Hautantiseptik

Günter Kampf

doi:10.1055/a-1398-5054

Krankenhaushygiene up2date, Table of Contents

Krankenhaushygiene up2date 2022; 17(01): 21-34
DOI: 10.1055/a-1398-5054

Präventionsmaßnahmen

Hautantiseptik

Günter Kampf

Abstract

All articles of this category

Die antiseptische Behandlung der Haut von Patienten ist ein Standardverfahren zur Prävention postoperativer Wundinfektionen sowie Katheter-assoziierter Septikämien. Die Zusammensetzung der Hautantiseptika variiert erheblich, der erwartbare gesundheitliche Patientennutzen ist unterschiedlich gut belegt.

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References

Literatur
1 Reichel M, Heisig P, Kohlmann T. et al. Alcohols for skin antisepsis at clinically relevant skin sites. Antimicrob Agents Chemother 2009; 53: 4778-4782
2 Durani P, Leaper D. Povidone-iodine: use in hand disinfection, skin preparation and antiseptic irrigation. Int Wound J 2008; 5: 376-387
3 Gottardi W. The uptake and release of molecular iodine by the skin: chemical and bactericidal evidence of residual effects caused by povidone-iodine preparations. J Hosp Infect 1995; 29: 9-18
4 Kampf G. Acquired resistance to chlorhexidine – is it time to establish an “antiseptic stewardship” initiative?. J Hosp Infect 2016; 94: 213-227
5 Muller G, Langer J, Siebert J. et al. Residual antimicrobial effect of chlorhexidine digluconate and octenidine dihydrochloride on reconstructed human epidermis. Skin Pharmacol Physiol 2014; 27: 1-8
6 Hubner NO, Siebert J, Kramer A. Octenidine dihydrochloride, a modern antiseptic for skin, mucous membranes and wounds. Skin Pharmacol Physiol 2010; 23: 244-258
7 Lutz JT, Diener IV, Freiberg K. et al. Efficacy of two antiseptic regimens on skin colonization of insertion sites for two different catheter types: a randomized, clinical trial. Infection 2016; 44: 707-712
8 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: 600-606
9 Harnoss JC, Assadian O, Kramer A. et al. Comparison of chlorhexidine-isopropanol with isopropanol skin antisepsis for prevention of surgical-site infection after abdominal surgery. Br J Surg 2018; 105: 893-899
10 KRINKO am Robert Koch Institut. Die Kategorien in der Richtlinie für Krankenhaushygiene und Infektionsprävention – Aktualisierung der Definitionen. Bundesgesundheitsblatt 2010; 53: 754-756
11 KRINKO am Robert Koch Institut. Prävention postoperativer Wundinfektionen. Bundesgesundheitsbl 2018; 61: 448-473
12 Darouiche RO, Wall MJ, Itani KM. et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010; 362: 18-26
13 Srinivas A, Kaman L, Raj P. et al. Comparison of the efficacy of chlorhexidine gluconate versus povidone iodine as preoperative skin preparation for the prevention of surgical site infections in clean-contaminated upper abdominal surgeries. Surgery Today 2015; 45: 1378-1384
14 Abreu D, Campos E, Seija V. et al. Surgical site infection in surgery for benign prostatic hyperplasia: comparison of two skin antiseptics and risk factors. Surg Infect 2014; 15: 763-767
15 Brown TR, Ehrlich CE, Stehman FB. et al. A clinical evaluation of chlorhexidine gluconate spray as compared with iodophor scrub for preoperative skin preparation. Surg Gynecol Obstetr 1984; 158: 363-366
16 Bibi S, Shah SA, Qureshi S. et al. Is chlorhexidine-gluconate superior than Povidone-Iodine in preventing surgical site infections? A multicenter study. . J Pakistan Med Assoc 2015; 65: 1197-1201
17 Xu PZ, Fowler JR, Goitz RJ. Prospective Randomized Trial Comparing the Efficacy of Surgical Preparation Solutions in Hand Surgery. Hand (NY) 2017; 12: 258-264
18 Sistla SC, Prabhu G, Sistla S. et al. Minimizing wound contamination in a 'clean' surgery: comparison of chlorhexidine-ethanol and povidone-iodine. Chemotherapy 2010; 56: 261-267
19 Bibbo C, Patel DV, Gehrmann RM. et al. Chlorhexidine provides superior skin decontamination in foot and ankle surgery: a prospective randomized study. Clin Orthop Relat Res 2005; 438: 204-208
20 Paocharoen V, Mingmalairak C, Apisarnthanarak A. Comparison of surgical wound infection after preoperative skin preparation with 4% chlorhexidine [correction of chlohexidine] and povidone iodine: a prospective randomized trial. Journal of the Medical Association of Thailand 2009; 92: 898-902
