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Schaumann K, Mütz D, Althaus L, Prinzen T, Schipper J, Klenzner T. Perioperative antibiotic prophylaxis in the setting of cochlear implantation: a retrospective analysis of 700 cases. Eur Arch Otorhinolaryngol 2024; 281:4021-4028. [PMID: 38480534 PMCID: PMC11266245 DOI: 10.1007/s00405-024-08515-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/24/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE Postoperative wound infections after cochlear implantation are rare but sometimes serious and can lead to explantation. Therefore, perioperative antibiotic administration is often recommended. However, in clinical practice, the type and duration of antibiotic prophylaxis varies between different centers. The aim of this study was to investigate the role of perioperative antibiotic prophylaxis in preventing postoperative complications. METHODS 700 patients who underwent cochlear implantation between 2007 and 2019 were retrospectively evaluated with regard to wound infections within the first 28 postoperative days. These were classified into major and minor complications. Data were analyzed using the IBM statistical program SPSS. RESULTS In 670 out of 700 patients the type and duration of perioperative antibiotic administration could be reconstructed from the records. Of these 67 patients (10%) received antibiotics as a single shot, 158 patients (23.6%) were treated with antibiotics for a period of 48 h, and 445 patients (66.4%) received prolonged antibiotic therapy for more than 72 h. In total 64 patients (9.5%) showed abnormalities in wound assessment within the first 28 postoperative days after implantation. Major infections (1.6%) were detected in 11 patients. Overall, there was no statistically significant difference in wound infection rates between the group receiving single-shot antibiosis and the group receiving 48 h prophylaxis or antibiotic treatment > 72 h (p = 0.46). CONCLUSION Patients receiving an antibiotic single shot do not appear to be at significantly increased risk for postoperative wound infections compared with patients with prolonged antibiotic treatment. Continuation of data collection across centers seems reasonable.
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Affiliation(s)
- Katharina Schaumann
- Department of Otorhinolaryngology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40255, Düsseldorf, Germany.
| | - D Mütz
- Department of Otorhinolaryngology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40255, Düsseldorf, Germany
| | - L Althaus
- Department of Otorhinolaryngology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40255, Düsseldorf, Germany
| | - T Prinzen
- Department of Otorhinolaryngology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40255, Düsseldorf, Germany
| | - J Schipper
- Department of Otorhinolaryngology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40255, Düsseldorf, Germany
| | - T Klenzner
- Department of Otorhinolaryngology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40255, Düsseldorf, Germany
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Nettelrodt KME, Tomsic I, Stolz M, Krauth C, Chaberny IF, von Lengerke T. Psychometric Properties of Scales Assessing Psychosocial Determinants of Staff Compliance with Surgical Site Infection Prevention: The WACH-Study. Psychol Res Behav Manag 2024; 17:2757-2767. [PMID: 39070067 PMCID: PMC11283262 DOI: 10.2147/prbm.s464335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/23/2024] [Indexed: 07/30/2024] Open
Abstract
Purpose Psychosocial determinants influence healthcare workers' compliance with surgical site infection (SSI) preventive interventions. In order to design needs-based interventions promoting compliance, such determinants must first be assessed using valid and reliable questionnaire scales. To compare professional groups without bias, the scales must also be measurement-equivalent. We examine the validity/reliability and measurement equivalence of four scales using data from physicians and nurses from outside the university sector. Additionally, we explore associations with self-reported SSI preventive compliance. Participants and Methods N = 90 physicians and N = 193 nurses (response rate: 31.5%) from nine general/visceral or orthopedic/trauma surgery departments in six non-university hospitals in Germany participated. A written questionnaire was used to assess the compliance with SSI preventive interventions and the determinants of compliance based on the Capability-Opportunity-Motivation-Behavior-Model. Psychometric testing involved single- and multiple-group confirmatory factor analyses, and explorative analyses used t-tests and multiple linear regression. Results The scales assessing individual determinants of compliance (capability, motivation, and planning) were found to be reliable (each Cronbach's α ≥ 0.85) and valid (each Root-Mean-Square-Error of Approximation ≤ 0.065, each Comparative-Fit-Index = 0.95) and revealed measurement equivalence for physicians and nurses. The scale assessing external determinants (opportunity) did not demonstrate validity, reliability, or measurement equivalence. Group differences were found neither in compliance (p = 0.627) nor determinants (p = 0.192; p = 0.866; p = 0.964). Capability (β = 0.301) and planning (β = 0.201) showed associations with compliance for nurses only. Conclusion The scales assessing motivation, capability, and planning regarding SSI preventive compliance provided reliable and valid scores for physicians and nurses in surgery. Measurement equivalence allows group comparisons of scale means to be interpreted without bias.
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Affiliation(s)
- Karolin M E Nettelrodt
- Department of Medical Psychology, Center of Public Health, Hannover Medical School, Hannover, Germany
| | - Ivonne Tomsic
- Department of Medical Psychology, Center of Public Health, Hannover Medical School, Hannover, Germany
| | - Maike Stolz
- Institute of Epidemiology, Social Medicine and Health Systems Research, Center of Public Health, Hannover Medical School, Hannover, Germany
| | - Christian Krauth
- Institute of Epidemiology, Social Medicine and Health Systems Research, Center of Public Health, Hannover Medical School, Hannover, Germany
| | - Iris F Chaberny
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
- Christian-Albrecht University of Kiel and University Medical Center Schleswig-Holstein, Institute of Hospital Epidemiology and Environmental Hygiene, Kiel, Germany
| | - Thomas von Lengerke
- Department of Medical Psychology, Center of Public Health, Hannover Medical School, Hannover, Germany
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Herrmann T, Spieth P, Richter T. [Influence of anesthesia on surgical site infections]. DIE ANAESTHESIOLOGIE 2024; 73:423-432. [PMID: 38780623 DOI: 10.1007/s00101-024-01418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Surgical site infections (SSI) are the most frequent cause of impaired perioperative wound healing, lead to increased postoperative morbidity, mortality and length of hospital stay and are therefore a relevant perioperative complication. In addition to numerous measures taken by the surgical departments, there are anesthesiological options that can help to reduce the risk of SSI. In addition to heat, volume and transfusion management these include, for example, the use of antibiotics and the choice of the anesthesia procedure. This article is intended to provide fundamental knowledge on SSI, shows various options for reducing them in the context of anesthesia and evaluates their effectiveness and evidence based on the current state of knowledge.
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Affiliation(s)
- Teresa Herrmann
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - Peter Spieth
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Torsten Richter
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
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Eckmann C, Aghdassi SJS, Brinkmann A, Pletz M, Rademacher J. Perioperative Antibiotic Prophylaxis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:233-242. [PMID: 38440828 DOI: 10.3238/arztebl.m2024.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Postoperative surgical site infections (SSI) account for almost 25% of all nosocomial infections in Germany and are a source of increased morbidity and mortality. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed and on national and international guidelines. RESULTS The individual risk factors for SSI must be assessed before any surgical procedure. A body-mass index above 30 kg/m2 is associated with an unadjusted risk ratio of 1.35 [1.28; 1.41] for SSI, which rises to 3.29 [2.99; 3.62] if the patient is also immunosuppressed. The risk of SSI is also significantly higher with certain types of procedure. Perioperative antibiotic prophylaxis (PAP) is clearly indicated for operations that carry a high risk of SSI (e.g., colorectal surgery) and for those that involve the implantation of alloplastic material (e.g., hip endoprostheses). PAP can usually be administered with basic antibiotics such as cefazoline. The basic principles of PAP are that it should be given by the anesthesia team in the interval from 60 minutes preoperatively up to shortly before the incision, and that its administration should only be for a short period of time, usually as a single shot. Continuing PAP onward into the postoperative period leads to increased toxicity, bacterial superinfections, and antibiotic resistance. CONCLUSION The evidence shows that perioperative antibiotic prophylaxis is a component of a bundle of measures that can help prevent SSI. Strict indications and adherence to the basic principles of PAP are essential for therapeutic success.
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Affiliation(s)
- Christian Eckmann
- Visceral and Thoracic Surgery and ABS-Team, Clinic Hannoversch Münden; Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin , Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Digital Clinician Scientist Program; Department of Anaesthesiology and Intensive Care Medicine, General Hospital of Heidenheim; Institute of Infectious Diseases and Infection Control, University Hospital, Jena,; Department of Pneumolgoy and Infectiology and ABSTeam, Hannover Medical School
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Hygiene requirements for cleaning and disinfection of surfaces: recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. GMS HYGIENE AND INFECTION CONTROL 2024; 19:Doc13. [PMID: 38655122 PMCID: PMC11035912 DOI: 10.3205/dgkh000468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
This recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) addresses not only hospitals, but also outpatient health care facilities and compiles current evidence. The following criteria are the basis for the indications for cleaning and disinfection: Infectious bioburden and tenacity of potential pathogens on surfaces and their transmission routes, influence of disinfecting surface cleaning on the rate of nosocomial infections, interruption of cross infections due to multidrug-resistant organisms, and outbreak control by disinfecting cleaning within bundles. The criteria for the selection of disinfectants are determined by the requirements for effectiveness, the efficacy spectrum, the compatibility for humans and the environment, as well as the risk potential for the development of tolerance and resistance. Detailed instructions on the organization and implementation of cleaning and disinfection measures, including structural and equipment requirements, serve as the basis for their implementation. Since the agents for surface disinfection and disinfecting surface cleaning have been classified as biocides in Europe since 2013, the regulatory consequences are explained. As possible addition to surface disinfection, probiotic cleaning, is pointed out. In an informative appendix (only in German), the pathogen characteristics for their acquisition of surfaces, such as tenacity, infectious dose and biofilm formation, and the toxicological and ecotoxicological characteristics of microbicidal agents as the basis for their selection are explained, and methods for the evaluation of the resulting quality of cleaning or disinfecting surface cleaning are presented.
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Schlager JG, Hartmann D, Kendziora B. [Surgical site infection and perioperative antibiotics in dermatosurgery]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:827-834. [PMID: 37823917 DOI: 10.1007/s00105-023-05233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Postoperative wound infections represent the most common complication in dermatosurgery. Given the low incidence and heterogeneous data, no standards for perioperative antibiotic prophylaxis (PAP) have been established in clinical practice. OBJECTIVES To summarize the current evidence on risk factors for postoperative wound infection in dermatosurgery and the new recommendations on PAP. MATERIALS AND METHODS Relevant study data and current recommendations were summarized descriptively. RESULTS Current evidence suggests that the following factors are associated with an increased risk of wound infection after dermatosurgical procedures: surgery to the lower extremity or the ear, postoperative hemorrhage, defect closure by flap or skin graft, large wound defect, immunosuppression, and male sex. Probably not affecting the risk of infection are diabetes, obesity, age, smoking, use of a blood thinner, multiple surgeries, or wound healing by second intention. Not all risk factors affect the risk of infection equally. They must be weighted differently and only in combination do they increase the risk of wound infection in a clinically relevant way. According to a current position paper of the German Society for Dermatosurgery, the indication for PAP should be made individually and only if multiple factors are present. Furthermore, patients with increased risk for bacterial endocarditis or hematogenic endoprosthesis infection should receive PAP prior to septic skin surgery. CONCLUSION In dermatologic surgery, PAP should be restricted to patients at high risk for wound infection. Further indications are the prevention of bacterial endocarditis and hematogenic endoprosthesis infection in high-risk individuals prior to septic surgery.
