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DOI: 10.1055/a-2062-3447
Was Schluckstörungen mit Hygiene zu tun haben
Infektionsprävention und Dysphagiologie
Unerkannte Dysphagien können zu Pneumonien führen. Logopäden sowie ärztlichem Fachpersonal mit dysphagiologischem Bezug kommt in diesem Kontext eine besondere Rolle in der Infektionsprävention zu. Dabei trägt diese Personengruppe selbst ein hohes Infektionsrisiko durch die notwendige Nähe zu Patienten. Dieser Übersichtsartikel stellt die verschiedenen Aspekte der „Schluckdiagnostik“ und ihre Interaktion mit der Infektionsprävention dar.
Abstract
Unrecognized dysphagia can lead to pneumonia. The significance of dysphagia in the context of infection surveillance is currently not mapped but can lead to bias in detecting nosocomial respiratory tract infections. The professional groups of speech therapists and medical dysphagiologists from the fields of ENT, gastroenterology, neurology, neurosurgery, neuropaediatrics, and anaesthesiology have a special role in infection prevention in this context. These professionals themselves are concerned about infection control due to their proximity to the respiratory tract, as they become susceptible to respiratory infections and can also represent superspreaders. This review article presents the different aspects of swallowing diagnostics and their interaction with infection prevention.
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Der Stellenwert der Dysphagiediagnostik und -therapie im Präventionsbundle der nosokomialen Atemwegsinfektionen sollte reevaluiert werden und einen Kernbestandteil der Prävention bilden.
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Unerkannte Dysphagien führen zu Infektionen, die dann ggf. auch Hygienemängel suggerieren können.
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Zur Diagnose eignet sich neben anderen Verfahren insbesondere die FEES-Untersuchung mit hoher Sensitivität und Spezifität.
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Dysphagie ist nicht gleich Dysphagie: sensible Dysphagie braucht im Gegensatz zu motorischen Schluckstörungen andere therapeutische Maßnahmen.
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Eine zusätzliche Schulung in der Händehygiene unter didaktisch günstigen Bedingungen ist zwar nicht verkehrt, jedoch in Bezug auf eine Häufung von dysphagieassoziierten Atemwegsinfektionen wenig hilfreich.
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Das logopädische Fachpersonal stellt aufgrund seiner Assoziation zum ungeschützten Atemweg von infektiösen Personen, der Notwendigkeit der körperlichen Nähe sowie ihrer Fluktuation auf den Stationen relevante und potenzielle Superspreader dar.
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Im Rahmen von kontaktassoziierten Erkrankungen (Gastroenteritiden) sollte das logopädische Fachpersonal in Ausbruchssitzungen integriert werden oder zumindest engmaschig informiert werden.
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Der obligatorische Einsatz von antiinfektiven Substanzen im Falle einer Aspiration muss sehr kritisch hinterfragt werden.
Publication History
Article published online:
27 November 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
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Literatur
- 1 Leistner R, Kankura L, Bloch A. et al. Attributable costs of ventilator-associated lower respiratory tract infection (LRTI) acquired on intensive care units: a retrospectively matched cohort study. Antimicrob Resist Infect Control 2013; 2: 1-6 DOI: 10.1186/2047-2994-2-13. (PMID: 23556425)
- 2 Zarb P, Coignard B, Griskeviciene J. et al. The European Centre for Disease Prevention and Control (ECDC) pilot point prevalence survey of healthcare-associated infections and antimicrobial use. Euro Surveill 2012; 17: 20316 DOI: 10.2807/ese.17.46.20316-en. (PMID: 23171822)
- 3 Plachouras D, Kärki T, Hansen S. et al. Antimicrobial use in European acute care hospitals: results from the second point prevalence survey (PPS) of healthcare-associated infections and antimicrobial use, 2016 to 2017. Euro Surveill 2018; 23: 1800393
- 4 KRINKO. Prävention der nosokomialen beatmungsassoziierten Pneumonie Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsbl 2013; 56: 1578-1590
- 5 Dickson RP, Erb-Downward JR, Huffnagle GB. The role of the bacterial microbiome in lung disease. Expert Rev Respir Med 2013; 7: 245-257 DOI: 10.1586/ers.13.24. (PMID: 23734647)
