Advertisement

Antiseptik bei Intensiv- und Malignompatienten

  • D. Gröschel

Zusammenfassung

Die Verminderung der natürlichen Infektionsabwehr führt bei Patienten in intensivmedizinischen Bereichen und auf onkologischen Stationen zu besonderer Gefährdung durch nosokomiale Infektionen sowie zu erhöhter Mortalität. Fortschritte in den Behandlungsmethoden haben das Infektionsrisiko noch erhöht, sei es durch die Umgehung normaler Abwehrmechanismen wie beim Durchstechen der Haut mit Kanülen und Kathetern, der Einführung von Trachealkanülen oder eines Blasendauerkatheters. Die antineoplastische Chemotherapie vermindert die zelluläre Abwehr sowie die lokalen Abwehrmechanismen z. B. durch ihre Mucosatoxizität. Antimikrobielle Medikamente können die normale Flora verändern und damit die Kolonisationsresistenz beeinträchtigen (s. Kap. 16).

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Ahrenholz DH, Simmons RL (197) Povidone-iodine in peritonitis. J Surg Res 26:458–463CrossRefGoogle Scholar
  2. Anderson RL (1989) Iodophor antiseptics: intrinsic microbial contamination with resistant bacteria. Infect Control Hosp Epidemiol 10: 443–446PubMedCrossRefGoogle Scholar
  3. Bell LM, Alpert G, Slight PH, Campos JM (1988) Malassezia furfur skin colonization in infancy. Infect Control Hosp Epidemiol 9: 151–153PubMedCrossRefGoogle Scholar
  4. Benzer H, Brühl P, Dietzel W, Kilian J, Lackner F, Reybrouck G, Rotter M, Werner G (1987) The hygienic situation in 56 German, 33 Austrian, and 25 Belgian intensive care units. Infect Control 8: 376–379PubMedGoogle Scholar
  5. Bodey GP, Buckley M, Sathe YS, Freireich EJ (1966) Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 64: 328–340PubMedGoogle Scholar
  6. Bowden TA, Dipiro JT, Michael KA (1987) Polyethylene glycol electrolyte lavage solution ( PEG-ELS ). Am Surg 53: 34–36Google Scholar
  7. Brun-Buisson C, Legrand P, Rauss A, Richard C, Montravers F, Besbes M, Meakins JL, Soussy CJ, Lemaire F (1989) Intestinal decontamination for control of nosocomial multiresistant Gram-negative bacilli. Ann Intern Med 110: 873–881PubMedGoogle Scholar
  8. Bruns DE, Herold DA, Rodeheaver GT, Edlich RF (1982) Polyethylene glycol intoxication in burn patients. Burns 9: 49–52CrossRefGoogle Scholar
  9. Denning DW, Haiduven-Griffiths D (1988) Eradication of low-level methicillin-resistant Staphylococcus aureus skin colonization with topical mupirocin. Infect Control Hosp Epidemiol 9: 261 - 263 PubMedCrossRefGoogle Scholar
  10. Doebbeling BN, Pfaller MA, Houston AK, Wenzel RP (1988) Removal of nosocomial pathogens from the contaminated glove. Ann Intern Med 109: 394–398PubMedGoogle Scholar
  11. Garibaldi RA (1988) Prevention of intraoperative wound contamination with chlorhexidine shower and scrub. J Hosp Infect 11 Suppl B:5–9PubMedCrossRefGoogle Scholar
  12. Glinz W (1987) Neuere Aspekte and zukünftige Entwicklungen in der Infektionsprophylaxe auf Intensivstationen. Schweiz Med Wochenschr 117: 426–432PubMedGoogle Scholar
  13. Goetz A, Muder RR (1989) Pseudomonas aeruginosa infections associated with use of povidone-iodine in patients receiving continuous ambulatory peritoneal dialysis. Infect Control Hosp Epidemiol 10: 447–450PubMedCrossRefGoogle Scholar
