implementing safer solutions more easily....76 sick days per year – this means indirect costs of...

Issue 2/2017

Implementing safer solutions more easily.

DISINFACTS

DISINFACTS 1/17 page 1

Major anniversary edition on hand andsurface hygiene

Safely paving the way.For 20 years, the German DESINFACTS has been a loyal companion for infection controlpractitioners. Its central concern: to provide targeted support in daily hygiene practice and thus improve infection protection.

EDITORIAL 03

ANNIVERSARYWhat readers say about the 04German DESINFACTS

Give me five: Hand hygiene highlights 06

Skin protection und skin care 08in numbers

Milestones of surface disinfection: 14From a red-headed stepchild to a constant

FORUMOld, new threat: Multi-resistant pathogens 10

BODE SCIENCE CENTER’s lunchtime symposium: “New hygiene strategies alongthe patient journey” 11

KNOWLEDGEStudy: How hand hygiene behaviour is recorded and measured 16

EXPERTISENew: X-Wipes Safety Pack for a safe surface hygiene 19

PRACTICESurface disinfection: Await drying or exposure time? 20

DESINFACTS

years


Editorial

Dear Reader,

One hurdle is hardly cleared, a new challenge appears. You as infection control practitioner know this from your daily work.

To support you in your difficult tasks, the German DESINFACTS and the English DISINFACTS regularly informyou about current hygiene and infection control issues. And – very much to our delight – this is very well received by you. Thanks to this interest, this year the German editionreached its 20th anniversary, which we want to celebratewith some special articles in this year’s issues.

Such an anniversary is always an occasion to look back.Hence, in this issue, we present important highlights of hand and surface hygiene of the past 20 years. Also in this issue: readers report on what they like aboutDESINFACTS and how the magazine supports them in their work.

Also, we would like to take the opportunity to say thank you – to the readers for their lively interest, to the interview partners for their substantiated and helpful recommendations and to the healthcare facilities for thebest practice insights.

I hope you enjoy our anniversary issue,

Dr. Henning MallwitzDirector Research & Development


Geared towards diversity: from latest scientific findings, legal backgrounds to useful tips for daily routine – for 20 years, the German DESINFACTS has provided information on current andpractice-related issues in hygiene, disinfection and infection control. Long-time readers report on which topics are particularly well received and on how the contents help in practice.

Informative, practical and always up to dateReaders about the German DESINFACTS:

ANNIVERSARY


years


“Wide range of topics”“I have been reading the German DESINFACTS sincewhen I started working in the infection controldepartment of the Klinikum Passau in 2011.What I particularly like is the wide range of topics – their selection is always informative and interesting. Also, the lengthof the articles is good – long enough to geta proper insight and short enough to readthe texts quickly

Bettina GaykInfection control nurse, Klinikum Passau, Germany

“Straight to the point”“Since 2011, I have been working in the field of hygiene;since then, I have regularly read DESINFACTS. I amparticularly pleased with the articles on new lawsor recommendations, such as the recent articleon the hand hygiene recommendation of theGerman Commission for Hospital Hygieneand Infection Prevention (KRINKO). For meit is very helpful that individual aspects areexamined more closely and are neatly summed up for daily routine. Some of the information given in DESINFACTS articles I alsouse for employee training.”

Carmen Zabrautanu Infection control nurse ISAR Klinikum Munich, Germany

“Strong practical relevance”“I am probably one of the first readers – I have read

the German DESINFACTS since the very first beginning, and I always look forward to the nextissue. What I have always like about the magazineis its strong practical relevance. A lot of the information – particularly on hand hygiene – I have

been able to use in daily routine. With DESINFECTS,I feel that I receive professional and good advice.”

Reiner KranabetterInfection control nurse, formerly Klinikum Nuremberg, Germany

“We keep all issues"“In our department, we have read the DESINFACTS

for at least 10 years. We like that the magazine isdelivered in paper form. Often, we mark interestingarticles or take notes. As we keep all issues, we cansimply access the information if required. By theway, we especially liked the article about the

resistance mechanisms of bacteria – it describedthem very clearly.”

Hygiene Department,Passau district healthcare facilities, Germany

ANNIVERSARYyears

Hand hygiene highlights

1) EURIDIKI guidelines (1996)

A little more than 20 years ago, the European Interdisciplinary Committee for Infection Prophylaxis (EURIDIKI) set a milestone for handhygiene by publishing its guidelines on hygienic hand disinfection [1].From legal backgrounds to psychological compliance barriers and thequality of hand disinfectants – the outlined findings and recommendationshave not lost their validity until today. They revealed clear weaknesses inhand hygiene compliance that the healthcare workers self-critically attributed to, for example, the own convenience and a lack of self-discipline.

Hand hygiene and DESINFACTS are inextricably linked. From studies, guidelines to practical experience – in the past 20 years, theGerman DESINFACTS has continuously informed about new relevant developments in hand hygiene. On the occasion of its anniversary, DISINFACTS looks back and introduces five hand hygiene highlights of the past 20 years.

