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Krankenhaushygiene up2date 2012; 07(03): 199-212
DOI: 10.1055/s-0032-1310268
Technische und bauliche Aspekte
© Georg Thieme Verlag KG Stuttgart · New York

Raumlufttechnik im OP und postoperative Wundinfektionen. Was gibt es Neues?

Petra Gastmeier
,
Christian Brandt
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Publication History

Publication Date:
10 September 2012 (online)

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Kernaussagen

Früher wurde häufig angenommen, dass spezielle raumlufttechnische Anlagen mit laminarer oder turbulenzarmer gefilterter Luft das Risiko der Entstehung von postoperativen Wundinfektionen reduzieren können.

Die Ergebnisse der vorliegenden Kohortenstudien, bei denen die Operationen unter Alltagsbedingungen durchgeführt wurden, zeigen jedoch keinen Hinweis auf den infektionspräventiven Effekt dieser Anlagen.

Es gibt sogar starke Hinweise, dass LAF das Wundinfektionsrisiko bei den orthopädischen Operationen mit Einsatz von Endoprothesen erhöht.

Die Daten zeigen, dass die Ergebnisse von einzelnen, alten, randomisierten, kontrollierten Studien (Efficacy Studies) nicht immer unbedingt auf die Alltagsbedingungen zu übertragen sind. Es sollte immer untersucht werden, ob sich der günstige Effekt einer medizinischen Maßnahme auch unter Alltagsbedingungen reproduzieren lässt (Effectiveness Studies).

 

