[Not Available]. / Tuberkulose in Anästhesie, Intensiv- und Notfallmedizin - Diagnostik und Umgang.

Tuberculosis is a rare disease in Germany. This is the result of systematic treatment, contact tracing, and supervision of public health institutions, but even more of good nutrition and immunity of the population. Considering migration waves, a higher incidence of non-diagnosed tuberculosis may be expected. Due to the airborne type of infection and constant manipulation of the airway, those working in anesthesia, intensive care and emergency medicine are exposed to an increased risk of infection with tuberculosis. To avoid hospital and community infection, several guidelines of national and international organizations are available.This article gives a summary of the mechanism and probability of infection, diagnosis of infection andpathogen detection; important guidelines are referred to, and everyday situations with risk of infection and their avoidance are described. The message is that self-protection should be possible by information and awareness.

Chlorhexidine gluconate dressings reduce bacterial colonization rates in epidural and peripheral regional catheters.

INTRODUCTION: Bacterial colonization of catheter tips is common in regional anesthesia and is a suspected risk factor for infectious complications. This is the first study evaluating the effect of CHG-impregnated dressings on bacterial colonization of regional anesthesia catheters in a routine clinical setting. METHODS: In this prospective study, regional anesthesia catheter infection rates were examined in two groups of patients with epidural and peripheral regional catheters. In the first group, regional anesthesia was dressed with a conventional draping. The second group of patients underwent catheter dressing using a CHG-impregnated draping. Removed catheters and the insertion sites were both screened for bacterial colonization. RESULTS: A total of 337 catheters from 308 patients were analysed. There was no significant reduction of local infections in either epidural or peripheral regional anesthesia catheters in both CHG and conventional groups. In the conventional group, 21% of the catheter tips and 41% of the insertion sites showed positive culture results. In the CHG-group, however, only 3% of the catheter tips and 8% of the insertion sites were colonised. CONCLUSION: CHG dressings significantly reduce bacterial colonization of the tip and the insertion site of epidural and peripheral regional catheters. However, no reductions in rates of local infections were seen.

[Antibiotic stewardship]. / Krankenhaushygiene - Antibiotic Stewardship.

Resistance against antibiotics is continuously increasing throughout the world and has become a very serious problem. For just this reason "Antibiotic Stewardship Programs" have been developed. These programs are intended to lead to a sustained improvement in the situation and to assure a rational practice for the prescription of anti-infective agents in medical facilities. The aim is to prescribe the correct antibiotic therapy to the right patient at the most appropriate point in time. An AWMF S3 guideline on this topic published by the German Society for Infectiology (S3-Leitlinie StrategienzurSicherungrationalerAntibiotika-AnwendungimKrankenhaus.AWMF-Registernummer 092/001 - S3 Guideline on Strategies for the Rational Use of Antibiotics in Hospitals. AWMF - Registry Number 092/001) has been available since the end of 2013. An essential aspect therein is the expert interdisciplinary cooperation of a team comprising a clinically experienced infectiologist, a hospital pharmacist and a consultant for microbiology.

[Preventive vaccinations for medical personnel]. / Krankenhaushygiene--Schutzimpfungen bei medizinischem Personal.

Vaccinations are among the most efficient and important preventive medical procedures. Modern vaccines are well tolerated. In Germany there are no longer laws for mandatory vaccinations, either for the general public or for medical personnel. Vaccinations are now merely "officially recommended" by the top health authorities on the basis of recommendations from the Standing Committee on Vaccinations (STIKO) of the Robert Koch Institute (RKI) according to § 20 para 3 of the Protection against Infection law (IfSG). The management of vaccine damage due to officially recommended vaccinations is guaranteed by the Federal States. Whereas vaccinations in childhood are generally considered to be a matter of course, the willingness to accept them decreases markedly with increasing age. In the medical sector vaccinations against, for example, hepatitis B are well accepted while other vaccinations against, for example, whooping cough or influenza are not considered to be so important. The fact that vaccinations, besides offering protection for the medical personnel, may also serve to protect the patients entrusted to medical care from nosocomial infections is often ignored.