21 Dior UP, Kathurusinghe S, Cheng C. et al. Effect of Surgical Skin Antisepsis on Surgical Site Infections in Patients Undergoing Gynecological Laparoscopic Surgery: A Double-Blind Randomized Clinical Trial. JAMA Surg 2020; 155: 807-815
22 Charles D, Heal CF, Delpachitra M. et al. Alcoholic versus aqueous chlorhexidine for skin antisepsis: the AVALANCHE trial. Can Med Assoc J 2017; 189: E1008-e1016
23 Gilliam DL, Nelson CL. Comparison of a one-step iodophor skin preparation versus traditional preparation in total joint surgery. Clin Orthop Relat Res 1990; 258-260
24 Segal CG, Anderson JJ. Preoperative skin preparation of cardiac patients. AORN J 2002; 76: 821-828
25 Maiwald M, Widmer AF. WHO's recommendation for surgical skin antisepsis is premature. Lancet Infect Dis 2017; 17: 1023-1024
26 Rodrigues AL, Simões MdeL. Incidence of surgical site infection with pre-operative skin preparation using 10% polyvidone-iodine and 0.5% chlorhexidine-alcohol. Rev Col Bras Cir 2013; 40: 443-448
27 Veiga DF, Damasceno CAV, Veiga-Filho J. et al. Povidone iodine versus chlorhexidine in skin antisepsis before elective plastic surgery procedures: a randomized controlled trial. Plast Reconstr Surg 2008; 122: 170e-171e
28 Berry AR, Watt B, Goldacre MJ. et al. A comparison of the use of povidone-iodine and chlorhexidine in the prophylaxis of postoperative wound infection. J Hosp Infect 1982; 3: 55-63
29 Cheng K, Robertson H, St Mart JP. et al. Quantitative analysis of bacteria in forefoot surgery: a comparison of skin preparation techniques. Foot Ankle Intern 2009; 30: 992-997
30 Casey A, Itrakjy A, Birkett C. et al. A comparison of the efficacy of 70% v/v isopropyl alcohol with either 0.5% w/v or 2% w/v chlorhexidine gluconate for skin preparation before harvest of the long saphenous vein used in coronary artery bypass grafting. Am J Infect Control 2015; 43: 816-820
31 Saltzman MD, Nuber GW, Gryzlo SM. et al. Efficacy of surgical preparation solutions in shoulder surgery. J Bone Joint Surg Am Vol 2009; 91: 1949-1953
32 Savage JW, Weatherford BM, Sugrue PA. et al. Efficacy of surgical preparation solutions in lumbar spine surgery. J Bone Joint Surg Am Vol 2012; 94: 490-494
33 Tuuli MG, Liu J, Stout MJ. et al. A Randomized Trial Comparing Skin Antiseptic Agents at Cesarean Delivery. N Engl J Med 2016; 374: 647-655
34 Peel TN, Dowsey MM, Buising KL. et al. Chlorhexidine-alcohol versus iodine-alcohol for surgical site skin preparation in an elective arthroplasty (ACAISA) study: a cluster randomized controlled trial. Clin Microbiol Infect 2019; 25: 1239-1245
35 Ngai IM, Van Arsdale A, Govindappagari S. et al. Skin Preparation for Prevention of Surgical Site Infection After Cesarean Delivery: A Randomized Controlled Trial. Obstetr Gynecol 2015; 126: 1251-1257
36 Broach RB, Paulson EC, Scott C. et al. Randomized Controlled Trial of Two Alcohol-based Preparations for Surgical Site Antisepsis in Colorectal Surgery. Ann Surg 2017; 266: 946-951
37 Kesani VP, Talasila S, Sheela SR. Chlorhexidine-alcohol versus Povidone-Iodine-alcohol for surgical site antisepsis in caesarean section. Int J Reprod Contracept Obstet Gynecol 2019; 8: 1359-1362
38 Ritter B, Herlyn PKE, Mittlmeier T. et al. Preoperative skin antisepsis using chlorhexidine may reduce surgical wound infections in lower limb trauma surgery when compared to povidone-iodine – a prospective randomized trial. Am J Infect Control 2020; 48: 167-172
39 Dumville JC, McFarlane E, Edwards P. et al. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev 2015;
40 National Institute for Health and Care Excellence (NICE). Surgical site infection: prevention and treatment. [B] Evidence review for the effectiveness of skin antiseptics in the prevention of surgical site infection. NICE guideline NG125 (April 2019). Verfügbar unter (Stand 19.04.2021): https://www.nice.org.uk/guidance/ng125/evidence/b-skin-antiseptics-in-the-prevention-of-surgical-site-infection-pdf-6727104399
