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Grimm C, Scheithauer S, Artelt T, Stieber A, Erlenwein J, Schuster M, Bauer M, Waeschle RM. Evaluation of the practice of reprocessing ORs in German hospitals from an infection prevention and control perspective. Infection 2024:10.1007/s15010-024-02303-z. [PMID: 38829479 DOI: 10.1007/s15010-024-02303-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/18/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND The aim of this study was to analyze the cleaning and disinfection of operating rooms (ORs) status quo focusing on hygiene plans in German hospitals. METHODS In 2016, a structured online survey was sent to infection prevention and control (IPC) specialists at the cost calculation hospitals of the Institute for the Hospital Remuneration System (InEK) and all university hospitals in Germany (n = 365). RESULTS With a response rate of 27.4%, 78% stated that written hygiene plans were available. After cleaning and disinfecting an OR with a "septic" patient, 55% waited until surfaces were dry before reusing in accordance with national recommendations, 27% waited > 30 min. Additionally, 28% of hospitals had ORs only for "septic" patients. In 56% "septic" patients were only operated on at the end of the program. Postoperative monitoring of patients with bacteria with special IPC requirements took place in the post anesthesia care unit (PACU) (29%), operating room (OR) (52%), intensive care unit (ICU) (53%), and in the intermediate care unit (IMC) (19%). DISCUSSION AND CONCLUSIONS Despite written hygiene plans in place the partly long duration of OR nonuse time following IPC measures, the consistent continued use of stratification for "septic" patients and the postoperative follow-up care of patients with colonizing/infecting bacteria with special IPC requirements in the OR and high care areas represent relevant potential for improvement.
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Affiliation(s)
- C Grimm
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - S Scheithauer
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen, Göttingen, Germany
| | - T Artelt
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen, Göttingen, Germany
| | - A Stieber
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - J Erlenwein
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - M Schuster
- Clinic for Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, RKH-Kliniken Landkreis Karlsruhe, Fürst-Stirum-Klinik Bruchsal and Rechbergklinik Bretten, Bruchsal, Germany
| | - M Bauer
- Clinic for Anesthesiology, Intensive Care Medicine and OR Management, RHÖN- KLINIKUM Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Reiner M Waeschle
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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Balakirski G, Becker SL, Hartmann D, Kofler L, Kunte C, Müller CSL, Volz T, Kendziora B, Schlager JG, Löser CR. Perioperative Antibiotikaprophylaxe in der Dermatochirurgie - Positionspapier der Arbeitsgruppe Antibiotic Stewardship der Deutschen Gesellschaft für Dermatochirurgie (DGDC), Teil 2: Spezielle Indikationen und Situationen. J Dtsch Dermatol Ges 2023; 21:1109-1119. [PMID: 37845076 DOI: 10.1111/ddg.15153_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/18/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungNeben der Vermeidung postoperativer Wundinfektionen nach dermatochirurgischen Eingriffen hat die perioperative Antibiotikaprophylaxe (PAP) das Ziel, das Auftreten weiterer postoperativer Infektionskomplikationen, insbesondere der bakteriellen Endokarditis oder hämatogener Gelenkprotheseninfektionen, zu verhindern. In der vorliegenden Arbeit werden spezielle Situationen dargestellt, in denen eine PAP notwendig werden kann. So benötigen Patienten nach Herzklappenersatz jeglicher Art, einschließlich Transkatheter‐Klappenersatz oder bei Verwendung von Prothesenmaterial zur Herzklappenkorrektur, oder Patienten nach einer durchgemachten bakteriellen Endokarditis bei zweizeitigen dermatochirurgischen Eingriffen, Eingriffen an der Schleimhaut oder ulzerierten Tumoren eine PAP.Auch die Anwendung einer PAP in speziellen Situationen wie bei sekundärer Wundheilung, septischen dermatochirurgischen Eingriffen oder Ulcus cruris‐Chirurgie werden in dieser Arbeit anhand der aktuellen wissenschaftlichen Literatur ausführlich dargestellt und diskutiert. Die vorliegende Arbeit ist der 2. Teil des Positionspapiers der Arbeitsgruppe Antibiotic Stewardship der Deutschen Gesellschaft für Dermatochirurgie und formuliert evidenzbasierte Empfehlungen für die Verabreichung einer PAP bei dermatochirurgischen Eingriffen bei speziellen Indikationen und Situationen. Dies ist von besonderer Wichtigkeit, da bei dermatochirurgischen Eingriffen, wie im ersten Teil dargelegt, im Regelfall auf eine PAP verzichtet werden kann und sollte.
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Affiliation(s)
- Galina Balakirski
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal
| | - Sören L Becker
- Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Daniela Hartmann
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, München
| | - Lukas Kofler
- Universitäts-Hautklinik, Universitätsklinikum Tübingen, Tübingen
| | - Christian Kunte
- Dermatochirurgie und Dermatologie, Artemed Fachklinik München GmbH & Co. KG, München
| | | | - Thomas Volz
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, München
| | - Benjamin Kendziora
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, München
| | - Justin Gabriel Schlager
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, München
| | - Christoph R Löser
- Hautklinik, Hauttumorzentrum, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Ludwigshafen
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Balakirski G, Becker SL, Hartmann D, Kofler L, Kunte C, Müller CSL, Volz T, Kendziora B, Schlager JG, Löser CR. Perioperative antibiotic prophylaxis in skin surgery - Position paper of the Antibiotic Stewardship working group of the German Society for Dermatologic Surgery (DGDC), Part 2: Special indications and situations. J Dtsch Dermatol Ges 2023; 21:1109-1117. [PMID: 37501398 DOI: 10.1111/ddg.15153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/18/2023] [Indexed: 07/29/2023]
Abstract
In addition to prevention of surgical site infections after skin surgery, perioperative antibiotic prophylaxis (PAP) aims to prevent the occurrence of other postoperative infectious complications, especially bacterial endocarditis and hematogenous joint prosthesis infections. This article discusses specific indications for the use of PAP. For example, patients who have undergone any type of heart valve replacement, including transcatheter valve replacement or use of prosthetic material to correct the heart valve, or patients who have experienced bacterial endocarditis, require PAP during skin surgery on mucosal membranes or ulcerated tumors. The use of PAP in special situations such as secondary wound healing, septic dermatosurgery or ulcer surgery is also presented and discussed in detail in this paper based on the current scientific literature. This paper represents the second part of the position paper of the Antibiotic Stewardship Working Group of the German Society for Dermatologic Surgery (DGDC) and summarizes evidence-based recommendations for the administration of PAP during skin surgery for special indications and situations. This is particularly important because, as detailed in Part 1 of this position paper, PAP can and usually should be avoided in skin surgery.