[Helsinki declaration on patient safety in anaesthesiology -part 10: infection control/hygiene]. / Deklaration von Helsinki zur Patientensicherheit in der Anästhesiologie - Teil 10: Infektionskontrolle†/†Hygiene.

There is a plethora of laws, regulations, guidelines and recommendations relating to infection control and hygiene. Major issues are the prevention of nosocomial infections, staff protection and environmental protection. Of the highest relevance are the infection control law [Infektionsschutzgesetz (IfSG)], the hygiene regulations of the German federal states [Hygieneverordnungen der Bundesländer], the German technical rules for biological materials [Technische Regel Biologische Arbeitsstoffe 250 (TRBA 250)] - biological materials in health-care and welfare work [Biologische Arbeitsstoffe im Gesundheitswesen und in der Wohlfahrtspflege], the guidelines for hospital hygiene and prevention of infection of the commission for hospital hygiene and prevention of infection of the Robert-Koch Institute [Richtlinie für Krankenhaushygiene und Infektionsprävention von der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut], the recommendations of the commission on anti-infectives, resistance and therapy of the Robert-Koch Institute [Empfehlungen der Kommission Antiinfektiva, Resistenz und Therapie (ART) beim Robert Koch-Institut]. Of subordinate importance are, e.g., the recommendations of the German Society for Anesthesiology and Intensive Medicine (DGAI). It is practically impossible for an anesthesiologist working in a hospital to have knowledge of all laws, regulations, guidelines and recommendations. And this is also not reasonable. Thus it is necessary to distinguish the relevant from the irrelevant. Checklists can be useful here. The most important and effective individual action in hospital hygiene is and remains hand hygiene as is propagated in the action "clean hands", irrespective of all laws, regulations, guidelines and recommendations.

[Water hygiene in hospitals]. / Krankenhaushygiene - Wasserhygiene im Krankenhaus.

As a general rule drinking water in hospitals does not represent a risk for the normal patient. However, for high-risk patients with compromised immune defense systems drinking water in hospitals may become a source of nosocomial infections. It may be contaminated with microorganisms that may have the potential to be infectious agents in the hospital environment. Of particular significance in such circumstances are the Gram-negative rods such as Pseudomonas aeruginosa, Acinetobacter spp. and Legionella bacteria. Accordingly, specific behavior patterns and measures in the handling of drinking water in hospitals are meaningful in order to reduce the risks of water-associated nosocomial infections.

[Air conditioning units and warm air blankets in the operating room]. / Krankenhaushygiene - Raumlufttechnische Anlagen und Warmluftdecken in Operationssälen.

Nowadays almost all operating rooms are equipped with air conditioning (AC units). Their main purpose is climatization, like ventilation, moisturizing, cooling and also the warming of the room in large buildings. In operating rooms they have an additional function in the prevention of infections, especially the avoidance of postoperative wound infections. This is achieved by special filtration systems and by the creation of specific air currents. Since hypothermia is known to be an unambiguous factor for the development of postoperative wound infections, patients are often actively warmed intraoperatively using warm air blankets (forced-air warming units). In such cases it is frequently discussed whether such warm air blankets affect the performance of AC units by changing the air currents or whether, in contrast, have exactly the opposite effect. However, it has been demonstrated in numerous studies that warm air blankets do not have any relevant effect on the functioning of AC units. Also there are no indications that their use increases the rate of postoperative wound infections. By preventing the patient from experiencing hypothermia, the rate of postoperative wound infections can even be decreased thereby.

[Hospital hygiene - transport of patients with multi-resistant pathogens]. / Krankenhaushygiene - Transport von Patienten mit multiresistenten Erregern.

