Scholar 

  6. Daeschlein G, Scholz S, Ahmed R, Von Woedtke T, Haase H, Niggemeier M, et al. Skin decontamination by low-temperature atmospheric pressure plasma jet and dielectric barrier discharge plasma. J Hosp Infect. 2012;81(3):177–83.

    Article  CAS  PubMed  Google Scholar 

  7. Daeschlein G, Scholz S, Arnold A, von Podewils S, Haase H, Emmert S, et al. In vitro susceptibility of important skin and wound pathogens against low temperature atmospheric pressure plasma jet (APPJ) and dielectric barrier discharge plasma (DBD). Plasma Process Polym. 2012;9(4):380–9.

    Article  CAS  Google Scholar 

  8. Daeschlein G, von Woedtke T, Kindel E, Brandenburg R, Weltmann KD, Jünger M. Antibacterial activity of an atmospheric pressure plasma jet against relevant wound pathogens in vitro on a simulated wound environment. Plasma Process Polym. 2010;7(3–4):224–30.

    Article  CAS  Google Scholar 

  9. Isbary G, Morfill G, Schmidt H, Georgi M, Ramrath K, Heinlin J, et al. A first prospective randomized controlled trial to decrease bacterial load using cold atmospheric argon plasma on chronic wounds in patients. Br J Dermatol. 2010;163(1):78–82.

    Article  CAS  PubMed  Google Scholar 

  10. Isbary G, Stolz W, Shimizu T, Monetti R, Bunk W, Schmidt H-U, et al. Cold atmospheric argon plasma treatment may accelerate wound healing in chronic wounds: results of an open retrospective randomized controlled study in vivo. Clin Plasma Med. 2013;1(2):25–30.

    Article  Google Scholar 

  11. Tipa RS, Kroesen GM. Plasma-stimulated wound healing. IEEE Trans Plasma Sci. 2011;39(11):2978–9.

    Article  Google Scholar 

  12. Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16(12):e288–303.

    Article  PubMed  Google Scholar 

  13. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784–91.

    Article  PubMed  Google Scholar 

  14. Allegranzi B, Nejad SB, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377(9761):228–41.

    Article  PubMed  Google Scholar 

  15. Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. Multistate point-prevalence survey of health care–associated infections. N Engl J Med. 2014;370(13):1198–208.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. European Centre for Disease Prevention and Control, Suetens C, Hopkins S, Kolman J, Högberg LD. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals: 2011–2012: Publications Office of the European Union; 2013.

    Google Scholar 

  17. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309–32.

    Article  PubMed  Google Scholar 

  18. Jarvis WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol. 1996;17(8):552–7.

    Article  CAS  PubMed  Google Scholar 

  19. Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20(11):725–30.

    Article  CAS  PubMed  Google Scholar 

  20. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43.

    Article  PubMed  Google Scholar 

  21. Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic resistance—the need for global solutions. Lancet Infect Dis. 2013;13(12):1057–98.

    Article  PubMed  Google Scholar 

  22. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57–65.

    Article  PubMed  Google Scholar 

  23. World Health Organization. Antimicrobial resistance: global report on surveillance. Geneva: World Health Organization; 2014.

    Google Scholar 

  24. Magill SS, Hellinger W, Cohen J, Kay R, Bailey C, Boland B, et al. Prevalence of healthcare-associated infections in acute care hospitals in Jacksonville, Florida. Infect Control Hosp Epidemiol. 2012;33(3):283–91.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Broex E, Van Asselt A, Bruggeman C, Van Tiel F. Surgical site infections: how high are the costs? J Hosp Infect. 2009;72(3):193–201.

    Article  CAS  PubMed  Google Scholar 

  26. Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011;32(2):101–14.

    Article  PubMed  Google Scholar 

  27. Bowler P, Duerden B, Armstrong DG. Wound microbiology and associated approaches to wound management. Clin Microbiol Rev. 2001;14(2):244–69.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Singh R, Singla P, Chaudhary U. Surgical site infections: classification, risk factors, pathogenesis and preventive management. Int J Pharma Res Health Sci. 2014;2(3):203–14.

    Google Scholar 

  29. Geffers C, Baerwolff S, Schwab F, Gastmeier P. Incidence of healthcare-associated infections in high-risk neonates: results from the German surveillance system for very-low-birthweight infants. J Hosp Infect. 2008;68(3):214–21.

    Article  CAS  PubMed  Google Scholar 

  30. Towfigh S, Cheadle WG, Lowry SF, Malangoni MA, Wilson SE. Significant reduction in incidence of wound contamination by skin flora through use of microbial sealant. Arch Surg. 2008;143(9):885–91.