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Affiliation(s)
- Galina Balakirski
- Center for Dermatology, Allergology and Dermatosurgery, Helios University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Lukas Kofler
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - Christian Kunte
- Department of Dermatologic Surgery and Dermatology, Artemed Clinic Munich, Munich, Germany
| | - Cornelia S L Müller
- Medical Supply Center for Histology, Cytology, and Molecular Diagnostics Trier, Trier, Germany
| | - Thomas Volz
- Department of Dermatology and Allergology, University Medical Center, Technical University of Munich, Munich, Germany
| | - Benjamin Kendziora
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Justin Gabriel Schlager
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Christoph R Löser
- Department of Dermatology, Ludwigshafen City Hospital, Ludwigshafen, Germany
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Empfehlungen zur Strukturierung der Herzschrittmacher- und Defibrillatortherapie – Update 2022. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-022-00524-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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5
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[Personal preference, experience, intuition and school of surgery dominate the use of wound drainage in dermatosurgery]. Hautarzt 2021; 72:115-124. [PMID: 33118045 PMCID: PMC7846541 DOI: 10.1007/s00105-020-04709-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hintergrund Die Verwendung von Drainagesystemen in der Dermatochirurgie erfolgt bislang ohne evidenzbasierte Daten. Indikationen, Komplikationen und Kontraindikationen werden traditionell von Operateur zu Operateur weitergegeben, sind jedoch bisher nicht definiert. Methodik Es wurde eine internetbasierte Umfrage erstellt und unter den Mitgliedern der DGDC e. V. (Deutsche Gesellschaft für Dermatochirurgie e. V.) ausgesandt. Abgefragt wurden das allgemeine Behandlungsverhalten im deutschsprachigen Raum in Bezug auf die Anwendung der Wunddrainage nach dermatologischen Operationen sowie die Nutzungsgewohnheiten und Erfahrungen der Kollegen mit Drainage-assoziierten Komplikationen. Ergebnisse Es haben 12,73 % der angeschriebenen DGDC-Mitglieder den Fragebogen beantwortet. Drainagen werden überwiegend im klinischen Umfeld eingesetzt, es werden alle abgefragten Drainagesysteme verwendet. Ausmaß und Komplexität des Eingriffs sind die wesentlichen Kriterien bei der Indikationsstellung. Der Einsatz von Drainagen ist abhängig vom Alter des Teilnehmers und erfolgt mehrheitlich bei Patienten, bei denen Komplikationen im postoperativen Verlauf erwartet werden (Adipositas, Nikotinabusus, Diabetiker). Diskussion Zusammenfassend verwendet die Mehrzahl der Teilnehmer Wunddrainagen und dies mehrheitlich intuitiv. Einheitliche fixe evidenzbasierte Parameter rund um die Verwendung von Wunddrainagen fehlen. Bei der Beurteilung der Notwendigkeit einer Wunddrainage scheint ein individuell unterschiedlich ausgeprägtes Sicherheitsbedürfnis bei den einen und „eminenzbasiertes“ Handeln bei den anderen Dermatochirurgen eine große Rolle zu spielen.
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Popp W, Alefelder C, Bauer S, Daeschlein G, Geistberger P, Gleich S, Herr C, Hübner NO, Jatzwauk L, Kohnen W, Külpmann R, Lemm F, Loczenski B, Spors J, Walger P, Wehrl M, Zastrow KD, Exner M. Air quality in the operating room: Surgical site infections, HVAC systems and discipline - position paper of the German Society of Hospital Hygiene (DGKH). GMS HYGIENE AND INFECTION CONTROL 2019; 14:Doc20. [PMID: 32047719 PMCID: PMC6997799 DOI: 10.3205/dgkh000335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In recent years, there has been an ongoing discussion about the value of laminar airflow (LAF=low turbulence displacement ventilation) in the operating room for prevention of surgical site infections (SSI). Some publications, e.g., from the WHO, issued the demand to no longer build LAF ceilings in operating rooms. The present statement deals critically with this position and justifies the use of LAF ceilings in different ways: Many of the papers cited by the WHO and others for the case against LAF do not provide reliable data.The remaining studies which might be used for answering the question give quite different results, also in favor of LAF.The size of the LAF ceiling in many studies is not given or mostly too small in comparison to actual technical requirements.LAF in different countries can mean quite different techniques (e.g., the US in comparison to Germany) so that the results of studies that do not take this into account may not be comparable.LAF has positive effects in terms of reducing particulate and bacterial load, associated with increased airflow in the surgical working area. A reduction of carcinogenic substances in the air may also be assumed, which would increase workers' safety. Thus, this paper recommends building LAF ceilings in the future as well, depending on the operations intended. Further, this paper gives an overview of possible reasons for surgical site infections and highlights the importance of discipline in the operating theatre.