An ever occurring problem in the health-care services is the handling of patients who are carriers of multi-resistant pathogens (MRP). As a general rule, these patients must be isolated. Thus, the transport of these patients not only within but also outside of the hospital can be a problem. It is not just a matter of making the necessary transport of the afflicted patient, e.g., to examination suites or operating rooms, possible but also above all of protecting other patients and personnel from transmission and potential infection with the pathogen. As a rule, the measures of "standard hygiene" are sufficient for an adequate protection of patients and personnel. Above all, hand disinfection is of decisive importance.

[Hospital hygiene - outbreak management of nosocomial infections]. / Krankenhaushygiene - Ausbruchmanagement bei nosokomialen Infektionen.

According to §6, section 3 of the German Protection against Infections Act [Infektionsschutzgesetz (IfSG)] an outbreak is defined as the occurrence in large numbers of nosocomial infections for which an epidemiological relationship is probable or can be assumed. About 2-10% of nosocomial infections in hospitals (about 5% in intensive care wards) occur within the framework of an outbreak. The heaped occurrence of nosocomial infections can be declared according to the prescribed surveillance of nosocomial infections (§23 IfSG) when, in the course of this assessment, a statistically significant increase in the rate of infections becomes apparent. On the other hand, the occurrence of an outbreak can also be recognized through the vigilance of all involved personnel and a general sensibilization towards this subject. The names of patients involved in outbreaks need not be reported to the responsible health authorities. As a consequence of the report the health authorities become involved in the investigation to determine the cause and its elimination, and to provide support and advice. The outbreak management should be oriented on the respective recommendations of the Robert Koch Institute.

[Fungal infections in the intensive care unit]. / Krankenhaushygiene - Pilzinfektionen auf der Intensivstation.

Invasive infections through to sepsis caused by fungi in intensive care units have increased markedly in the past few years. In the mean time almost every tenth case of sepsis in the intensive care unit is the result of an invasive fungal infection. Not only hemato-oncological or organ-transplanted patients are affected but increasingly also those patients who have been under intensive care for a considerable time and who exhibit particular risk factors. The lethality among the afflicted patients is high. The diagnosis of fungal infections is still difficult; unambiguous, highly sensitive and specific test procedures are still lacking. The decision for therapy must often be made empirically and as early as possible. In the past few years newly developed antimycotic agents have opened up new options for therapy.

[Hygiene specialists]. / Krankenhaushygiene - Hygienefachpersonal.

In 2009 the Commission for Hospital Hygiene and Prevention of Infections (CHHPI) at the Robert Koch Institute (RKI) published recommendations on the personnel and organisational prerequisites for the prevention of nosocomial infections. Emphasis was placed on the tasks of all members of professional groups who belong to or work closely with a team of hygiene specialists in an institution for outpatient or inpatient medical care. Since these recommendations have not yet been adequately implemented and because of the repeated occurrence of hygiene deficits in the health-care services the legislature has been forced to pass a new law on hospital hygiene. This law requires the managers of hospitals and other medical facilities to avoid nosocomial infections and to abide by the recommendations of CHHPI and RKI. The already existing shortage of hygiene specialists, and especially of hospital hygiene specialists, is thereby further intensified. Thus there are initiatives to provide physicians working in hospitals with further training in hygiene so that they can take over the functions of a hospital hygiene specialist.

Impact of a single perioperative dose of dexamethasone on the incidence of surgical site infections: a case-control study.

