Chirurgen sind am häufigsten von mehrphasischen nosokomialen Ausbrüchen betroffen – Ergebnisse einer systematischen Literaturrecherche

Zusammenfassung

Hintergrund: Kommt es während eines noso­komialen Ausbruchs nach einem Intervall ohne neue Infektionen erneut zu Betroffenen, so liegt ein mehrphasiger (polyphasischer) Ausbruch vor. Der vorliegende Beitrag stellt eine systematische Literaturrecherche zu solchen polyphasischen Ausbrüchen dar. Material und Methoden: Als Datenquelle dienten die Outbreak Worldwide-Database, PubMed und die Literaturverzeichnisse relevanter Artikel. Ergebnisse: 124 mehrphasige Ausbrüche (Dauer im Median 50 Wochen) wurden in die Auswertung eingeschlossen und anschließend mit 2089 einphasigen Ausbrüchen verglichen. Chirurgische Fachabteilungen waren signifikant häufiger von polyphasischen als von monophasischen (33,9 % vs. 24,5 %; p < 0,05) Ausbrüchen betroffen. Ausbrüche durch Hepatitis-B-Virus zeigten signi­fikant häufiger einen polyphasischen Verlauf. ­Mehrere – voneinander unabhängige – Ursachen oder die Entstehung einer sekundären Quelle im ­Verlauf des nosokomialen Ausbruchs waren die häufigsten Gründe für einen polyphasischen Verlauf. Schlussfolgerung: Polyphasische nosokomiale Ausbrüche sind bislang nur wenig untersucht worden und es besteht weiterhin ein großer Forschungsbedarf in diesem Bereich. Sowohl das ­klinisch tätige Personal als auch Mitarbeiter der Krankenhaushygiene sollten bei Ausbruchsuntersuchungen stets die Möglichkeit mehrerer Quellen bedenken. 

Abstract

Background: So-called polyphasic nosocomial outbreaks describe a situation in which additional infections occur after a certain case-free interval – despite the detection of the outbreak's source. This article summarises the results of a systematic search of the medical literature on polyphasic outbreaks. Materials and Methods: For this purpose, the Outbreak Worldwide-Database, PubMed and refer­ence lists of relevant articles were screened. Results: A total of 124 polyphasic outbreaks (median duration of 50 weeks) was included in the analysis and then compared to 2089 monophasic nosocomial outbreaks. Surgical departments were significantly more often involved in polyphasic outbreaks than they were in monophasic events (33.9 % vs. 24.5 %; p < 0.05). Hepatitis B virus outbreaks were significantly more often seen as poly­phasic events. Either there had been more than one source initially, or a new source devel­oped during the first phase of the outbreak and led to additional cases thereafter. Conclusions: Up to now, only little is known about polyphasic nosocomial outbreaks. Thus, there is a further need to close this gap of information in the future. Personnel on the ward as well as ­infection control staff should always consider the possibility of the existence of more than one ­source when investigating a nosocomial outbreak. 

Schlüsselwörter

Infektion - nosokomiale Infektion - Qualitätssicherung - Risikomanagement

Key words

infection - nosocomial infection - quality assurance - risk management

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