Give me five:

“The own laziness is the main reason to omit disinfection.“ [1]

3) WHO campaign (2005)

“Clean Care is Safer Care” – with this global campaignto promote patient safety, the World Health Organization (WHO) opened a new chapter of handhygiene, shifting the focus to hand disinfection as oneof the key elements to prevent nosocomial infection.Meanwhile, around 19 000 health facilities from 177 countries and regions have registered their participation in the campaign [4]. In Germany, the campaign was implemented in 2008 as “Aktion Saubere Hände” (Clean Hands Campaign). 1 000 hospitals, 276 geriatric and nursinghomes and 1 000 outpatient facilities participate in thisnational campaign [5].

“Hand hygiene reduces infections and enhancespatient safety across all settings (…).” [3]

2) KRINKO recommendations on hand hygiene (2000)

Short, but important – that is how the hand hygiene recommendation ofthe German Commission for Hospital Hygiene and Infection Prevention(KRINKO), which was published in 2000, can be characterised [2]. Onfour pages including a list of 33 references, it underlines the significanceof hand hygiene as one of the most important infection control measuresin hospitals. Difficult for daily routine: the recommendation specifies tenindications that absolutely require a hygienic hand disinfection. Additionally, KRINKO lists some situations that indicate – depending onthe risk – a hand disinfection or a handwash.

The personnel’s hands are the main transmitter of pathogens (…).“ [2]


4) KRINKO recommendationson hand hygiene (2016)

The recommendations published by the German Commission for Hospital Hygiene and Infection Prevention (KRINKO) in 2016 present the state of theart in hand hygiene. They consider all important aspectsrelating to hand hygiene and provide a comprehensive,scientifically founded analysis of 423 sources. Significant for clinical practice: KRINKO moves awayfrom the individual indications and now follows WHO’s5 Moments instead. Additionally, it is worth notinghow detailed the updated recommendations addressthe measures to improve compliance. They attach greatimportance to, for example, implementing multimodalintervention programmes and optimising work processes.

ANNIVERSARY

“Process optimisation plays a key role in improving compliance sustainably (…).” [3]

years

http://www.bode-science-center.com/center/glossary/who-guidelines-on-hand-hygiene-in-health-care.htmlhttp://www.bode-science-center.com/center/glossary/who-guidelines-on-hand-hygiene-in-health-care.html


5. Psychological factors in hand hygiene

Already back in 1996, EURIDIKI found that there is a blatant imbalancebetween the knowledge of how important hand hygiene is and its implementation in daily routine [1]. This is aggravated by the fact that evenwhen there is a high level of motivation to perform hand hygiene, only asmall percentage of healthcare workers actually perform hand hygiene.Meanwhile, there are many studies that demonstrate differing approachesof how to close the gap between intention and behaviour in hand hygiene.Also KRINKO recommends promoting “psychosocial factors such as behaviour planning and control as well as the cooperation in the wardteam” [6].

“Knowledge alone only rarely changes behaviour (…).” [3]

ANNIVERSARY

Sources:

1. Europäisches interdisziplinäres Komitee für Infektionsprophylaxe, EURIDIKI. Meine Hände sind sauber. Warum soll ich sie desinfizieren?Leitfaden zur hygienischen Händedesinfektion. Wiesbaden, mhp-Verlag,1996.

2. Händehygiene. Mitteilung der Kommission für Krankenhaushygiene undInfektionsprävention am Robert Koch-Institut. Bundesgesundheitsbl - Gesundheitsforsch – Gesundheitsschutz 2000 · 43:230–233.

3. Pittet D, Donaldson L. Clean Care is Safer Care: the first global challengeof the WHO World Alliance for Patient Safety. Infect Control Hosp Epidemiol. 2005 Nov;26(11):891-4.

4. www.who.int/gpsc/5may/registration_update/en/ (Accessed on 02 February 2017).

5. www.aktion-sauberehaende.de/ash/global/teilnehmende-einrichtungen/(Accessed on 02 February 2017).

6. Händehygiene in Einrichtungen des Gesundheitswesens. Empfehlung derKommission für Krankenhaushygiene und Infektionsprävention (KRINKO)beim Robert Koch-Institut (RKI). Bundesgesundheitsbl. 2016, 59:1189-1220.

years

http://www.bode-science-center.com/science/study/article/study-a-person-oriented-approach-to-hand-hygiene-behaviour-emotional-empathy-fosters-hand-hygiene.html

Staff who suffer from occupational skin diseases are often off sick due to chronic symptoms: employees concerned take an average of 76 sick days per year – this means indirect costs of around € 6.150due to productivity loss.

Because hygiene is a matter of the skin:

Protection and care are the basis foran efficient hand disinfection

76days per year

Federal Institute for Occupational Safety and Health (BAuA).Working world in the course of time – facts and figures (2015).

Diepgen, T et al. Cost of illness from occupational hand eczema in Germany. Contact dermatitis.2013, 96:2.

No anniversary without special number. So, the 20th birthday of the German DESINFACTS is a good occasion to introducefurther important numbers related to hygiene. This time’s focus: figures on skin health.

Skin diseases top the list of occupational diseases:Every third reported occupational illness is work-related skin eczema

ANNIVERSARYyears



Three quarters of all surgeons do not apply skinprotection/skincare products at the beginning of

their working day; only every second uses such products regularly.