AIMS: Dexamethasone is recommended in several international guidelines to prevent postoperative nausea and vomiting, a problem especially frequent in gynecological patients. Despite the increasing use of dexamethasone for this indication there are limited data concerning potential harmful effects of corticosteroids in surgical patients, especially the potential negative impact on wound healing and surgical site infection (SSI). This case-control study was conducted to look for potentially harmful effects of a single perioperative dose of dexamethasone with respect to the occurrence of SSI in gynecological and obstetric surgery patients. MATERIALS AND METHODS: We retrospectively analyzed 3449 patients undergoing inpatient gynecological or obstetric surgical procedures for the occurrence of deep SSI requiring surgical intervention or prolonged antibiotic treatment. These case patients were matched to control patients according to the surgeon performing the procedure, the type of surgery, biometric data, and known risk factors for SSI. Furthermore, timely linearity of dexamethasone use and SSI rate was exploratorily analyzed using several auto-regressive, integrated, moving-average models. RESULTS: Forty patients with deep SSI were matched to 158 controls. The risk profile for wound infections of both groups was comparable. Forty-five percent (95% confidence interval: 29-62%) of the case patients were treated with dexamethasone and 49% (95% confidence interval: 41-57%) of the control group received the drug. An increasing use of dexamethasone over time was not followed by an increased SSI rate. There were no timely correlations between dexamethasone usage and the occurrence of SSI. CONCLUSION: In this case-control study we could not detect any evidence for an increased risk for SSI after a single-dose of dexamethasone (4-8 mg) in gynecological patients.

[The taking and transport of biological samples]. / Krankenhaushygiene - Abnahme und Transport von mikrobiologischen Proben.

The results of microbiological tests are the foundation for a targetted therapy and the basis for monitoring infections. The quality of each and every laboratory finding depends not only on an error-free analytical process. The pre-analysis handling procedures are of particular importance. They encompass all factors and influences prior to the actual analysis. These include the correct timepoint for sample taking, the packaging and the rapid transport of the material to be investigated. Errors in the pre-analytical processing are the most frequent reasons for inappropriate findings.

[Hospital hygiene. Norovirus infections]. / Krankenhaushygiene. Norovirus-Erkrankungen.

Outbreaks of gastroenteritis caused by noroviruses have become an increasing problem for institutions in the health-care system over the past years. Staff members are also afflicted by the outbreaks of infection due to the highly contagious nature of noroviruses and this can lead to bottlenecks in health-care management and to economic losses. An acute gastroenteritis due to norovirus usually begins with severe nausea, heavy often projectile vomiting and a pronounced feeling of unwellness. In addition, there can be diarrhoea and abdominal cramps. The incubation time amounts to around one day. As a rule the disease is self-limiting and clears up after 2 to 3 days. However, the clinical pictures for one and the same type of pathogen can vary markedly from mild to severe illness. Since there is no way to treat the cause of a noroviral infection, prophylactic hygiene measures, especially of standard hygiene, are of particular importance. The necessary hygiene measures (especially hand hygiene) are aimed at interrupting the faecal-oral transmission pathway.

[The hospital infection surveillance system (KISS)]. / Krankenhaushygiene - Das Krankenhaus-Infektions-Surveillance-System (KISS).

According to §23 of the prevention of infections act (Infektionsschutzgesetzes, IfSG), the directors of hospitals and facilities for ambulant operations are obliged to continuously record and evaluate nosocomial infections. In this way it is intended that quality management with regard to the prevention of nosocomial infections should be improved. The national reference centre for the surveillance of nosocomial infections (NRC) has developed a computer and internet-assisted system and made it available: the hospital infection surveillance system (KISS). With this method at hand it is now possible to conduct a uniform surveillance of nosocomial infections that takes the most important influencing and risk factors into consideration and thus permits orienting comparisons. Participation in the KISS is possible free of charge.

[Resistance to antibiotics and multiresistant pathogens]. / Krankenhaushygiene - Antibiotikaresistenzen und multiresistente Erreger.

Resistance to antibiotics and the directly related proportion of multiresistant bacterial pathogens (MRP) is increasing continuously. This applies particularly for intensive care units. The most relevant MRP are methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended spectrum ss-lactamase formers (ESBL), multiresistant pseudomonades and Acinetobacter species. According to WHO the world is in danger of entering a so-called "post-antibiotic era", in which it is no longer possible to treat the causes of infectious diseases with antibiotics. The reasons for this development are considered to be the increased morbidity of patients as well as the too frequent, too long-enduring and often inappropriate usage of antimicrobial substances. But also the increasing number of invasive measures and interventions as well as the still existing inadequate maintenance of hygiene standards and the inadequate establishment of non-medicamentous measures (e.g. hand disinfection) for infection prophylaxis play a significant role.