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Affiliation(s)
- Justin Gabriel Schlager
- Klinik und Poliklinik für Dermatologie und Allergologie, LMU Klinikum - Campus Innenstadt, Frauenlobstr. 9-11, 80337, München, Deutschland.
| | - Daniela Hartmann
- Klinik und Poliklinik für Dermatologie und Allergologie, LMU Klinikum - Campus Innenstadt, Frauenlobstr. 9-11, 80337, München, Deutschland
| | - Benjamin Kendziora
- Klinik und Poliklinik für Dermatologie und Allergologie, LMU Klinikum - Campus Innenstadt, Frauenlobstr. 9-11, 80337, München, Deutschland
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Gebäude West 38 (W38), Hamburg, Deutschland
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Löser CR, Becker SL, Hartmann D, Kofler L, Kunte C, Müller CSL, Schlager JG, Balakirski G. Perioperative antibiotic prophylaxis in skin surgery - Position paper of the Antibiotic Stewardship working group of the German Society for Dermatologic Surgery (DGDC), Part 1: Procedure- and patient-related risk factors. J Dtsch Dermatol Ges 2023; 21:949-956. [PMID: 36892413 DOI: 10.1111/ddg.14947] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/13/2022] [Indexed: 03/10/2023]
Abstract
The aim of perioperative antibiotic prophylaxis (PAP) is to prevent the occurrence of surgical site infections (SSIs) or other infectious complications (especially bacterial endocarditis or septic arthritis). PAP is effective in surgeries where overall infection rates are high even without considering patient-related risk factors (such as orthopedic surgery or fracture repair). Surgery on airways, gastrointestinal, genital, or urinary tract is also considered to be associated with a risk of infection and may require PAP. Overall, SSIs in skin surgery are relatively rare and vary between 1% and 11% depending on the localization, complexity of the wound closure and patient cohort. Therefore, the general surgical recommendations regarding PAP only partially reflect the needs of dermatologic surgery. In contrast to the USA, where recommendations on the use of PAP in skin surgery already exist, there are currently no guidelines for the use of PAP specifically designed for dermatologic surgery in Germany. In the absence of an evidence-based recommendation, the use of PAP is guided by the experience of the surgeons and leads to a heterogeneous use of antimicrobial substances. In this work, we summarize the current scientific literature on the use of PAP and make a recommendation depending on procedure- and patient-related risk factors.
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Affiliation(s)
- Christoph R Löser
- Department of Dermatolgogy, Ludwigshafen City Hospital, Ludwigshafen
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich
| | - Lukas Kofler
- Department of Dermatology and Center for Dermatologic Surgery, Eberhard-Karls University of Tübingen, Tübingen
| | - Christian Kunte
- Department of Dermatologic Surgery and Dermatology, Artemed Clinic Munich, Munich
| | - Cornelia S L Müller
- Medical Supply Center for Histology, Cytology, and Molecular Diagnostics Trier, Trier
| | - Justin Gabriel Schlager
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich
| | - Galina Balakirski
- Center for Dermatology, Allergology and Dermatosurgery, Helios University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal
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Löser CR, Becker SL, Hartmann D, Kofler L, Kunte C, Müller CSL, Schlager JG, Balakirski G. Perioperative Antibiotikaprophylaxe in der Dermatochirurgie - Positionspapier der Arbeitsgruppe Antibiotic Stewardship der Deutschen Gesellschaft für Dermatochirurgie (DGDC), Teil 1: Eingriffs- und patientenbezogene Risikofaktoren. J Dtsch Dermatol Ges 2023; 21:949-957. [PMID: 37700414 DOI: 10.1111/ddg.14947_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: 07/13/2022] [Accepted: 10/13/2022] [Indexed: 09/14/2023]
Abstract
ZusammenfassungDie perioperative Antibiotikaprophylaxe (PAP) hat das Ziel, postoperative Wundinfektionen und Infektionskomplikationen (insbesondere bakterielle Endokarditis oder septische Arthritis) bei chirurgischen Eingriffen zu vermeiden. Die PAP hat sich besonders bei Eingriffen bewährt, bei denen die Infektionsraten auch ohne Berücksichtigung der patientenbezogenen Risikofaktoren insgesamt hoch sind (wie für orthopädische Eingriffe oder die Versorgung von Frakturen). Auch Operationen mit Eröffnung der Atemwege, des Verdauungs‐, Genital‐ oder Harntrakts gelten als mit Infektionsrisiko behaftet und können eine PAP erfordern. In der Dermatochirurgie sind Infektionskomplikationen insgesamt verhältnismäßig selten und variieren in Abhängigkeit von der Lokalisation, Komplexität des Eingriffes und der Patientenkohorte zwischen 1% und 11%. Daher spiegeln die allgemeinchirurgischen Empfehlungen bezüglich der PAP die Bedürfnisse der Dermatochirurgie nur begrenzt wider. Im Gegensatz zu den USA, wo eine entsprechende Empfehlung vorliegt, existiert in Deutschland zurzeit keine speziell für dermatochirurgische Eingriffe konzipierte Leitlinie zur Anwendung von PAP. In Abwesenheit evidenzbasierter Empfehlungen wird die PAP durch die Erfahrung der einzelnen Operateure geprägt, was zu einer heterogenen Anwendung antimikrobieller Substanzen führt. In der vorliegenden Arbeit wird die aktuelle wissenschaftliche Literatur zu dem Thema zusammengefasst und die daraus resultierende Empfehlung zur Anwendung der PAP in Abhängigkeit von eingriffs‐ und patientenbezogenen Risikofaktoren formuliert.
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Affiliation(s)
- Christoph R Löser
- Hautklinik, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Ludwigshafen
| | - 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
| | - Lukas Kofler
- Universitäts-Hautklinik, Universitätsklinikum Tübingen
| | - Christian Kunte
- Dermatochirurgie und Dermatologie, Artemed Fachklinik München GmbH & Co. KG, München
| | | | - Justin Gabriel Schlager
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München
| | - Galina Balakirski
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal
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Ristow O, Rückschloß T, Schnug G, Moratin J, Bleymehl M, Zittel S, Pilz M, Sekundo C, Mertens C, Engel M, Hoffmann J, Smielowski M. Comparison of Different Antibiotic Regimes for Preventive Tooth Extractions in Patients with Antiresorptive Intake-A Retrospective Cohort Study. Antibiotics (Basel) 2023; 12:997. [PMID: 37370316 DOI: 10.3390/antibiotics12060997] [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: 05/01/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023] Open
Abstract
In the present study, the impacts on success rates between three different antibiotic regimes in patients receiving preventive tooth extraction during/after antiresorptive treatment were compared. For the retrospective analysis, we enrolled patients who had undergone tooth extraction from 2009 to 2019 according to the specified preventive conditions under antiresorptive therapy. Three antibiotic regimens were distinguished: (Group 1) intravenous for 7 days, (Group 2) oral for 14 days, and (Group 3) oral for 7 days of application. The primary endpoint was the occurrence of medication-related osteonecrosis of the jaw at 12 weeks after surgery. A total of 760 patients and 1143 extraction regions were evaluated (Group 1 n = 719; Group 2 n = 126; Group 3 n = 298). The primary endpoint showed no significant difference in the development of medication-related osteonecrosis of the jaw between the groups studied (Group 1 n = 50/669 (7%); Group 2 n = 9/117 (7%); Group 3 n = 17/281 (6%); p = 0.746). Overall, the success rate was 93% after intervention when preventive measures were followed. With the same success rate, a reduced, oral administration of antibiotics seems to be sufficient regarding the possible spectrum of side effects, the development of resistance and the health economic point of view.
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Affiliation(s)
- Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Thomas Rückschloß
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Gregor Schnug
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Julius Moratin
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Moritz Bleymehl
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Sven Zittel
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Maximilian Pilz
- Department of Biometry, Institute of Medical Biometry, University of Heidelberg, Im Neuenheimer Feld 130.3, D-69120 Heidelberg, Germany
| | - Caroline Sekundo
- Department of Conservative Dentistry, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Christian Mertens
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Michael Engel
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Maximilian Smielowski
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
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Kolbe-Busch S, Chaberny IF. [Resource conservation from the perspective of infection prevention]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:220-229. [PMID: 36592189 DOI: 10.1007/s00104-022-01784-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Procedures to prevent surgical site infections require a high input of human, technical and natural resources. This paper explores ways to optimize the use of resources in caring for patients who undergo a surgical procedure without compromising patient safety. METHODS Review of the contribution of selected procedures for infection prevention in surgical patients considering current evidence and recommendations by comparing current guidelines and results of clinical trials. Analysis of interventions to implement and increase compliance. RESULTS Knowledge of current evidence-based recommendations enables not only the identification of procedures with proven effect on infection prevention but also those that are ineffective and thus dispensable. There is still need for further controlled studies, e.g. on the use of antiseptics, that can confirm the evidence level of preventive procedures. Infection surveillance in combination with process and compliance monitoring by infection prevention specialists with a feedback system to healthcare workers are suitable control instruments for infection control management. In the case of increased infection rates, the implementation of evidence-based recommended measures through tailored bundle interventions is successful. Technical measures to maintain environmental conditions must be included in the control process. CONCLUSION The reduction of healthcare-associated infections by implementing tailored interventions of infection prevention measures and elimination of ineffective procedures conserves resources and promotes patient safety.
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Affiliation(s)
- Susanne Kolbe-Busch
- Institut für Hygiene, Krankenhaushygiene und Umweltmedizin, Zentrum für Infektionsmedizin, Universitätsklinikum Leipzig, Liebigstr. 22, 04103, Leipzig, Deutschland.
| | - Iris F Chaberny
- Institut für Hygiene, Krankenhaushygiene und Umweltmedizin, Zentrum für Infektionsmedizin, Universitätsklinikum Leipzig, Liebigstr. 22, 04103, Leipzig, Deutschland
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Burchard R, Sayn L, Schmidt R, Graw JA, Scheicher T, Soost C, Gruenewald A. The Level of Surface Coverage of Surgical Site Disinfection Depends on the Visibility of the Antiseptic Agent-A Virtual Reality Randomized Controlled Trial. J Clin Med 2023; 12:1472. [PMID: 36836006 PMCID: PMC9961233 DOI: 10.3390/jcm12041472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Surgical site infections (SSIs) have a significant impact on outcome associated with surgical treatment. Therefore, skin antisepsis has evolved as a standard preoperative procedure in the operating room to reduce the perioperative risk of an SSI. In their "Global Guidelines for the prevention of surgical site infections", the World Health Organization (WHO) recommend the use of an agent with remanent additives and considers colored agents as helpful. However, colored and remanent disinfectants are not available in Germany. The aim of the present study was to investigate whether using a colored antiseptic solution increases the quality of preoperative skin antisepsis. METHODS This study was designed as a randomized, double-blinded controlled trial. To examine the level of coverage of skin antisepsis, an appropriate virtual reality (VR) environment was generated. Participants could see a movable surgical clamp with a swab in their hand. When touching the skin, the participants recognized an optical change in the appearance of the skin: Using a colored antiseptic solution resulted in orange-colored skin. Using an uncolored agent, a shiny wet look was visible without a change in natural skin color. RESULTS Data of 141 participants (female: 61.0% (n = 86); mean age: 28 y (Range 18-58 y, SD = 7.53 y)) were included in the study. The level of disinfection coverage was higher in the group using the colored disinfectant. On average, 86.5% (sd = 10.0) of the leg skin was covered when a colored disinfectant was used, whereas only 73.9% (sd = 12.8) of the leg skin was covered when the participants had to use an uncolored agent (p < 0.001, effect size: f = 0.56, η2 = 0.24). CONCLUSIONS The use of an uncolored disinfectant leads to a lower surface coverage of the perioperative skin disinfection. Thus far, it is unclear whether using uncolored disinfectants is associated with higher risks for perioperative infections compared with the use of non-remanent disinfectants. Therefore, further research is necessary and current German guidelines should be re-evaluated accordingly.
