Der Unfallchirurg

, Volume 114, Issue 3, pp 236–240

Strategien zur Prävention von postoperativen Wundinfektionen

Leitthema

Zusammenfassung

Postoperative Wundinfektionen stellen ernste Komplikationen bei chirurgischen und orthopädischen Eingriffen dar und führen zu einer Verlängerung der Verweildauer im Krankenhaus, verursachen zusätzliche Kosten und gehen mit einer erhöhten Morbidität und Mortalität einher. Deshalb ist die Vermeidung von postoperativen Wundinfektionen essentiell und stellt eine Herausforderung im Gesundheitswesen dar. Strategien zur Vermeidung werden präsentiert und erörtert. Eine aktive Surveillance postoperativer Wundinfektionen, die Einführung einer Checkliste, Compliancebeobachtungen und Schulungen/Training von medizinischem Personal sowie Staphylococcus-aureus-/MRSA-Screening, Clipping anstelle der Rasur, die korrekte Einhaltung der perioperativen Antibiotikaprophylaxe, die intraoperative Aufrechterhaltung einer Normothermie und die Blutglukosekontrolle sind essentiell für ein umfassendes Bündel an Infektionspräventionsmaßnahmen, um postoperative Wundinfektionen zu vermeiden.

Schlüsselwörter

Surveillance Präventionsmaßnahmen Hygiene Compliance Screening 

Strategies to prevent surgical site infections

Abstract

Surgical site infections (SSI) are a severe complication following surgical or orthopaedic procedures and are associated with significant increases in hospital length of stay (LOS), additional costs, morbidity and mortality. Hence, the prevention of SSI is essential and poses a major challenge in the healthcare system. Strategies and key points are presented and discussed. Infection control measures such as active surveillance of SSI, implementation of a checklist, compliance observations and instruction/training of healthcare workers as well as Staphylococcus aureus/MRSA screening, clipping instead of shaving, adherence to perioperative antibiotic prophylaxis, maintaining intraoperative normothermia and blood glucose control are essential for a comprehensive bundle in order to prevent SSI.