[Hygiene standards for spinal anaesthesia]. / Spinalanästhesie - Hygienestandards bei Spinalanästhesie.

Infections after performance of a spinal anaesthesia (SPA) are rare. Reports in the literature on the frequency of cases of meningitis that occur after a spinal anaesthesia vary between 3.7/100,000 and 7.2/100,000. Spinal abscesses after SPA have a calculated incidence of 1/1,260,000. However, such abscesses are often associated with serious consequences for the patient. Epidural/spinal abscesses can damage the spinal cord through compression or directly. Mortality is reported to range from almost 10% up to 16%. Prognostic factors for an unfavourable course are old age, the extent of spinal cord compression and the time between the onset of symptoms and the start of therapy. Paralyses that exist for less than 36 hours are associated with a better survival or, respectively, a better recovery of neurological functions. Altogether, only about 40% of the patients recover completely, the rest suffer from persisting neurological deficits. In 27% of the cases, the neurological deficits are severe. According to legislation, every institution has to have a hygiene plan or a hygiene SOP, also for the performance of SPA. In 2006 the scientific working group "Regional Anaesthesia" of the German Society for Anaesthesiology and Intensive Care Medicine (Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin, DGAI) published hygiene recommendations for the execution and further management of regional anaesthetic procedures that can be used for orientation. These recommendations are based to a large extent on guidelines of the Robert Koch Institute (RKI) for the prevention of infections associated with vessel catheters. When an infection occurs, a timely diagnosis with the help of MRI studies and, if necessary, liquor puncture as well as a rapid initiation of treatment is of decisive importance for the prevention of late squeals.

[Nosocomial infections]. / Krankenhaushygiene - Nosokomiale Infektionen.

It is estimated for the year 2006 that around 500,000 to 600,000 nosocomial infections occurred in Germany and that among these 10,000 to 15,000 patients died of the infection. Nosocomial infections in general lengthen the duration of hospitalisation by on average 4 days - with associated extra costs of 4000 to 20,000 Euro per case. About a third of all infections acquired in hospital are considered to be avoidable. However, the classification of an infection as nosocomial does not automatically mean that a causal relationship exists between a medical intervention and the occurrence of the infection. Also a nosocomial infection is not a synonym for medical or nursing errors. The first epidemiological report of the EU emphasises the health-political and health-economical significance of nosocomial infections and classifies the increasing number of infections acquired in hospitals as a most important danger - even higher than the threats of pandemic influenza and HIV.

[Legal basis for the hygienic processing of medicinal products]. / Krankenhaushygiene - Gesetzliche Grundlagen der Aufbereitung von Medizinprodukten.

The major objectives of the German Medicinal Products Act (Medizinproduktegesetz, MPG) and the Medicinal Products Marketing Act (Medizinprodukte-etreiberverordnung, MPBetreibV) are to avoid the dangers (to health) arising from medicinal products (MP). This necessitates procedures for the professional maintenance of the, according to regulations low in germs or sterile, MP to be used. These procedures are associated with qualified personnel, appropriate resources, a reproducibly successful processing procedure and control of the technical-unctional safety of the MP.

[Hospital hygiene - Influenza]. / Krankenhaushygiene--Influenza.

Influenza is a severe, febrile disease of the airways that occurs epidemically in the winter months. It is caused by influenza viruses. In cycles of about 30 years, these seasonal epidemics progress to pandemics with high numbers of infections and deaths worldwide. In order to prevent just this situation, so-called pandemic plans have been developed worldwide. Besides vaccination, general hygienic precautions and antiviral therapies are the most important measures in the management of influenza. We can only wait and see whether or not the newly appeared H1N1 variant of the influenza virus A (Mexican flu, swine flu) will actually turn out to be a new worldwide pandemic.