Improvement within 7 days:When used twice a day, skin protection products can restore the damaged skin barrier and improve the skin hydration.

A study demonstrates that Sterillium® classic pure increases the skin hydration by up to 30 %

within 10 days.

Big knowledge gaps in skin protection and skin care:

up to 30per cent

Only half of the nursing staff applies skinprotection/skincare products at least onceor twice a day.

Harnoss, J. et al. Practice of skin protection and skin care among German surgeons and influence onthe efficacy of surgical hand disinfection and surgical glove perforation. BMC Infect Dis, 2011, 14:315.

Große-Schütte, K et al. Practices of skin care among nurses in medical and surigalintensive care units: results of a self-administered questionnaire. GMS Kranken-haushyg Interdiszip, 2011, 6(1).

Jordan, L. Efficacy of a Hand Regimen in Skin Barrier Protection in Individuals withOccupational Irritant Contact Dermatitis. J Drugs Dermatol. 2016;15(suppl 11).

RCTS‘ Study No. 3295, 2014. Evaluating the effect of a hand sanitizer using an exaggerated handwash method.

2xper day

Sterillium classic pure: Active substances: Propan-2-ol, propan-1-ol, mecetronium etilsulfate. Composition: 100 g solution contain: Active substances: Propan-2-ol 45.0 g, propan-1-ol 30.0 g, mecetroniumetilsulfate 0,2 g. Other ingredients: Glycerol 85 %, tetradecan-1-ol, purified water. Indications: For hygienic and surgical hand disinfection. For skin disinfection prior to injections and punctures. Contraindications:Not suitable for the disinfection of mucous membranes. Do not use in the immediate proximity of the eyes or open wounds. Hypersensitivity (allergy) to one of the ingredients. Side effects:Slight dryness or irritation of the skin is uncommon. In such a case, it is recommended to intensify general skin care. Allergic reactions are rare. Warnings: Hand disinfection serves to prevent the transmissionof infections, e.g. in patient care. Sterillium classic pure should not be used in neonates and premature infants. Only use in babies and infants after medical consultation. Avoid contact of solution with eyes. Incase of contact with eyes, rinse opened eyes several minutes under running water. Avoid transfer of the solution from one container to another to prevent contamination. In case a transfer is necessary, the solution may only be poured under aseptic conditions (e.g. use of sterile containers under Laminar Air Flow). Only use electrical equipment after complete drying. Do not bring into contact with open flames.Do not use near sources of ignition. Flashpoint 23 °C, flammable. When preparation is used as directed, risks of fire and explosion are not to be expected. In case of spilling the disinfectant, the following measures have to be taken: clean up the solution immediately, dilute with plenty of water, ventilate room, and remove sources of ignition. Do not smoke. In case of fire, extinguish with water, extinguishingpowder, foam, or CO2.BODE Chemie GmbH, Melanchthonstraße 27, 22525 Hamburg

ANNIVERSARYyears

http://www.bode-science-center.com/science/study/article/study-evaluating-the-effect-of-a-hand-sanitiser-using-an-exaggerated-handwash-method.htmlhttp://www.bode-science-center.com/science/study/article/study-evaluating-the-effect-of-a-hand-sanitiser-using-an-exaggerated-handwash-method.html


FORUM

Preventing infections with MDR pathogensFor health facilities, this situation is a tremendous chal-lenge, which needs to be addressed at several levels.In addition to a rational use of antimicrobials and thedevelopment of new drugs, consistent hygiene is amajor lever for an effective strategy against MDR pa-thogens. At its lunchtime symposium “Pathogens resi-stant to antibiotics: new hygiene strategies along thepatient journey” on 17 November 2016 in Berlin, Ger-many, the BODE SCIENCE CENTER introduced concreteapproaches that hygiene can deliver.

A representative poll – conducted in 2015 on behalf ofAsklepios – reached an interesting conclusion: 65 %of the Germans are afraid of acquiring an infectionwith multidrug-resistant (MDR) pathogens during theirhospital stay. Thus, the MDR infection ranks first, whenthe Germans were asked for their greatest concernsrelating to a hospital stay [1]. A result that unmistakablyunderlines the current importance of this issue.

From MRSA to MRGNHowever, the problems with multidrug-resistant pathogens are anything but new. MRSA has been investigated intensively since its first description already back in 1961. Particularly the 2000s saw anenormous increase in MRSA: the share of MRSA in Staphylococcus aureus isolates grew from 1.1 % in1990 to 20.3 % in 2007. Recent years, however, witnessed a declining trend for MRSA [2].

Instead, the spotlight is increasingly on the more andmore frequently occurring multi-resistant Gram-nega-tive (MRGN) pathogens. Meanwhile, 3MRGN and4MRGN, which are resistant to three and four groupsof antibiotics, respectively, have developed into a se-rious danger in healthcare facilities.

These pathogens are particularly a threat to immuno-suppressed patients, as they are more susceptible tonosocomial infections, such as bloodstream infectionand pneumonia. Early this year, this development be-came especially dramatic when a 70-year-old Ameri-can patient died from an infection with Klebsiellapneumoniae although she had been treated with the26 antibiotics authorised in the US [3].