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Affiliation(s)
- Rene Burchard
- Department of Orthopedics and Trauma Surgery, University Hospital of Giessen and Marburg, 35043 Marburg, Germany
- Department of Orthopedics and Trauma Surgery, Lahn-Dill-Kliniken, 35683 Dillenburg, Germany
| | - Lukas Sayn
- Medical Informatics and Microsystems Engineering, University of Siegen, 57076 Siegen, Germany
| | - Ricardo Schmidt
- Medical Informatics and Microsystems Engineering, University of Siegen, 57076 Siegen, Germany
| | - Jan A. Graw
- Department of Anesthesiology and Intensive Care Medicine, Ulm University Hospital, 89081 Ulm, Germany
| | | | | | - Armin Gruenewald
- Medical Informatics and Microsystems Engineering, University of Siegen, 57076 Siegen, Germany
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12
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Busch L, Hanuschik AM, Avlasevich Y, Darm K, Hochheiser EF, Kohler C, Idelevich EA, Becker K, Rotsch P, Landfester K, Darvin ME, Meinke MC, Keck CM, Kramer A, Zwicker P. Advanced Skin Antisepsis: Application of UVA-Cleavable Hydroxyethyl Starch Nanocapsules for Improved Eradication of Hair Follicle-Associated Microorganisms. Pharmaceutics 2023; 15:609. [PMID: 36839931 PMCID: PMC9966858 DOI: 10.3390/pharmaceutics15020609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Hair follicles constitute important drug delivery targets for skin antisepsis since they contain ≈25% of the skin microbiome. Nanoparticles are known to penetrate deeply into hair follicles. By massaging the skin, the follicular penetration process is enhanced based on a ratchet effect. Subsequently, an intrafollicular drug release can be initiated by various trigger mechanisms. Here, we present novel ultraviolet A (UVA)-responsive nanocapsules (NCs) with a size between 400 and 600 nm containing hydroxyethyl starch (HES) functionalized by an o-nitrobenzyl linker. A phase transfer into phosphate-buffered saline (PBS) and ethanol was carried out, during which an aggregation of the particles was observed by means of dynamic light scattering (DLS). The highest stabilization for the target medium ethanol as well as UVA-dependent release of ethanol from the HES-NCs was achieved by adding 0.1% betaine monohydrate. Furthermore, sufficient cytocompatibility of the HES-NCs was demonstrated. On ex vivo porcine ear skin, a strong UVA-induced release of the model drug sulforhodamine 101 (SR101) could be demonstrated after application of the NCs in cyclohexane using laser scanning microscopy. In a final experiment, a microbial reduction comparable to that of an ethanol control was demonstrated on ex vivo porcine ear skin using a novel UVA-LED lamp for triggering the release of ethanol from HES-NCs. Our study provides first indications that an advanced skin antisepsis based on the eradication of intrafollicular microorganisms could be achieved by the topical application of UVA-responsive NCs.
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Affiliation(s)
- Loris Busch
- Center of Experimental and Applied Cutaneous Physiology, Department of Dermatology, Venereology and Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Pharmaceutics and Biopharmaceutics, Philipps University Marburg, Robert-Koch-Str. 4, 35037 Marburg, Germany
| | - Anna Maria Hanuschik
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., 17475 Greifswald, Germany
| | - Yuri Avlasevich
- Max Planck Institute for Polymer Research, Ackermannweg 10, 55128 Mainz, Germany
| | - Katrin Darm
- Friedrich Loeffler—Institute of Medical Microbiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., 17475 Greifswald, Germany
| | - Elisa F. Hochheiser
- Friedrich Loeffler—Institute of Medical Microbiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., 17475 Greifswald, Germany
| | - Christian Kohler
- Friedrich Loeffler—Institute of Medical Microbiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., 17475 Greifswald, Germany
| | - Evgeny A. Idelevich
- Friedrich Loeffler—Institute of Medical Microbiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., 17475 Greifswald, Germany
- Institute of Medical Microbiology, University Hospital Münster, Domagkstraße 10, 48149 Münster, Germany
| | - Karsten Becker
- Friedrich Loeffler—Institute of Medical Microbiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., 17475 Greifswald, Germany
| | - Peter Rotsch
- OSA Opto Light GmbH, Köpenicker Str. 325, 12555 Berlin, Germany
| | - Katharina Landfester
- Max Planck Institute for Polymer Research, Ackermannweg 10, 55128 Mainz, Germany
| | - Maxim E. Darvin
- Center of Experimental and Applied Cutaneous Physiology, Department of Dermatology, Venereology and Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Martina C. Meinke
- Center of Experimental and Applied Cutaneous Physiology, Department of Dermatology, Venereology and Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Cornelia M. Keck
- Department of Pharmaceutics and Biopharmaceutics, Philipps University Marburg, Robert-Koch-Str. 4, 35037 Marburg, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., 17475 Greifswald, Germany
| | - Paula Zwicker
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., 17475 Greifswald, Germany
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13
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Farke S. Netzwerk-Metaanalyse zur Vorbereitung kolorektaler Operationen. COLOPROCTOLOGY 2023. [DOI: 10.1007/s00053-022-00667-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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14
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Peritoneal antiseptic irrigation to prevent surgical site infection after laparotomy for hepatobiliary or gastrointestinal surgery (PAISI)-protocol for a randomized controlled study. Trials 2022; 23:1029. [PMID: 36539884 PMCID: PMC9763791 DOI: 10.1186/s13063-022-06975-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Postoperative surgical site infections (SSIs) remain common after laparotomy for resections of the gastrointestinal or hepatobiliary tract. Especially organ/space infections (CDC class III SSI) can be life-threatening, require relaparotomy, intensive care or interventional drainage of intraabdominal abscesses. The PAISI study aims to investigate whether the use of prophylactic peritoneal irrigation with NaOCl/HOCl solution can reduce the SSI rates following laparotomy for resections of the gastrointestinal or hepatobiliary tract, compared to standard irrigation with physiological electrolyte solution (Ringer's solution). Secondarily, to evaluate whether the use of prophylactic peritoneal irrigation with NaOCl/HOCl solution can reduce postoperative morbidity and mortality as well as the rate of re-operations and length of hospital stay. METHODS PAISI is a prospective, randomized, observer- and patient-blinded, monocentric, two-arm surgical study in an adaptive parallel groups design, comparing peritoneal and wound irrigation with NaOCl/HOCl (50/50ppm) solution to irrigation with Ringer's solution. The primary endpoint of the study is the SSI rate within 30 days postoperatively. Since there is no data on incidence rates from randomized clinical trials, the rates for sample size calculation were estimated according to the clinical experience at our institution. Therefore, the study design includes one unblinded look at the data by a second statistician, which will be performed after half of the patients reached the primary endpoint. This interim information will be used to check the assumptions and if needed, the sample size will be adjusted. The O'Brien-Fleming spending function is used to determine the efficacy test boundary and the non-binding futility boundary. The one-sided z-test (Group sequential test of two proportions) at the 2.5% significance level with a total of two looks at the data will have overall 80% power. DISCUSSION The results of this study will provide high-level evidence for future research and clinical recommendations regarding the use of NaOCl/HOCl solution in abdominal surgery and provide the participating patients the opportunity of a potentially improved treatment. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00028037. Registered on 27 May 2022.
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15
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Seifert J. [Current hygiene regulations in the operating theatre with special focus on constructional and functional measures]. CHIRURGIE (HEIDELBERG, GERMANY) 2022; 93:1197-1206. [PMID: 35316345 PMCID: PMC8938722 DOI: 10.1007/s00104-022-01613-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/03/2022]
Abstract
The article provides an overview of the most important innovations in hygiene recommendations that were published in 2018 by the Committee for Hospital Hygiene and Infection Prevention (KRINKO) on the prevention of postoperative wound infections. This summarizes several older recommendations and supplements, updates and extends them. The article focusses on technical and constructional hygiene regulations for operating theaters and includes the position of the German Statutory Accident Insurance (DGUV).
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Affiliation(s)
- Julia Seifert
- Klinik für Unfallchirurgie und Orthopädie, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Deutschland.
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16
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Bolten A, Kringos DS, Spijkerman IJB, Sperna Weiland NH. The carbon footprint of the operating room related to infection prevention measures: a scoping review. J Hosp Infect 2022; 128:64-73. [PMID: 35850380 DOI: 10.1016/j.jhin.2022.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Infection prevention measures are widely used in operating rooms (ORs). However, the extent to which they are at odds with ambitions to reduce the health sector's carbon footprint remains unclear. AIM To synthesize the evidence base for the carbon footprint of commonly used infection prevention measures in the OR, namely medical devices and instruments, surgical attire and air treatment systems. METHODS A scoping review of the international scientific literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search was performed in PubMed and Google Scholar. Articles published between 2010 and June 2021 on infection prevention measures, their impact on the health sector's carbon footprint, and risk for surgical site infections (SSIs) were included. FINDINGS Although hospitals strive to reduce their carbon footprint, many infection prevention measures result in increased emissions. Evidence suggests that the use of disposable items instead of reusable items generally increases the carbon footprint, depending on sources of electricity. Controversy exists regarding the correlation between air treatment systems, contamination and the incidence of SSIs. The literature indicates that new air treatment systems consume more energy and do not necessarily reduce SSIs compared with conventional systems. CONCLUSION Infection prevention measures in ORs can be at odds with sustainability. The use of new air treatment systems and disposable items generally leads to significant greenhouse gas emissions, and does not necessarily reduce the incidence of SSIs. Alternative infection prevention measures with less environmental impact are available. Implementation could be facilitated by embracing environmental impact as an additional dimension of quality of care, which should change current risk-based approaches for the prevention of SSIs.
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Affiliation(s)
- A Bolten
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - D S Kringos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - I J B Spijkerman
- Department of Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - N H Sperna Weiland
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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17
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Anforderungen an die Hygiene bei der Reinigung und Desinfektion von Flächen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:1074-1115. [PMID: 36173419 PMCID: PMC9521013 DOI: 10.1007/s00103-022-03576-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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18
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Daeschlein G, Westphal S, Mirzayeva G, Zouboulis CC, Schlatterer K. Hygiene in der Dermatologie – Teil 1: Einführung und Umgebungshygiene. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1709-8540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
ZusammenfassungDermatologie-typische Abläufe in der Patientenversorgung werden in dieser Arbeit im Hinblick auf mögliche Hygienerisiken dargestellt. Das potenziell kontaminierte Oberflächenorgan Haut und seine Umgebung stellen in der medizinischen Versorgung in Bezug auf den intensiven, längeren und großflächigen Kontakt, der mit hautärztlichen und pflegerischen Maßnahmen einhergeht, eine Herausforderung dar.
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Affiliation(s)
- Georg Daeschlein
- Hochschulkliniklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
| | - Sabine Westphal
- Institut für Laboratoriumsmedizin, Städtisches Klinikum Dessau, Dessau-Roßlau, Deutschland
| | - Gulnara Mirzayeva
- Hochschulkliniklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
| | - Christos C. Zouboulis
- Hochschulkliniklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
| | - Kathrin Schlatterer
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
- Institut für Laboratoriumsmedizin, Sankt Gertrauden Krankenhaus, Berlin, Deutschland
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19
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Enz A, Klinder A, Bisping L, Lutter C, Warnke P, Tischer T, Mittelmeier W, Lenz R. Knot tying in arthroplasty and arthroscopy causes lesions to surgical gloves: a potential risk of infection. Knee Surg Sports Traumatol Arthrosc 2022; 31:1824-1832. [PMID: 36048202 PMCID: PMC10089991 DOI: 10.1007/s00167-022-07136-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/19/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Recent studies have shown that the incidence of glove lesions during arthroscopy is much lower than that during primary and revision arthroplasty. However, the rate of glove damage after knot tying has not yet been systematically recorded. Therefore, the aim of the study was to determine the impact of surgical knot tying on glove integrity. It was hypothesized that knot tying increases the rate of glove damage, especially in arthroscopic surgery, which could be of special relevance in the treatment of rotator cuff tears. METHODS Gloves that were changed immediately before suturing and only worn during knot tying were investigated for their integrity by means of water tightening test according to EN455. A total of 234 gloves from 40 total hip arthroplasties (THAs), 42 total knee arthroplasties (TKAs) and 36 rotator cuff repairs (RCRs) were collected. A bacterial pass-through test (BPTT) on glove lesions was performed under simulated sterile surgical conditions for 3 surgeons after a wear duration of 45 min. RESULTS Glove damage by knot tying occurred in 25% of THA, 36.6% of TKA and 25% of RCR surgeries. In THA, the pulling hand (PH) was affected in 46.2%, and the main area of damage (15.4%) was detected on the tip of the middle finger; in TKAs the PH was damaged in 75%, and in RCRs the PH was affected in 66.7%, with most of the lesions (20% each) occurring on the tip of the index finger and the ring finger. The BPTT showed Staphylococcus hominis and Bacillus cereus. CONCLUSION Intraoperative knot tying causes damage to gloves, which is of special relevance for arthroscopic surgery. Whereas knot tying is only partly responsible for glove damage in arthroplasty, the general rate of glove damage in arthroscopic surgery is low without knot tying. The surgical knot tying process must be understood as a possible damaging impact on the glove. Therefore, single gloving is not recommended, which is especially important in arthroscopic surgery, where double gloving is not yet standard. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Andreas Enz
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, Doberanerstraße 142, 18057, Rostock, Germany.
| | - Annett Klinder
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, Doberanerstraße 142, 18057, Rostock, Germany
| | - Lucas Bisping
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, Doberanerstraße 142, 18057, Rostock, Germany
| | - Christoph Lutter
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, Doberanerstraße 142, 18057, Rostock, Germany
| | - Philipp Warnke
- Institute of Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Thomas Tischer
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, Doberanerstraße 142, 18057, Rostock, Germany
| | - Wolfram Mittelmeier
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, Doberanerstraße 142, 18057, Rostock, Germany
| | - Robert Lenz
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, Doberanerstraße 142, 18057, Rostock, Germany
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Gummert J, Beckmann A, Bauer A, Heinemann M, Markewitz A, Falk V, Boening A. Basis-Anforderungen einer Fachabteilung für Herzchirurgie. Thorac Cardiovasc Surg 2022; 70:452-457. [PMID: 35998669 DOI: 10.1055/s-0042-1755191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
The evolution and progress in cardiovascular medicine and substantial changes in the German health care system require both a reflection of the principles of patient-centered care in general and an update of the criteria that define a department of cardiac surgery in Germany. This position paper lists the core requirements for a cardiac surgical department with regard to infrastructure, facilities, necessary staff, and standard of care (processes). This standard may be used by hospitals and health care providers to ensure the safety and quality of cardiac surgical departments in Germany.