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Affiliation(s)
- Walter Popp
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | - Sonja Bauer
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | | | - Sabine Gleich
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Caroline Herr
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | - Lutz Jatzwauk
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | | | | | | | - Jörg Spors
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Peter Walger
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Markus Wehrl
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | - Martin Exner
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
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7
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Kramer A, Pochhammer J, Walger P, Seifert U, Ruhnke M, Harnoss JC. [Spectrum of pathogens in postoperative complications of visceral surgery : The problem of multidrug resistance]. Chirurg 2018; 88:369-376. [PMID: 28229205 DOI: 10.1007/s00104-017-0382-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In general surgery the etiology of surgical site infections has not significantly changed over the last 30 years. Gram-positive bacteria, e.g. coagulase negative staphylococci (CNS), Staphylococcus aureus and Enterococcus spp. as well as Gram-negative bacteria, e.g. Escherichia coli, Enterobacter spp., Klebsiella spp. and Pseudomonas aeruginosa, are the most common findings. Although in general surgery 10% of the S. aureus causing postoperative wound infections were methicillin resistant (MRSA), no cases of multidrug-resistant Gram-negative (MRGN) bacteria were reported. Yeasts (particularly Candida spp.) are rarely the pathogen causing surgical site infections (≤3%) and concomitant risk factors are typical (e.g. diabetes, chemotherapy, immunosuppression and malnutrition). Viruses are rarely the cause of surgical site infections. Transmission can occur by HBV, HCV or HIV positive surgical staff or in organ transplantations and postoperative reactivation of persistent infections is possible (especially for HBV, HCV, CMV, EBV and HIV). The principles for prevention of surgical site infections are dealt with as consequences of preoperative colonization by MRSA, methicillin-sensitive S. aureus (MSSA) and MRGN and reviewed with respect to screening, perioperative antibiotic prophylaxis and decolonization. In nosocomial peritonitis, the selection of antibiotics should consider previous antibiotic treatment. A single intra-abdominal detection of Candida spp. usually does not require antimycotic treatment in postoperatively stable and immunocompetent patients but is recommended in severe community-acquired or nosocomial peritonitis. Viral infections can be avoided by screening of organ donors and serological surveillance of surgery personnel.
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Affiliation(s)
- A Kramer
- Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald, Walther-Rathenau-Str. 49a, 17495, Greifswald, Deutschland.
| | - J Pochhammer
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Marienhospital Stuttgart, Vinzenz von Paul Kliniken, Stuttgart, Deutschland
| | - P Walger
- Internistische Intensivmedizin und Infektiologie, Johanniterkrankenhaus, Johanniterkliniken Bonn, Bonn, Deutschland
| | - U Seifert
- Friedrich-Loeffler-Institut für Medizinische Mikrobiologie, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - M Ruhnke
- Paracelsus-Klinik Osnabrück, Osnabrück, Deutschland
| | - J C Harnoss
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Müller CSL, Hubner W, Thieme-Ruffing S, Pföhler C, Vogt T, Volk T, Gärtner BC, Bialas P. Pre- and perioperative aspects of dermatosurgery. J Dtsch Dermatol Ges 2017; 15:117-146. [PMID: 28214316 DOI: 10.1111/ddg.13181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/13/2016] [Indexed: 12/12/2022]
Abstract
Dermatosurgery occupies an exceptional position among all surgical disciplines. Above all, this includes the fact that, with very few exceptions, the vast majority of surgical interventions can be performed under local or regional anesthesia, usually in smaller procedure rooms that are spatially separated from larger operating suites. Thus, peri- and postinterventional patient monitoring is the responsibility of the dermatosurgeon and his team. Though inherently smaller, this team still has to observe numerous perioperative requirements that - in larger surgical specialties - would be attended to by a host of various specialists working in concert. Said requirements include hygienic aspects, knowledge concerning pre- and intraoperative patient monitoring, managing surgical site infections, adequate postsurgical pain management, as well as detailed pharmacological knowledge with respect to common local anesthetics and the toxic and allergic reactions associated therewith. Not only does this require interdisciplinary collaboration and shared responsibility for the patient. It also necessitates the development and implementation of quality-oriented and evidence-based guidelines that, in the dermatosurgical setting, usually extend far beyond the scope of the specialty per se. The objective of the present CME article is the condensed presentation of interdisciplinary aspects relating to the most important perioperative issues.
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Affiliation(s)
- Cornelia S L Müller
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Wakiko Hubner
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Sigrid Thieme-Ruffing
- Institute for Medical Microbiology and Hygiene, Saarland University Medical Center, Homburg/Saar, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thomas Vogt
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thomas Volk
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Barbara C Gärtner
- Institute for Medical Microbiology and Hygiene, Saarland University Medical Center, Homburg/Saar, Germany
| | - Patric Bialas
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany
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Harnoss JC, Assadian O, Karl Diener M, Müller T, Baguhl R, Dettenkofer M, Scheerer L, Kohlmann T, Heidecke CD, Gessner S, Wolfgang Büchler M, Kramer A. Microbial Load in Septic and Aseptic Procedure Rooms. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:465-475. [PMID: 28764834 PMCID: PMC5545629 DOI: 10.3238/arztebl.2017.0465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 11/25/2016] [Accepted: 05/02/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Highly effective measures to prevent surgical wound infections have been established over the last two decades. We studied whether the strict separation of septic and aseptic procedure rooms is still necessary. METHODS In an exploratory, prospective observational study, the microbial concentration in an operating room without a room ventilating system (RVS) was analyzed during 16 septic and 14 aseptic operations with the aid of an air sampler (50 cm and 1 m from the operative field) and sedimentation plates (1 m from the operative field, and contact culture on the walls). The means and standard deviations of the microbial loads were compared with the aid of GEE models (generalized estimation equations). RESULTS In the comparison of septic and aseptic operations, no relevant differences were found with respect to the overall microbial concentration in the room air (401.7 ± 176.3 versus 388.2 ± 178.3 CFU/m3; p = 0.692 [CFU, colony-forming units]) or sedimentation 1 m from the operative field (45.3 ± 22.0 versus 48.7 ± 18.5 CFU/m2/min; p = 0.603) and on the walls (35.7 ± 43.7 versus 29.0 ± 49.4 CFU/m2/min; p = 0.685). The only relevant differences between the microbial spectra associated with the two types of procedure were a small amount of sedimentation of Escherichia coli and Enterococcus faecalis in septic operations, and of staphylococcus aureus and pseudomonas stutzeri in aseptic operations, up to 30 minutes after the end of the procedure. CONCLUSION These data do not suggest that septic and aseptic procedure rooms need to be separated. In interpreting the findings, one should recall that the study was not planned as an equivalence or non-inferiority study. Wherever patient safety is concerned, high-level safety concepts should only be demoted to lower levels if new and convincing evidence becomes available.