Keywords

Surveillance Prevention measures Infection control Compliance Screening 

Literatur

  1. 1.
    Anderson DJ, Kaye KS, Classen D et al (2008) Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol 29(Suppl 1):51–61CrossRefGoogle Scholar
  2. 2.
    Anonymus (2008) Arbeitskreis Krankenhaus- und Praxishygiene der AWMF. Leitlinie „Händedesinfektion und Händehygiene“. Hyg Med 33:300–313Google Scholar
  3. 3.
    Anonymus (2007) Prevention of postoperative surgical wound infection: recommendations of the Hospital Hygiene and Infection Prevention Committee of the Robert Koch Institute. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 50:377–393CrossRefGoogle Scholar
  4. 4.
    Beckmann A, Doebler K, Schaefer E et al (2011) Sternal surgical site infection prevention – is there any room for improvement? Eur J Cardiothorac Surg (Epub ahead of print)Google Scholar
  5. 5.
    Bode LG, Kluytmans JA, Wertheim HF et al (2010) Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 362:9–17PubMedCrossRefGoogle Scholar
  6. 6.
    Brandt C, Sohr D, Behnke M et al (2006) Reduction of surgical site infection rates associated with active surveillance. Infect Control Hosp Epidemiol 27:1347–1351PubMedCrossRefGoogle Scholar
  7. 7.
    Chaberny IF, Bindseil A, Sohr D et al (2008) A point-prevalence study for MRSA in a German university hospital to identify patients at risk and to evaluate an established admission screening procedure. Infection 36:526–532PubMedCrossRefGoogle Scholar
  8. 8.
    Chaberny IF, Schwab F, Ziesing S et al (2008) Impact of routine surgical ward and intensive care unit admission surveillance cultures on hospital-wide nosocomial methicillin-resistant Staphylococcus aureus infections in a university hospital: an interrupted time-series analysis. J Antimicrob Chemother 62:1422–1429PubMedCrossRefGoogle Scholar
  9. 9.
    Classen DC, Evans RS, Pestotnik SL et al (1992) The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 326:281–286PubMedCrossRefGoogle Scholar
  10. 10.
    Defez C, Fabbro-Peray P, Cazaban M et al (2008) Additional direct medical costs of nosocomial infections: an estimation from a cohort of patients in a French university hospital. J Hosp Infect 68:130–136PubMedCrossRefGoogle Scholar
  11. 11.
    Gastmeier P, Geffers C, Brandt C et al (2006) Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infections. J Hosp Infect 64:16–22PubMedCrossRefGoogle Scholar
  12. 12.
    Gastmeier P, Kampf G, Wischnewski N et al (1998) Prevalence of nosocomial infections in representative German hospitals. J Hosp Infect 38:37–49PubMedCrossRefGoogle Scholar
  13. 13.
    Geubbels EL, Bakker HG, Houtman P et al (2004) Promoting quality through surveillance of surgical site infections: five prevention success stories. Am J Infect Control 32:424–430PubMedCrossRefGoogle Scholar
  14. 14.
    Gomez MI, Acosta-Gnass SI, Mosqueda-Barboza L et al (2006) Reduction in surgical antibiotic prophylaxis expenditure and the rate of surgical site infection by means of a protocol that controls the use of prophylaxis. Infect Control Hosp Epidemiol 27:1358–1365PubMedCrossRefGoogle Scholar
  15. 15.
    Graf K, Ott E, Vonberg RP et al (2010) Economic aspects of deep sternal wound infections. Eur J Cardiothorac Surg 37:893–896PubMedCrossRefGoogle Scholar
  16. 16.
    Graf K, Sohr D, Haverich A et al (2009) Decrease of deep sternal surgical site infection rates after cardiac surgery by a comprehensive infection control program. Interact Cardiovasc Thorac Surg 9:282–286CrossRefGoogle Scholar
  17. 17.
    Griesdale DE, De Souza RJ, Van Dam RM et al (2009) Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ 180:821–827PubMedGoogle Scholar
  18. 18.
    Haynes AB, Weiser TG, Berry WR et al (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360:491–499PubMedCrossRefGoogle Scholar
  19. 19.
    Heipel D, Ober JF, Edmond MB et al (2007) Surgical site infection surveillance for neurosurgical procedures: a comparison of passive surveillance by surgeons to active surveillance by infection control professionals. Am J Infect Control 35:200–202PubMedCrossRefGoogle Scholar
  20. 20.
    Hubner NO, Goerdt AM, Stanislawski N et al (2010) Bacterial migration through punctured surgical gloves under real surgical conditions. BMC Infect Dis 10:192PubMedCrossRefGoogle Scholar
  21. 21.
    Itani KM, Jensen EH, Finn TS et al (2008) Effect of body mass index and ertapenem versus cefotetan prophylaxis on surgical site infection in elective colorectal surgery. Surg Infect (Larchmt) 9:131–137Google Scholar
  22. 22.
    Jamsen E, Nevalainen P, Kalliovalkama J et al (2010) Preoperative hyperglycemia predicts infected total knee replacement. Eur J Intern Med 21:196–201PubMedCrossRefGoogle Scholar
  23. 23.
