Zusammenfassung
Chirurgische Wundinfektionen gehören zu den häufigsten nosokomialen Infektionen auf chirurgischen Stationen. Risikofaktoren für eine postoperative Wundinfektion sind vor allem Grundleiden des Patienten, aber auch vermeidbare Risikofaktoren im Krankenhaus. Dazu gehören z. B. eine ungenügende Antibiotikaprophylaxe, die fehlende Vorbereitung der Patienten durch Sistieren des Rauchens und Gewichtsabnahme und vor allem bei Implantatoperationen eine fehlende Dekolonisation von Staphylococcus-aureus-Trägern. Eine gut organisierte Surveillance postoperativer Wundinfektionen und ein konstruktives Feedback an die Operierenden führte in allen bisherigen Studien zu einer 30%igen Reduktion dieser infektiösen Komplikation. Die Weltgesundheitsorganisation hat 2009 Richtlinien publiziert, die das Risiko postoperativer infektiöser und nicht-infektiöser Komplikationen vermindern können.
Abstract
Surgical site infections are the most common nosocomial infections in surgical wards. The main risk factor is the comorbidity of patients. In addition, there are many preoperative and intraoperative factors that increase the risk of surgical site infections. Appropriate antimicrobial prophylaxis, adequate preparation of the patients by cessation of smoking and reducing weight are likely to prevent postoperative infections outside the operating theatre. The WHO has issued guidelines to prevent not only infectious, but also non-infectious complications after surgery. Surveillance of surgical site infections itself with adequate feedback to the surgeons decreases the rate by approximately 30%.
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Literatur
Brandt C, Hott U, Sohr D et al. (2008) Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery. Ann Surg 248: 695–700
Brandt C, Sohr D, Behnke M et al. (2006) Reduction of surgical site infection rates associated with active surveillance. Infect Control Hosp Epidemiol 27: 1347–1351
Buehlmann M, Frei R, Fenner L et al. (2008) Highly effective regimen for decolonization of methicillin-resistant Staphylococcus aureus carriers. Infect Control Hosp Epidemiol 29: 510–516
Chaberny IF, Ziesing S, Mattner F et al. (2005) The burden of MRSA in four German university hospitals. Int J Hyg Environ Health 208: 447–453
Culver DH, Horan TC, Gaynes RP et al. (1991) Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 91: 152S–157S
Eiff C von, Becker K, Machka K et al. (2001) Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med 344: 11–16
Farber BF, Kaiser DL, Wenzel RP (1981) Relation between surgical volume and incidence of postoperative wound infection. N Engl J Med 305: 200–204
Harbarth S, Samore MH, Lichtenberg D, Carmeli Y (2000) Is prolonged antibiotic prophylaxis after major surgery associated with an increased risk of nosocomial bloodstream infection? J Am Coll Surg 190: 503–504
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
Mertz D, Frei R, Jaussi B et al. (2007) Throat swabs are necessary to reliably detect carriers of Staphylococcus aureus. Clin Infect Dis 45: 475–477
Mertz D, Frei R, Periat N et al. (2009) Exclusive Staphylococcus aureus throat carriage: at-risk populations. Arch Intern Med 169: 172–178
Misteli H, Weber WP, Reck S et al. (2009) Surgical glove perforation and the risk of surgical site infection. Arch Surg 144: 553–558
National Nosocomial Infections Surveillance (NNIS) (2004) System report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32: 470–485
Pittet D, Ducel G (1994) Infectious risk factors related to operating rooms. Infect Control Hosp Epidemiol 15: 456–462
Rotter ML (1988) A placebo-controlled trial of the effect of two preoperative baths or showers with chlorhexidine detergent on postoperative wound infection rates. J Hosp Infect 12: 137–138
Ruden H, Gastmeier P, Daschner FD, Schumacher M (1997) Nosocomial and community-acquired infections in Germany. Summary of the results of the First National Prevalence Study (NIDEP). Infection 25: 199–202
Segers P, Speekenbrink RG, Ubbink DT et al. (2006) Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial. JAMA 296: 2460–2466
Weber WP, Marti WR, Zwahlen M et al. (2008) The timing of surgical antimicrobial prophylaxis. Ann Surg 247: 918–926
Widmer AF (2001) New developments in diagnosis and treatment of infection in orthopedic implants. Clin Infect Dis 33 (Suppl 2): S94–S106, S94–S106
Widmer AF (2009) The team will consistently use methods known to minimize the risk for surgical site infection. In: Gawande A, Weiser TG (eds) WHO guidelines for safe surgery. WHO, Geneva, pp 43–72
Widmer AF, Gaechter A, Ochsner PE, Zimmerli W (1992) Antimicrobial treatment of orthopedic implant-related infections with rifampin combinations. Clin Infect Dis 14: 1251–1253
Zimmerli W, Widmer AF, Blatter M et al. (1998) Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group. JAMA 279: 1537–1541
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Widmer, A., Battegay, M. Postoperative Wundinfektionen. Internist 51, 142–153 (2010). https://doi.org/10.1007/s00108-009-2414-y
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DOI: https://doi.org/10.1007/s00108-009-2414-y