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Affiliation(s)
- Julian-Camill Harnoss
- Department of General, Visceral and Transplantation Surgery and Study Center of the German Surgical Society (SDGC), University of Heidelberg
| | - Ojan Assadian
- Division for Hospital Hygiene, Vienna General Hospital, Medical University Vienna
| | - Markus Karl Diener
- Department of General, Visceral and Transplantation Surgery and Study Center of the German Surgical Society (SDGC), University of Heidelberg
| | - Thomas Müller
- Institute for Hygiene and Environmental Medicine, University of Greifswald
| | - Romy Baguhl
- Institute for Hygiene and Environmental Medicine, University of Greifswald
| | - Markus Dettenkofer
- Institute of Hospital Hygiene und Infection Prevention, Klinikum Konstanz
| | - Lukas Scheerer
- Department of General, Visceral and Transplantation Surgery and Study Center of the German Surgical Society (SDGC), University of Heidelberg
| | | | - Claus-Dieter Heidecke
- Clinic and Outpatient Clinic for Surgery—Department of General Surgery, Visceral, Thoracic and Vascular Surgery, University of Greifswald
| | - Stephan Gessner
- Institute for Hygiene and Environmental Medicine, University of Greifswald
| | - Markus Wolfgang Büchler
- Department of General, Visceral and Transplantation Surgery and Study Center of the German Surgical Society (SDGC), University of Heidelberg
| | - Axel Kramer
- Institute for Hygiene and Environmental Medicine, University of Greifswald
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10
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Leitfaden und Empfehlungen für die Hygiene in der Koloproktologie – Teil 1. COLOPROCTOLOGY 2017. [DOI: 10.1007/s00053-017-0149-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Müller CSL, Hubner W, Thieme-Ruffing S, Pföhler C, Vogt T, Volk T, Gärtner BC, Bialas P. Prä- und perioperative Aspekte der Versorgung dermatochirurgischer Patienten. J Dtsch Dermatol Ges 2017; 15:117-148. [PMID: 28214321 DOI: 10.1111/ddg.13181_g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/13/2016] [Indexed: 12/12/2022]
Abstract
Die Dermatochirurgie nimmt hinsichtlich vieler Punkte eine Sonderstellung unter den operativen Fächern ein. Hierzu gehört in erster Linie die Tatsache, dass bis auf wenige Ausnahmen fast alle Eingriffe traditionell in Lokal- bzw. Regionalanästhesie und oft auch in räumlich-infrastruktureller Trennung von den großen Zentral-Operationssälen stattfinden können. Die peri- und postoperative Überwachung obliegt dabei dem dermatochirurgischen Operationsteam. Das sui generis kleinere OP-Team hat somit eine ganze Reihe perioperativer Notwendigkeiten zu beachten, um die sich in den "großen" chirurgischen Fächern eine Vielzahl verschiedener beteiligter Fachgruppen gemeinsam kümmern. Hierzu gehören neben Hygieneaspekten, Kenntnissen in der Überwachung der Patienten sowie dem Aspekt der surgical site infections auch Fragen zur postoperativen Schmerztherapie sowie detailliertes pharmakologisches Wissen über die zur Anwendung kommenden Lokalanästhetika und das Handling der damit assoziierten toxischen und allergischen Reaktionen. Eine interdisziplinäre Zusammenarbeit und Verantwortung für den Patienten ist notwendig und erfordert die Erarbeitung und Umsetzung qualitätsorientierter und evidenzbasierter Handlungsanweisungen, die im dermatochirurgischen OP-Setting meist weit über das eigentliche Fach hinausgehen. Ziel dieses Weiterbildungsartikels soll die komprimierte Darstellung der genannten fachübergreifenden Standpunkte bezüglich der wichtigsten perioperativen Aspekte sein.
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Affiliation(s)
- Cornelia S L Müller
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Wakiko Hubner
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Sigrid Thieme-Ruffing
- Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Claudia Pföhler
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Thomas Vogt
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Thomas Volk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Barbara C Gärtner
- Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Patric Bialas
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg/Saar
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Fröhlich V, Johandl S, De Zwart P, Stöckle U, Ochs BG. Navigated TKA After Osteotomy Versus Primary Navigated TKA: A Matched-Pair Analysis. Orthopedics 2016; 39:S77-82. [PMID: 27219735 DOI: 10.3928/01477447-20160509-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/02/2016] [Indexed: 02/03/2023]
Abstract
This article presents clinical and radiological outcome analysis of navigated total knee arthroplasty (TKA) following osteotomy compared with primary navigated TKA implantation. The study group (29 legs) received navigated TKA (Columbus with deep-dish, cruciate-retaining inlay, Aesculap AG, Tuttlingen, Germany) following distal femoral (6 legs) or high tibial (23 legs) osteotomy, and the control group (29 legs) received a primary navigated TKA. All patients were examined clinically and radiologically in a retrospective matched-pair analysis. Both groups showed comparable clinical scores (Oxford Knee Score, Tegner and Lysholm scores, and Knee Society Score). Radiological evaluations offered no relevant differences. The study group showed a significant mediolateral ligamentous instability (3 legs ≤5°, 1 leg 6°-9°, 25 legs ≥10° mediolateral deviation) compared with the control group (14 legs ≤5°, 9 legs 6°-9°, 6 legs >10°; P<.001). Significantly higher mediolateral ligamentous instability was seen in otherwise comparable clinical and radiological results in patients with navigated TKA implantation following osteotomy, compared with primary TKA. [Orthopedics; 2016. 39(3):S77-S82.].
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Prävention der postoperativen Wundinfektion. Anaesthesist 2016; 65:328-36. [DOI: 10.1007/s00101-016-0169-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/08/2016] [Accepted: 03/18/2016] [Indexed: 01/28/2023]
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Postoperative Wundinfektionen: Über Miasmen, Luftkeime und andere Risikofaktoren. Anaesthesist 2016; 65:325-7. [DOI: 10.1007/s00101-016-0174-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Infektionsschutz und spezielle Hygienemaßnahmen in klinischen Disziplinen. KRANKENHAUS- UND PRAXISHYGIENE 2016. [PMCID: PMC7152143 DOI: 10.1016/b978-3-437-22312-9.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Busch J, Trierweiler-Hauke B. Hygiene auf der IMC-Station. PFLEGEWISSEN INTERMEDIATE CARE 2016. [PMCID: PMC7124074 DOI: 10.1007/978-3-662-49511-7_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Im Kapitel Hygiene auf der IMC-Station wird dargelegt, dass die Einhaltung von Hygienemaßnahmen nach den neuesten wissenschaftlichen Erkenntnissen zu den Basismaßnahmen einer jeden IMC-Station gehört. Neben den Standard-Hygienemaßnahmen einer IMC-Station werden die besonderen Aspekte der hygienischen Körperpflege beschrieben. Die erforderlichen Interventionen zur Vermeidung von Katheterinfektionen werden begründet. Die Vorbereitung, Anlage und Pflege der Katheter werden detailliert dargestellt, sodass jeder Lernende dies als Handlungsanweisung verwenden kann und dem Erfahrenen eine Detailprüfung ermöglicht wird. Wichtige Aspekte der Wund-, Drainagen- und Stomapflege werden besprochen und eine Kurzübersicht zur Pflege von Patienten mit MRE gegeben.
