Hygiene in der Orthopädie und Unfallchirurgie

Der Infektionsschutz des Patienten, aber auch des Mitarbeiters, durch Hygienemaßnahmen ist unerlässlicher Bestandteil des Qualitätsmanagements zur Gewährleistung der Patientensicherheit.

Die Krankenhaushygiene beeinflusst maßgeblich die Strukturqualität der Einrichtung, integriert hygienische Standards in alle diagnostischen und therapeutischen Verfahrensabläufe (Prozessqualität) und ermöglicht sowohl durch Überwachung der Prozessqualität als auch durch die Infektionsüberwachung die Ermittlung der Ergebnisqualität.

Nachfolgend sollen aus interdisziplinärer Sicht Schwerpunkte für ein Qualitätsmanagement der Hygiene einschließlich Möglichkeiten zur Gewährleistung der Compliance in Klinik und Praxis der Orthopädie und Unfallchirurgie aufgezeigt werden.

• Quellenangaben

• 1 Gemeinsame Leitlinie der Deutschen Gesellschaft für Orthopädie und orthopädische Chirurgie (DGOOC), des Berufsverbandes der Ärzte für Orthopädie (BVO) und des Arbeitskreises „Krankenhaus- & Praxishygiene“ der AWMF. Hygienemaßnahmen bei Intraartikulären Punktionen und Injektionen. AWMF-Leitlinien-Register Nr. 029/006 2008
• 2 Desinfektionsmittel-Kommission im Verbund für Angewandte Hygiene (VAH). Desinfektionsmittel-Liste des VAH, jeweils aktuelle Ausgabe. Wiesbaden: mhp;
• 3 Trautmann M, Kramer A. Injektionen und Punktionen. In: Kramer A, Assadian O, Exner M, Hübner NO, Simon A, Hrsg Krankenhaus- und Praxishygiene. München: Elsevier Urban & Fischer; 2011: 240-243
• 4 Arbeitskreis „Krankenhaus- & Praxishygiene“ der AWMF. Hygienemaßnahmen bei Liquorpunktionen, Liquorableitungen und Injektionen am ZNS. AWMF-Leitlinien-Register Nr. 029/041 2011
• 5 Wissenschaftlicher Arbeitskreis Regionalanästhesie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI). Hygieneempfehlungen für die Anlage und weiterführende Versorgung von Regionalanästhesie-Verfahren – Die „15 Gebote“ des Wissenschaftlichen Arbeitskreises Regionalanästhesie. Anasth Intensivmed 2006; 47: 372-379
• 6 Wacha H. Grundlagen der perioperativen Antibiotikaprophylaxe (PAP). In: Kramer A, Assadian O, Exner M, Hübner NO, Simon A, Hrsg Krankenhaus- und Praxishygiene. München: Elsevier Urban & Fischer; 2011: 97-100
• 7 Oldhafer K, Jürs U, Kramer A et al. Empfehlungen zur Prävention postoperativer Infektionen im Operationsgebiet. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 2007; 50: 377-393
• 8 Pedersen AB, Svendsson JE, Johnsen SP et al. Risk factors for revision due to infection after primary total hip arthroplasty. A population-based study of 80,756 primary procedures in the Danish Hip Arthroplasty Registry. Acta Orthop 2010; 81 (5) 542-547
• 9 Berbari EF, Osmon DR, Carr A et al. Dental procedures as risk factors for prosthetic hip or knee infection: a hospital-based prospective case-control study. Clin Infect Dis 2010; 50 (1) 8-16
• 10 Tomas T. Patient-related risk factors for infected total arthroplasty. Acta Chir Orthop Traumatol Cech 2008; 75 (6) 451-456
• 11 Rodriguez-Bano J, del Toro MD, Lupion C et al. Arthroplasty-related infection: incidence, risk factors, clinical features, and outcome. Enferm Infecc Microbiol Clin 2008; 26 (10) 614-620
• 12 Cordero-Ampuero J, de Dios M. What are the risk factors for infection in hemiarthroplasties and total hip arthroplasties?. Clin Orthop Relat Res 2010; 468 (12) 3268-3277
• 13 Dowsey MM, Choong PF. Obesity is a major risk factor for prosthetic infection after primary hip arthroplasty. Clin Orthop Relat Res 2008; 466 (1) 153-158
