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Nosokomiale Infektionen in Kinderkliniken

Nosocomial infections in pediatric hospitals

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Zusammenfassung

Zielsetzung

Nosokomiale Infektionen in Kinderkliniken gelangten in den letzten Jahren durch eine Reihe entsprechender Berichte in die öffentliche Wahrnehmung. Dabei wird fälschlicherweise das Problem der nosokomialen Übertragung gleichgesetzt mit Infektionen durch multiresistente Erreger. Ziel des vorliegenden Beitrags ist es, einen Überblick über die tatsächliche Bandbreite nosokomialer Infektionen in Kinderkliniken zu geben und adäquate präventive Maßnahmen aufzuzeigen, die den besonderen Bedingungen von Kinderkliniken gerecht werden.

Hintergrund

Nosokomiale Infektionen sind nur zu einem kleinen Prozentsatz durch multiresistente Erreger bedingt. In den meisten Fällen sind virulente Pathogene ursächlich, die bei Kindern mit hoher Morbidität zu entsprechenden Infektionen führen. Im Fokus der öffentlichen Berichterstattung stehen meist Ausbruchssituationen mit gramnegativen Erregern auf neonatologischen Intensivstationen. Tatsächlich spielen ZVK-assoziierte (ZVK: zentraler Venenkatheter) Infektionen mit grampositiven Erregern sowie nosokomiale Virusinfektionen, die nicht nur Intensivstationen, sondern auch allgemeinpädiatrische Abteilungen betreffen, im klinischen Alltag eine wesentlich bedeutendere Rolle.

Prävention

Unverändert bleibt die wichtigste präventive Maßnahme zur Vermeidung nosokomialer Infektionen die konsequente Umsetzung der Händehygiene, die nicht nur dem Personal, sondern auch Besuchern und Angehörigen nahegebracht werden sollte. Darüber hinaus bedarf es gerade in Kinderkliniken einer hinreichenden Ausstattung mit Personal und einer ausreichenden räumlichen Infrastruktur, die eine Trennung (potenziell) infektiöser von nichtinfektösen Patienten erlaubt. Die häufigste nosokomiale Infektion auf Intensivstationen – die ZVK-assoziierte Sepsis – kann durch ein Bündel von Maßnahmen, die von der sterilen Anlage bis hin zur Pflege der Kathetereintrittsstelle reichen, vermieden werden.

Abstract

Aim

During recent years, health-care associated infections (HAIs) in pediatric hospitals have evolved into an issue of intense public interest. Unfortunately, the appearance of HAIs is often misinterpreted as infections with multiresistent pathogens. The aim of the present review is to outline the real extent of HAIs in pediatric hospitals and to delineate adequate measures for prevention.

Background

Only a small percent of HAIs are due to multiresistent bacterial strains. In the majority of HAIs virulent pathogens cause infections in children with high morbidity. The publicly perceived outbreaks are in most events HAIs caused by gram-negative pathogens in neonatal intensive care units (NICUs). In contrast, most cases of nosocomial infections in pediatric hospitals are caused by central line-associated infections with gram-positive pathogens and due to transmission of viral pathogens.

Prevention

Appropriate hand hygiene remains undoubtedly the main pillar of HAI prevention and should be enforced not only with respect to all health care professionals but also with regard to parents, relatives, and visitors. In addition, pediatric hospitals are in particular need of adequate staffing and room infrastructure allowing the separation of infectious from non-infectious patients. Overcrowding and understaffing is regarded as a key component promoting HAIs. Finally, the prevention of central-line associated blood stream infections (CLABSIs) is achievable through the application of insertion and maintenance bundles focusing on sterile insertion techniques and aseptic catheter handling.

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  1. Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland

    S. Gehring & F. Zepp

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Correspondence to S. Gehring.

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Gehring, S., Zepp, F. Nosokomiale Infektionen in Kinderkliniken. Monatsschr Kinderheilkd 161, 687–696 (2013). https://doi.org/10.1007/s00112-013-2881-z

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