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Affiliation(s)
- Jutta Busch
- Campus Kiel, UKSH Akademie gemeinnützige GmbH, Kiel, Germany
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Bauer M, Scheithauer S, Moerer O, Pütz H, Sliwa B, Schmidt C, Russo S, Waeschle R. Implementierung eines rationalen Hygienestandards zur Aufbereitung von Operationssälen. Anaesthesist 2015; 64:765-77. [DOI: 10.1007/s00101-015-0086-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ellenrieder M, Redanz S, Bader R, Mittelmeier W, Podbielski A. Influence of Antimicrobial Coatings of Vacuum-Assisted Closure Dressings on Methicillin-Resistant Staphylococcus aureus Growth Kinetics: An In Vitro Study. Surg Infect (Larchmt) 2015; 16:139-45. [DOI: 10.1089/sur.2013.268] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Martin Ellenrieder
- Department of Orthopedics, University Medicine Rostock, Rostock, Germany
| | - Sylvio Redanz
- Institute of Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Rainer Bader
- Department of Orthopedics, University Medicine Rostock, Rostock, Germany
| | | | - Andreas Podbielski
- Institute of Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
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Keshmiri A, Maderbacher G, Baier C, Springorum HR, Grifka J, Schaumburger J. [Prevention of periprosthetic joint infections : Not evidence-based strategies]. DER ORTHOPADE 2015; 44:338-43. [PMID: 25701387 DOI: 10.1007/s00132-015-3082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical site infections are the most common nosocomial infections in orthopedic surgery. Strategies to prevent these infections are of enormous relevance. OBJECTIVES Evidence-based procedures such as hand disinfection, prophylactic antibiotic application, hair removal with electric clippers, or preoperative treatment of Staphyloccus aureus are listed in national and international guidelines. Beside these measures, several scientifically not confirmed methods, e.g., the administration of antibiotic prophylaxis for several days or the usage of helmets during surgery, are still practiced. These measures are not evidence-based and should not be performed anymore. CONCLUSION Only the consequent implementation of evidence-based procedures can help prevent surgical site infections.
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Affiliation(s)
- A Keshmiri
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum, Bad Abbach, Deutschland,
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Schächinger V, Nef H, Achenbach S, Butter C, Deisenhofer I, Eckardt L, Eggebrecht H, Kuon E, Levenson B, Linke A, Madlener K, Mudra H, Naber C, Rieber J, Rittger H, Walther T, Zeus T, Kelm M. Leitlinie zum Einrichten und Betreiben von Herzkatheterlaboren und Hybridoperationssälen/Hybridlaboren. KARDIOLOGE 2015. [DOI: 10.1007/s12181-014-0631-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Adler AC, Spegel H, Kolb S, Hierl W, Müller C, Höller C, Liebl B, Rudolph P, Herr C. Modellprojekt zur Verbesserung der Hygiene in stationären Pflegeeinrichtungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 57:1424-31. [DOI: 10.1007/s00103-014-2064-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Joint punctures and injections are a widely used approach to obtain a differential diagnostic assessment for the formation of a treatment concept for recurrent joint effusions, to exclude a periprosthetic infection in painful and loosened endoprostheses before a planned revision, to assign the origin of pain symptoms to a specific joint or to provide a treatment for arthritis of any kind. In all medical fields the standardization of processes has progressed. Therefore, for joint punctures there are standards relating to the implementation and hygiene of intra-articular punctures or injections in order to prevent the occurrence of complications, such as joint infections.
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Affiliation(s)
- S Arnold
- Orthopädische Universitätsklinik Friedrichsheim gGmbH, Marienburgstraße 2, 60528, Frankfurt am Main, Deutschland,
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Kampf G, Ostermeyer C. Small volumes of n-propanol (60%) applied for 3 minutes may be ineffective for surgical hand disinfection. Antimicrob Resist Infect Control 2014; 3:15. [PMID: 24822090 PMCID: PMC4017236 DOI: 10.1186/2047-2994-3-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 03/16/2014] [Indexed: 11/10/2022] Open
Abstract
Background There is a trend in some countries to recommend the use of surgical hand disinfectants at volumes as low as 4 ml per application. Aim To determine whether the volume applied and hand size influence the efficacy of surgical hand disinfection. Methods Thirteen experiments, according to EN 12791, resulting in 269 datasets from 75 subjects were analyzed. Hands were first washed for one minute with soap. The pre-values were obtained by rubbing the finger tips in tryptic soy broth for one minute. Each subject treated his/her hands with n-propanol (60%, v/v), with as many portions as necessary to keep the hands wet for three minutes (6–12 ml). Bacterial post-values were taken from one hand (immediate effect); the other hand was gloved for three hours (sizes 7–9). The second post-value was taken when the glove was removed (3 h effect). Results The mean immediate log10 reduction of CFU was 2.56 ± 1.12. The glove size had no significant effect on the efficacy of disinfection (p = 0.182; ANOVA). However, a volume of 6 ml was significantly less effective than 9 ml for glove sizes of 7.5–8 (p < 0.05; Tukey post hoc analysis). The mean log10 reduction after 3 h was 2.12 ± 1.24. A volume of 6 ml was again significantly less effective than 12 ml for glove size 7 and than 9 ml for glove sizes 7.5–8 (p < 0.05). Conclusions The application of small volumes of surgical hand disinfectant when using the EN 12791 reference procedure is likely to yield poor efficacy results, regardless of hand size.