41 Wade RG, Burr NE, McCauley G. et al. The Comparative Efficacy of Chlorhexidine Gluconate and Povidone-iodine Antiseptics for the Prevention of Infection in Clean Surgery: A Systematic Review and Network Meta-analysis. Ann Surg 2020;
42 Peel TN, Watson E, Lee SJ. Randomised Controlled Trials of Alcohol-Based Surgical Site Skin Preparation for the Prevention of Surgical Site Infections: Systematic Review and Meta-Analysis. J Clin Med 2021; 10: 663
43 Dörfel D, Maiwald M, Daeschlein G. et al. Comparison of the antimicrobial efficacy of povidone-iodine-alcohol versus chlorhexidine-alcohol for surgical skin preparation on the aerobic and anaerobic skin flora of the shoulder region. Antimicrob Resist Infect Control 2021; 10: 17
44 Kadler BK, Mehta SS, Funk L. Propionibacterium acnes infection after shoulder surgery. Int J Shoulder Surg 2015; 9: 139-144
45 Mitchell IM, Pollock JC, Jamieson MP. et al. Transcutaneous iodine absorption in infants undergoing cardiac operation. Ann Thorac Surg 1991; 52: 1138-1140
46 Smerdely P, Lim A, Boyages SC. et al. Topical iodine-containing antiseptics and neonatal hypothyroidism in very-low-birthweight infants. Lancet 1989; 2: 661-664
47 Tomoda C, Kitano H, Uruno T. et al. Transcutaneous iodine absorption in adult patients with thyroid cancer disinfected with povidone-iodine at operation. Thyroid 2005; 15: 600-603
48 Mimoz O, Lucet JC, Kerforne T. et al. Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial. Lancet 2015; 386: 2069-2077
49 Lachapelle JM. A comparison of the irritant and allergenic properties of antiseptics. Eur J Dermatol 2014; 24: 3-9
50 Wulf NR, Schmitz J, Choi A. et al. Iodine allergy: Common misperceptions. Am J Health-System Pharm 2021; 78: 781-793
51 Varelmann D, Hostmann F, Stüber F. et al. Livide Verfärbung der Hand als unerwünschtes Ereignis bei axillärer Plexusanästhesie. Der Anaesthesist 2004; 53: 441-444
52 Campbell ST, Goodnough LH, Bennett CG. et al. Antiseptics Commonly Used in Total Joint Arthroplasty Interact and May Form Toxic Products. J Arthroplasty 2018; 33: 844-846
53 WHO. Global guidelines for the prevention of surgical site infections. Geneva: WHO; 2016
54 Shepherd MJ, Moore G, Wand ME. et al. Pseudomonas aeruginosa adapts to octenidine in the laboratory and a simulated clinical setting, leading to increased tolerance to chlorhexidine and other biocides. J Hosp Infect 2018; 100: e23-e29
55 Wand ME, Jamshidi S, Bock LJ. et al. SmvA is an important efflux pump for cationic biocides in Klebsiella pneumoniae and other Enterobacteriaceae. Sci Rep 2019; 9: 1344
56 Mueller-Wirth N, Buenter A, Jörg L. et al. IgE-mediated chlorhexidine allergy-Cross-reactivity with other biguanide disinfectants. Allergy 2020; 75: 3237-3247
57 KRINKO am Robert Koch Institut. Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt 2017; 60: 171-215
58 Lai NM, Lai NA, O'Riordan E. et al. Skin antisepsis for reducing central venous catheter-related infections. Cochrane Database Syst Rev 2016;
59 McCann M, Fitzpatrick F, Mellotte G. et al. Is 2% chlorhexidine gluconate in 70% isopropyl alcohol more effective at preventing central venous catheter-related infections than routinely used chlorhexidine gluconate solutions: A pilot multicenter randomized trial (ISRCTN2657745)?. Am J Infect Control 2016; 44: 948-949
60 Guenezan J, Marjanovic N, Drugeon B. et al. Chlorhexidine plus alcohol versus povidone iodine plus alcohol, combined or not with innovative devices, for prevention of short-term peripheral venous catheter infection and failure (CLEAN 3 study): an investigator-initiated, open-label, single centre, randomised-controlled, two-by-two factorial trial. Lancet Infect Dis 2021; 21: 1038-1048
61 KRINKO am Robert Koch Institut. Anforderungen an die Hygiene bei Punktionen und Injektionen. Bundesgesundheitsbl 2011; 54: 1135-1144
62 Allegranzi B, Bischoff P, de Jonge S. et al. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 2016; 16: e276-e287
63 Carre Y, Moal B, Germain C. et al. Randomized study of antiseptic application technique in healthy volunteers before vascular access insertion (TApAS trial). J Infect 2020; 81: 532-539
64 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