• 14 Urquhart DM, Hanna FS, Brennan SL et al. Incidence and risk factors for deep surgical site infection after primary total hip arthroplasty: a systematic review. J Arthroplast 2010; 25 (8) 1216-1222
• 15 Ridgeway S, Wilson J, Charlet A et al. Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg 2005; 87 (6) 844-850
• 16 Patel VP, Walsh M, Sehgal B et al. Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty. J Bone Joint Surg Am 2007; 89 (1) 33-38
• 17 Malinzak RA, Ritter MA, Berend ME et al. Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplasty 2009; 24 (6 Suppl) 84-88
• 18 Jorgensen PH, Fuursted K, Holmstrup P et al. Antibiotic prophylaxis in relation to dental treatment of patients with hip or knee joint prosthesis is seldom necessary. Ugeskr Laeger 2010; 172 (46) 3170-3173
• 19 Ong KL, Kurtz SM, Lau E et al. Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplasty 2009; 24 (6 Suppl) 105-109
• 20 Bongartz T, Halligan CS, Osmon DR et al. Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis. Arthritis Rheum 2008; 59 (12) 1713-1720
• 21 Willis-Owen CA, Konyves A, Martin DK. Factors affecting the incidence of infection in hip and knee replacement: an analysis of 5277 cases. J Bone Joint Surg Br 2010; 92 (8) 1128-1133
• 22 Molina-Cabrillana J, Chirino Cabrera A, Rodriguez-Alvarez JP et al. Effect of surveillance on surgical site infection rate in knee and hip arthroplasty. Rev Clin Esp 2007; 207 (8) 388-393
• 23 Engesaeter LB, Espehaug B, Lie SA et al. Does cement increase the risk of infection in primary total hip arthroplasty? Revision rates in 56,275 cemented and uncemented primary THAs followed for 0–16 years in the Norwegian Arthroplasty Register. Acta Orthop 2006; 77 (3) 351-358
• 24 Steinitz D, Harvey EJ, Leighton RK et al. Is homologous blood transfusion a risk factor for infection after hip replacement?. Can J Surg 2001; 44 (5) 355-358
• 25 Cruse PJ, Foord R. A five-year prospective study of 23.649 surgical wounds. Arch Surg 1973; 107: 206-210
• 26 Kramer A. Role of disinfection in the infection prevention multibarrier system. GMS Krankenhaushyg Interdiszip 2007; 2 (1) 13
• 27 Pons-Busom M, Aguas-Compaired M, Delás J et al. Compliance with local guidelines for antibiotic prophylaxis in surgery. Infect Control Hosp Epidemiol 2004; 25 (4) 308-312
• 28 Thompson KM, Oldenburg WA, Deschamps C et al. Chasing zero: the drive to eliminate surgical site infections. Ann Surg 2011; 254 (3) 430-436
• 29 Uckay I, Harbarth S, Peter R et al. Preventing surgical site infections. Expert Rev Anti Infect Ther 2010; 8 (6) 657-670
• 30 Lipke VL, Hyott AS. Reducing surgical site infections by bundling multiple risk reduction strategies and active surveillance. AORN J 2010; 92 (3) 288-296
• 31 Bode LG, Kluytmans JA, Wertheim HF et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010; 362 (1) 9-17
• 32 Kramer A, Kampf G, Oldhafer K et al. Prävention von SSI in der Chirurgie. In: Kramer A, Assadian O, Exner M, Hübner NO, Simon A, Hrsg Krankenhaus- und Praxishygiene. München: Elsevier Urban Fischer; 2011: 294-302
• 33 Wojkowska-Mach J, Bulanda M, Jaje E et al. The risk related to surgical site infections after hip endoarthroplasty-surveillance outcome analysis in two Polish orthopaedic centres. Ortop Traumatol Rehabil 2009; 11 (3) 253-263
• 34 Hinz P, Kramer A, Frank M et al. Unfallchirurgie und Traumatologie. In: Kramer A, Assadian O, Exner M, Hübner NO, Simon A, Hrsg Krankenhaus- und Praxishygiene. München: Elsevier Urban & Fischer; 2011: 102-103