    Article  PubMed  Google Scholar 

  31. Gjødsbøl K, Christensen JJ, Karlsmark T, Jørgensen B, Klein BM, Krogfelt KA. Multiple bacterial species reside in chronic wounds: a longitudinal study. Int Wound J. 2006;3(3):225–31.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Neu HC. The crisis in antibiotic resistance. Science. 1992;257(5073):1064–74.

    Article  CAS  PubMed  Google Scholar 

  33. Krizek TJ, Robson MC. Evolution of quantitative bacteriology in wound management. Am J Surg. 1975;130(5):579–84.

    Article  CAS  PubMed  Google Scholar 

  34. Chen S, Anderson MV, Cheng WK, Wongworawat MD. Diabetes associated with increased surgical site infections in spinal arthrodesis. Clin Orthop Relat Res. 2009;467(7):1670–3.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Gaynes RP, Culver DH, Horan TC, Edwards JR, Richards C, Tolson JS, et al. Surgical site infection (SSI) rates in the United States, 1992–1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis. 2001;33(Supplement_2):S69–77.

    Article  PubMed  Google Scholar 

  36. Harrington G, Russo P, Spelman D, Borrell S, Watson K, Barr W, et al. Surgical-site infection rates and risk factor analysis in coronary artery bypass graft surgery. Infect Control Hosp Epidemiol. 2004;25(6):472–6.

    Article  PubMed  Google Scholar 

  37. Leong G, Wilson J, Charlett A. Duration of operation as a risk factor for surgical site infection: comparison of English and US data. J Hosp Infect. 2006;63(3):255–62.

    Article  CAS  PubMed  Google Scholar 

  38. Malone DL, Genuit T, Tracy JK, Gannon C, Napolitano LM. Surgical site infections: reanalysis of risk factors. J Surg Res. 2002;103(1):89–95.

    Article  PubMed  Google Scholar 

  39. ter Gunne AFP, Cohen DB. Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine. 2009;34(13):1422–8.

    Article  Google Scholar 

  40. Vilar-Compte D, de Iturbe IÁ, Martín-Onraet A, Pérez-Amador M, Sánchez-Hernández C, Volkow P. Hyperglycemia as a risk factor for surgical site infections in patients undergoing mastectomy. Am J Infect Control. 2008;36(3):192–8.

    Article  PubMed  Google Scholar 

  41. Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial. Lancet. 2001;358(9285):876–80.

    Article  CAS  PubMed  Google Scholar 

  42. Hetem DJ, Bootsma MC, Bonten MJ. Prevention of surgical site infections: decontamination with mupirocin based on preoperative screening for Staphylococcus aureus carriers or universal decontamination? Clin Infect Dis. 2015;62(5):631–6.

    Article  PubMed  Google Scholar 

  43. Darouiche RO, Wall MJ Jr, Itani KM, Otterson MF, Webb AL, Carrick MM, et al. Chlorhexidine–alcohol versus povidone–iodine for surgical-site antisepsis. N Engl J Med. 2010;362(1):18–26.

    Article  CAS  PubMed  Google Scholar 

  44. Tanner J, Norrie P, Melen K. Preoperative hair removal to reduce surgical site infection. The Cochrane Library; 2011.

    Book  Google Scholar 

  45. Parienti JJ, Thibon P, Heller R, Le Roux Y, von Theobald P, Bensadoun H, et al. Hand-rubbing with an aqueous alcoholic solution vs traditional surgical hand-scrubbing and 30-day surgical site infection rates: a randomized equivalence study. JAMA. 2002;288(6):722–7.

    Article  PubMed  Google Scholar 

  46. Obermeier A, Schneider J, Wehner S, Matl FD, Schieker M, von Eisenhart-Rothe R, et al. Novel high efficient coatings for anti-microbial surgical sutures using chlorhexidine in fatty acid slow-release carrier systems. PLoS One. 2014;9(7):e101426.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med. 1996;334(19):1209–16.

    Article  CAS  PubMed  Google Scholar 

  48. Buchleitner AM, Martínez-Alonso M, Hernández M, Solà I, Mauricio D. Perioperative glycaemic control for diabetic patients undergoing surgery. The Cochrane Library; 2012.

    Book  Google Scholar 

  49. Meyhoff CS, Wetterslev J, Jorgensen LN, Henneberg SW, Høgdall C, Lundvall L, et al. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial. JAMA. 2009;302(14):1543–50.

