| dc.contributor.advisor | Laier-Groeneveld, Gerhard Prof. Dr. | |
| dc.contributor.author | Hoffmann, Lisa Barbara | |
| dc.date.accessioned | 2017-03-16T10:00:02Z | |
| dc.date.available | 2017-04-05T22:50:10Z | |
| dc.date.issued | 2017-03-16 | |
| dc.identifier.uri | http://hdl.handle.net/11858/00-1735-0000-0023-3DDD-7 | |
| dc.identifier.uri | http://dx.doi.org/10.53846/goediss-6179 | |
| dc.language.iso | deu | de |
| dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ | |
| dc.subject.ddc | 610 | de |
| dc.title | Übertragungen von Keimen auf einer speziellen, vorwiegend nicht-invasiven Beatmungsintensivstation | de |
| dc.type | doctoralThesis | de |
| dc.title.translated | Transmission of germs in a special, predominantly noninvasive respiratory intensive care unit | de |
| dc.contributor.referee | Laier-Groeneveld, Gerhard Prof. Dr. | |
| dc.date.examination | 2017-03-29 | |
| dc.description.abstracteng | Both the transmission of germs from one patient to another and nosocomial infections play a major role in the intensive care unit (ICU). Intubation and sedation of the patient contribute to this risk as well as invasive aditus.
Studies have shown that the initiation of noninvasive ventilation in chronic respiratory weakness may lead to a decrease in the number of infections. If intubation can be avoided through early noninvasive ventilation, the absolute survival rate increases by approximately 20% (Brochard et. al. 1995). The risk of nosocomial pneumonia is reduced significantly.
The working group Heimbeatmung und Respiratorentwöhnung e.V., now DIGAB, defined different hygienic standards for patients treated in this way (Laier-Groeneveld 1996).
In the noninvasive respiratory ICU (RICU) of the Klinikum Niederrhein, it is standard practice to carry out various microbiological examinations upon admission and discharge of the patient, as well as weekly and in the course of bronchoscopy.
This clinical trial examined all microbiological data collected in 2010 for the transfer of germs from one patient to another and the impact of the transmissions on infection risk, underlying disease, therapy and prognosis during both the inpatient stay and following the patient’s discharge from the clinic.
In addition, all nosocomial infections were recorded during the same period and their significance in terms of underlying disease, therapy and prognosis was evaluated.
The results show that there were very few germ transmissions on the RICU. Germ transmission only occurred in 11% of the patients and in 3% of 363 patients contacts. The longer the patients were treated in the RICU--i.e. the longer their contact and length of stay in hospital were-- the higher the risk of germ transmission was. The number of infections was comparable to those seen in conventional ICUs, with fewer infections associated with the respiratory tract. This is remarkable since primarily patients suffering from pulmonary diseases, and therefore with an impaired and weakened respiratory tract, were treated in the RICU, which means that an increased infection rate would have been highly likely. There was no evidence of an increased risk of developing an infection when germs had been transferred. However, there was an increased mortality in patients with confirmed germ transmission or infection. This can be explained by the fact that the patients with germ transfers were, on the one hand, more severely ill: firstly, the blood gas levels measured on admission and discharge show that their respiratory function was poorer, and secondly, the ventilation therapy on discharge was more intense. On the other hand, there were predominantly obstructive pulmonary diseases, with ventilation therapy originally triggered by a chronic disease. Here, the parenchyma of the lung is impaired as part of the underlying disease and the function of the body's natural barrier against pathogens is reduced.
The study results do not confirm the existence of an increased risk of germ transfer in patients treated within the noninvasive RICU. An impact on the outcome of this patient collective cannot be demonstrated. It can therefore be concluded that a modification of the hygienic measures, as recommended by DIGAB for the RICU or for patient treatment within a comparable setting, is not indicated. | de |
| dc.contributor.coReferee | Perl, Thorsten PD Dr. | |
| dc.contributor.thirdReferee | Scheithauer, Simone Prof. Dr. | |
| dc.subject.eng | Infektion | de |
| dc.subject.eng | noninvasive | de |
| dc.subject.eng | icu | de |
| dc.subject.eng | transmission | de |
| dc.identifier.urn | urn:nbn:de:gbv:7-11858/00-1735-0000-0023-3DDD-7-1 | |
| dc.affiliation.institute | Medizinische Fakultät | de |
| dc.subject.gokfull | Anästhesiologie / Intensivmedizin / Notfallmedizin / Analgesie - Allgemein- und Gesamtdarstellungen (PPN619875917) | de |
| dc.subject.gokfull | Innere Medizin - Allgemein- und Gesamtdarstellungen (PPN619875747) | de |
| dc.description.embargoed | 2017-04-05 | |
| dc.identifier.ppn | 88228892X | |