• 35 Roth B, Assadian O, Wurmitzer F et al. Wundinfektionen nach antiseptischer Primärversorgung kontaminierter traumatischer Wunden mit Polihexanid, PVP-Iod bzw. Wasserstoffperoxid. GMS Krankenhaushyg Interdiszip 2007; 2 (2) Doc58 (20071228)
• 36 Kramer A, Assadian O, Frank M et al. Prevention of post-operative infections after surgical treatment of bite wounds. GMS Krankenhaushyg Interdiszip 2010; 5 (2) Doc12 (20100921)
• 37 Kramer A, Assadian O, Gruber B et al. Prävention von postoperativen Wundinfektionen, Teil 1: Präoperative Maßnahmen – Einfluss der Haarentfernung. Hyg Med 2008; 33 (10) 402-407
• 38 Hübner NO, Kellner NB, Partecke LI et al. Determination of antiseptic efficacy of rubs on the forearm and consequences for surgical hand disinfection. J Hosp Infect 2011; 78 (1) 11-15
• 39 Below H, Brauer VFH, Kramer A. Iodresorption bei antiseptischer Anwendung von Iodophoren und Schlussfolgerungen zur Risikobewertung. GMS Krankenhaushyg Interdiszip 2007; 2 (2) Doc41 (20071228)
• 40 Kramer A, Hübner N, Below H et al. Improving adherence to surgical hand preparation. J Hosp Infect 2008; 70 (Suppl. 01) 35-43
• 41 Rotter M. Desinfektion der Hände. In: Kramer A, Assadian O, Hrsg Wallhäusers Praxis der Sterilisation, Desinfektion, Antiseptik und Konservierung. Stuttgart: Thieme; 2008: 146-161
• 42 Harnoss JC, Kramer A, Heidecke CD et al. Wann sollte in Operationsräumen ein Wechsel chirurgischer Handschuhe erfolgen?. Zentralbl Chir 2010; 135 (1) 25-27
• 43 Hübner NO, Assadian O, Grohmann SA et al. Efficacy of five alcohol-based skin antiseptics on sebaceous skin used at shorter application times than the current recommendation of 10 minutes. Eur J Clin Microbiol Infect Dis 2011; 30 (7) 825-829
• 44 Kampf G, Pitten FA, Heeg P et al. Efficacy of two ethanol-based skin antiseptics on the forehead at shorter application times. BMC Microbiol 2007; 7: 85
• 45 Lademann O, Kramer A, Richter H et al. Antisepsis of the follicular reservoir by treatment with tissue-tolerable plasma (TTP). Laser Phys Lett 2011; 8 (4) 313-317
• 46 Dohmen PM, Konertz W. A review of current strategies to reduce intraoperative bacterial contamination of surgical wounds. GMS Krankenhaushyg Interdiszip 2007; 2 (2) 38
• 47 Dohmen PM, Gabbieri D, Weymann A et al. Reduction in surgical site infection in patients treated with microbial sealant prior to coronary artery bypass graft surgery: a case-control study. J Hosp Infect 2009; 72 (2) 119-126
• 48 Dohmen PM, Gabbieri D, Weymann A et al. A retrospective non-randomized study on the impact of INTEGUSEAL, a preoperative microbial skin sealant, on the rate of surgical site infections after cardiac surgery. Int J Infect Dis 2011; 15 (6) e395-e400
• 49 Wilson SE. Microbial sealing: a new approach to reducing contamination. J Hosp Infect 2008; 70 (Suppl. 02) 11-14
• 50 Kramer A, Assadian O, Lademann J. Prevention of postoperative wound infections by covering the surgical field with iodine-impregnated incision drape (Ioban 2). GMS Krankenhaushyg Interdiszip 2010; 5 (2) 8
• 51 Webster J, Alghamdi AA. Use of plastic adhesive drapes during surgery for preventing surgical site infection. Cochrane Database Syst Rev 2007; (4) CD006353
• 52 Chang CC, Lin HC, Lin HW et al. Anesthetic management and surgical site infections in total hip or knee replacement: a population-based study. Anesthesiol 2010; 113 (2) 279-284
• 53 Agarwal DS. Subcutaneous staphylococcal infection in mice. I. The role of cotton-dust in enhancing infection. Br J Exp Pathol 1967; 48 (4) 436-449