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Affiliation(s)
- Günter Kampf
- Bode Science Center, Bode Chemie GmbH, Melanchthonstrasse 27, Hamburg 22525, Germany ; Institut für Hygiene und Umweltmedizin, Ernst-Moritz-Arndt Universität Greifswald, Walther-Rathenau-Str. 49a, Greifswald 17489, Germany
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Abstract
Prewarming is a useful and effective measure to reduce perioperative hypothermia. Due to §23(3) of the German Infektionsschutzgesetz (Gesetz zur Verhütung und Bekämpfung von Infektionskrankheiten beim Menschen, Infection Act, act on protection and prevention of infectious diseases in man) and the recommendations of the Hospital Hygiene and Infection Prevention Committee of the Robert Koch Institute, implementation of prewarming is clearly recommended. There are several technically satisfactory and practicable devices available allowing prewarming on the normal hospital ward, in the preoperative holding area or in the induction room of the operating theater (OR) The implementation of prewarming requires additional equipment and training of staff. Using a locally adapted concept for the implementation of prewarming does not lead to inefficiency in the perioperative process. In contrast, the implementation can help to achieve stable arrival times for patients in the OR.
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Maschuw K, Heinz C, Maurer E, Reuss A, Schade-Brittinger C, Bartsch DK. Intracutaneous suture versus transcutaneous skin stapling for closure of midline or horizontal skin incision in elective abdominal surgery and their outcome on superficial surgical site infections--INTRANS: study protocol for a randomized controlled trial. Trials 2014; 15:25. [PMID: 24433264 PMCID: PMC3899381 DOI: 10.1186/1745-6215-15-25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 01/08/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Surgical site infections are the third most frequent type of nosocomial infections. Evidence-based recommendations have been given regarding preoperative hospitalization, hygiene and air-conditioning, patient conditions, and wound dressing. However, no general recommendations concerning wound closure exist. Systematic reviews and meta-analyses suppose a benefit of intracutaneous suture compared to skin staples in orthopedic and obstetric surgery. Literature data for skin closure in elective abdominal surgery are still deficient. METHODS/DESIGN Patients scheduled for any elective abdominal surgery requiring midline or horizontal laparotomy are potentially eligible for the trial. Trial-specific exclusion criteria are date of admission exceeding four days prior to surgery, antibiotic treatment within the past 14 days, any previous midline or horizontal laparotomy in case the procedure requires the same skin incision as before, neurophysiological deficits or severe psychiatric or neurologic diseases that do not allow an informed consent or compliance, and participation in any other interventional trial with interference of intervention and outcome. The trial is created for process innovation within standardized surgical procedures. It is designed as a prospective randomized controlled single center trial in a parallel design including an active comparator and an intervention group. The intervention addresses the closure of skin after the main surgical procedure: intracutaneous suture in the intervention group and transcutaneous skin stapling in the control group. The rate of superficial surgical site infections is defined as the primary endpoint. Secondary endpoints are time for skin closure, satisfaction with the cosmetic outcome 30 days after surgery, prolongation of hospital stay, and duration of sick-leave due to surgical site infections. The primary efficacy analysis follows the intention-to-treat principle. A χ2 test will be applied. DISCUSSION The trial is expected to balance the shortcomings of the current evidence. It will help to define the gold standard for wound closure in elective abdominal surgery. Patients' safety and quality of life are assumed to be enhanced. Therapy costs are likely to be reduced and health care optimized. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00004542.
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Affiliation(s)
- Katja Maschuw
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Giessen and Marburg GmbH–Location Marburg, Baldingerstrasse, D-35043 Marburg, Germany
| | - Christine Heinz
- Coordinating Centre for Clinical Trials-KKS, Philipps-University Marburg, Karl-von-Frisch-Strasse 4, D-35043 Marburg, Germany
| | - Elisabeth Maurer
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Giessen and Marburg GmbH–Location Marburg, Baldingerstrasse, D-35043 Marburg, Germany
| | - Alexander Reuss
- Coordinating Centre for Clinical Trials-KKS, Philipps-University Marburg, Karl-von-Frisch-Strasse 4, D-35043 Marburg, Germany
| | - Carmen Schade-Brittinger
- Coordinating Centre for Clinical Trials-KKS, Philipps-University Marburg, Karl-von-Frisch-Strasse 4, D-35043 Marburg, Germany
| | - Detlef Klaus Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Giessen and Marburg GmbH–Location Marburg, Baldingerstrasse, D-35043 Marburg, Germany
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Lemmen S. Prävention von Wundinfektionen. ARTHROSKOPIE 2013. [DOI: 10.1007/s00142-013-0772-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Patient safety in hospitals is difficult to define and is not measurable by operational safety parameters as in other fields. So-called adverse events (AE) are a collective of complications, failures, mistakes, errors and violations. Estimations of at least 9.2 % AEs in surgery with 0.1 % fatalities are given worldwide but there are no correlations between objective quantification of AEs and subjective or public perception of safety during the perioperative period. Patient safety during this period is mostly endangered by wound infections (safety 98 %) and nosocomial infections (safety 97 %). In spite of these facts, safety parameters for problems in anesthesia, blood transfusion, in retaining surgical instruments and so-called index events, such as patient and side identification errors are much higher. Patient safety is maintained in hospitals by objective means (surgical). Checklists have been proven to improve safety and critical incidence reporting, training and changing of attitudes could have further advantages but they are difficult to measure.
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Behnke M, Hansen S, Leistner R, Diaz LAP, Gropmann A, Sohr D, Gastmeier P, Piening B. Nosocomial infection and antibiotic use: a second national prevalence study in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:627-33. [PMID: 24133543 PMCID: PMC3796357 DOI: 10.3238/arztebl.2013.0627] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 05/29/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND In 2011, seventeen years after the first national study on the prevalence of nosocomial infections and antibiotic use in German hospitals, a second national prevalence study was carried out according to the specifications of the European Centre for Disease Prevention and Control (ECDC). METHODS The ECDC protocol, containing uniform surveillance definitions and ascertainment methods, was implemented. The only infections counted were those that were active or under treatment with antibiotics on the day of the study. In addition to the representative sample required by the ECDC, which consisted of 46 hospitals, further hospitals participated on a voluntary basis. RESULTS Data on 41 539 patients in 132 hospitals were analyzed. The prevalence of infections that had arisen during the current hospital stay was 3.8% in the overall group and 3.4% in the representative sample of 9626 patients in 46 hospitals. The prevalence of all nosocomial infections, including those acquired before the current hospital stay and still present upon admission, was 5.1% in both the overall group and the representative sample. The prevalence of antibiotic use on the day of the study was 25.5% and 23.3% in the two groups, respectively. CONCLUSION The prevalence of nosocomial infection has not changed since 1994, but the prevalence of antibiotic use has increased. In interpreting these findings, one should bear in mind that confounders may have influenced them in different directions: The mean length of hospital stay is now shorter than in 1994, but the mean age of hospitalized patients is higher.