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Affiliation(s)
- Jan Gummert
- Herzchirurgie, Herz-Diabetes-Zentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Andreas Beckmann
- Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, DGTHG, Berlin, Germany
| | - Adrian Bauer
- Department of Cardiac and Vascular Surgery; Clinical Perfusion; MediClin Herzzentrum Coswig, Coswig, Germany
| | - Markus Heinemann
- Department of Cardiac and Vascular Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - Andreas Markewitz
- Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, DGTHG, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Andreas Boening
- Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
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21
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Berktold M, Fuchs S, Kuppelwieser B, Ulmer H, Kettner M, Thummer L, Wöll E, Lass-Flörl C. "Beyond the Guidelines" - Deviations in Adherence to Infection Control Measures in Tyrolean hospitals, Austria. Am J Infect Control 2022; 51:406-412. [PMID: 35870661 DOI: 10.1016/j.ajic.2022.07.005] [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: 03/11/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Hospital-acquired infections (HAI) represent increasing problems in health-care facilities worldwide. Adequate infection control measures are key elements in preventing those infections. Expert societies have published recommendations that help to reduce HAI. METHODS In November 2019, a questionnaire-based point-prevalence survey, eliciting the adherence of 14 Tyrolean hospitals to the recommendations of the Centers of Disease Control and Prevention (CDC) was performed. Additionally, standard infection control measures performed by different medical (clinical and infection control specialists) disciplines as well as the performed infection control measures of nurses and physicians were compared. RESULTS The survey revealed varying adherence to CDC-recommendations of different medical disciplines, with highest congruence by the infection control specialists and lower congruencies by all surveyed clinical disciplines. Concordance rate between nurses and physicians was high. DISCUSSION Explanations for the varying congruencies of clinical disciplines on the one hand and the infection control specialists on the other hand may be versatile. Possible lacks of knowledge about the required hygiene measures should be taken into account. CONCLUSION The present survey showed moderate adherence of Tyrolean hospitals to the recommendations provided by CDC, however with noticeable differences between different medical disciplines. Nurses and doctors in most cases reported identically.
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Affiliation(s)
- Michael Berktold
- Institute for Hygiene and Medical Microbiology, Medical University of Innsbruck, Austria.
| | - Stefan Fuchs
- Institute for Hygiene and Medical Microbiology, Medical University of Innsbruck, Austria
| | - Bettina Kuppelwieser
- Institute for Hygiene and Medical Microbiology, Medical University of Innsbruck, Austria
| | - Hanno Ulmer
- Department for Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Austria
| | | | - Lucas Thummer
- Infection Control Team, District Hospital St. Johann, Austria
| | - Ewald Wöll
- Department of Internal Medicine, Hospital St. Vinzenz, Zams, Austria
| | - Cornelia Lass-Flörl
- Institute for Hygiene and Medical Microbiology, Medical University of Innsbruck, Austria
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22
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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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23
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Strobel RM, Leistner R, Leonhardt M, Neumann K, Eschlböck SM, Lee LDG, Seifarth C, Schineis CHW, Kamphues C, Weixler B, Beyer K, Lauscher JC. Is There an Association between Intra-Operative Detection of Pathogens in Subcutaneous Tissue and Surgical Site Infections? Results from a Prospective Study. Surg Infect (Larchmt) 2022; 23:372-379. [PMID: 35263172 DOI: 10.1089/sur.2021.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Surgical site infections (SSIs) are a common complication in visceral surgery. Pathogens causing SSIs vary depending on the type of surgery. Patients and Methods: Within the scope of the Reduction of Postoperative Wound Infections by Antiseptica (RECIPE) trial we analyzed the pathogens cultured in intra-operative, subcutaneous swabs and in swabs from SSI in a single-center, prospective, randomized controlled study. Definition of SSI complied with the criteria of the U.S. Centers for Disease Control and Prevention (CDC). Results: The overall rate of SSI was 28.2% in 393 patients. Colorectal surgery was performed in 68.2% of elective laparotomies. Pathogens were more often detected in intra-operative subcutaneous swabs in patients who developed SSIs than in patients who did not develop SSIs (64.4% vs. 38.0%; p < 0.001). Enterococci were found in 29.1% of intra-operative swabs in patients with SSIs, followed by Escherichia coli in 15.5%. A higher rate of Enterococcus faecium was found in patients with anemia versus those without anemia (9.2% vs. 2.3%; p = 0.006) and in patients who smoked versus those who did not (11.8% vs. 3.6%; p = 0.008). A positive subcutaneous swab (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.47-4.29; p = 0.001), pre-operative anemia (OR, 1.84; 95% CI, 1.08-3.13; p = 0.016), and renal insufficiency (OR, 2.15; 95% CI, 1.01-4.59; p = 0.048) were risk factors for SSIs. Conclusions: There is an association between the intra-operative detection of pathogens in subcutaneous tissue and the development of SSIs in visceral surgery. The most prevalent pathogens causing SSIs were enterococci and Escherichia coli. More efforts are justified to reduce subcutaneous colonization with pathogens, for example by using intra-operative wound irrigation with polyhexanide solution. This trial is registered at www.ClinicalTrials.gov (ID: NCT04055233).
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Affiliation(s)
- Rahel M Strobel
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Rasmus Leistner
- Department of Gastroenterology, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Marja Leonhardt
- Innlandet Hospital Trust, Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Brumunddal, Norway
| | - Konrad Neumann
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Sophie M Eschlböck
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Lucas D G Lee
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Claudia Seifarth
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Christian H W Schineis
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Carsten Kamphues
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Benjamin Weixler
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Katharina Beyer
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Johannes C Lauscher
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
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Enz A, Kostuj T, Warnke P, Osmanski-Zenk K, Mittelmeier W, Klinder A. Intraoperative damage to surgical gloves during various operations on the musculoskeletal system: a multicenter study. Arch Orthop Trauma Surg 2022; 142:57-65. [PMID: 32862266 PMCID: PMC8732942 DOI: 10.1007/s00402-020-03594-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/16/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Various orthopedic surgical procedures cause mechanical stress for gloves. In some cases, sharp-edged objects impact on the glove surfaces. The systematic description of lesions is still missing. METHODS 2289 gloves from 409 surgeries [primary hip and knee arthroplasties (PA), revisions arthroplasties (RA) and arthroscopic shoulder, hip and knee surgery (AY)] from 3 clinics were examined for lesions using water tightening test according to the European norm EN 455-1. RESULTS Arthroscopies showed the lowest rate of operations with damaged gloves (6.9%). Depending on clinic, 32.7% and 59.2% of PA surgeries generated damaged gloves, while in RA, these numbers rose to 76.0% and 72.8%, respectively. In PA and RA, the most affected finger was the index finger, whereas in arthroscopies, more damage occurred on the middle finger and the thumb. The size of the lesions was rather small with the vast majority being 1 mm or 2 mm in size. CONCLUSION All investigated interventions led to glove lesions. With increasing mechanical stress, the number of glove defects increased. EN 455 does not account for the intraoperative tear risk. Stricter requirements for gloves should be introduced. Glove change intervals should be defined and implemented, and new materials should be developed.
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Affiliation(s)
- Andreas Enz
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany.
| | - Tanja Kostuj
- Orthopädisch-Traumatologisches Zentrum, St. Marien-Hospital Hamm, Hamm, Germany
| | - Philipp Warnke
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsmedizin Rostock, Rostock, Germany
| | - Katrin Osmanski-Zenk
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany
| | - Wolfram Mittelmeier
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany
| | - Annett Klinder
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany
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Ristow O, Hofele C, Münch P, Danner S, Dietzel A, Krisam J, Klose C, Pilz M, Hoffmann J, Freudlsperger C. APOS-antibiotic prophylaxis for preventing infectious complications in orthognathic surgery: study protocol for a phase III, multicentre, randomised, controlled, double blinded, clinical trial with two parallel study arms. Trials 2021; 22:762. [PMID: 34727951 PMCID: PMC8561874 DOI: 10.1186/s13063-021-05710-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 10/08/2021] [Indexed: 01/08/2023] Open
Abstract
Background It is a constant debate among surgeons whether the use of prolonged postoperative antibiotics may reduce surgical site infection rates. As specific treatment guidelines are still lacking, many surgeons continue to use broad-spectrum antibiotics, causing not only increased costs but also contributing to the potential for antibiotic resistance. Hence, there is an urgent need for an appropriately designed prospective clinical trial, to investigate whether a prophylactic use of antibiotics after surgery actually decreases surgical site infections to a clinically relevant degree. Methods This study presents a multicentre, randomised, controlled, double-blinded, clinical trial with two parallel study arms to demonstrate that no postoperative antibiotic prophylaxis (AP) is not inferior to antibiotic prophylaxis with respect to surgical site infections in patients having undergone orthognathic surgery. The primary efficacy endpoint is defined as the occurrence of postoperative surgical site infections within 30 days of surgery. Secondary endpoints are further efficacy and subject-oriented parameters within 90 days after surgery. The entire trial is planned for 54 months, with an enrolment of 1420 patients over 39 months by 14 national participating centres. Discussion As a highly standardised procedure on an exceeding, healthy and young homogenous study population and identical processes all over the world, elective orthognathic surgery as clean-contaminated procedure provides comparable intervention groups with balanced baseline characteristics, comparable surgical duration, even when performed within multiple centres. Therefore, evaluating antibiotic prophylaxis after orthognathic surgery will be of high scientific value representable for other surgical procedures. Trial registration DRKS—German Clinical Trials Register—DRKS00022838; EudraCT No. 2020-001397-30. Registered on 29 March 2021
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Affiliation(s)
- Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.
| | - Christof Hofele
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Philipp Münch
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Sylvia Danner
- Coordination Centre for Clinical Trials (KKS), University of Heidelberg, 69120, Heidelberg, Germany
| | - Anja Dietzel
- Coordination Centre for Clinical Trials (KKS), University of Heidelberg, 69120, Heidelberg, Germany
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics, Department of Biometry, University of Heidelberg, Im Neuenheimer Feld 130.3, D-69120, Heidelberg, Germany
| | - Christina Klose
- Institute of Medical Biometry and Informatics, Department of Biometry, University of Heidelberg, Im Neuenheimer Feld 130.3, D-69120, Heidelberg, Germany
| | - Maximilian Pilz
- Institute of Medical Biometry and Informatics, Department of Biometry, University of Heidelberg, Im Neuenheimer Feld 130.3, D-69120, Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Christian Freudlsperger
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
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Enz A, Kamaleddine I, Groß J, Schafmayer C, Alwafai E, Sievers L, Mittelmeier W, Klinder A. Is Single Gloving Still Acceptable? Investigation and Evaluation of Damages on Sterile Latex Gloves in General Surgery. J Clin Med 2021; 10:jcm10173887. [PMID: 34501334 PMCID: PMC8432096 DOI: 10.3390/jcm10173887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 01/24/2023] Open
Abstract
(1) Background: The sterile latex surgical glove is an important part of protecting both the patient and the surgical team from infections. However, mechanical stress can damage the integrity of the glove material and thus may lead to infections. (2) Method: A total of 896 gloves from 448 surgeries were tested and evaluated by the water tightening test according to EN455 and ASTM D5151-19. (3) Results: From 448 surgeries, 18.8% of the interventions showed glove damage. In vascular surgery, gloves were damaged in 20.8%, in thoracic surgery 9.1%, in laparoscopic interventions 21.7%, in the subgroup hernia surgeries (TAPP) 17.6% and in open interventions 17.6%. A total of 101 damages were found on 896 gloves; one glove could have several damages. During vascular surgery, 60% of the damages were on the subordinated hand of the surgeon, and 73.3% of the damages had a size of 1 mm. In laparoscopic procedures, the subordinated hand was also more frequently affected (61.3%) than the dominant hand; 64.5% of the damages were 1 mm in size. In the hernia surgery subgroup (TAPP), no damage was larger than 1 mm; 66.7% were in the subordinated hand area. The duration of surgery had no influence on the lesion rate. (4) Conclusion: The damage rate in low impact procedures is high and represents an underestimated problem in soft tissue surgery. The use of single gloving can therefore lead to the risk of infection. EN455 and ASTM D5151-19 does not take into consideration the risk of intraoperative lesions. Double gloving and glove change algorithms should be established.