- 6 Deutsche Gesellschaft für Infektiologie e.V. (DGI). et al. S3- Leitlinie Strategien zur Sicherung rationaler Antibiotika-Anwendung im Krankenhaus. Stand: 2018. AWMF-Registernummer 092/001. Accessed October 23, 2023 at: https://register.awmf.org/de/leitlinien/detail/092–001
- 7 Frank U, Frank K. COVID-19-New challenges in dysphagia and respiratory therapy. Nervenarzt 2022; 93: 167-174 DOI: 10.1007/s00115-021-01162-5. (PMID: 34241639)
- 8 Christmas C, Rogus-Pulia N. Swallowing Disorders in the Older Population. J Am Geriatr Soc 2019; 67: 2643-2649 DOI: 10.1111/jgs.16137. (PMID: 31430395)
- 9 Warnecke T, Labeit B, Schroeder J. et al. Neurogenic Dysphagia: Systematic Review and Proposal of a Classification System. Neurology 2021; 96: e876-e889 DOI: 10.1212/WNL.0000000000011350. (PMID: 33318164)
- 10 Arnold M, Liesirova K, Broeg-Morvay A. et al. Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome. PLoS One 2016; 11: e0148424 DOI: 10.1371/journal.pone.0148424. (PMID: 26863627)
- 11 Schindler A, Pizzorni N, Cereda E. et al. Consensus on the treatment of dysphagia in Parkinson's disease. J Neurol Sci 2021; 430: 120008 DOI: 10.1016/j.jns.2021.120008. (PMID: 34624796)
- 12 Lee J, Madhavan A, Krajewski E. et al. Assessment of dysarthria and dysphagia in patients with amyotrophic lateral sclerosis: Review of the current evidence. Muscle Nerve 2021; 64: 520-531
- 13 Lawlor CM, Choi S. Diagnosis and Management of Pediatric Dysphagia: A Review. JAMA Otolaryngol Head Neck Surg 2020; 146: 183-191 DOI: 10.1001/jamaoto.2019.3622. (PMID: 31774493)
- 14 Takizawa C, Gemmell E, Kenworthy J. et al. A Systematic Review of the Prevalence of Oropharyngeal Dysphagia in Stroke, Parkinson's Disease, Alzheimer's Disease, Head Injury, and Pneumonia. Dysphagia 2016; 31: 434-441 DOI: 10.1007/s00455-016-9695-9. (PMID: 26970760)
- 15 Košutova P, Mikolka P. Aspiration syndromes and associated lung injury: incidence, pathophysiology and management. Physiol Res 2021; 70 (Suppl. 04) S567-s583 DOI: 10.33549/physiolres.934767. (PMID: 35199544)
- 16 Wolf U, Eckert S, Walter G. et al. Prevalence of oropharyngeal dysphagia in geriatric patients and real-life associations with diseases and drugs. Sci Rep 2021; 11: 21955
- 17 Zuercher P, Moret CS, Dziewas R. et al. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. Crit Care 2019; 23: 103 DOI: 10.1186/s13054-019-2400-2. (PMID: 30922363)
- 18 Baijens LW, Clavé P, Cras P. et al. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 2016; 11: 1403-1428 DOI: 10.2147/CIA.S107750. (PMID: 27785002)
- 19 Pezdirec M, Strojan P, Boltezar IH. Swallowing disorders after treatment for head and neck cancer. Radiol Oncol 2019; 53: 225-230 DOI: 10.2478/raon-2019-0028. (PMID: 31194691)
- 20 McIntyre M, Doeltgen S, Dalton N. et al. Post-extubation dysphagia incidence in critically ill patients: A systematic review and meta-analysis. Aust Crit Care 2021; 34: 67-75 DOI: 10.1016/j.aucc.2020.05.008. (PMID: 32739246)
- 21 Dalhoff K, Abele-Horn M, Andreas S. et al. Epidemiology, Diagnosis and Treatment of Adult Patients with Nosocomial Pneumonia - Update 2017 - S3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy, the German Radiological Society and the Society for Virology. Pneumologie 2018; 72: 15-63
- 22 Marchese MR, Ausili Cefaro C, Mari G. et al. Oropharyngeal dysphagia after hospitalization for COVID-19 disease: our screening results. Dysphagia 2022; 37: 447-453
- 23 Bushuven S, Niebel I, Huber J. et al. Emotional and Psychological Effects of Dysphagia: Validation of the Jugendwerk Dysphagia Emotion and Family Assessment (JDEFA). Dysphagia 2022; 37: 375-391 DOI: 10.1007/s00455-021-10289-1. (PMID: 33817751)
- 24 Bushuven S, Dettenkofer M, Dietz A. et al. Interprofessional perceptions of emotional, social, and ethical effects of multidrug-resistant organisms: A qualitative study. PLoS One 2021; 16: e0246820 DOI: 10.1371/journal.pone.0246820. (PMID: 33617529)
- 25 Bushuven S, Dietz A, Bushuven S. et al. Interprofessional perceptions and emotional impact of multidrug-resistant organisms: A qualitative study. Am J Infect Control 2019; 47: 876-882 DOI: 10.1016/j.ajic.2019.01.019. (PMID: 30850246)
- 26 Chen SC, Huang BS, Hung TM. et al. Swallowing ability and its impact on dysphagia-specific health-related QOL in oral cavity cancer patients post-treatment. Eur J Oncol Nurs 2018; 36: 89-94 DOI: 10.1016/j.ejon.2018.07.002. (PMID: 30322515)