  • Literatur

  • 1 Richter-Kuhlmann E. Endoprothesenregister: „Ganze Produktgruppen werden vom Markt verschwinden“. Dtsch Arztebl 2008; 105: A16
    Search in Google Scholar
  • 2 ECDC Report Surveillance of Surgical Site Infections. 2011; http://ecdc.europe.eu/en/activities/surveillance/HAI/about-HAI-Net/Pages/SSI.aspx
    Search in Google Scholar
  • 3 Kurtz S, Lau E, Schmier J et al. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty 2008; 23: 984-991
    CrossrefSearch in Google Scholar
  • 4 Kappstein I. Die Luft als Erregerreservoir für postoperative Wundinfektionen. Teil 1: Welche Aussagen lassen die klinischen Studien zu?. Krankenh hyg up2date 2007; 2: 53-68
    Thieme ConnectSearch in Google Scholar
  • 5 Lidwell O, Lowbury E, Whyte W et al. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. Br Med J 1982; 285: 10-14
    CrossrefSearch in Google Scholar
  • 6 Lidwell OM. Infection and failure rates: Is my infection (failure) rate too high?. J Hosp Infect 1991; 18: 255-260
    CrossrefSearch in Google Scholar
  • 7 van Griethausen A, Soies-van Rooijen N, Hoogenboom-Verdegaal A. Surveillance of wound infections and a new theatre: unexpected lack of improvement. J Hosp Infect 1996; 34: 99-106
    CrossrefSearch in Google Scholar
  • 8 Pasquarella C, Sansebastiano G, Ferretti S et al. A mobile laminar airflow unit to reduce air bacterial contamination at surgical area in a conventionally ventilated operating theatre. J Hosp Infect 2007; 66: 313-319
    CrossrefSearch in Google Scholar
  • 9 Rodridues da Costa A, Kothari A, Bannister G et al. Investigating bacterial growth in surgical theatres: establishing the effect of laminar airflow on bacterial growth on plastic, metal and wood surfaces. Ann R Coll Surg Engl 2008; 90: 417-419
    CrossrefSearch in Google Scholar
  • 10 CDC/HICPAC. Guidelines for environmental infection control in health care facilities. MMWR Morb Mortal Wkly Rep 2003; 52: 1-42
    Search in Google Scholar
  • 11 Anforderungen der Hygiene bei Operationen und anderen invasiven Eingriffen. Bundesgesundheitsbl 2000; 43: 644-648
    CrossrefSearch in Google Scholar
  • 12 Cacciari P, Giannoni R, Marcelli E et al. Cost evaluation of a ventilation system for operating theatre: an ultraclean design versus a conventional one. Ann Ig 2004; 16: 803-809
    Search in Google Scholar
  • 13 Brandt C, Hott U, Sohr D et al. Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery. Ann Surg 2008; 248: 695-700
    CrossrefSearch in Google Scholar
  • 14 Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 1996; 334: 1209-1215
    CrossrefSearch in Google Scholar
  • 15 Melling A, Ali B, Scott E et al. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial. Lancet 2001; 358: 876-880
    CrossrefPubMedSearch in Google Scholar
  • 16 McGovern P, Albrecht M, Belani K et al. Forced-air warming and ultra-clean ventilation do not mix: an investigation of theatre ventilation, patient warming and joint replacement infection in orthopaedics. J Bone Joint Surg Br 2011; 93: 1537-1544
    CrossrefSearch in Google Scholar
  • 17 Lipsett P. Do we really need laminar flow ventilation in the operating room to prevent surgical site infections?. Ann Surg 2008; 248: 701-703
    CrossrefSearch in Google Scholar
  • 18 Assadian O, Kuelpmann R, Zhumadilova A et al. Protective effect of HEPA-filtered operating room air ventilation with or without laminar airflow on surgical site infections. Ann Surg 2009; 250: 659-660
    CrossrefSearch in Google Scholar
  • 19 Brandt C, Rüden H, Gastmeier P. Protective effect of HEPA-filtered operating room air ventilation with or without laminar airflow on surgical site infections. Ann Surg 2009; 250: 660
    CrossrefSearch in Google Scholar
  • 20 Kramer A, Külpmann R, Wille F et al. Infektiologische Bedeutung von Raumlufttechnischen Anlagen (RLTA) in Operations- und Eingriffsräumen. Zentralbl Chirurgie 2010; 135: 11-17
    Search in Google Scholar
  • 21 Breier A-C, Brandt C, Sohr D et al. Laminar airflow and the size of the ceiling size: No impact on infection rates following hip and knee prosthesis. Infect Control Hosp Epidemiol 2011; 32: 1097-1102
    CrossrefSearch in Google Scholar
  • 22 Taylor G, Bannister G. Infection and interposition between ultraclean air source and wound. J Bone Joint Surg Br 1993; 75: 544-548
    Search in Google Scholar
  • 23 Salvati E, Robinson R, Zeno S et al. Infection rates after 3175 total hip and knee replacements performed with and without a horizontal unidirectional filtered air-flow system. J Bone Joint Surg Am 1982; 64: 525-535
    Search in Google Scholar
  • 24 Hooper G, Rothwell A, Frampton C et al. Does the use of laminar airflow and space suits reduce early deep infection after total hip and knee replacement?. J Bone Joint Surg 2011; 93: 85-90
    CrossrefSearch in Google Scholar
  • 25 Engesaeter L, Lie S, Espehaug B et al. Antibiotic prophylaxis in total hip arthroplasty. Acta Orthop Scand 2003; 74: 644-651
    CrossrefPubMedSearch in Google Scholar
  • 26 Miner A, Losina E, Katz J et al. Deep infection after total knee replacement: impact of laminar airflow systems and body exhaust suits in the modern operating room. Infect Control Hosp Epidemiol 2007; 28: 222-226
    CrossrefSearch in Google Scholar
  • 27 Kakwani R, Yohannan D, Wahab K. The effect of laminar air-flow on the results of Austin-Moore hemiarthropalsty. Injury 2007; 38: 820-823
    CrossrefSearch in Google Scholar
  • 28 Gastmeier P, Breier A-C, Brandt C. Influence of laminar airflow on prosthetic joint infections: a systematic review. J Hosp Infect 2012; 81: 73-78
    CrossrefSearch in Google Scholar
  • 29 Humphreys H. Surgical site infection, ultraclean ventilated operating theatres and prosthetic joint surgery: where now?. J Hosp Infect 2012; 81: 71-72
    CrossrefSearch in Google Scholar