From strategies to prevent MRSA and resistances among Gram-negative pathogens to hygiene management in case of ESBL – for many years, DISINFACTS has reported on the risks of resistant pathogens. An issue that is bound to become more explosive, as current studies and reports suggest.

Old, new threat:

Multi-resistant pathogens

Sources:

1. Asklepios Kliniken, press release on study “Patientensicherheit – worauf es Patienten ankommt” (Patient safety – what is important for patients),15 September 2015,https://www.asklepios.com/konzern/unternehmen/aktuell/pressemitteilungen/, accessed on 02 February 2017

2. Empfehlungen zur Prävention und Kontrolle von Methicilin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Empfehlung der Kommission fürKrankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesund-heitsbl 2014 · 57:696–732.

3. US-Seniorin stirbt nach Indienreise: Klebsiella gegen 26 Antibiotika resistent. www.aerzteblatt.de/nach-richten/72500/US-Seniorin-stirbt-nach-Indienreise-Klebsiella-gegen-26-Antibiotika-resistent. Accessedon 02 February 2017.

Very close to the patient: New hygiene strategies – in the form of SOPs – completely focus on patient protection.

AdmissionIn Germany, between 400 000 and600 000 people acquire a nosocomialinfection (NI) every year

Placing avenous accessRisk: Bloodstream infection (sepsis)• Approx. 75 000 nosocomial

cases of sepsis per year Placing aurinary catheterRisk: Urinary tract infection• Every sixth patient has an

indwelling urinary catheterinserted

SurgeryRisk: Surgicalsite infection• Up to every 10th bowel

surgery is concerned

DischargeNI prolongs a hospitalstay by Ø 10 days

From admission to discharge a patient undergoes many care measures thatinvolve the risk of infection. Standardised operating procedures (SOP �),that consider all these critical moments can provide better patient protection here.

SOP strategy against infections:

Care ofventilated patientsRisk: Infection of lowerrespiratory tract• One quarter of all NI

Postoperativedressing changeRisk: Surgical siteinfection• Every fourth NI

54 million inpatient surgeries and medical proceduresper year in Germany

Sources: German National Reference Centre (NRZ),Commission for Hospital Hygiene and Infectious Disease Prevention (KRINKO),German Federal Ministry for Education and Research (BMBF),Federal Statistical OfficeFigures from the German market

SOP �

SOP �

SOP �

SOP �

http://www.bode-science-center.com/center/expert-knowledge/new-hygiene-strategies/detail-new-hygiene-strategies/article/abstract-from-very-close-hygiene-along-the-patient-journey.htmlhttp://www.bode-science-center.com/center/expert-knowledge/new-hygiene-strategies/detail-new-hygiene-strategies/article/abstract-from-very-close-hygiene-along-the-patient-journey.html

Focus on hand hygiene: the SOPs of the BODE SCIENCE CENTERIt is known how hygiene works – yet, there are still shortcomings in the consistent implementation. At the lunchtime symposium, Dr. Henning Mallwitz,

What doesn’t kill them makes them stronger – that isoften said about bacteria. Using smart resistance mechanisms, they increasingly annul the mode of action of common antibiotics. When these drugs, however, do not have an effect anymore, medicineloses its weapons in the fight against the microscopicmicroorganisms. Experts agree: the post-antibiotic era– about which WHO already warned – could soon become reality.

Already today, in Germany four to twelve people dieof a preventable nosocomial infection every day. Multidrug-resistant pathogens are a particular threathere [1]. To counteract this development, new hygienestrategies are needed, as these can immediately contribute to infection control and thus to patient protection.

New hygiene strategies along the patient journey

BODE SCIENCE CENTER’s lunchtime symposium:

How are antimicrobial resistances avoided as quickly and systematically as possible? This question wasdiscussed at BODE SCIENCE CENTER’s lunchtime symposium held in Berlin on 17 November 2016. At thecentre of attention: new hygiene strategies that transparently optimise processes and thus make an important contribution to infection prevention and patient protection. Hence, innovative approaches tolastingly increase compliance have one primary task: sustainable process optimisation.

Experts answer questions on antimicrobial resistance and newhygiene strategies: Prof. Dr. UweFrank, PD. Dr. Andrej Trampuz,Dr. Henning Mallwitz, ClaudiaBecker (from left to right).

Pain, stiffening, amputation:every single infection can havedevastating consequences

PD Dr. Andrej Trampuz, Senior Physician, Head of Infectiology and Septic Surgery, Charité Berlin, Germany

FORUM

http://www.bode-science-center.com/center/expert-knowledge/new-hygiene-strategies/detail-new-hygiene-strategies/article/interview-pain-arthrodesis-amputation-every-infection-can-have-devastating-consequences.htmlhttp://www.bode-science-center.com/center/expert-knowledge/new-hygiene-strategies/detail-new-hygiene-strategies/article/interview-pain-arthrodesis-amputation-every-infection-can-have-devastating-consequences.htmlhttp://www.bode-science-center.com/center/expert-knowledge/new-hygiene-strategies/detail-new-hygiene-strategies/article/interview-pain-arthrodesis-amputation-every-infection-can-have-devastating-consequences.html

An SOP is like a thread that guides employees through common nursingand medical tasks that involve a risk of infection for the patient. Centre ofattention when developing the SOPs was the patient protection. Hence,an SOP does not only focus on the technique, but emphasises the

situations that involve a risk of infection andthus supports the hand hygiene compliance exactly where it matters. Many nursing tasks arehighly complex: the aseptic change of a wounddressing, for example, comprises 14 individualsteps; four of them involve a particular risk ofinfection for the patient. Thanks to the BODESCIENCE CENTER’s SOPs, these situations become easier to understand.