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Affiliation(s)
- Michael Behnke
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | - Sonja Hansen
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | - Rasmus Leistner
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | | | - Alexander Gropmann
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | - Dorit Sohr
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | - Brar Piening
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
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Dresing K. Infektionen in Unfallchirurgie und Orthopädie. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2013; 25:220-4. [DOI: 10.1007/s00064-013-0254-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Fichtner A, Haupt E, Karwath T, Wullenk K, Pöhlmann C, Jatzwauk L. A single standardized practical training for surgical scrubbing according to EN1500: effect quantification, value of the standardized method and comparison with clinical reference groups. GMS ZEITSCHRIFT FUR MEDIZINISCHE AUSBILDUNG 2013; 30:Doc24. [PMID: 23737921 PMCID: PMC3671320 DOI: 10.3205/zma000867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 02/03/2013] [Accepted: 02/08/2013] [Indexed: 11/30/2022]
Abstract
UNLABELLED The standardized training of practical competences in skills labs is relatively new among German Medical Faculties. The broad acceptance and outstanding evaluation results do not provide objective data on the efficiency and cost-efficiency of these trainings. This study aims on the quantification of the teaching effect of the surgical scrubbing technique EN1500 and its comparison with clinical references of OR personnel. METHODS 161 4(th) year medical students were randomized into intervention and control group. The intervention group received a 45 minute standardized peer-teaching training of practical competences necessary in the OR including the scrubbing according to EN1500. Fluorescence dye was mixed in the disinfectant solution. After hand disinfection, standardized fotographs and semi-automated digital processing resulted in quantification of the insufficiently covered hand area. These results were compared with the control group that received the training after the test. In order to provide information on the achieved clinical competence level, the results were compared with the two clinical reference groups. RESULTS The intervention group remained with 4,99% (SD 2,34) insufficiently covered hand area after the training compared to the control group 7,33% (SD 3,91), p<0,01. There was no significant difference between control group and reference groups: surgeons 9,32% (SD 4,97), scrub nurses 8,46% (SD 4,66). The student intervention group showed results that were significantly better than the clinical references. The methodic mistake remained negligible. In the sub-group analysis, the students with low or medium experience in surgical scrubbing and hand disinfection derived highest benefit from the training, whereas students with no or high experience did benefit less. All participants showed better results on hand palms compared to back of hand areas. DISCUSSION A single standardized peer-teaching of surgical scrubbing and hand disinfection according to EN1500 is sufficient to improve the measurable coverage of hand area and reduce the disinfection gap by 1/3. In absolute measures, the competence level of experienced surgeons and scrub nurses is achieved or even exceeded.
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Affiliation(s)
- Andreas Fichtner
- Universitätsklinikum Halle, Klinik für Anästhesiologie und Operative Intensivmedizin, Leiter Erxleben Lernzentrum, Halle (Saale), Deutschland.
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Abstract
<b><i>Hintergrund: </i></b>Postoperative Wundinfektionen gehören zu den häufigsten nosokomialen Infektionen. Die Zunahme von mehrfachresistenten gramnegativen Erregern bereitet gerade in der Viszeralmedizin besondere Sorge. <b><i>Methode und Ergebnisse: </i></b>Da nicht alle Risiken für nosokomiale Infektionen beherrschbar sind, können diese Infektionen niemals vollständig vermieden werden. Umso wichtiger ist es, die vorhandenen Maßnahmen konsequent anzuwenden, um den medizinischen Fortschritt, der in der Viszeralmedizin gerade auch durch neue endoskopische und operative Verfahren in den letzten Jahren erkennbar ist, nutzen zu können. Das Verständnis der Erreger und der Infektionsbiologie ist dabei genauso wichtig wie die Kenntnis der nötigen Präventionsmaßnahmen und ihre Einbindung in klinische Prozesse. Bei invasiven Maßnahmen greifen dabei mit dem Patientenweg, dem Weg der Instrumente, der sonstigen OP/Endoskopie-Materialien und Medikamente, der OP-Einrichtung und dem Team mehrere Prozesse ineinander. <b><i>Schlussfolgerung: </i></b>Eine optimale Infektionsprävention ist nur bei einer Optimierung aller Prozesse sowie ihrer Interaktion zu erreichen. Anhand einer Übersicht zu Epidemiologie, Risikofaktoren und Möglichkeiten zur Vermeidung von Infektionen in der Viszeralmedizin soll ein Beitrag geleistet werden, um Viszeralmediziner für das Thema Infektionsprävention und Hygiene zu sensibilisieren und die Patientensicherheit zu erhöhen.
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Busch J, Trierweiler-Hauke B. Hygiene auf der IMC-Station. PFLEGEWISSEN INTERMEDIATE CARE 2013. [PMCID: PMC7122968 DOI: 10.1007/978-3-642-30001-1_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Laut Aussage des Bundesgesundheitsministeriums im Juli 2011 erkranken in Deutschland jährlich 400.000–600.000 Menschen an einer Krankenhausinfektion. Schätzungsweise zwischen 7.500 und 15.000 Menschen sterben jährlich an einer Krankenhausinfektion. 20–30% der Infektionen könnten durch die Einhaltung von Hygienemaßnahmen vermieden werden (BMG 2012).
