Die Luft als Erregerreservoir für postoperative Wundinfektionen

Kernaussagen

• Aus den klinischen Studien lässt sich keine wissenschaftliche Evidenz ableiten, wonach die Luft als Erregerreservoir für postoperative Wundinfektionen eine relevante Rolle spielen würde. Dies gilt ausdrücklich auch für die orthopädisch-unfallchirurgische Implantationschirurgie.

• RLT-Anlagen haben allein die Aufgabe, Operationssäle mit frischer, sauberer Luft zu versorgen. Der Aufbau der Anlagen muss die dafür erforderlichen Voraussetzungen schaffen, die jedoch mit einem wesentlich geringeren technischen Aufwand als in der DIN 1946 - 4 gefordert verwirklicht werden können.

• Für LAF-Anlagen gibt es auch im Bereich der Knochenchirurgie keine Indikation; aber auch die turbulenzarme Verdrängungslüftung (TAV) ist in ihrer Effektivität nicht belegt.

In einem der folgenden Hefte von KHHu2d werden die zahlreichen mikrobiologischen Studien mit Luftkeimzahl- und Umgebungskontaminationsmessungen in Operationsabteilungen unter experimentellen und praktischen Bedingungen analog zu der vorliegenden Diskussion der klinischen Studien zusammenfassend dargestellt.