Optimised processes: Can be realised immediately, have a long-term successThe practical test confirms the sustainable success of this approach: Claudia Becker, Infection control nurse for Hospital Hygiene at

St. Nikolaus-Stiftshospital GmbH in Andernach, Germany implementedthe SOP for the aseptic dressing change in her facility. Using this optimised process, the employees could increase the hand hygiene compliance when changing wound dressing aseptically from 75 % to 88 % within a few months.

Director Research & Development at BODE ChemieGmbH introduced a new solution: the standard operating procedures (SOPs) of the BODE SCIENCECENTER. During a patient journey, i.e. the journey patients experience fromadmission to discharge,patients undergo many treatment procedures.SOPs address importantnursing activities, often associated with nosocomialinfections. The BODE SCIENCE CENTER provides information and materialfor optimised processesfor inserting a peripheralvenous catheter (risk ofbloodstream infection),for inserting a urinary tractcatheter (risk of urinary tract infection), for tracheostomy suctioning (risk of ventilation-associated pneumonia), and for changing a sterilewound dressing (risk of surgical site infection) (see figure page 10).

Informative mixture: practice-oriented speeches and lively discussions at the lunchtime symposium in Berlin.

In hygiene, the problem is not lack of knowledge,but primarily poor implementation

Dr. Henning Mallwitz, Director Research & Development, BODE Chemie GmbH, Hamburg,Germany


FORUM

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She already had prepared to the fact that her leg needed to be amputated to finally live a life free of pain. Only a differentiated diagnosis revealed an infection with a resistant microorganism – and allowed a targeted therapy. The new procedure saved the leg of the patient and put a stop to the chronic pains.

Antimicrobial resistance and the associated problems will probably accompany us for a long time. However, our experts at BODE SCIENCE

CENTER’s lunchtime symposium could makeclear that there are measures that can be implemented immediately and can considerably increase patient protection.

Hand hygiene plays a key role here. TheSOPs of the BODE SCIENCE CENTER, for example, provide promising measures topromote hand hygiene compliance.

A success that was of direct benefit to the patients: atthe same time, the surgical site infections for the indicator surgery ‘colon’ decreased, which in turn hada positive effect on the use of antibiotics.

Dangerous infection: a look behind the statisticsWhen looking at the figures and statistics, it becomesclear why it is so important to increase the hand hygiene compliance and thus prevent nosocomial infections:there is a personal fate, an individual story behind every infection.

In Germany, 400 000 to 600 000patients acquire one of these infections – 35 000 of them even involve a multidrug-resistant pathogen [1]. A case study by Dr. Andrej Trampuz, Head of Infectiology and Septic Surgery at Charité Berlin, Germany demonstrated how serious such an infection can be:after her cruciate ligament plastic surgery, a 30-year-old policewoman complained about chronic pains.

You want to learn more? Discover the exclusive symposium interviews, reports and short videos under the new “Expert knowledge” section on the BODE SCIENCE CENTER website.

In antibiotic therapy, we are already runningon empty

Prof. Dr. Uwe Frank Microbiologist, Hygienist &Infectiologist (German Society for InfectiousDiseases, DGI); Centre for Infectiology, MedicalMicrobiology and Hygiene, Division of Hospitaland Environmental Hygiene, Heidelberg University Hospital, Germany; Institute of Environmental Medicine and Hospital Hygiene,University Medical Centre Freiburg, Germany

Theory is good – precise instructionsare better

Claudia Becker, infection controlNurse for Hospital Hygiene, St. Nikolaus-Stiftshospital GmbH, Andernach, Germany

Source:1. German National Point Prevalence Survey on

Nosocomial Infections and antimicrobial use. 2011


FORUM

http://www.bode-science-center.com/center/expert-knowledge/new-hygiene-strategies/detail-new-hygiene-strategies/article/interview-in-antibiotic-therapy-we-are-running-on-empty.htmlhttp://www.bode-science-center.com/center/expert-knowledge/new-hygiene-strategies/detail-new-hygiene-strategies/article/interview-in-antibiotic-therapy-we-are-running-on-empty.htmlhttp://www.bode-science-center.com/center/expert-knowledge/new-hygiene-strategies/detail-new-hygiene-strategies/article/interview-theory-is-good-precise-instructions-are-better.htmlhttp://www.bode-science-center.com/center/expert-knowledge/new-hygiene-strategies/detail-new-hygiene-strategies/article/interview-theory-is-good-precise-instructions-are-better.htmlhttp://www.bode-science-center.com/center/expert-knowledge/new-hygiene-strategies/detail-new-hygiene-strategies/article/interview-theory-is-good-precise-instructions-are-better.htmlhttp://www.bode-science-center.com/center/expert-knowledge/new-hygiene-strategies/detail-new-hygiene-strategies/article/interview-theory-is-good-precise-instructions-are-better.htmlhttp://www.bode-science-center.com/center/expert-knowledge.html