    Kao LS, Meeks D, Moyer VA et al (2009) Peri-operative glycaemic control regimens for preventing surgical site infections in adults. Cochrane Database Syst Rev CD006806Google Scholar
  24. 24.
    Kirkland KB, Briggs JP, Trivette SL et al (1999) The impact of surgical-site infections in the 1990 s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 20:725–730PubMedCrossRefGoogle Scholar
  25. 25.
    Koburger T, Hubner NO, Braun M et al (2010) Standardized comparison of antiseptic efficacy of triclosan, PVP-iodine, octenidine dihydrochloride, polyhexanide and chlorhexidine digluconate. J Antimicrob Chemother 65:1712–1719PubMedCrossRefGoogle Scholar
  26. 26.
    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 87:663–669PubMedCrossRefGoogle Scholar
  27. 27.
    Leibowitz G, Raizman E, Brezis M et al (2010) Effects of moderate intensity glycemic control after cardiac surgery. Ann Thorac Surg 90:1825–1832PubMedCrossRefGoogle Scholar
  28. 28.
    Mangram AJ, Horan TC, Pearson ML et al (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–280PubMedCrossRefGoogle Scholar
  29. 29.
    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 358:876–880PubMedCrossRefGoogle Scholar
  30. 30.
    Miller M, Cook HA, Furuya EY et al (2009) Staphylococcus aureus in the community: colonization versus infection. PLoS One 4:6708CrossRefGoogle Scholar
  31. 31.
    Munoz P, Hortal J, Giannella M et al (2008) Nasal carriage of S. aureus increases the risk of surgical site infection after major heart surgery. J Hosp Infect 68:25–31PubMedCrossRefGoogle Scholar
  32. 32.
    Nair BG, Newman SF, Peterson GN et al (2010) Feedback mechanisms including real-time electronic alerts to achieve near 100% timely prophylactic antibiotic administration in surgical cases. Anesth Analg 111:1293–1300PubMedCrossRefGoogle Scholar
  33. 33.
    Niel-Weise BS, Wille JC, Van Den Broek PJ (2005) Hair removal policies in clean surgery: systematic review of randomized, controlled trials. Infect Control Hosp Epidemiol 26:923–928PubMedCrossRefGoogle Scholar
  34. 34.
    Partecke LI, Goerdt AM, Langner I et al (2009) Incidence of microperforation for surgical gloves depends on duration of wear. Infect Control Hosp Epidemiol 30:409–414PubMedCrossRefGoogle Scholar
  35. 35.
    Perl TM, Cullen JJ, Wenzel RP et al (2002) Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 346:1871–1877PubMedCrossRefGoogle Scholar
  36. 36.
    Prospero E, Barbadoro P, Marigliano A et al (2010) Perioperative antibiotic prophylaxis: improved compliance and impact on infection rates. Epidemiol Infect 19:1–6CrossRefGoogle Scholar
  37. 37.
    Qadan M, Akca O, Mahid SS et al (2009) Perioperative supplemental oxygen therapy and surgical site infection: a meta-analysis of randomized controlled trials. Arch Surg 144:359–366PubMedCrossRefGoogle Scholar
  38. 38.
    Safdar N, Bradley EA (2008) The risk of infection after nasal colonization with Staphylococcus aureus. Am J Med 121:310–315PubMedCrossRefGoogle Scholar
  39. 39.
    Sax H, Uckay I, Balmelli C et al (2011) Overall Burden of Healthcare-Associated Infections Among Surgical Patients: Results of a National Study. Ann Surgn 253(2):365–370CrossRefGoogle Scholar
  40. 40.
    Swenson BR, Sawyer RG (2010) Importance of alcohol in skin preparation protocols. Infect Control Hosp Epidemiol 31:977PubMedCrossRefGoogle Scholar
  41. 41.
    Tanner J, Woodings D, Moncaster K (2006) Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev 3: CD004122PubMedGoogle Scholar
  42. 42.
    Ubbink DT, Vermeulen H, Goossens A et al (2008) Occlusive vs gauze dressings for local wound care in surgical patients: a randomized clinical trial. Arch Surg 143:950–955PubMedCrossRefGoogle Scholar
  43. 43.
    Van Rijen MM, Bonten M, Wenzel RP et al (2008) Intranasal mupirocin for reduction of Staphylococcus aureus infections in surgical patients with nasal carriage: a systematic review. J Antimicrob Chemother 61:254–261Google Scholar
  44. 44.
    Van Tiel FH, Elenbaas TW, Voskuilen BM et al (2006) Plan-do-study-act cycles as an instrument for improvement of compliance with infection control measures in care of patients after cardiothoracic surgery. J Hosp Infect 62:64–70CrossRefGoogle Scholar
  45. 45.
    Von Eiff C, Becker K, Machka K et al (2001) Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med 344:11–16CrossRefGoogle Scholar
  46. 46.
    Weber WP, Marti WR, Zwahlen M et al (2008) The timing of surgical antimicrobial prophylaxis. Ann Surg 247:918–926PubMedCrossRefGoogle Scholar
  47. 47.
    Zanetti G, Giardina R, Platt R (2001) Intraoperative redosing of cefazolin and risk for surgical site infection in cardiac surgery. Emerg Infect Dis 7:828–831PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Institut für Medizinische Mikrobiologie und Krankenhaushygiene Medizinische Hochschule HannoverHannoverDeutschland

Personalised recommendations