  14. van Griethuysen AJA, Clasener HAL, Vollaard EJ, Niessen M (1987) Colonization resistance: a guide to antibiotic policy in the ICU (letter). Infect Control 8: 296–270Google Scholar
  15. Gründling M, Feyerherd F, Panzig B, Borchert K (1990) Untersuchungen zur aeroben Besiedlung von Mund and Trachea bei Beatmungspatienten unter Selektiver Munddekontamination ( SMD ). Hyg Med 15: 375–379Google Scholar
  16. Gênther I, Merka V, Bohnenstengel C (1981) Das antimikrobielle Regime unter gnotobiotischen Bedingungen im Krankenhaus-Reinraumtechnik. In: Weuffen W, Oberdoerster F, Kramer A (Hrsg) Krankenhaushygiene, 2. Aufl. Barth, Leipzig, S 324–329Google Scholar
  17. Hansbrough JF, Boyce ST, Cooper ML, Foreman TJ (1989) Burn wound closure with cultured autologous keratinocytes and fibroblasts attached to a collagen-glycosaminoglycan substrate. J Am Med Wom Assoc 262: 2125–2130CrossRefGoogle Scholar
  18. Kaplowitz LG, Comstock JA, Landwehr DM, Dalton HP, Mayhall CG (1988) A prospective study of infections in hemodialysis patients: patient hygiene and other risk factors for infection. Infect Control Hosp Epidemiol 9: 534–541PubMedCrossRefGoogle Scholar
  19. Kearney JN, Arain T, Holland KT (1988) Antimicrobial properties of antiseptic-impregnated biological dressings. J Hosp Infect 11: 68–76PubMedCrossRefGoogle Scholar
  20. Larson E (1988 a) A causal link between handwashing and risk of infection? Examination of the evidence. Infect Control Hosp Epidemiol 9:28–36Google Scholar
  21. Larson E (1988 b) Guideline for use of topical antimicrobial agents. Am J Infect Control 16:253-L266Google Scholar
  22. Leclair JM, Winston KR, Sullivan BF, O’Connell JM, Harrington SM, Goldmann DA (1988) Effect of preoperative shampoos with chlorhexidine or iodophor on emergence of resident scalp flora in neurosurgery. Infect Control Hosp Epidemiol 9: 8–12PubMedCrossRefGoogle Scholar
  23. Lewis R (1988) Antiseptic resistance in JK and other coryneforms. J Hosp Infect 11: 150–154PubMedCrossRefGoogle Scholar
  24. Lippert H, Kramer A, Weuffen W (1981) Infektiöser Hospitalismus in der chirurgischen Intensivtherapie and seine Bekämpfung. In: Weuffen W, Oberdoerster F, Kramer A (Hrsg) Krankenhaushygiene, 2. Aufl. Barth, Leipzig, S 305–315Google Scholar
  25. Maki DG, Bond JD (1981) A comparative study of polyantibiotic and iodophor ointments in prevention of vascular catheter-related infection. Am J Med 70: 739–744PubMedCrossRefGoogle Scholar
  26. McGinley KJ, Larson EL, Leyden JJ (1988) Composition and density of microflora in the subungual space of the hand. J Clin Microbiol 26: 950–953PubMedGoogle Scholar
  27. Morse LJ, Williams HL, Grenn FP, Eldridge EE, Rotta JR (1967) Septicemia due to Klebsiella pneumoniae originating from a hand-cream dispenser. N Engl J Med 277:472 - 473 PubMedCrossRefGoogle Scholar
  28. Newsom SWB, Rowland C (1989) Application of the hygienic hand desinfection test to the gloved hand. J Hosp Infect 14: 245–247PubMedCrossRefGoogle Scholar
  29. Nichols RL, Broido P, Condon RE, Gorbach SL, Nyhus LM (1973) Effect of preoperative neomycin-erythromycin intestinal preparation on the incidence of infectious complications following colon surgery. Ann Surg 178: 453–459PubMedCrossRefGoogle Scholar