From a red-headed stepchild to a constant

Milestones of surface disinfection:

From 1997 until today, in addition to hand hygiene, the German DESINFACTS always also has had surface disinfection in mind. Remarkably,only 17 years ago, some experts questioned the necessity of routine surface disinfection [1]. An attitude that seems unthinkable today, as surface disinfection meanwhile has established itself as elementary component of the multi-barrier system to prevent infection in healthcarefacilities. DISINFACTS presents the findings and advances that have beenimportant milestones over the past 20 years.

The recommendation of the GermanCommission for Hospital Hygiene and Infection Prevention (KRINKO) publishedin 2004 – “Hygiene requirements forcleaning and disinfecting surfaces” – mar-ked an important milestone for surface hygiene in healthcare settings [2].It is the only guidelines that comprises evidence-based surface disinfection measures and thus provides a practicalguide.

Key points in the KRINKO recommendation:• Surface disinfection is an essential

component of the multi-barrier systemto protect against infection.

• As part of risk assessment, every healthcare facility needs to determinethe surfaces that require disinfection.

• Near-patient and other hospital surfaceswith frequent hand and skin contactpose a particular risk of transmission

The KRINKO recommendation

One of the most important improvements considerably simplifying surface disin-fection was the development of wipes dispenser systems, for example X-Wipes(since 2004), and of pre-saturated disinfection wipes in the Flowpack, such asMikrobac Tissues (since 2008). Their easy handling ensures that application errors are avoided and hygiene risks are minimised.

And what’s more: pre-saturated single-use wipes with differing active ingredientscan be used for a broad range of applications – from the disinfection of digital devices to the disinfection of ultrasound probes. Rapid disinfection wipes,for example from the Bacillol line, offer particularly short exposure times and thus allow the disinfected surfaces or devices to be used again shortly after disinfection.

Convenience-Trend

EXPERTISE


http://www.productcatalogue.bode-chemie.com/products/surface/surface-disinfection-pre-soaked-tissues.phphttp://www.productcatalogue.bode-chemie.com/products/surface/mikrobac_tissues.php

KNOWLEDGE


Sources:

1. Gemeinsame Stellungnahme der hygienisch-medizi-nischen wissenschaftlichen Fachgesellschaften zurFlächendesinfektion. Deutsche Gesellschaft für Hy-giene und Mikrobiologie (DGHM), Deutsche Gesell-schaft für Krankenhaushygiene (DGKH), Deutsch-sprachiger Arbeitskreis für Krankenhaushygiene Ge-sellschaft für Hygiene und Umweltmedizin (GHU).Hyg Med 2000; 25 (11):469-472.

2. Anforderungen an die Hygiene bei der Reinigung undDesinfektion von Flächen. Empfehlung der Kommis-sion für Krankenhaushygiene und Infektionspräven-tion beim Robert Koch-Institut (RKI). Bundesgesund-heitsbl - Gesundheitsforsch - Gesundheitsschutz2004 · 47:51–61.

3. Kramer A et al. How long do nosocomial pathogenspersist on inanimate surfaces? A systematic review.BMC Infectious Diseases 2006; 6: 130.

4. Engelhart S et al. Pseudomonas aeruginosa outbreakin a haematology-oncology unit associated with con-taminated surface cleaning equipment. J Hosp Infect.2002 Oct;52(2):93-8.

5. Kampf G Flächendesinfektion. Krankenh hyg up2date2013; 8: 273–288.

Klebsiella spp.Pseudomonas aeruginosaEscherichia coliStaphylococcus aureus incl. MRSAEnterococcus spp. incl. VRE und VSE

up to 30 months up to 16 monthsup to 16 months up to 7 months up to 4 months

Persistence of clinically relevant pathogens on inanimate surfaces

Bacteria

Candida albicans up to 4 months Fungi

VacciniavirusAdenovirusHAVNorovirus

up to 5 monthsup to 3 monthsup to 2 monthsup to 7 days

Viruses

Germs can remain infectious on inanimate surfaces for weeks or evenmonths. The study by Kramer et al. published in 2006 demonstrated for how long the pathogens can persist on surfaces [3]. The findings on the microorganisms’ ability to survive on surfaces have raised the awareness ofhow important it is to routinely disinfect surfaces in healthcare facilities.

Persistence of microorganisms

Many studies that identified inanimate surfaces as source of nosocomial outbreaks have confirmed how crucial surface disinfection is to prevent nosocomial infections. In one ward, for example, Pseudomonas aeruginosa was found to be the elicitor of an outbreak ina haematological oncology unit [4]. Overall, studies have proved that, incases of outbreaks, the immediate patient surroundings often are contaminated with pathogens, such as Clostridium difficile, MRSA, VRE, Acinetobacter baumannii and noroviruses [5].