    Article  CAS  PubMed  Google Scholar 

  50. Beldi G, Bisch-Knaden S, Banz V, Mühlemann K, Candinas D. Impact of intraoperative behavior on surgical site infections. Am J Surg. 2009;198(2):157–62.

    Article  PubMed  Google Scholar 

  51. Silva JM, de Oliveira AMR, Nogueira FAM, Vianna PMM, Pereira Filho MC, Dias LF, et al. The effect of excess fluid balance on the mortality rate of surgical patients: a multicenter prospective study. Crit Care. 2013;17(6):R288.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Masden D, Goldstein J, Endara M, Xu K, Steinberg J, Attinger C. Negative pressure wound therapy for at-risk surgical closures in patients with multiple comorbidities: a prospective randomized controlled study. Ann Surg. 2012;255(6):1043–7.

    Article  PubMed  Google Scholar 

  53. Dumville JC, Gray TA, Walter CJ, Sharp CA, Page T, Macefield R, et al. Dressings for the prevention of surgical site infection. The Cochrane Library; 2016.

    Book  Google Scholar 

  54. Ata A, Lee J, Bestle SL, Desemone J, Stain SC. Postoperative hyperglycemia and surgical site infection in general surgery patients. Arch Surg. 2010;145(9):858–64.

    Article  PubMed  Google Scholar 

  55. Gyssens IC. Preventing postoperative infections: current treatment recommendations. Drugs. 1999;57(2):175–85.

    Article  CAS  PubMed  Google Scholar 

  56. Vu MM, Gutowski KA, Blough JT, Simmons CJ, Kim JY. Development of an individualized surgical risk calculator for abdominoplasty procedures. Plast Reconstr Surg. 2015;136(4S):95–6.

    Article  Google Scholar 

  57. Massenburg BB, Sanati-Mehrizy P, Jablonka EM, Taub PJ. Risk factors for prolonged length of stay in abdominoplasty. Plast Reconstr Surg. 2015;136(4S):164–5.

    Article  Google Scholar 

  58. Richardson D, Fisher SE, Vaughan DE, Brown JS. Radial forearm flap donor-site complications and morbidity: a prospective study. Plast Reconstr Surg. 1997;99(1):109–15.

    Article  CAS  PubMed  Google Scholar 

  59. Infektionen NRfrSvn. Modul OP-KISS, Referenzdaten Berechnungszeitraum: Januar 2012 bis Dezember 2016. 2017.

    Google Scholar 

  60. Rutkowski R, Schuster M, Unger J, Metelmann I, Chien TTT. Cold atmospheric plasma in context of surgical site infection. In: Comprehensive clinical plasma medicine. Cham: Springer International Publishing; 2018. p. 151–62.

    Chapter  Google Scholar 

  61. U.S. Department of Health and Human Services CfDCaP. Meeting Minutes: Healthcare Infection Control Practices Advisory Committee (HICPAC). 2014.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany

    Rico Rutkowski

  2. Department of Basic Science in Medicine and Pharmacy, School of Medicine and Pharmacy, Vietnam National University Hanoi, Cau Giay, Ha Noi, Vietnam

    Vu Thi Thom

  3. Department of Plastic, Aesthetic and Maxillofacial Surgery, E hospital, Cau Giay, Ha Noi, Vietnam

    Nguyen Dinh Minh

  4. Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Greifswald, Germany

    Hans-Robert Metelmann

Authors
  1. Rico Rutkowski
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  2. Vu Thi Thom
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  3. Nguyen Dinh Minh
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  4. Hans-Robert Metelmann
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Corresponding author

Correspondence to Rico Rutkowski .

Editor information

Editors and Affiliations

  1. Greifswald University Hospital, Greifswald, Germany

    Hans-Robert Metelmann

  2. Leibniz Institute for Plasma Science and Technology (INP), Greifswald, Germany

    Thomas von Woedtke

  3. Leibniz Institute for Plasma Science and Technology (INP), Greifswald, Germany

    Klaus-Dieter Weltmann

  4. University Medical Center Rostock, Rostock, Germany

    Steffen Emmert

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Rutkowski, R., Thom, V.T., Minh, N.D., Metelmann, HR. (2022). Cold Atmospheric Plasma Treatment and Surgical Site Infections. In: Metelmann, HR., von Woedtke, T., Weltmann, KD., Emmert, S. (eds) Textbook of Good Clinical Practice in Cold Plasma Therapy. Springer, Cham. https://doi.org/10.1007/978-3-030-87857-3_11

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  • DOI: https://doi.org/10.1007/978-3-030-87857-3_11

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  • Online ISBN: 978-3-030-87857-3

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