• 54 Hoborn J. Wet strike – through and transfer of bacteria through operating barrier material. Hyg Med 1990; 15: 15-20
• 55 Kramer A, Külpmann R, Wille F et al. Infektiologische Bedeutung von Raumlufttechnischen Anlagen (RLTA) in Operations- und Eingriffsräumen. Zentralbl Chir 2010; 135 (1) 11-17
• 56 CEN/TC205/WG 14 DIN EN 13795-1 Operationsabdecktücher, -mäntel und Rein-Luft-Kleidung zur Verwendung als Medizinprodukte für Patienten, Klinikpersonal und Geräte. Teil 1: Allgemeine Anforderungen für Hersteller, Aufbereiter und Produkte. Berlin: Beuth; 2009
• 57 Rutala WA, Weber DJ. A review of single-use and reusable gowns and drapes in health care. Infect Control Hosp Epidemiol 2001; 22 (4) 248-257
• 58 Blomstedt B, Osterberg B, Bergstrand A. Suture material and bacterial transport. An experimental study. Acta Chir Scand 1977; 143 (2) 71-73
• 59 Osterberg B, Blomstedt B. Effect of suture materials on bacterial survival in infected wounds. An experimental study. Acta Chir Scand 1979; 145 (7) 431-434
• 60 Chu CC, Williams DF. Effects of physical configuration and chemical structure of suture materials on bacterial adhesion. A possible link to wound infection. Am J Surg 1984; 147 (2) 197-204
• 61 Howe ECW, Marston AT. A study on sources of post-operative staphylococcal infections. Surgery Gynec Obstet 1962; 115: 266
• 62 Edmiston CE, Seabrook GR, Goheen MP et al. Bacterial adherence to surgical sutures: can antibacterial-coated sutures reduce the risk of microbial contamination?. J Am Coll Surg 2006; 203 (4) 481-489
• 63 Gomez-Alonso A, Garcia-Criado FJ, Parreno-Manchado FC et al. Study of the efficacy of coated VICRYL Plus antibacterial suture (coated Polyglactin 910 suture with Triclosan) in two animal models of general surgery. J Infect 2007; 54 (1) 82-88
• 64 Marco F, Vallez R, Gonzalez P et al. Study of the efficacy of coated Vicryl plus antibacterial suture in an animal model of orthopedic surgery. Surg Infect 2007; 8 (3) 359-365
• 65 Ming X, Rothenburger S, Nichols MM. In vivo and in vitro antibacterial efficacy of PDS plus (polidioxanone with triclosan) suture. Surg Infect 2008; 9 (4) 451-457
• 66 Fleck T, Moidl R, Blacky A et al. Triclosan-coated sutures for the reduction of sternal wound infections: economic considerations. Ann Thorac Surg 2007; 84 (1) 232-236
• 67 Pico RB, Jimenez LA, Sanchez MC et al. Prospective study comparing the incidence of wound infection following appendectomy for acute appendicitis in children: conventional treatment versus using reabsorbable antibacterial suture or gentamicin-impregnated collagen fleeces. Cir Pediatr 2008; 21 (4) 199-202
• 68 Rozzelle CJ, Leonardo J, Li V. Antimicrobial suture wound closure for cerebrospinal fluid shunt surgery: a prospective, double-blinded, randomized controlled trial. J Neurosurg Pediatr 2008; 2: 111-117
• 69 Justinger C, Moussavian MR, Schlueter C et al. Antibacterial coating of abdominal closure sutures and wound infection. Surg 2009; 145 (3) 330-334
• 70 Galal I, El-Hindawy K. Impact of using triclosan-antibacterial sutures on incidence of surgical site infection. Am J Surg 2011; 1879-1883
• 71 Zhang ZT, Zhang HW, Fang XD et al. Cosmetic outcome and surgical site infection rates of antibacterial absorbable (Polyglactin 910) suture compared to Chinese silk suture in breast cancer surgery: a randomized pilot research. Chin Med J 2011; 124 (5) 719-724
• 72 Togo S, Kubota T, Takahashi T et al. Usefulness of absorbable sutures in preventing surgical site infection in hepatectomy. J Gastrointest Surg 2008; 12 (6) 1041-1046
