Post-Operative Wound Infections - you can’t prevent 100% of them
After the closing round of questions that concludes each module, presented by the leaders to each speaker and the public, the third section focuses on the management of antibiotics. PD Dr Roland Schulze-Röbbecke, Consultant for Hygiene and Medical Microbiology, addresses the issue of Post-Operative Wound Infection (POWI). The approach of reducing POWI by reducing the bacteria that can enter the operating wound from environment has mostly been exhausted in the industrialized countries. “The general belief that POWI occurs because of dirty surgical instruments, air conditioners that don’t work or surgery rooms not being cleaned properly is actually false. In rich industrialized countries at least, this doesn’t play any role at all in practice. Most incidences of POWI are rather caused by bacteria that the patient brings into operating room themselves, and these can only be partly eliminated”, explained Schulze-Röbbecke. Current evidence-based recommendations on how to reduce POWI rates focus on the bacteria on the patient’s own body which inevitably enter the operating wound in each operation. The risk of POWI caused by this type of bacteria, endogenous bacteria, can be reduced by sufficient peri-operative antimicrobial prophylaxis for many operations, for example.

Further evidence-based preventive measures focus on maintaining normal levels of body temperature and blood sugars, as well as on achieving optimal blood flow ratios and oxygen supply to the operated tissue so that the patient’s physiological defence mechanisms are impaired as little as possible. Pre-operative antiseptic skin preparation (washing) with products which contain alcohol, an agent which works quickly, and Chlorhexidine, as a residual active agent, is also relevant. The recording and evaluation (monitoring) of POWI incidence is very important as reducing POWI rates is impossible without this data being present. “Complete elimination of POWI is impossible, at our current level of knowledge”, said Schulze-Röbbecke, “this is because many of the significant risk factors cannot be influenced, for example severe primary disease, old age, obesity and nicotine abuse”.
Antibiotic Stewardship - decreases the rate of pathogens’ resistance to antibiotics in clinics
Anne Eva Lauprecht, a hospital doctor specializing in hygiene at the Essen-Mitte clinic group, shows that the “Clean and Isolate” strategy alone is not enough to bring about a reduction in hospital infections. On the contrary, this costs hospitals a lot of money although there isn’t any scientific evidence in favor of many of these measures. In addition, the individual outcomes for isolated patients are poorer than those for patients treated without these hygiene measures. This is because isolated patients have less contact with care staff and doctors. The national German Prevalence Survey for 2016 showed that the prevalence of nosocomial infections in hospitals was 4.6%, just slightly lower than it was five years ago when it was 5.1%. The primary objective must be to improve infection prevention significantly and to implement strategies for a reasonable level of antibiotic therapy in line with Antibiotic Stewardship (ABS) in hospitals as well as in the outpatient sector. “Using ABS, we can do more than simply significantly reduce the local rate of pathogens’ resistance to antibiotics in local hospitals within a short time” summed up Lauprecht, “moreover, studies overwhelmingly show that Clostridium difficile infections can be drastically reduced by ABS and by restricting prescription of certain groups of antibiotics”. The ABS expert also remarked that a consistently high rate of resistance to many antibiotics and the constant rise in 3MRGN E-coli in hospitals are generally problems that are caused in-house. This is crucial, particularly for calculated antibiotic therapy. A low rate of pathogen resistance to antibiotics results in safer medical treatment and thus ensures a better quality of care, continued Lauprecht.

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