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Affiliation(s)
- Andreas Enz
- Orthopaedic Clinic and Policlinic, University Medical Centre Rostock, 18057 Rostock, Germany; (L.S.); (W.M.); (A.K.)
- Correspondence: ; Tel.: +49-381-494-9301
| | - Imad Kamaleddine
- Department of General, Visceral, Vascular and Transplant Surgery, Surgical Clinic and Polyclinic of University Medical Centre Rostock, 18057 Rostock, Germany; (I.K.); (J.G.); (C.S.); (E.A.)
| | - Justus Groß
- Department of General, Visceral, Vascular and Transplant Surgery, Surgical Clinic and Polyclinic of University Medical Centre Rostock, 18057 Rostock, Germany; (I.K.); (J.G.); (C.S.); (E.A.)
| | - Clemens Schafmayer
- Department of General, Visceral, Vascular and Transplant Surgery, Surgical Clinic and Polyclinic of University Medical Centre Rostock, 18057 Rostock, Germany; (I.K.); (J.G.); (C.S.); (E.A.)
| | - Emad Alwafai
- Department of General, Visceral, Vascular and Transplant Surgery, Surgical Clinic and Polyclinic of University Medical Centre Rostock, 18057 Rostock, Germany; (I.K.); (J.G.); (C.S.); (E.A.)
| | - Larissa Sievers
- Orthopaedic Clinic and Policlinic, University Medical Centre Rostock, 18057 Rostock, Germany; (L.S.); (W.M.); (A.K.)
| | - Wolfram Mittelmeier
- Orthopaedic Clinic and Policlinic, University Medical Centre Rostock, 18057 Rostock, Germany; (L.S.); (W.M.); (A.K.)
| | - Annett Klinder
- Orthopaedic Clinic and Policlinic, University Medical Centre Rostock, 18057 Rostock, Germany; (L.S.); (W.M.); (A.K.)
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Löser CR, Dirschka T, Felcht M, Dippel E, Kevekordes S. Hygieneempfehlungen in der ambulanten Dermatochirurgie. J Dtsch Dermatol Ges 2021; 19:1165-1169. [PMID: 34390134 DOI: 10.1111/ddg.14499_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Christoph R Löser
- Hautklinik, Hauttumorzentrum, Klinikum Ludwigshafen gGmbH, Ludwigshafen
| | | | - Moritz Felcht
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim
| | - Edgar Dippel
- Hautklinik, Hauttumorzentrum, Klinikum Ludwigshafen gGmbH, Ludwigshafen
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Kollenbach P. [Reprocessing of medical devices in clinical and practical routine]. Aktuelle Urol 2021; 52:367-381. [PMID: 34318462 DOI: 10.1055/a-1529-4935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Clinics and hospitals are facing increasing challenges due to changes and reforms regarding the hygienic perspective on surgical procedures and the reprocessing of medical devices. Differences regarding the implementation of provisions in the individual German federal states add to the difficulty of maintaining an overview of all provisions. The KRINKO Recommendations for the Prevention of Nosocomial Infections (2018) and the Requirements for the Reprocessing of Medical Devices (2012) are the central documents for surgical operations. Regarding infection hygiene, it is no longer reasonable and expedient today to differentiate between outpatient and inpatient procedures. Patient factors such as previous illnesses, previous surgical procedures, obesity etc. have come to play a more important role in the risk assessment of the entire surgical unit. More and more importance is being attached to the consideration of surveillance data.For the reprocessing of medical devices, there are also different risk assessments depending on the construction and use of the medical device. The steps required for reprocessing are determined by such assessments. A focus on reprocessing may be expected for the validation of processes. Achieving and, in particular, documenting a reproducible, hygienically correct reprocessing is associated with a high organisational effort. For manual as well as automated reprocessing, instructions have to be created for each task, and these instructions also have to be documented and monitored. For automated reprocessing, compliance efforts are a bit lower. Regular training and further education are essential in each case.In addition to economic issues regarding reprocessing, we are faced with problems financing today's high hygienic requirements. Negotiations involving the National Association of Statutory Health Insurance Physicians are ongoing. How successful they are remains to be seen. Health insurance companies are taking a rigid stance these days.
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Utzolino S, Eckmann C, Lock JF. [Prevention of Surgical Site Infections]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:502-515. [PMID: 34298570 DOI: 10.1055/a-1249-5169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The burden of surgical site infections (SSIs) is increasing. The number of surgical procedures continues to rise, and surgical patients present increasingly complex comorbidities. Half of SSIs are deemed preventable using evidence-based strategies. It is recommended for patients to bathe or shower prior to surgery. Hair should be removed only with a clipper. Shaving is strongly discouraged at all times. Antimicrobial prophylaxis should be administered only when indicated, based on guidelines, and timed correctly in order to achieve a bactericidal concentration in the tissues when the incision is made. Prophylaxis must not be continued beyond surgery. For skin preparation in the operating room an alcohol-based agent plus chlorhexidine or octenidine is recommended. During surgery, glycemic control and goal-directed fluid therapy should be implemented. Normothermia should be targeted in all patients. The perioperative use of an increased fraction of inspired oxygen may reduce the risk of SSI. Using a surgical safety checklist during a team time-out immediately before surgery reduces the incidence of SSI.
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Standardized aseptic dressing change procedure: Optimizations and adherence in a prospective pre- and postintervention cohort study. Infect Control Hosp Epidemiol 2021; 43:736-741. [PMID: 34027842 DOI: 10.1017/ice.2021.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The "HygArzt" project investigated the effectiveness of hygiene measures introduced by an infection prevention link physician (PLP). OBJECTIVE To investigate whether the introduction of a standardized aseptic dressing change concept (ADCC) by a PLP can increase hand hygiene adherence and adherence to specific process steps during an aseptic dressing change (ADC) in a trauma surgery and orthopedic department. METHODS We defined 4 required hand disinfection indications: (1) before the preparation of ADC equipment, (2) immediately before the ADC, (3) before the clean phase, and (4) after the ADC. A process analysis of the preintervention phase (331 ADCs) was used to develop a standardized ADCC. The ADCC was introduced and iteratively adopted during the intervention phase. The effect was evaluated during the postintervention phase (374 ADCs). RESULTS Hand hygiene adherence was significantly increased by the introduction of the ADCC for all indications: (1) before the preparation of the ADC equipment (from 34% before to 85% after, P <.001), (2) immediately before an ADC (from 32% before to 85% after; P < .001), (3) before the clean phase (from 42% before to 96% after; P < .001), and (4) after an ADC (from 74% before to 99% after; P < .001). Overall hand hygiene adherence was analyzed before the indications for an ADC (from 9.6% before to 74% after; P < .001). The same strategy was applied to the following process parameters: use of a clean work surface, clean withdrawal of equipment from the dressing trolley, and appropriate waste disposal. CONCLUSIONS A PLP sufficiently implemented a standardized concept for aseptic dressing change during an iterative improvement process, which resulted in a significant improvement in hand hygiene and adherence to other specific ADCC process steps.
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Löser CR, Dirschka T, Felcht M, Dippel E, Kevekordes S. Hygiene recommendations for outpatient dermatosurgery. J Dtsch Dermatol Ges 2021; 19:1165-1168. [PMID: 34015186 DOI: 10.1111/ddg.14499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/22/2021] [Indexed: 11/30/2022]
Abstract
The German Infection Protection Act and country-specific laws demand appropriate measures to prevent nosocomial infections and propagation of pathogens, especially those with resistances. This also concerns outpatient surgery of the skin. Special focus is placed on hand hygiene, antiseptics, hygienic modes of operation and professional instrument reprocessing. Every dermatological institution that operates on an outpatient basis is obliged to organize and be responsible for its hygiene. The legal framework is regulated by various laws and regulations and must be observed.
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Affiliation(s)
- Christoph R Löser
- Department of Dermatology, Skin Tumor Center, Ludwigshafen Medical Center, Ludwigshafen, Germany
| | | | - Moritz Felcht
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Edgar Dippel
- Department of Dermatology, Skin Tumor Center, Ludwigshafen Medical Center, Ludwigshafen, Germany
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Ramírez A, Ochoa D, Llanque G, Trelles B, Watanabe R, Alvitez-Temoche D, Mayta-Tovalino F. Historical Evolution and Filtering Characteristics of Masks and Respirators in Dentistry in the Context of COVID-19: A Literature Review. J Int Soc Prev Community Dent 2021; 11:248-255. [PMID: 34268186 PMCID: PMC8257016 DOI: 10.4103/jispcd.jispcd_22_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/03/2021] [Accepted: 03/19/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES At present, it is very important to identify the available literature regarding the use of masks and respirators by analyzing their historical evolution in the medical field. In addition, consideration should be given to the major filtering characteristics of those most used due to the current SARS-CoV-2 pandemic. Therefore, the purpose of this literature review is to describe the qualitative evolution that facemasks and respirators have undergone along with their different characteristics. MATERIALS AND METHODS This literature review was conducted between September and December 2020. Articles were identified from PubMed Central, Scopus, and Web of Science. The following keywords were used: "COVID-19," "dentistry," and "masks." These MeSH terms were combined with the Boolean operators "AND" and "OR." RESULTS We found 36 articles in PubMed Central, 21 in Scopus, and 17 in Web of Science, which included reviews, clinical, descriptive, and experimental trials. CONCLUSION The emergence of new pathogens leads to continuous improvement in masks and respirators. It was determined that for the dental field, respirators with filtration characteristics greater than 95%, such as FFP3, N100, N95, and KN95, are indicated in addition to their decontamination and reuse processes.