• 73 Watanabe A, Kohnoe S, Shimabukuro R et al. Risk factors associated with surgical site infection in upper and lower gastrointestinal surgery. Surg Today 2008; 38 (5) 404-412
• 74 Baracs J, Huszar O, Sajjadi SG et al. Surgical site infections after abdominal closure in colorectal surgery using triclosan-coated absorbable suture (pds plus) vs. uncoated sutures (pds ii): A randomized multicenter study. Surg Infect 2011; 12 (6) 483-489
• 75 Mingmalairak C, Ungbhakorn P, Paocharoen V. Efficacy of antimicrobial coating suture coated polyglactin 910 with tricosan (Vicryl plus) compared with polyglactin 910 (Vicryl) in reduced surgical site infection of appendicitis, double blind randomized control trial, preliminary safety report. J Med Assoc Thai 2009; 92 (6) 770-775
• 76 Chen SY, Chen TM, Dai NT et al. Do antibacterial-coated sutures reduce wound infection in head and neck cancer reconstruction?. Eur J Surg Oncol 2011; 37 (4) 300-304
• 77 Heger U, Voss S, Knebel P et al. Prevention of abdominal wound infection (PROUD trial, DRKS00000390): study protocol for a randomized controlled trial. Trials 2011; 12 (1) 245
• 78 Allen DB, Maguire JJ, Mahdavian M et al. Wound hypoxia and acidosis limit neutrophil bacterial killing mechanisms. Arch Surg 1997; 132: 991-996
• 79 Greif R, Akca O, Horn EP et al. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. N Engl J Med 2000; 342 (3) 161-167
• 80 Hopf HW, Hunt TK, West JM et al. Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg 1997; 132: 997-1004
• 81 Winkler M, Akca O, Birkenberg B et al. Aggressive warming reduces blood loss during hip arthroplasty. Anesth Analg 2000; 91 (4) 978-984
• 82 Ng SF, Oo CS, Loh KH et al. A comparative study of three warming interventions to determine the most effective in maintaining perioperative normothermia. Anesth Analg 2003; 96 (1) 171-176
• 83 Diab-Elschahawi M, Berger J, Blacky A et al. Impact of different-sized laminar air flow versus no laminar air flow on bacterial counts in the operating room during orthopedic surgery. AJIC 2011; 39 (7) 25-29
• 84 Knochen H, Hübner NO, Below H et al. Einfluss der Fußbodendesinfektion auf die mikrobielle und partikuläre Belastung der Raumluft in Augen-OP-Räumen mit Verdrängungslüftungsbereichen. Klin Monatsbl Augenheilkd 2010; 227 (11) 871-878
• 85 Aboelela SW, Stone PW, Larson EL. Effectiveness of bundled behavioural interventions to control healthcare-associated infections: a systematic review of the literature. J Hosp Infect 2007; 66 (2) 101-108
• 86 Ecri Institute (ed) Cultures, bundles, and other options for MRSA control. Health Hazard Manage Monit 2007; 20: 1-10
• 87 Kramer A, Schilling M, Heidecke CD. Infektionspräventions-Check-in und Infektionspräventions-Check-out zur Prävention nosokomialer Infektionen. Zentralbl Chir 2010; 135: 44-48
• 88 Schneider A, Bierling G. HuR Hygiene und Recht. Entscheidungssammlung – Richtlinien. Wiesbaden: mhp; 2011. 21. Lieferung
• 89 KRINKO und RKI. Kommentar zu den Empfehlungen zur Prävention und Kontrolle von MRSA-Stämmen in Krankenhäusern und anderen medizinischen Einrichtungen. Epid Bull 2008; 42: 363-364
• 90 Technische Regel für Gefahrstoffe (TRGS) 4011. Gefährdung durch Hautkontakt – Ermittlung, Beurteilung. Juni 2008, zuletzt berichtigt. GMBl; 2011 Nr. 9: 175
• 91 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 (5) 695-700
• 92 Breier AC, Brandt C, Sohr D et al. Laminar airflow ceiling size: no impact on infection rates following hip and knee prosthesis. Infect Control Hosp Epidemiol 2011; 32 (11) 1097-1102