Surfaces as sources of outbreaks

Closely examined:

How hand hygiene behaviour is recorded and measured

The most important terms at a glance:

The hand hygiene behaviourcomprises all hand hygiene

measures – i.e. handwashing, hygienic and surgicalhand disinfection. In infection control, hand disinfectionis and will remain of central significance.

Another relevant aspect is how hand hygiene is

performed. In addition to the sequence of the individual steps, the hand hygiene technique also includes the type and volume of product.

When hand hygiene is performed in compliance

with guidelines, this is called hand hygiene compliance. Here, it is not only important to use theright measure and the correct technique: in compliance, it is particularly the moment, in which ahand disinfection is indicated, that plays a leading role.

It is easier to measure how often hand hygiene is

performed than the hand hygiene compliance. However, the frequency is only an approximation tothe measurement of the compliance, as it does notconsider the technique and indication.

Reactivity (observer effect): In case the measuring method has an influence on the behaviour of the employees, this is the reactivity effect, which is also referred to as “Hawthorne effect” or “observer bias”.

In infection control, great emphasis is placed on hand hygiene and hand hygiene compliance. Terms alsofrequently used are hand hygiene behaviour and frequency. But what is the difference and how can thesevalues be determined reliably? In their review, Diefenbacher et al. investigated the most common measuring methods.

Hand hygiene behaviour:

Hand hygiene technique:

Hand hygiene compliance:

Hand hygiene frequency:

Reactivity:

KNOWLEDGE



Comparison of methods:

Hand hygiene and the compliance can be closely examined with differing procedures. Every method highlightsvarious aspects and has specific advantages and disadvantages.

Determining the consumption of hand disinfectants is one of the simplest methodsthat allows to draw conclusions about handhygiene. For this, the consumption of products is recorded regularly. Then, the approximate number of hand hygiene procedures is determined on the basis of theconsumed quantity.

• Advantages: Simple procedure; simple evaluation; anonymous data; low reactivity.

• Disadvantages: Exact stocktaking necessary; hand hygiene behaviourcan only be approximated; does not include indications.

Here, the test persons assess their hand hygiene behaviour over a certain period. Thiscan either be done in general terms or withthe help of a type of diary (day reconstructionmethod).

• Advantages: Considers indications and technique; individual data collection;low implementation effort.

• Disadvantages: Memory is prone to distortion; reactivity.

a) Electronic countingA hand disinfectant dispenser, which isequipped with an electronic counter, automatically documents every dispenser actuation.

• Advantages: Simple implementation; simple data evaluation; low reactivity.

• Disadvantages: No individual data; hand hygiene behaviour can onlybe approximated; does not include indications.

b) Compliance Monitoring Systems (CMS)CMS not only document hand hygiene activities. Motion sensors or more complextracking systems additionally register the employees’ movements and thus record certain indications, which are then mergedwith the data on hand hygiene behaviour.

• Advantages: Low reactivity; recording recording of hand hygiene behaviour and indication.

• Disadvantages: More complex and more expensive than automated counting procedures; prone to systematic errors when detecting indications.

Automated procedures:

Measurement of the consumption:

Self-evaluation report:

KNOWLEDGE

Source: 1. Diefenbacher, S. et al. Verfahren zur Erfas-

sung des Händehygieneverhaltens – Einemethodische Betrachtung aus verhaltens-wissenschaftlicher Perspektive. Hy-giene&Medizin, 2016, 46(6).

a) Direct observationWith this method, an observer records anemployee’s hand hygiene behaviour. Thedata can be collected with observation formsor with the aid of a portable device (e.g. tablet computer). Direct observation can bedone openly or directly and by differinggroups of persons (external observer, employees from other wards; members ofother professional groups (e.g. infection control practitioners)).

• Advantages: Completely reflects hand hygiene compliance (measure, indicationand technique); individual data collection

• Disadvantages: Labour intensive and costly; observers need to be trained; distortion through reactivity.

b) Video-based observationFor the video-based observation, a camera records the hand hygiene behaviour. Theevaluation is done subsequently, separatedin terms of time and staff. Mounted or portable: cameras can be firmly installed andthus record a complete room or area or accompany the employees in form of portable miniature cameras

• Advantages: Completely reflects hand hygiene compliance (measure, indicationand technique); individual data collection;reactivity decreases after a short while.

• Disadvantages: Data processing and evaluation is very complex; privacy needsto be respected.

Observation:


INSIGHTS


EXPERTISE

High flexibility combined with maximum safety:

The new X-Wipes Safety Pack for surface hygiene

Highest hygiene standards apply to high-risk areas with patients especially susceptible toinfection. In these areas, surfaces are often disinfected with pre-soaked single-use wipesprovided in wipes dispenser systems. However, a study of the BODE SCIENCE CENTER revealed that these dispensers have a high associated risk potential: data from 13 hospitals proved that the use-solutions in wipes dispenser systems were highly contaminated. Around 42.4 % of the examined samples harboured differing pathogens –including Gram-negative Serratia.

Hence, HARTMANN developed a disposable wipes dispenser system that eliminates reprocessing, which is often prone to error: the X-Wipes Safety Pack is discarded after use,thus reducing the risk of contamination such as the formation of biofilm as far as possible.