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Affiliation(s)
- Angela Ramírez
- Academic Department, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Dagny Ochoa
- Academic Department, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Ginna Llanque
- Academic Department, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Briggitte Trelles
- Academic Department, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Romel Watanabe
- Department of Rehabilitative Stomatology, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Daniel Alvitez-Temoche
- Academic Department, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Frank Mayta-Tovalino
- Postgraduate Department, CHANGE Research Working Group, Faculty of Health Sciences, Universidad Científica del Sur, Lima, Perú
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Tomsic I, Ebadi E, Gossé F, Hartlep I, Schipper P, Krauth C, Schock B, Chaberny IF, von Lengerke T. Determinants of orthopedic physicians' self-reported compliance with surgical site infection prevention: results of the WACH-trial's pilot survey on COM-B factors in a German university hospital. Antimicrob Resist Infect Control 2021; 10:67. [PMID: 33827692 PMCID: PMC8025554 DOI: 10.1186/s13756-021-00932-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/22/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prevention of surgical site infections (SSIs), which due to their long-term consequences are especially critical in orthopedic surgery, entails compliance with over 20 individual measures. However, little is known about the psychosocial determinants of such compliance among orthopedic physicians, which impedes efforts to tailor implementation interventions to improve compliance. Thus, for this professional group, this pilot survey examined psychosocial determinants of self-reported compliance, which have been theoretically derived from the COM-B (Capability, Opportunity, Motivation and Behavior) model. METHODS In 2019, a cross-sectional survey was conducted in a tertiary care university orthopedic clinic in Hannover, Germany, as a pilot for the WACH-trial ("Wundinfektionen und Antibiotikaverbrauch in der Chirurgie" [Wound Infections and Antibiotics Consumption in Surgery]). Fifty-two physicians participated (38 surgeons, 14 anesthesiologists; response rate: 73.2%). The questionnaire assessed self-reported compliance with 26 SSI preventive measures, and its psychosocial determinants (COM-B). Statistical analyses included descriptive, correlational, and linear multiple regression modeling. RESULTS Self-reported compliance rates for individual measures varied from 53.8 to 100%, with overall compliance (defined for every participant as the mean of his or her self-reported rates for each individual measure) averaging at 88.9% (surgeons: 90%, anesthesiologists: 85.9%; p = 0.097). Of the components identified in factor analyses of the COM-B items, planning, i.e., self-formulated conditional plans to comply, was the least pronounced (mean = 4.3 on the 7-point Likert scale), while motivation was reported to be the strongest (mean = 6.3). Bi-variately, the overall compliance index co-varied with all four COM-B-components, i.e., capabilities (r = 0.512, p < 0.001), opportunities (r = 0.421, p = 0.002), planning (r = 0.378, p = 0.007), and motivation (r = 0.272, p = 0.051). After mutual adjustment and adjustment for type of physician and the number of measures respondents felt responsible for, the final backward regression model included capabilities (β = 0.35, p = 0.015) and planning (β = 0.29, p = 0.041) as COM-B-correlates. CONCLUSION Though based on a small sample of orthopedic physicians in a single hospital (albeit in conjunction with a high survey response rate), this study found initial evidence for positive correlations between capabilities and planning skills with self-reported SSI preventive compliance in German orthopedic physicians. Analyses of the WACH-trial will further address the role of these factors in promoting SSI preventive compliance in orthopedic surgery. TRIAL REGISTRATION This survey was conducted as part of the research project WACH ("Wundinfektionen und Antibiotikaverbrauch in der Chirurgie" [Wound Infections and Antibiotic Consumption in Surgery]), which has been registered in the German Clinical Trial Registry ( https://www.drks.de/ ; ID: DRKS00015502).
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Affiliation(s)
- Ivonne Tomsic
- Centre for Public Health and Healthcare, Department of Medical Psychology (OE 5430), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Ella Ebadi
- Centre for Laboratory Medicine, Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Frank Gossé
- Spinal Surgery and Conservative Orthopaedics, Clinic of Orthopaedics of Hannover Medical School at DIAKOVERE Annastift, Hannover, Germany
| | - Ina Hartlep
- Center for Infection Medicine (ZINF), Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Pamela Schipper
- Center for Infection Medicine (ZINF), Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Christian Krauth
- Centre for Public Health and Healthcare, Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Bettina Schock
- Center for Infection Medicine (ZINF), Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Iris F Chaberny
- Center for Infection Medicine (ZINF), Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Thomas von Lengerke
- Centre for Public Health and Healthcare, Department of Medical Psychology (OE 5430), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Brunauer A, Verboket RD, Kainz DM, von Stetten F, Früh SM. Rapid Detection of Pathogens in Wound Exudate via Nucleic Acid Lateral Flow Immunoassay. BIOSENSORS-BASEL 2021; 11:bios11030074. [PMID: 33800856 PMCID: PMC8035659 DOI: 10.3390/bios11030074] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/24/2021] [Accepted: 03/03/2021] [Indexed: 12/15/2022]
Abstract
The rapid detection of pathogens in infected wounds can significantly improve the clinical outcome. Wound exudate, which can be collected in a non-invasive way, offers an attractive sample material for the detection of pathogens at the point-of-care (POC). Here, we report the development of a nucleic acid lateral flow immunoassay for direct detection of isothermally amplified DNA combined with fast sample preparation. The streamlined protocol was evaluated using human wound exudate spiked with the opportunistic pathogen Pseudomonas aeruginosa that cause severe health issues upon wound colonization. A detection limit of 2.1 × 105 CFU per mL of wound fluid was achieved, and no cross-reaction with other pathogens was observed. Furthermore, we integrated an internal amplification control that excludes false negative results and, in combination with the flow control, ensures the validity of the test result. The paper-based approach with only three simple hands-on steps has a turn-around time of less than 30 min and covers the complete analytical process chain from sample to answer. This newly developed workflow for wound fluid diagnostics has tremendous potential for reliable pathogen POC testing and subsequent target-oriented therapy.
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Affiliation(s)
- Anna Brunauer
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - René D Verboket
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Daniel M Kainz
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Felix von Stetten
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Susanna M Früh
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
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35
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Anforderungen an die Infektionsprävention bei der medizinischen Versorgung von immunsupprimierten Patienten. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:232-264. [PMID: 33394069 PMCID: PMC7780910 DOI: 10.1007/s00103-020-03265-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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36
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Dörfel D, Maiwald M, Daeschlein G, Müller G, Hudek R, Assadian O, Kampf G, Kohlmann T, Harnoss JC, Kramer A. Comparison of the antimicrobial efficacy of povidone-iodine-alcohol versus chlorhexidine-alcohol for surgical skin preparation on the aerobic and anaerobic skin flora of the shoulder region. Antimicrob Resist Infect Control 2021; 10:17. [PMID: 33482910 PMCID: PMC7821636 DOI: 10.1186/s13756-020-00874-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Cutibacterium acnes is part of the anaerobic skin microbiome and resides in deeper skin layers. The organism is an agent of surgical site infections (SSI) in shoulder surgery. We hypothesized that prolonged skin preparation with an agent that penetrates deeply into the skin would be beneficial. Thus, we compared two classes of antiseptics, each combined with alcohol, each applied with two different contact times. Methods Using a cross-over arrangement, shoulders of 16 healthy volunteers were treated for 2.5 min (standard) or 30 min (prolonged) with alcohol-based chlorhexidine (CHG-ALC) or alcohol-based povidone-iodine (PVP-I-ALC). Skin sites were sampled before, immediately after, and 3 h after treatment, using a standardized cup-scrub technique. Results Aerobic skin flora was reduced more effectively by PVP-I-ALC than by CHG-ALC after 2.5 min application and immediate sampling (reduction factor [RF] 2.55 ± 0.75 vs. 1.94 ± 0.91, p = 0.04), but not after prolonged contact times and 3-h sampling. Coagulase-negative staphylococci were completely eliminated after PVP-I-ALC application, but still recovered from 4 of 32 samples after CHG-ALC application. Anaerobic flora was reduced more effectively by PVP-I-ALC than CHG-ALC after standard (RF 3.96 ± 1.46 vs. 1.74 ± 1.24, p < 0.01) and prolonged (RF 3.14 ± 1.20 vs. 1.38 ± 1.16, p < 0.01) contact times and immediate sampling, but not after 3-h sampling. No adverse events were reported. Conclusions PVP-I-ALC showed marginal benefits concerning the aerobic flora, but more substantial benefits over CHG-ALC concerning the anaerobic flora of the shoulder. Standard and prolonged contact times showed superiority for PVP-I-ALC for anaerobic flora at all immediate sampling points, but missed significance at 3-h sampling. The results underscore the need for protection against C. acnes and coagulase-negative staphylococci in orthopaedic surgery. The clinical relevance of these findings, however, should be studied with SSI as an endpoint.
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Affiliation(s)
- Dorothea Dörfel
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Matthias Maiwald
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Postgraduate School of Medicine, Singapore, Singapore
| | - Georg Daeschlein
- Department of Dermatology, University Medicine Greifswald, Greifswald, Germany.,Working Group Clinical Antisepsis, German Society of Hospital Hygiene, Berlin, Germany
| | - Gerald Müller
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Robert Hudek
- Shoulder and Elbow Surgery, Rhön-Klinikum AG, Bad Neustadt/Saale, Germany
| | - Ojan Assadian
- Regional Hospital Wiener Neustadt, Vienna, Austria.,Institute for Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - Günter Kampf
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Thomas Kohlmann
- Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Julian Camill Harnoss
- Department of General, Visceral and Transplantation Surgery and Study Center, German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany.
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37
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Exner M, Bhattacharya S, Gebel J, Goroncy-Bermes P, Hartemann P, Heeg P, Ilschner C, Kramer A, Ling ML, Merkens W, Oltmanns P, Pitten F, Rotter M, Schmithausen RM, Sonntag HG, Steinhauer K, Trautmann M. Chemical disinfection in healthcare settings: critical aspects for the development of global strategies. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc36. [PMID: 33520601 PMCID: PMC7818848 DOI: 10.3205/dgkh000371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Chemical disinfection is an indispensable means of preventing infection. This holds true for healthcare settings, but also for all other settings where transmission of pathogens poses a potential health risk to humans and/or animals. Research on how to ensure effectiveness of disinfectants and the process of disinfection, as well as on when, how and where to implement disinfection precautions is an ongoing challenge requiring an interdisciplinary team effort. The valuable resources of active substances used for disinfection must be used wisely and their interaction with the target organisms and the environment should be evaluated and monitored closely, if we are to reliable reap the benefits of disinfection in future generations. In view of the global threat of communicable diseases and emerging and re-emerging pathogens and multidrug-resistant pathogens, the relevance of chemical disinfection is continually increasing. Although this consensus paper pinpoints crucial aspects for strategies of chemical disinfection in terms of the properties of disinfectant agents and disinfection practices in a particularly vulnerable group and setting, i.e., patients in healthcare settings, it takes a comprehensive, holistic approach to do justice to the complexity of the topic of disinfection.
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Affiliation(s)
- Martin Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Jürgen Gebel
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Philippe Hartemann
- Departement Environnement et Santé Publique S.E.R.E.S., Faculté de Médecine, Nancy, France
| | - Peter Heeg
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Germany
| | - Carola Ilschner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Moi Lin Ling
- Infection Prevention & Control, Singapore General Hospital, Singapore
| | | | | | - Frank Pitten
- IKI – Institut für Krankenhaushygiene & Infektionskontrolle GmbH, Gießen, Germany
| | | | | | - Hans-Günther Sonntag
- Institute of Hygiene and Medical Microbiology, University of Heidelberg, Germany
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Artamonova I, Schmitt L, Yazdi AS, Megahed M, Felbert V, Balakirski G. Postoperative Komplikationen bei dermatochirurgischen Patienten im Rahmen der stationären mikroskopisch‐kontrollierten Chirurgie: Eine monozentrische epidemiologische Studie. J Dtsch Dermatol Ges 2020; 18:1437-1448. [DOI: 10.1111/ddg.14148_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/25/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Inga Artamonova
- Abteilung für Orthopädie und Unfallchirurgie Marienhospital Brühl
- Klinik für Dermatologie und Allergologie Universitätsklinikum der RWTH Aachen
| | - Laurenz Schmitt
- Klinik für Dermatologie und Allergologie Universitätsklinikum der RWTH Aachen
| | - Amir S. Yazdi
- Klinik für Dermatologie und Allergologie Universitätsklinikum der RWTH Aachen
| | - Mosaad Megahed
- Klinik für Dermatologie und Allergologie Universitätsklinikum der RWTH Aachen
| | - Verena Felbert
- Klinik für Dermatologie und Allergologie Universitätsklinikum der RWTH Aachen
| | - Galina Balakirski
- Klinik für Dermatologie und Allergologie Universitätsklinikum der RWTH Aachen
- Klinik und Poliklinik für Dermatologie und Allergologie Universitätsklinikum Bonn
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39
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Wandhoff B, Schröder C, Nöth U, Krause R, Schmidt B, David S, Scheller EE, Jahn F, Behnke M, Gastmeier P, Kramer TS. Efficacy of universal preoperative decolonization with Polyhexanide in primary joint arthroplasty on surgical site infections. A multicenter before-and after-study. Antimicrob Resist Infect Control 2020; 9:188. [PMID: 33256845 PMCID: PMC7708093 DOI: 10.1186/s13756-020-00852-0] [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] [Received: 07/28/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Surgical site infections (SSI) are rare but severe complications after total joint arthroplasty (TJA). Decolonization measures prior to elective orthopedic surgeries have shown to reduce the risk of SSI with Staphylococcus aureus (S. aureus). Objective To determine the efficacy of universal decolonization with Polyhexanide on SSI rates with a focus on Staphylococcus aureus in patients with TJA. Methods Patients scheduled for elective hip or knee TJA in 5 participating certified orthopedic centers were included between 2015 and 2018 into this before and after study. Data on patients, surgeries and infections were prospectively collected. CDC-criteria were used to define and categorize Infections within 90 days after surgery. From January 2017 on, patients received decolonization sets containing Polyhexanide. Patients performed a 5 day decolonization regimen starting 4 days prior to surgery which included wipes, nasal decontamination and oral solution. Results Thirteen thousand, three hundred fifteen patients received TJA. During intervention 4437 decolonization sets were distributed among 7175 patients. Overall SSI rates increased from 0.68 /100 surgeries to 0.91/ 100 surgeries after implementation of the intervention (IRR 1.32; 95% CI 0.90–1.96). Time series analysis identified an increasing trend of SSI prior to the intervention. After implementation overall SSI rates plateaued. Regression analysis revealed surgery during intervention period to be an independent risk factor for developing a SSI (OR 1.34; 95%CI 1.18–1.53). Initial SSI rates due to S. aureus were 0.24/100 surgeries and decreased to 0.14/100 surgeries (IRR 0.57; 95% CI 0.25–1.22) after introduction of decolonization. Regression analysis revealed surgery during intervention period to be an independent protective factor for developing a SSI with S. aureus (OR 0.57, 95% CI: 0.33–0.99). Overall deep S. aureus SSI decreased significantly from 0.22/100 surgeries to 0.00/100 surgeries in patients adherent to protocol (IRR 0.00, 95% CI 0.00–.85). Conclusion Universal decolonization with Polyhexanide did not reduce overall surgical site infections, but was effective in reducing Staphylococcus aureus - surgical site infections following elective joint arthroplasty. Polyhexanide could extend the list of alternatives to already established decolonization strategies. Trial registration The trial was registered at the German Registry for clinical studies www.drks.de (DRKS00011505).