• 93 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 (4) 659-660
• 94 Trautmann M. Kommentar. Hyg Med 2011; 36 (12) 511
• 95 Heidecke CD, Kramer A, Hübner NO, Goerdt A, Schreiber A. Senkung von POI durch Einführung des Infektionspräventions-Check-in. Kongress für Krakenhaushygiene der DGKH Hyg Med 2012; Abstract 11
• 96 Ellenrieder M, Lenz R, Haenle M et al. Two-stage revision of implant-associated infections after total hip and knee arthroplasty. GMS Krankenhaushyg Interdiszip 2011; 6 (1) Doc17 (20111215)
• 97 Hooper GJ, Rothwell AG, Frampton C et al. Does the use of laminar flow and space suits reduce early deep infection after total hip and knee replacement?: the ten-year results of the New Zealand Joint Registry. J Bone Joint Surg Br 2011; 93 (1) 85-90
• 98 Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG). Perioperative Antibiotika-Prophylaxe. Empfehlungen einer Expertenkommission. Chemother J 2010; 19: 70-84
• 99 Bernau A, Heeg P. Experimentelle Untersuchungen zu Fragen der Hautdesinfektion. Orthop Prax 1985; 21: 351-358
• 100 Debreceni G, Meggyesi R, Mestyan G. Efficacy of spray disinfection with a 2-propanol and benzalkonium chloride containing solution before epidural catheter insertion – a prospective, randomized, clinical trial. Br J Anaesth 2007; 98: 131-135
• 101 Ramirez-Arcos S, Goldman M. Skin disinfection methods: prospective evaluation and postimplementation results. Transfusion 2010; 50 (1) 59-64
• 102 Nawrath EM, Walther W, Robra BP. Stand und Perspektiven der Antibiotika-Prophylaxe bei Patienten mit künstlichem Gelenkersatz. Deutsche Zahnärztl Z 2009; 64 (1) 34-42
• 103 Bundeszahnärztekammer (BZÄK) und Deutscher Arbeitskreis für Hygiene in der Zahnmedizin (DAHZ). http://www.bauer-reif-dental.de/fileadmin/user_upload/pdf/2011_Hygieneplan_DAHZ-BZAEK.pdf
• 104 Greenblatt DY, Rajamanickam V, Mell MW. Predictors of surgical site infection after open lower extremity revascularization. J Vasc Surg 2011; 54 (2) 433-439
• 105 Harrop JS, Styliaras JC, Ooi YC et al. Contributing factors to surgical site infections. J Am Acad Orthop Surg 2012; 20 (2) 94-101
• 106 Gibbons C, Bruce J, Carpenter J et al. Identification of risk factors by systematic review and development of risk-adjusted models for surgical site infection. Health Technol Assess 2011; 15 (30) 1-156 iii–iv
• 107 Ridgeway S, Wilson J, Charlet A et al. Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br 2005; 87 (6) 844-850
• 108 Wojkowska-Mach J, Bulanda M, Jaje E et al. The risk related to surgical site infections after hip endoarthroplasty – surveillance outcome analysis in two Polish orthopaedic centres. Ortop Traumatol Rehabil 2009; 11 (3) 253-263
• 109 Harnoss JC, Partecke LI, Heidecke CD et al. Concentration of bacteria passing through puncture holes in surgical gloves. Am J Infect Control 2010; 38 (2) 154-158
• 110 Partecke LI, Goerdt AM, Langner I et al. Incidence of microperforation for surgical gloves depends on duration of wear. Infect Control Hosp Epidemiol 2009; 30 (5) 409-414
• 111 Hübner NO, Goerdt AM, Stanislawski N et al. Bacterial migration through punctured surgical gloves under real surgical conditions. BMC Infect Dis 2010; 10: 192
• 112 Kampf G, Kramer A. Efficacy of hand hygiene agents at short application times. Am J Infect Control 2005; 33 (7) 429-431
• 113 Freise J, Kohaus S, Korber A et al. Contact sensitization in patients with chronic wounds: results of a prospective investigation. J Eur Acad Dermatol Venereol 2008; 22 (10) 1203-1207