- 27 Bükki J, Klein J, But L. et al. Methicillin-resistant Staphylococcus aureus (MRSA) management in palliative care units and hospices in Germany: a nationwide survey on patient isolation policies and quality of life. Palliat Med 2013; 27: 84-90 DOI: 10.1177/0269216311425709. (PMID: 22045727)
- 28 Boaden E, Burnell J, Hives L. et al. Screening for aspiration risk associated with dysphagia in acute stroke. Cochrane Database Syst Rev 2021; 10: Cd012679
- 29 Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 1988; 2: 216-219 DOI: 10.1007/BF02414429. (PMID: 3251697)
- 30 Dziewas R, Auf dem Brinke M, Birkmann U. et al. Safety and clinical impact of FEES - results of the FEES-registry. Neurol Res Pract 2019; 1: 16
- 31 Braithwaite J, Clay-Williams R, Vecellio E. et al. The basis of clinical tribalism, hierarchy and stereotyping: a laboratory-controlled teamwork experiment. BMJ Open 2016; 6: e012467 DOI: 10.1136/bmjopen-2016-012467. (PMID: 27473955)
- 32 Rausch M, Thelen K, Beudert I. Kompetenzprofil für die Logopädie. Frechen: Deutscher Bundesverband für Logopädie eV (dbl); 2014
- 33 Dziewas R, Glahn J, Helfer C. et al. Flexible endoscopic evaluation of swallowing (FEES) for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German stroke society. BMC Med Educ 2016; 16: 70 DOI: 10.1186/s12909-016-0587-3. (PMID: 26911194)
- 34 Saccente-Kennedy B, Archer J, Symons HE. et al. Quantification of Respirable Aerosol Particles from Speech and Language Therapy Exercises. J Voice 2022; DOI: 10.1016/j.jvoice.2022.07.006.
- 35 Rouse R, Regan J. Psychological impact of COVID-19 on speech and language therapists working with adult dysphagia: A national survey. Int J Lang Commun Disord 2021; 56: 1037-1052 DOI: 10.1111/1460-6984.12654. (PMID: 34331499)
- 36 Marler H, Ditton A. "I'm smiling back at you": Exploring the impact of mask wearing on communication in healthcare. Int J Lang Commun Disord 2021; 56: 205-214 DOI: 10.1111/1460-6984.12578. (PMID: 33038046)
- 37 de Oliveira E Silva AC, Nogueira WP, Gir E. et al. Limiting factors of face shield use for health professionals during the COVID-19 pandemic. Work 2021; 70: 355-363
- 38 Shahouzaie N, Gholamiyan Arefi M. Telehealth in speech and language therapy during the COVID-19 pandemic: a systematic review. Disabil Rehabil Assist Technol 2022; 1-8 DOI: 10.1080/17483107.2022.2122605. (PMID: 36129435)
- 39 Latoszek BBV, Hetjens S. Efficacy of Novafon Local Vibration Voice Therapy and Water Resistance Therapy: a meta-analysis. Laryngorhinootologie 2023; 102: 662-668 DOI: 10.1055/a-1976-9766. (PMID: 36580973)
- 40 Watson NA, Siddiqui Z, Miller BJ. et al. Non-aesthetic uses of botulinum toxin in the head and neck. Eur Arch Otorhinolaryngol 2021; 278: 4147-4154 DOI: 10.1007/s00405-021-06750-4. (PMID: 33738565)
- 41 Wang T, Dong L, Cong X. et al. Comparative efficacy of non-invasive neurostimulation therapies for poststroke dysphagia: A systematic review and meta-analysis. Neurophysiol Clin 2021; 51: 493-506 DOI: 10.1016/j.neucli.2021.02.006. (PMID: 34535361)
- 42 KRINKO. Anforderungen an die Hygiene bei der Aufbereitung von Medizinprodukten. Bundesgesundheitsbl 2012; 55: 1244-1310
- 43 Kampf G, Jung M, Suchomel M. et al. Prion disease and recommended procedures for flexible endoscope reprocessing - a review of policies worldwide and proposal for a simplified approach. J Hosp Infect 2020; 104: 92-110 DOI: 10.1016/j.jhin.2019.08.005. (PMID: 31408691)
- 44 Wu AW. Medical error: the second victim. The doctor who makes the mistake needs help too. Bmj 2000; 320: 726-727 DOI: 10.1136/bmj.320.7237.726. (PMID: 10720336)
- 45 Strametz R. Mitarbeitersicherheit ist Patientensicherheit – Psychosoziale Unterstützung von Behandelnden im Krankenhaus. Stuttgart: Kohlhammer; 2021
- 46 Strametz R, Fendel JC, Koch P. et al. Prevalence of Second Victims, Risk Factors, and Support Strategies among German Nurses (SeViD-II Survey). Int J Environ Res Public Health 2021; 18: 10594
- 47 Michalsen A, Neitzke G, Dutzmann J. et al. [Overtreatment in intensive care medicine-recognition, designation, and avoidance : Position paper of the Ethics Section of the DIVI and the Ethics section of the DGIIN]. Med Klin Intensivmed Notfmed 2021; 116: 281-294 DOI: 10.1007/s00063-021-00794-4. (PMID: 33646332)