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Affiliation(s)
- Björn Wandhoff
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Hindenburgdamm 27, 12203, Berlin, Germany.,Evangelisches Waldkrankenhaus Spandau, Stadtrandstraße, 555, Berlin, Germany
| | - Christin Schröder
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Ulrich Nöth
- LADR MVZ GmbH Neuruppin, Zur Mesche 20, 16816, Neuruppin, Germany
| | - Robert Krause
- Oberlinklinik-Orthopädische Fachklinik, Rudolf-Breitscheid-Straße 24, 14482, Potsdam, Germany
| | - Burkhard Schmidt
- Oberlinklinik-Orthopädische Fachklinik, Rudolf-Breitscheid-Straße 24, 14482, Potsdam, Germany
| | - Stephan David
- Evangelisches Krankenhaus Paul Gerhardt Stift, Paul-Gerhardt-Straße 42-45, 06886, Lutherstadt Wittenberg, Germany
| | - Eike-Eric Scheller
- Evangelisches Krankenhaus Hubertus, Spanische Allee 10-14, 14129, Berlin, Germany
| | - Friedrich Jahn
- Evangelische Elisabeth Klinik, Lützowstraße 26, 10785, Berlin, Germany
| | - Michael Behnke
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Tobias Siegfried Kramer
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Germany. .,National Reference Center for Surveillance of Nosocomial Infections, Hindenburgdamm 27, 12203, Berlin, Germany. .,Evangelisches Waldkrankenhaus Spandau, Stadtrandstraße, 555, Berlin, Germany. .,LADR MVZ GmbH Neuruppin, Zur Mesche 20, 16816, Neuruppin, Germany.
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Pudszuhn A, Voegeler S, Berger C, Treskatsch S, Angermair S, Hansen S, Hofmann VM. [Elective tracheostomy in COVID-19 patients: experience with a standardized interdisciplinary approach]. HNO 2020; 68:838-846. [PMID: 32840646 PMCID: PMC7445822 DOI: 10.1007/s00106-020-00917-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Berichtet wird über die Erfahrungen mit einer interdisziplinären klinikinternen SOP (Standard Operation Procedure) zur Tracheostomie (TS) bei „Coronavirus-Disease“(COVID-19)-Patienten, unter Berücksichtigung der allgemeinen nationalen und internationalen Empfehlungen. Der interdisziplinär festgelegte operative Zeitpunkt der TS aufgrund einer prolongierten invasiven Beatmung und frustranen Weaning-Versuchen betraf Phasen sowohl hoher als auch niedriger Erkrankungsaktivität. Es wurden 5 TS bei Patienten mit einem Durchschnittsalter von 70,6 Jahren durchgeführt. Neben den Standard-COVID-19-Schutzmaßnahmen für das medizinische Personal zur Vermeidung einer nosokomialen COVID-19-Infektion führt die SOP-unterstützte Kommunikation während der TS zu einer periprozeduralen Sicherheit aller Beteiligten. COVID-19-Erkrankungen des medizinischen Personals der beteiligten Abteilungen sind bisher nicht bekannt.
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Affiliation(s)
- A Pudszuhn
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland.
| | - S Voegeler
- Klinik für Anästhesiologie und Intensivmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - C Berger
- Klinik für Anästhesiologie und Intensivmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - S Treskatsch
- Klinik für Anästhesiologie und Intensivmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - S Angermair
- Klinik für Anästhesiologie und Intensivmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - S Hansen
- Institut für Hygiene und Umweltmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - V M Hofmann
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
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41
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Krümpelmann U, Boseila A, Löhnert M, Kaup O, Clarenbach JJ, Görner M. An analysis of totally implantable central venous port system infections in an urban tertiary referral center. J Chemother 2020; 33:228-237. [PMID: 33030416 DOI: 10.1080/1120009x.2020.1829327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A frequent complication of central venous port systems (CVP) is infection (CVP-I), either local (CVP-LI) or a life-threatening blood stream infection (CVP-BSI). We examined the course of CVP-I including results of an antibiotic eradication attempt of CVP-BSI. We investigated adults with CVP-I from 2010 to 2018 who had to undergo port explantation or were treated by a combination of systemic antibiotics and antibiotic lock therapy (ALT). In nine years we diagnosed 206 CVP-I (CVP-LI: 52; CVP-BSI: 152). In 146 patients with CVP-I the port system was primary explanted, while 56 patients received antibiotics/ALT. 79% of Gram negative pathogens and 50% of coagulase negative staphylococci (CoNS) were eradicated. Failure of antibiotic treatment was more often associated with short time span since CVP implantation, neutropenia and polymicrobial infection. All patients with non-neoplastic disease survived, while 18/173 patients (10%) with underlying malignant disease had a fatal outcome in the same hospital stay.
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Affiliation(s)
| | - Ahmed Boseila
- Department of Thoracic Surgery, Klinikum Bielefeld Mitte, Bielefeld, Germany
| | - Mathias Löhnert
- Department of Visceral Surgery, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | - Olaf Kaup
- Microbiologic Laboratory, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | - Jacob J Clarenbach
- Zentrum für Diabetes, Nieren- und Hochdruckkrankheiten MVZ GmbH, Bielefeld, Germany
| | - Martin Görner
- Department of Oncology, Klinikum Bielefeld Mitte, Bielefeld, Germany
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42
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Hand- und Fußverletzungen beim Rheumatiker. Unfallchirurg 2020; 123:616-624. [DOI: 10.1007/s00113-020-00823-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Artamonova I, Schmitt L, Yazdi AS, Megahed M, von Felbert V, Balakirski G. Postoperative complications in dermatological patients undergoing microscopically controlled surgery in inpatient setting (next-day surgery): A single-center epidemiological study. J Dtsch Dermatol Ges 2020; 18:1437-1446. [PMID: 32597032 DOI: 10.1111/ddg.14148] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical site infections (SSI), bleeding, and necrosis are possible complications of dermatological surgery, and their rates are well described for Mohs surgery (same-day surgery). However, there are only limited data on their occurrence in microscopically controlled surgery of the form in which it is practiced in German hospitals (next-day surgery). MATERIALS AND METHODS We performed a retrospective analysis of patient records of patients hospitalized for microscopically controlled surgery during the year 2017 (12 months) in the Department of Dermatology and Allergology at the University Hospital of the RWTH Aachen (Aachen, Germany). The investigation addressed postoperative outcomes. RESULTS 319 patients underwent 528 dermatosurgical procedures in the defined period. Bleeding and necrosis occurred in 3.8 % (20/528) and 1.7 % (9/528) of the procedures, respectively. SSI occurred in 5.1 % (27/528) of the cases. The occurrence of bleeding was a statistically significant risk factor for SSI (p = 0.01). Furthermore, bleeding, SSI, and wound closure with a full-thickness graft were statistically significant risk factors for the development of necrosis (p < 0.05). Diabetes or immunosuppression were not found to be statistically significant risk factors for the development of SSI or necrosis after dermatologic surgery (p > 0.05). CONCLUSIONS Complication rates in microscopically controlled surgery (next-day surgery) are generally low and similar to those reported for Mohs surgery (same-day surgery). Therefore, it appears that some evidence-based perioperative recommendations that have been developed for Mohs surgery could be applied to German inpatient dermatosurgery. However, prospective studies with larger patient numbers are required to offer concrete recommendations specifically for microscopically controlled surgery (next-day surgery).
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Affiliation(s)
- Inga Artamonova
- Department of Orthopedics and Trauma Surgery, Marienhospital Brühl, Brühl, Germany.,Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Laurenz Schmitt
- Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Amir S Yazdi
- Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Mosaad Megahed
- Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Verena von Felbert
- Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Galina Balakirski
- Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany.,Department of Dermatology and Allergology, University Hospital of Bonn, Bonn, Germany
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Matuschek C, Moll F, Fangerau H, Fischer JC, Zänker K, van Griensven M, Schneider M, Kindgen-Milles D, Knoefel WT, Lichtenberg A, Tamaskovics B, Djiepmo-Njanang FJ, Budach W, Corradini S, Häussinger D, Feldt T, Jensen B, Pelka R, Orth K, Peiper M, Grebe O, Maas K, Bölke E, Haussmann J. The history and value of face masks. Eur J Med Res 2020; 25:23. [PMID: 32576263 PMCID: PMC7309199 DOI: 10.1186/s40001-020-00423-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/15/2020] [Indexed: 01/13/2023] Open
Abstract
In the human population, social contacts are a key for transmission of bacteria and viruses. The use of face masks seems to be critical to prevent the transmission of SARS-CoV-2 for the period, in which therapeutic interventions are lacking. In this review, we describe the history of masks from the middle age to modern times.