• 114 Reichel M, Heisig P, Kohlmann T et al. Alcohols for skin antisepsis at clinically relevant skin sites. Antimicrob Agents Chemother 2009; 53 (11) 4778-4782
• 115 Krobbuaban B, Diregpoke S, Prasan S et al. Alcohol-based chlorhexidine vs. povidone iodine in reducing skin colonization prior to regional anesthesia procedures. J Med Assoc Thai 2011; 94 (7) 807-812
• 116 Wistrand C, Nilsson U. Effects and experiences of warm versus cold skin disinfection. Br J Nurs 2011; 20 (3) 148 150–151
• 117 Dettenkofer M, Wilson C, Gratwohl A et al. Skin disinfection with octenidine dihydrochloride for central venous catheter site care: a double-blind, randomized, controlled trial. Clin Microbiol Infect 2010; 16 (6) 600-606
• 118 Justinger C, Schuld J, Sperling J et al. Triclosan-coated sutures reduce wound infections after hepatobiliary surgery – a prospective non-randomized clinical pathway driven study. Langenbecks Arch Surg 2011; 396 (6) 845-850
• 119 Justinger C, Slotta JE, Schilling MK. Incisional hernia after abdominal closure with slowly absorbable versus fast absorbable, antibacterial-coated sutures. Surgery 2012; 151 (3) 398-403
• 120 Isik I, Selimen D, Senay S et al. Efficiency of antibacterial suture material in cardiac surgery: a double-blind randomized prospective study. Heart Surg Forum 2012; 15 (1) E40-45
• 121 Baracs J, Huszar O, Sajjadi SG et al. Surgical site infections after abdominal closure in colorectal surgery using triclosan-coated absorbable suture (PDS Plus) vs. uncoated sutures (PDS II): a randomized multicenter study. Surg Infect 2011; 12 (6) 483-489
• 122 Rasic Z, Schwarz D, Adam VN et al. Efficacy of antimicrobial triclosan-coated polyglactin 910 (Vicryl* Plus) suture for closure of the abdominal wall after colorectal surgery. Coll Antropol 2011; 35 (2) 439-443
• 123 Stadler S, Fleck T. Triclosan-coated sutures for the reduction of sternal wound infections? A retrospective observational analysis. Interact Cardiovasc Thorac Surg 2011; 13 (3) 296-299
• 124 Williams N, Sweetland H, Goyal S et al. Randomized trial of antimicrobial-coated sutures to prevent surgical site infection after breast cancer surgery. Surg Infect 2011; 12 (6) 469-474
• 125 Zhang ZT, Zhang HW, Fang XD et al. Cosmetic outcome and surgical site infection rates of antibacterial absorbable (Polyglactin 910) suture compared to Chinese silk suture in breast cancer surgery: a randomized pilot research. Chin Med J 2011; 124 (5) 719-724
• 126 Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 1996; 334 (19) 1209-1215
• 127 Linam WM, Margolis PA, Staat MA et al. Risk factors associated with surgical site infection after pediatric posterior spinal fusion procedure. Infect Control Hosp Epidemiol 2009; 30 (2) 109-116
• 128 Gastmeier P, Breier AC, Sohr D et al. Prävention der postoperativen Wundinfektionen. Erkenntnisse aus 14 Jahren KISS (Krankenhausinfektionssurveillancesystem). Trauma Berufskrankh 2012; 14 (Suppl. 02) 110-114
• 129 Bryce EA, Walker M, Bevan C et al. Contamination of bronchoscopes with Mycobacterium tuberculosis. Can J Infect Control 1993; 8 (2) 35-36
• 130 Roosendaal R, Kuipers EJ, van den Brule AJ et al. Detection of Helicobacter pylori DNA by PCR in gastrointestinal equipment. Lancet 1993; 341 (8849) 900
• 131 Spach DH, Silverstein FE, Stamm WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 1993; 118 (2) 117-128