Literatur

• 1 Külpmann R, Meierhans R. Raumlufttechnische Anlagen in Krankenhäusern.  KHHu2d. 2006;  1 69-81
• 2 Levenson S M, Trexler P C, Malm O J, Horowitz R W, Moncrief jr W H. A disposable plastic isolator for operating in a sterile environment.  Surgical Forum. 1960;  11 306-308
• 3 Charnley J. A sterile-air operating theatre enclosure.  British Journal of Surgery. 1964;  51 195-202
• 4 Charnley J. A clean-air operating enclosure.  British Journal of Surgery. 1964;  51 202-205
• 5 Charnley J, Eftekhar N. Postoperative infection in total prosthetic replacement arthroplasty of the hip joint with special reference to the bacterial content of the air of the operating room.  British Journal of Surgery. 1969;  56 640-649
• 6 Laufman H. Current status of special air-handling systems in operating rooms.  Medical Instrumentation. 1973;  7 7-15
• 7 Laufman H. What’s wrong with our operating rooms?.  American Journal of Surgery. 1971;  122 332-343
• 8 Laufman H. Surgical hazard control - Effect of architecture and engineering.  Archives of Surgery. 1973;  107 552-559
• 9 Laufman H. The operating room. In: Bennett JV, Brachman PS (Hrsg) Hospital Infections. Boston; Little, Brown and Company 1979: 129-137
• 10 Noble W C. Dispersal of skin microorganisms.  Br J Dermatol. 1975;  93 477-485
• 11 Kolmos H J, Svendsen R N, Nielsen S V. The surgical team as a source of postoperative wound infections caused by Streptococcus pyogenes.  J Hosp Infect. 1997;  35 207-214
• 12 Casewell M W, Hill R LR. The carrier state: methicillin-resistant Staphylococcus aureus.  J Antimicrob Chemother. 1986;  18, Suppl. A 1-12
• 13 Hill J, Howell A, Blowers R. Effect of clothing on dispersal of Staphylococcus aureus by males and females.  Lancet. 1974;  2 1131-1133
• 14 Whyte W. The role of clothing and drapes in the operating room.  J Hosp Infect. 1988;  11, Suppl. C 2-17
• 15 Charnley J. Operating-theatre ventilation.  Lancet. 1970;  1 1053-1054
• 16 Altemeier W A, Culbertson W R, Hummel R P. Surgical considerations of endogenous infections - Sources, types, and method of control.  Surgical Clinics of North America. 1968;  48 227-240
• 17 Seropian R, Reynolds B M. The importance of airborne contamination as a factor in postoperative wound infection.  Archives of Surgery. 1969;  98 654-658
• 18 Bernard H R, Cole W R. Bacterial air contamination and its relation to post-operative sepsis.  Annals of Surgery. 1962;  156 12-18
• 19 Howe C W, Marston A T. A study on sources of postoperative staphylococcal infection.  Surgery in Gynecology and Obstetrics. 1962;  115 266-275
• 20 Blakemore W S, McGarrity G J, Thurer R J, Wallace H W, MacVaugh III,  H, Coriell L L. Infection by air-borne bacteria with cardiopulmonary bypass.  Surgery. 1971;  70 830-838
• 21 Shaw D, Doig C M, Douglas D. Is airborne infection in operating-theatres an important cause of wound infection in general surgery?.  Bulletin de la Société Internationale de Chirurgie. 1974;  33 35-41
• 22 Clark R E, Amos W C, Higgins V, Bemberg K F, Weldon C S. Infection control in cardiac surgery.  Surgery. 1976;  79 89-96
• 23 Drake C T, Goldman E, Nichols R L, Piatruszka K, Nyhus L M. Environmental air and airborne infections.  Annals of Surgery. 1977;  185 219-223
• 24 Bengtsson S, Hambraeus A, Laurell G. Wound infections after surgery in a modern operating suite: clinical, bacteriological and epidemiological findings.  Journal of Hygiene, Cambridge. 1979;  83 41-57
• 25 Everett W D, Kipp H. Epidemiologic observations of operating room infections resulting from variations in ventilation and temperature.  American Journal of Infection Control. 1991;  19 277-282
• 26 Duhaime A-C, Bonner K, McGowan K L, Schut L, Sutton L N, Plotkin S. Distribution of bacteria in the operating room environment and ist relation to ventricular shunt infections: a prospective study.  Child’s Nervous System. 1991;  7 211-214
• 27 Griethuysen A JA, Spies-van Rooijen R , Hoogenboom-Verdegaal A MM. Surveillance of wound infections an a new theatre: unexpected lack of improvement.  Journal of Hospital Infection. 1996;  34 99-106
• 28 Brown jr. I W, Moor G F, Hummel B W, Marshall jr. W G, Collins J P. Toward further reducing wound infections in cardiac operations.  Annals of Thoracic Surgery. 1996;  62 1783-1789
• 29 Horan T C, Gaynes R P, Martone W J, Jarvis W R, Emori T G. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections.  Infection Control an Hospital Epidemiology. 1992;  13 606-608
• 30 Culver D H, Horan T C, Gaynes R P, Martone W J, Jarvis W R, Emori T G, Banerjee S N, Edwards J R, Tolson J S, Henderson T S, Hughes J M. Surgical wound infections rates by wound class, operative procedure, and patient risk index.  American Journal of Medicine. 1991;  91, Suppl. 3B 152S-157S
• 31 Centers for Disease Control and Prevention . National nosocomial infections surveillance (NNIS) report, data summary from October 1986 - April 1997, issued May 1997.  American Journal of Infection Control. 1997;  25 477-487
• 32 Wiley A M, Barnett M. Clean surgeons and clean air.  Clinical Orthopaedics and Related Research. 1973;  96 168-175
• 33 Fitzgerald jr. R H, Bechtol C O, Eftekhar N, Nelson J P. Reduction of deep sepsis after total hip arthroplasty.  Archives of Surgery. 1979;  114 803-804.
• 34 Ritter M A, Stringer E A. Laminar air-flow versus conventional air operating systems: a seven year patient follow-up.  Clinical Orthopaedics and Related Research.. 1980;  150 177-180
• 35 Nelson J P, Glassburn A R, Talbott R D, McElhinney J P. The effect of previous surgery, operating room environment, and preventive antibiotics on postoperative infection following total hip arthroplasty.  Clinical Orthopaedics and Related Research. 1980;  147 167-169
• 36 Salvati E A, Robinson R P, Zeno S M, Koslin B L, Brause B D, Wilson jr P D. Infection rates after 3175 total hip and total knee replacements performed with and without a horizontal unidirectional filtered air-flow system.  Journal of Bone and Joint Surgery. 1982;  64-A 525-535
• 37 Lidwell O M, Lowbury E JL, Whyte W, Blowers R, Stanley S J, Lowe D. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study.  British Medical Journal. 1982;  285 10-14
• 38 Lowbury E JL, Lidwell O M. Multi-hospital trial on the use of ultraclean air systems on orthopaedic operating rooms to reduce infection: preliminary communication.  J R Soc Med. 1978;  71 800-806
• 39 Lidwell O M, Lowbury E JL, Whyte W, Blowers R, Stanley S J, Lowe D. Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates.  Journal of Hospital Infection. 1983;  4 111-131
• 40 Lidwell O M, Lowbury E JL, Whyte W, Blowers R, Stanley S J, Lowe D. Bacteria isolated from deep joint sepsis after operation for total hip or knee replacement and the sources of the infections with Staphylococcus aureus.  Journal of Hospital Infection. 1983;  4 19-29
• 41 Deutsches Institut für Normung .Raumlufttechnik - Raumlufttechnische Anlagen in Krankenhäusern (VDI-Lüftungsregeln) DIN 1946 Teil 4. Berlin; Beuth Verlag 1989