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Simon A, Christiansen B. Zur Fortentwicklung der Arbeiten bei den Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:1427-31. [DOI: 10.1007/s00103-012-1550-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Waldow T, Szlapka M, Hensel J, Plötze K, Matschke K, Jatzwauk L. Skin sealant InteguSeal® has no impact on prevention of postoperative mediastinitis after cardiac surgery. J Hosp Infect 2012; 81:278-82. [DOI: 10.1016/j.jhin.2012.04.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 04/27/2012] [Indexed: 11/30/2022]
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Das Mediastinitisregister. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2012. [DOI: 10.1007/s00398-011-0900-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Lewalter K, Lemmen SW. [Prevention of wound infections: basic measures]. DER ORTHOPADE 2012; 41:11-4. [PMID: 22273701 DOI: 10.1007/s00132-011-1835-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Individual patient risk factors for wound infections, such as alcohol abuse, smoking or obesity can usually only be modified to a small extent. Studies have shown a reduction of surgical site infections due to the implementation of a benchmarking surveillance system. In order to prevent surgical site infections a variety of interventions are available, such as glucose control, correction of anemia and malnutrition and antibiotic therapy of infections before elective surgery. Reduction of the microbial skin flora by whole body washing procedures, avoidance of sharp razor shaving, application of antibiotic prophylaxis and correct surgical hand disinfection are additional measures. Intraoperative hypothermia should be avoided and strict compliance with asepsis is mandatory. Postoperative preventive measures include appropriate wound care and rapid removal of wound drainage.
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Affiliation(s)
- K Lewalter
- Zentralbereich für Krankenhaushygiene und Infektiologie, Universitätsklinikum Aachen (RWTH), Pauwelsstraße 30, 52074 Aachen, Deutschland
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Kramer A, Assadian O, Wendt M, Stengel D, Seifert J. Functional separation of septic and aseptic surgical procedures. GMS KRANKENHAUSHYGIENE INTERDISZIPLINAR 2012; 6:Doc12. [PMID: 22242093 PMCID: PMC3252653 DOI: 10.3205/dgkh000169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Current evidence does not favour constructional over functional separation of septic and aseptic surgical procedures in terms of overall hygiene maintenance and incidence of skin and soft tissue infections. In both laminar and turbulent flow air operating theatres, air is not a relevant source of pathogens if surface disinfection is carried out properly.Final cleaning after a septic procedure includes a thorough wipe-disinfection of all potentially contaminated near and distant surfaces, including maintaining the necessary and effective exposure time of the chosen surface disinfectant. Cleaning utensils and clothes of all team members must be disposed of before leaving the theatre, and a complete change of gowns is mandatory before re-entering the operating room area. Strict adherence to this code of behaviour will allow for efficient functional separation of clean and contaminated surgical procedures without compromising patient safety.
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Affiliation(s)
- Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
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Graf K, Ott E, Vonberg RP, Kuehn C, Schilling T, Haverich A, Chaberny IF. Surgical site infections--economic consequences for the health care system. Langenbecks Arch Surg 2011; 396:453-9. [PMID: 21404004 DOI: 10.1007/s00423-011-0772-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 02/24/2011] [Indexed: 11/28/2022]
Abstract
PURPOSES Unfortunately, surgical site infections (SSIs) are a quite common complication and represent one of the major causes of postoperative morbidity and mortality, and may furthermore lead to enormous additional costs for hospitals and health care systems. METHODS In order to determine the estimated costs due to SSIs, a MEDLINE search was performed to identify articles that provide data on economic aspects of SSIs and compared to findings from a matched case-control study on costs of SSIs after coronary bypass grafting (CABG) in a German tertiary care university hospital. RESULTS A total of 14 studies on costs were found. The additional costs of SSI vary between $3,859 (mean) and $40,559 (median). Median costs of a single CABG case in the recently published study were $49,449 (€36,261) vs. $18,218 (€13,356) in controls lacking infection (p < 0.0001). The median reimbursement from health care insurance companies was $36,962 (€27,107) leading to a financial loss of $12,482 (€9,154) each. CONCLUSION Costs of SSIs may almost triple the individual overall health care costs and those additional charges may not be sufficiently covered. Appropriate measures to reduce SSI rates must be taken to improve the patient's safety. This should also diminish costs for health care systems which benefits the entire community.
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Affiliation(s)
- Karolin Graf
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, D-30625, Germany.
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Treitl M, Rademacher A, Becker-Lienau J, Reiser MF, Hoffmann U, Czihal M. Successful Antibiotic Treatment of Severe Staphylococcal Infection of a Long Stent Graft in the Superficial Femoral Artery with Graft Preservation in the Long Term. Cardiovasc Intervent Radiol 2010; 34:642-6. [DOI: 10.1007/s00270-010-0040-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 10/28/2010] [Indexed: 11/28/2022]
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Die Kategorien in der Richtlinie für Krankenhaushygiene und Infektionsprävention – Aktualisierung der Definitionen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53:754-6. [DOI: 10.1007/s00103-010-1106-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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[Requirements for hygiene in the medical care of immunocompromised patients. Recommendations from the Committee for Hospital Hygiene and Infection Prevention at the Robert Koch Institute (RKI)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53:357-88. [PMID: 20300719 PMCID: PMC7095954 DOI: 10.1007/s00103-010-1028-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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A 1-minute hand wash does not impair the efficacy of a propanol-based hand rub in two consecutive surgical hand disinfection procedures. Eur J Clin Microbiol Infect Dis 2009; 28:1357-62. [DOI: 10.1007/s10096-009-0792-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 07/15/2009] [Indexed: 10/20/2022]
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Nassauer A, Fouquet H, Mielke M. [Control of infection risks--primum non nocere. Remarks with reference to hygiene standards in medical malpractice law]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2009; 52:689-98. [PMID: 19526203 DOI: 10.1007/s00103-009-0873-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Nassauer
- Fachgebiet 14, Robert Koch-Institut, Nordufer 20, 13353 Berlin.
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Hemmer W, Rybak K, Markewitz A, Israel C, Krämer LI, Neuzner J, Nowak B, Pfeiffer D, Schuchert A, Wiegand U. Empfehlungen zur Strukturierung der Herzschrittmacher- und Defibrillatortherapie. DER KARDIOLOGE 2009. [DOI: 10.1007/s12181-008-0136-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Empfehlungen zur Strukturierung der Herzschrittmacher- und Defibrillatortherapie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2008. [DOI: 10.1007/s00398-008-0668-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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