The integrated fleece roll offers another plus in terms ofsafety as it additionally reduces the risk of introducinggerms when filling the bag. Therefore, the X-Wipes SafetyPack is ideal for high-risk areas such as intensive care, hae-matological oncology or neonatology units, but also for

wards, in which a correct dispenser reprocessing isnot possible or not desired.

In clinical routine, it is not only safety that playsa significant role, but also user-friendliness. Here,the innovative design of the Safety Pack scoresbig: the patented diamond-shaped opening ensures a particularly safe and user-friendly dispensing of the wipes. It prevents the wipesfrom tearing too early and slipping back.

Furthermore, the flexible bag is particularly stable and thus guarantees a safe stability to thelast wipe. The dispenser is compatible with all liquid surface disinfectants from HARTMANN andcan be filled immediately.

Thus, although offering maximum safety, the X-Wipes Safety Pack saves precious time.

Did you already know?For high-risk areas, the expertsof the German Association for Applied Hygiene (VAH) also recommend using wipes dispenser systems that do not require reprocessing – except for wipes dispenser systems that are only filled with alcohol-based disinfectants. Read more in the expert interview in the BODE SCIENCE CENTER.

Sources:

1. Kampf G et al. Poorly processed reusable dispensers for surface disinfection tissues are a possible source of infection. BMC Infectious Diseases 2014, 14:37.

2. Mitteilung der Desinfektionsmittel-Kommission im VAH unter Mitwirkung der „4+4-Arbeitsgruppe“. Zur Verwendung von Tuchspendersystemen in Bereichen mit besonderem Infek-tionsrisiko.(Statement of the Disinfectants Commission of the German Association for Applied Hygiene (VAH) with thecollaboration of the „4+4 Working Group“ on the use of wipes dispenser systems in areas with particular risk ofinfection). Hyg Med 2014; 39 – 9.

http://www.productcatalogue.bode-chemie.com/products/surface/x-wipes_dispenser.phphttp://www.bode-science-center.com/science/study/article/expert-interview-on-biofilm-developing-gram-negative-pathogens.htmlhttp://www.bode-science-center.com/science/study/article/expert-interview-on-biofilm-developing-gram-negative-pathogens.html

Research for infection protection. www.bode-science-center.comBSB10

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CreditsConcept / editorial office: SCI COM GmbH, scientific communication Schmilinskystraße 32, 20099 Hamburg, Telephone: +49 40 / 25 32 86-05, Fax: -08,E-mail: [email protected] Niknam (responsible), Angelika Schulz, Anja Garcia ZiemsenISSN 1618-8292

Design: Beling Grafikdesign, HamburgDISINFACTS is published by order of BODE Chemie GmbH, Hamburg

Picture credits:Title: iStockphoto; page 2: iStockphoto; page 4: Beling Grafikdesign; page 5: B. Gayk/R. Kranabetter/C. Zabrautanu,Abteilung Hygiene, Landkreis Passau Gesundheitseinricht-ungen; page 6/7: Shambroom Photography; page 8: Marco Grundt Fotografie; page 10: Beling Grafikdesign;page 11/12/13: Yvonne Fischer; page 14/15: Marco GrundtFotografie; page 16: Shambroom Photography; page 18: iStockphoto; page 19: Beling Grafikdesign, Marco Grundt Fotografie

PRACTICE

In surface disinfection, the exposure time is an essential factor. Only if disinfectant solutions can acton a surface long enough, microorganisms are reliablykilled and inactivated, respectively. Provided that thesurface is wetted adequately, the time until the disinfected surface is dry again normally suffices, as thedisinfectant continues to inactivate microorganismseven when the surface is visibly dry. The reason: activeingredients attach to the microorganisms or are absorbed by them, so that the disinfectant continues toact after drying [1].

Using surfaces again after dryingRoutinely disinfected surfaces may be used again assoon as they are visibly dry. This means that these surfaces can be used again before the specified expo-sure time is over [1].

To ensure efficient work processes, it is crucial to be able to use surfaces again as soon as possible after disinfection. In daily routine, it is often asked whether disinfected surfaces can be used again after they are dryor if it is necessary to await the complete specified exposure time.

Surface disinfection:

Await drying or exposure time?

Using surfaces again after the exposure timeIn the following cases, surfaces may only be used againwhen the specified exposure time is over [1, 2]:

• targeted disinfection of surfaces that are contaminatedwith blood, pus, excretions and other body fluids

• terminal disinfection• reprocessing of medical devices• bathtub disinfection• disinfection of surfaces in contact with food that need

to be rinsed with water afterwards• officially ordered disinfection measures in accordance

with Art. 18 of the German Federal Law on the Prevention of Infectious Diseases in Humans.

Sources:

1. Anforderungen an die Hygiene bei der Reinigung und Desinfektion von Flächen. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention beimRobert Koch-Institut (RKI). Bundesgesundheitsbl - Gesundheitsforsch - Gesundheitsschutz 2004 · 47:51–61.

2. Desinfektionsmittel-Liste des VAH: Eine kurze Einführung. Desinfektionsmittel‐Kommission im VAH, 2015.

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