  30. Onesko KM, Wienke EC (1987) The analysis of the impact of a mild, low-iodine, lotion soap on the reduction of nosocomial methicillin-resistant Staphylococcus aureus: a new opportunity for surveillance by objectives. Infect Control 8: 284–288PubMedGoogle Scholar
  31. Rahman M, Noble WC, Cookson B (1987) Mupirocin-resistant Staphylococcus aureus. Lancet II:387Google Scholar
  32. Reber H (1960) Versagen der Händedesinfektion bei Besiedlung mit Cloaca cloacae. Pathol Microbiol (Basel) 23: 587–590Google Scholar
  33. Rodeheaver G, Turnbull V, Edgerton MT, Kurtz L, Edlich RF (1976) Pharmacokinetics of a new skin wound cleanser. Am J Surg 132: 67–74PubMedCrossRefGoogle Scholar
  34. Rotstein C, Cummings KM, Nicolaou AL, Lucey J, Fitzpatrick J (1988) Nosocomial infection rates at an oncology center. Infect Control Hosp Epidemiol 9: 13–19PubMedCrossRefGoogle Scholar
  35. Rotter M, Larson SO, Cooke EM, Dankert J, Daschner F, Greco D, Grönroos P, Jepsen OB, Lystad A, Nyström B (1988) A comparison of the effects of preoperative whole-body bathing with detergent alone and with detergent containing chlorhexidine gluconate on the frequency of wound infections after clean surgery. J Hosp Infect 11: 310–320PubMedCrossRefGoogle Scholar
  36. Samaranayake LP, Robertson AG, McFarlane TW, Soutar DS, Ferguson MM (1988) The effect of chlorhexidine and benzydamine mouthwashes on mucositis induced by therapeutic irradiation. Clin Radiol 39: 291–294PubMedCrossRefGoogle Scholar
  37. Schimpff SC, Young VM (1981) Epidemiology and Prevention of Infection in the Compromised Host. In: Rubin AH, Young LS (Ed) Clinical Approach to Infection Control in the Compromised Host. Plenum, New York, pp 5–33Google Scholar
  38. Smerdely P, Boyages SC, Wu D, Leslie G, John E, Lim A, Waite K, Roberts V, Arnold J, Eastman CJ (1989) Topical iodine-containing antiseptics and neonatal hyperthyroidism in very-low-birth-weight infants. Lancet II:661–664Google Scholar
  39. Thompson RL, Haley CE, Searcy MA, Guenthner SM, Kaiser DL, Gröschel DHM, Gillenwater JY,Wenzel RP (1984) Catheter-associated bacteriuria. J Am Med Wom Assoc 251: 747–751Google Scholar
  40. Tetteroo GWM, Wagenvoort IHT, Castelein A, Tilanus HW, Ince C, Bruining HA (1990) Selective decontamination to reduce gram-negative colonisation and infections after oesophageal resection. Lancet 335: 704–707PubMedCrossRefGoogle Scholar
  41. Vogel F, Rommelsheim K, Exner M (1984) Auswirkungen der intratrachealen Aminoglykosidapplikation zur Prophylaxe and Therapie von Beatmungspneumonien. In: Lode H, Kemmerich B, Klastersky J (Hrsg) Aktuelle Aspekte der bakteriellen and nichtbakteriellen Pneumonien. Thieme, Stuttgart, S 204–211Google Scholar
  42. Vorherr H, Ulrich JA, Messer RH, Hurwitz EB (1980) Antimicrobial effect of chlorhexidine on bacteria of groin, perineum and vagina. J Reprod Med 24: 153–157PubMedGoogle Scholar
  43. Wahlin YB (1989) Effects of chlorhexidine mouthrinse on oral health in patients with acute leukemia. Oral Surg Oral Med Oral Pathol 68: 279–287PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • D. Gröschel

There are no affiliations available

Personalised recommendations