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Affiliation(s)
- Christiane Matuschek
- Department of Radiation Oncology, Heinrich-Heine-University, Duesseldorf, Germany
| | - Friedrich Moll
- Department of the History, Philosophy and Ethics of Medicine, Heinrich-Heine-University, Duesseldorf, Germany
| | - Heiner Fangerau
- Department of the History, Philosophy and Ethics of Medicine, Heinrich-Heine-University, Duesseldorf, Germany
| | - Johannes C Fischer
- Institute for Transplant Diagnostics and Cell Therapeutics, Heinrich-Heine-University, Duesseldorf, Germany
| | - Kurt Zänker
- University Witten/Herdecke, Center for Biomedical Education and Research (ZBAF), Witten, Germany
| | - Martijn van Griensven
- Department cBITE, Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht, The Netherlands
| | - Marion Schneider
- Department of Experimental Anesthesiology, University of Ulm, Ulm, Germany
| | - Detlef Kindgen-Milles
- Department of Anesthesiology and Intensive Care Medicine, Heinrich-Heine-University, Duesseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department for General Visceral and Pediatric Surgery, Heinrich-Heine-University, Duesseldorf, Germany
| | - Artur Lichtenberg
- Department for Cardiac Surgery, Heinrich-Heine-University, Duesseldorf, Germany
| | - Bálint Tamaskovics
- Department of Radiation Oncology, Heinrich-Heine-University, Duesseldorf, Germany
| | | | - Wilfried Budach
- Department of Radiation Oncology, Heinrich-Heine-University, Duesseldorf, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital LMU Munich, Munich, Germany
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectiology, Heinrich-Heine-University, Duesseldorf, Germany
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectiology, Heinrich-Heine-University, Duesseldorf, Germany
| | - Björn Jensen
- Department of Gastroenterology, Hepatology and Infectiology, Heinrich-Heine-University, Duesseldorf, Germany
| | - Rainer Pelka
- Institute for Applied Statistics, Munich, Germany
| | - Klaus Orth
- University of Hannover, Hannover, Germany
| | | | - Olaf Grebe
- Department of Cardiology, Rhythmology and Intensive Care Medicine, Evangelical Hospital, Duesseldorf, Germany
| | - Kitti Maas
- Department of Radiation Oncology, Heinrich-Heine-University, Duesseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Heinrich-Heine-University, Duesseldorf, Germany.
| | - Jan Haussmann
- Department of Radiation Oncology, Heinrich-Heine-University, Duesseldorf, Germany
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45
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Masson C, Birgand G, Castro-Sánchez E, Eichel VM, Comte A, Terrisse H, Rubens-Duval B, Gillois P, Albaladejo P, Picard J, Bosson JL, Mutters NT, Landelle C. Is virtual reality effective to teach prevention of surgical site infections in the operating room? study protocol for a randomised controlled multicentre trial entitled VIP Room study. BMJ Open 2020; 10:e037299. [PMID: 32565477 PMCID: PMC7311029 DOI: 10.1136/bmjopen-2020-037299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/31/2020] [Accepted: 05/05/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Some surgical site infections (SSI) could be prevented by following adequate infection prevention and control (IPC) measures. Poor compliance with IPC measures often occurs due to knowledge gaps and insufficient education of healthcare professionals. The education and training of SSI preventive measures does not usually take place in the operating room (OR), due to safety, and organisational and logistic issues. The proposed study aims to compare virtual reality (VR) as a tool for medical students to learn the SSI prevention measures and adequate behaviours (eg, limit movements…) in the OR, to conventional teaching. METHODS AND ANALYSIS This protocol describes a randomised controlled multicentre trial comparing an educational intervention based on VR simulation to routine education. This multicentre study will be performed in three universities: Grenoble Alpes University (France), Imperial College London (UK) and University of Heidelberg (Germany). Third-year medical students of each university will be randomised in two groups. The students randomised in the intervention group will follow VR teaching. The students randomised in the control group will follow a conventional education programme. Primary outcome will be the difference between scores obtained at the IPC exam at the end of the year between the two groups. The written exam will be the same in the three countries. Secondary outcomes will be satisfaction and students' progression for the VR group. The data will be analysed with intention-to-treat and per protocol. ETHICS AND DISSEMINATION This study has been approved by the Medical Education Ethics Committee of the London Imperial College (MEEC1920-172), by the Ethical Committee for the Research of Grenoble Alpes University (CER Grenoble Alpes-Avis-2019-099-24-2) and by the Ethics Committee of the Medical Faculty of Heidelberg University (S-765/2019). Results will be published in peer-reviewed medical journals, communicated to participants, general public and all relevant stakeholders.
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Affiliation(s)
- Claire Masson
- TIMC-IMAG, CNRS, Grenoble INP, University Grenoble Alpes, Grenoble, France
- Infection control unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Gabriel Birgand
- Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College, London, Greater London, United Kingdom
| | - Enrique Castro-Sánchez
- Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College, London, Greater London, United Kingdom
| | - Vanessa Maria Eichel
- Section for Hospital Hygiene and Environmental Health, Centre of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Alexa Comte
- TIMC-IMAG, CNRS, Grenoble INP, University Grenoble Alpes, Grenoble, France
| | - Hugo Terrisse
- TIMC-IMAG, CNRS, Grenoble INP, University Grenoble Alpes, Grenoble, France
| | - Brice Rubens-Duval
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble Alpes University Hospital, Grenoble, France
| | - Pierre Gillois
- TIMC-IMAG, CNRS, Grenoble INP, University Grenoble Alpes, Grenoble, France
| | - Pierre Albaladejo
- TIMC-IMAG, CNRS, Grenoble INP, University Grenoble Alpes, Grenoble, France
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble Alpes University Hospital, Grenoble, France
| | - Julien Picard
- TIMC-IMAG, CNRS, Grenoble INP, University Grenoble Alpes, Grenoble, France
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean Luc Bosson
- TIMC-IMAG, CNRS, Grenoble INP, University Grenoble Alpes, Grenoble, France
| | - Nico Tom Mutters
- Section for Hospital Hygiene and Environmental Health, Centre of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Caroline Landelle
- TIMC-IMAG, CNRS, Grenoble INP, University Grenoble Alpes, Grenoble, France
- Infection control unit, Grenoble Alpes University Hospital, Grenoble, France
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Simon P. [Anti-infective treatment in obesity-"just double it?"]. Anaesthesist 2020; 69:588-592. [PMID: 32488536 DOI: 10.1007/s00101-020-00800-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Adaequate antibiotic therapy is crucial for successful anti-infective therapy. In addition to the choice of the right antibiotic and the duration of therapy, the dose also plays a decisive role. Obesity has an influence on the pharmacokinetics of antibiotics, which can lead to underdosing if previous weight-independent dosing regimes are used. It is therefore necessary to carry out systematic measurements of concentrations in obese patients. Since pharmacokinetic differences between plasma and the interstitial fluid of different target tissues have been observed for different antibiotics, the measurement is also necessary in the target tissue. The technique of microdialysis is best suited for this purpose as it allows concentrations to be measured continuously in the target tissue.
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Affiliation(s)
- P Simon
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland.
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Surgical site infections after microscopically controlled skin surgery in immunocompromised patients: a retrospective two-center cohort study. Arch Dermatol Res 2020; 312:491-499. [PMID: 32009218 DOI: 10.1007/s00403-020-02035-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/06/2020] [Accepted: 01/18/2020] [Indexed: 10/25/2022]
Abstract
The data on the risk of surgical site infections (SSI) after skin surgery in patients undergoing immunosuppressive treatment are limited and the results of the existing single-center studies are controversial. At the same time, perioperative antibiotic prophylaxis (PAP) for immunocompromised patients seems to be overused. We performed a retrospective analysis of the SSI rates after extensive dermatosurgical procedures performed from January 2017 to December 2017 in patients with impaired immune status due to a hematological disorder or immunosuppressive treatment at two German dermatosurgical centers. The SSI rate in immunocompromised patients was 6.7%. The independent risk factors for SSI found in the studied population were the occurrence of bleeding after one of the surgical stages and the use of oral anticoagulation with two different agents (the combination of acetylsalicylic acid and a direct oral anticoagulant). 44.4% (4/9) of the procedures complicated with an SSI involved wound closure with a skin flap, which was statistically significant (p = 0.041). Other risk factors identified were older age of the patients and increased duration of hospitalization (p < 0.05). Localization of the surgical site, number of surgical stages required for tumor clearance, and diabetes mellitus were not found to be statistically significant risk factors for occurrence of SSI in the studied population. SSI rates in immunocompromised patients undergoing skin surgery are low; therefore, we recommend against routine use of PAP for this cohort.
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Ritter B, Herlyn PKE, Mittlmeier T, Herlyn A. Preoperative skin antisepsis using chlorhexidine may reduce surgical wound infections in lower limb trauma surgery when compared to povidone-iodine - a prospective randomized trial. Am J Infect Control 2020; 48:167-172. [PMID: 31604621 DOI: 10.1016/j.ajic.2019.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND For the prevention of surgical wound infections (SSIs), local microorganism counts can be lowered by skin antisepsis prior to surgical incisions. Until now, it has been unclear which antiseptic is the most effective. METHODS This prospective randomized trial analyzed the efficacy of 2 frequently used agents in the reduction of postoperative wound complication rates after aseptic trauma surgery on the lower leg and foot. In the study, 279 consecutive participants were randomized; 112 received surgical skin preparations using chlorhexidine (CHX) (ChloraPrep; Becton Dickinson, Franklin Lakes, NJ) and 167 received preparations with povidone-iodine (PVP-I) (Braunoderm; B. Braun Melsungen AG, Melsungen, Germany). Primary clinical endpoints were SSIs and wound healing disorders (WHDs) within 6 months after surgery. Secondary outcome variables included demographic and perioperative risk factors for SSIs. RESULTS Rates of WHDs and SSIs were significantly higher in the PVP-I treatment group, which experienced 9 SSIs and 12 WHDs (n = 21; 12.6%), compared to the CHX treatment group, which had 2 SSIs and 3 WHDs (n = 5; 4.5%) (P = .022). Perioperative risk factors for WHDs were obesity and longer surgery time, whereas SSIs were increased in participants with cardiovascular diseases and suction drainage. Logistic regression analysis showed that the odds of complications of wound healing were 3.5 times higher for PVP-I than for CHX (odds ratio = 3.5; 95% confidence interval, 1.1-11.2; P = .032). CONCLUSIONS Preoperative skin antisepsis for trauma surgery of the lower leg and foot using CHX led to significantly fewer complications of wound healing when compared to PVP-I.
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Affiliation(s)
- Benedikt Ritter
- Department of Trauma, Orthopaedic, Plastic and Hand Surgery, Augsburg University Medicine, Augsburg, Germany
| | - Philipp Karl Ewald Herlyn
- Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Rostock, Germany
| | - Thomas Mittlmeier
- Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Rostock, Germany
| | - Anica Herlyn
- Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Rostock, Germany.
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Bauer A, Grünewald M, Eberhardt H, Schulz R, Martus P, Brüggenjürgen B, Joos S, Sturm H. Ambulatory screening and decontamination to prevent Staphylococcus aureus complications in patients undergoing elective surgery (STAUfrei): study protocol for a controlled intervention study. BMC Infect Dis 2020; 20:95. [PMID: 32005137 PMCID: PMC6995168 DOI: 10.1186/s12879-020-4804-7] [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] [Received: 11/29/2019] [Accepted: 01/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical site infections (SSI) are the most common health care associated infections in German acute hospitals and can result in prolonged hospital stays, increased use of antibiotics and utilisation of care. Staphylococcus aureus bacteria (methicillin-resistant S Aureus (MRSA) and methicillin-susceptible S Aureus (MSSA)) are amongst the most prominent causes of SSI. While up to 90% of documented S Aureus colonization is already detectable prior to hospital admission, the majority of hygiene measures in Germany is focused on the hospital setting. It is hypothesized that early detection and decontamination of S Aureus colonization in primary care can prevent health care associated infections and reduce the number of S Aureus isolates in the hospital setting. METHODS This study is a controlled interventional study (N = 13,260) with a pre-post comparison. The intersectoral intervention (over 2 years) will encompass the following elements: ambulatory detection and decontamination of MRSA and MSSA prior to elective surgery combined with a structured follow-up care. Patients from the control group will be screened in the hospital setting, in accordance with the standard operating procedure (SOP) in routine care. The primary endpoint is the reduction of MRSA and MSSA colonization upon hospital admission. Secondary endpoints are complication rate (SSI), length of stay, recolonization of patients (3 and 6 months after release), patient and provider satisfaction, patient compliance and cost development. DISCUSSION In case of positive results, the chance of a widespread uptake and implementation in routine care are considered high. The active involvement of primary care providers in the implementation of screening and decontamination as well as follow-up care is a unique feature of this study. The positive resonance of primary care providers during the recruitment phase highlights the relevance of the topic to the participating actors. These efforts are coupled with patient education and specifically trained medical staff, promising a sustained impact. The STAUfrei care pathway can homogenize current practices in routine care and provide a template for further intersectoral cooperation. TRIAL REGISTRATION German Clinical Trials Register (DRKS), DRKS00016615. Registered on April 1st, 2019.
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Affiliation(s)
- Antonia Bauer
- Institute of General Practice and Interprofessional Care, Faculty of Medicine of the Eberhard Karls University Tübingen, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany.
| | | | | | | | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University Hospital Tübingen, Tübingen, Germany
| | | | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, Faculty of Medicine of the Eberhard Karls University Tübingen, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany
| | - Heidrun Sturm
- Institute of General Practice and Interprofessional Care, Faculty of Medicine of the Eberhard Karls University Tübingen, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany
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50
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Einfluss der Darmvorbereitung auf Wundinfektionen und Anastomoseninsuffizienzen bei elektiven Kolonresektionen: Ergebnisse einer retrospektiven Studie mit 260 Patienten. Chirurg 2020; 91:491-501. [DOI: 10.1007/s00104-019-01099-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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