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Postoperative Wundinfektionen

Der Chirurg als Täter oder Opfer?

Responsibility of surgeons for surgical site infections

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Zusammenfassung

Die Entstehung der meisten postoperativen Wundinfektionen lässt sich auf das Zeitintervall des Aufenthalts des Patienten in einem bestimmten Krankenhausbereich – den OP-Saal – zurückführen. Deshalb wird ihre Prävention häufig als eine Verantwortung angesehen, die völlig auf den Schultern des Chirurgen ruht. Dabei kann die Quelle der für eine Wundinfektionen verantwortlichen Erreger sowohl endogener als auch exogener Natur sein. Für die Mehrheit der Wundinfektionen wird eine endogene Ursache angenommen, d. h. die Erreger waren bereits im Körper des Patienten vorhanden. Deshalb ist der Chirurg nur in Ausnahmefällen als Täter anzusehen, in den meisten Fällen ist er auch ein Opfer der postoperativen Wundinfektionen.

Aber nicht nur exogene, sondern auch viele endogene Infektionen sind vermeidbar. Zur Abschätzung des Einflusses einer kontinuierlichen Surveillance mit regelmäßigem Feedback der Infektionsraten und dadurch bedingte Stimulation von weiteren Präventionsmaßnahmen, wurden die Daten von 130 operativen Abteilungen analysiert, die mindestens 4 Jahre am Krankenhaus-Infektions-Surveillance-System (KISS) teilgenommen haben. Im Vergleich zum ersten Jahr der Teilnahme wurde im 3. Jahr eine signifikante Reduktion um 25% beobachtet. Allerdings kann der Chirurg allein meistens nicht solche Erfolge erreichen, in der Regel ist eine Zusammenarbeit aller Beteiligten nötig.

Abstract

Surgical site infections can be traced to discrepancies in one specific hospital department: the operating suite. Therefore, prevention is often viewed as resting completely on the surgeon. However, the source of micro-organisms responsible for surgical site infections can be endogenous or exogenous. Most infections are believed to be the former, i.e. caused by micro-organisms already resident in the patient’s body. Therefore the surgeon can be regarded as suspect only in exceptional cases and usually himself a victim. Prevention is possible not only for exogenous surgical site infection but also many endogenous infections. A multicenter surveillance of infection rates at 130 operative departments participating for at least 4 years in the German National Nosocomial Infection Surveillance System was conducted. A significant 25% reduction in the 3rd year was observed compared with patients who underwent surgery within the 1st year of participation. However, surgeons alone cannot achieve such a decrease, and a team approach is required under most circumstances.

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Authors and Affiliations

  1. Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625 , Hannover

    P. Gastmeier

  2. Institut für Hygiene und Umweltmedizin, Universitätsmedizin Berlin – Charité

    C. Brandt, D. Sohr & H. Rüden

  3. Nationales Referenzzentrum für die Surveillance von Nosokomialen Infektionen

    P. Gastmeier, C. Brandt, D. Sohr & H. Rüden

Authors
  1. P. Gastmeier
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  2. C. Brandt
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  3. D. Sohr
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  4. H. Rüden
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Correspondence to P. Gastmeier.

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Gastmeier, P., Brandt, C., Sohr, D. et al. Postoperative Wundinfektionen. Chirurg 77, 506–511 (2006). https://doi.org/10.1007/s00104-006-1193-4

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  • DOI: https://doi.org/10.1007/s00104-006-1193-4

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