• 132 Fraser VJ, Zuckerman G, Clouse RE et al. A prospective randomized trial comparing manual and automated endoscope disinfection methods. Infect Control Hosp Epidemiol 1993; 14: 383-389
• 133 Armstrong RW, Bolding F. Septic arthritis after arthroscopy: The contributing roles of intraarticular steroids and environmental factors. Am J Infect Contr 1994; 22: 16-18
• 134 Bradley CR, Babb JR. Endoscopic decontamination: automated vs. manual. J Hosp Infect 1995; 30 (Suppl) 537-542
• 135 Andrieu J, Barny S, Colardelle P et al. Prevalence and risk factors of hepatitis C virus infection in a hospitalized population in a gastroenterology unit. Role of endoscopic biopsies. Gastroenterol Clin Biol 1995; 19 (4) 340-345
• 136 Bronowicki JP, Venard V, Botte C et al. Patient to patient transmission of hepatitis C virus during colonoscopy. New Engl J Med 1997; 337: 237-240
• 137 Roth K, Heeg P, Reichl R et al. Quality assurance on reprocessing accessories for flexible endoscopes – just how clean are cleaned instruments really. Zentr Steril 1999; 7 (2) 84-96
• 138 Srinivasan A, Wolfenden LL, Song X et al. An outbreak of pseudomonas aeruginosa infections associated with flexible bronchoscopes. New Engl J Med 2003; 348: 221-227
• 139 Hedke J, Skripitz R, Ellenrieder M et al. Low-grade-infection after a total knee arthroplasty caused by Actinomyces naeslundii. J Med Microbiol 2012; 28 (4) 242-243
• 140 Haenle M, Podbielski A, Ellenrieder M et al. Periprothetische Infektionen nach Hüft-Totalendoprothese mit ESBL-bildenden Bakterien: Bedeutung für die klinische Praxis. Orthopäde 2011; 40 (6) 528-534
• 141 Haenle M, Skripitz C, Mittelmeier W et al. Ökonomische Auswirkungen infizierter Hüft-Totalendoprothesen im DRG-System. Orthopäde 2012;
• 142 Herzog R, Morscher E. Behandlung von infizierten Hüft-Totalendoprothesen. Orthopäde 1995; 24 (4) 326-334
• 143 Fink B, Vogt S, Reinsch M, Büchner H. Sufficient release of antibiotic by a spacer 6 weeks after implantation in two-stagerevision of infected hip prostheses. Clin Orthop Relat Res 2011; 469 (11) 3141-3147
• 144 Fink B, Rechtenbach A, Büchner H et al. Articulating spacers used in two-stage revision of infected hip and knee prostheses abrade with time. Clin Orthop Relat Res 2011; 469 (4) 1095-1102
• 145 Gollwitzer H, Thomas P, Diehl P et al. Biomechanical and allergological characteristics of a biodegradable poly (D,L-lactic acid) coating for orthopaedic implants. J Orthop Res 2005; 23 (4) 802-809
• 146 Hardes J, Ahrens H, Gebert C et al. Lack of toxicological side-effects in silver-coated megaprostheses in humans. Biomaterials 2007; 28 (18) 2869-2875
• 147 Ellenrieder M, Haenle M, Lenz R et al. Titanium-copper-nitride coated spacers for two-stage revision of infected total hip endoprostheses. GMS Krankenhhyg Interdiszip 2011; 6 (1) Doc16
• 148 Hübner NO, Kramer A, Mittelmeyer W. Mastering old challenges with new alliances – how to breathe life in the amendments to the federal regulations for infection control in Germany. GMS Krankenhaushyg Interdiszip 2011; 6 (1) Doc27 (20111215)
• 149 Kasteren van ME, Mannien J, Ott A et al. Antibiotic prophylaxis and the risk of surgical site infections following total hip arthroplasty: timely administration is the most important factor. Clin Infect Dis 2007; 44 (7) 921-927
• 150 Kramer A, Assadian O, Exner M, Hübner NO, Simon A (Hrsg) Krankenhaus- und Praxishygiene. München: Elsevier Urban & Fischer; 2011
• 151 Kramer A, Assadian O (Hrsg) Wallhäusers Praxis der Sterilisation, Desinfektion, Antiseptik und Konservierung. Stuttgart: Thieme; 2008