Zusammenfassung
Die moderne Chirurgie ermöglicht immer komplexere operative Eingriffe bei immer älteren
und komorbiden Patienten. Dies geht mit einem potenziell erhöhten Risiko für perioperative
Infektionen (SSI) einher. Für deren Vermeidung sind Sauberkeit, Händedesinfektion
und steriles Arbeiten essenziell, während einige traditionelle Hygienemaßnahmen zur
Prävention untauglich
sind. In diesem Beitrag werden Unterschiede der relevantesten Leitlinien zu SSI ggf.
besonders herausgestellt.
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.
Schlüsselwörter
chirurgische Wundinfektion - antibiotische Prophylaxe - Prävention - präoperative
Behandlung - Antisepsis
Key words
surgical site infection - surgical wound infection - antibiotic prophylaxis - prevention
- preoperative care - antisepsis
