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The consensus-based guideline “hand antisepsis and hand hygiene” for Germany has the following sections: Prevention of nosocomial infections by hygienic hand antisepsis, prevention of surgical site infections by surgical hand antisepsis, infection prevention in the community by hand antisepsis in epidemic or pandemic situations, hand washing, selection of alcohol-based hand rubs and wash lotions, medical gloves and protective gloves, preconditions for hand hygiene, skin protection and skin care, quality assurance of the implementation of hand hygiene measures and legal aspects. The guideline was developed by the German Society for Hospital Hygiene in cooperation with 22 professional societies, 2 professional organizations, the German Care Council, the Federal Working Group for Self-Help of People with Disabilities and Chronic Illness and their Family Members, the General Accident Insurance Institution Austria and the German-speaking Interest Group of Infection Prevention Experts and Hospital Hygiene Consultants.

Chemical disinfection is an indispensable means of preventing infection. This holds true for healthcare settings, but also for all other settings where transmission of pathogens poses a potential health risk to humans and/or animals. Research on how to ensure effectiveness of disinfectants and the process of disinfection, as well as on when, how and where to implement disinfection precautions is an ongoing challenge requiring an interdisciplinary team effort. The valuable resources of active substances used for disinfection must be used wisely and their interaction with the target organisms and the environment should be evaluated and monitored closely, if we are to reliable reap the benefits of disinfection in future generations. In view of the global threat of communicable diseases and emerging and re-emerging pathogens and multidrug-resistant pathogens, the relevance of chemical disinfection is continually increasing. Although this consensus paper pinpoints crucial aspects for strategies of chemical disinfection in terms of the properties of disinfectant agents and disinfection practices in a particularly vulnerable group and setting, i.e., patients in healthcare settings, it takes a comprehensive, holistic approach to do justice to the complexity of the topic of disinfection.

Objective: Vancomycin-resistant (VRE) are of major concern in infection control. Although broad infection control actions to check VRE have been implemented, VRE remain part of daily infection prevention in clinical settings. Cleaning procedures in the inanimate ward environment might play a key role in controlling VRE. In order to optimize infection control management at University Hospital Frankfurt, Germany (UHF), this study evaluates the impact of HO-containing cleaning wipes compared to Glucoprotamin containing wipes on VRE prevalence in intensive care wards.Methods: Retrospective analyses were conducted of the VRE prevalence on environmental materials obtained from three intensive care units (ICU) at UHF for 17 months prior to (T1) and during the 25 months after (T2) the implementation of HO-containing cleaning wipes from January 2016 to June 2019. The bactericidal power of the two disinfectants against VRE was compared using the 4-field test according to EN 16615 (2015).Results: At T1 and T2, n=666 and n=710 environmental samples, respectively, were obtained. At T1, 24.2% (n=161/666; 95% confidence interval: 21.0–27.6) and at T2, 6.9% (n=49/710; 5.1–9.0) samples were positive for VRE. disinfectant testing did not reveal any superiority of HO over glucoprotamin. No effect on the VRE prevalence in patients’ rectal screening materials was observed.Conclusion: Though Glucoprotamin and HO were equally effective against VRE, the prevalence of VRE in ICU environment at UHF decreased after implementation of HO-containig wipes. This might be due to multiple factors, of which we consider the impact of the to be the strongest. Success of infection control strategies might depend on the compliance of the persons critically involved. Transparent information on infection control strategies is suggested to increase compliance and should therefore be considered both in daily infection control and outbreak management.

Multiply-resistant Pseudomonas aeruginosa were first detected in north-eastern Germany at the end of 1996; since then they have been isolated predominantly from patients in intensive care units. Colonization/infection, especially of the respiratory tract, has been demonstrated in 80 patients, with strains resistant to β-lactams, carbapenems, aminoglycosides and quinolones. Amikacin showed in-vitro synergy with cefepime, ceftazidime or piperacillin/tazobactam. Horizontal transfer of strains was followed by PFGE and identical strains were detected in the environment, but the source of infection was not established. Rigorous infection control and restricted clinical use of carbapenems limited further dissemination of this outbreak. [ABSTRACT FROM PUBLISHER]

Since the publication of the first “Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems) in hospitals” () in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section “Ventilation and air conditioning technology” attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care.

[english] Background: Recent research suggests that specific ethanol-based skin antiseptics exhibit their efficacy on the resident skin flora of the forehead in only 2.5 minutes. We have now looked at the efficacy of two skin antiseptics based on 63% (w/w) propan-2-ol (iso-propanol) and applied for 10 and 2 minutes on skin with a high density of sebaceous glands. Methods: Each experiment was performed in a reference-controlled cross-over design with at least 20 participants. Application of isopropanol (70%, v/v) for 10 minutes to the forehead served as the reference treatment. Pre-values and post-values (immediately after the application and after 30 min) were obtained by swabbing a marked area of 5 cm for about 10 s. Swabs were vortexed in tryptic soy broth containing valid neutralizing agents. After serial dilution aliquots were spread on tryptic soy agar. Colonies were counted after incubation of plates at 36°C for 48 h. The mean log reduction of bacteria was calculated. The Wilcoxon matched-pairs signed-ranks test was used for a comparison of treatments.Results: Skin antiseptic A applied for 10 min (one experiment) was equally effective to the reference treatment. When applied for 2 min (two experiments) it was still equally effective to the reference treatment immediately after application (e.g. 1.6 versus 1.4 log reduction) and after 30 min (1.7 versus 1.4 log reduction). Skin antiseptic B applied for 10 and 2 min (one experiment each) was also equally effective to the reference treatment both immediately after application and after 30 min.Conclusions: The clear and coloured skin antiseptics applied for 2 min on the skin of the forehead fulfilled the national efficacy requirements for skin antisepsis. The shorter application time on skin with a high density of sebaceous glands will allow acting more efficiently in clinical practice.

The German national guideline to prevent the spread of MRSA in acute care hospitals demands isolation of patients with MRSA, whereas a guideline for management of MRSA/MRDO-patients in rehabilitation is pending. Many rehabilitation clinics believe they should isolate these patients and therefore deny rehabilitation of this patient group arguing that rehabilitation and isolation are incompatible. In order to improve the rehabilitation of MDRO-patients the MDRO network Rhein-Main has developed a recommendation for rehabilitation clinics.Based on literature data on the prevalence of MRSA/MDRO in rehabilitation clinics, the data on transmission of MDRO in such clinics and on existing recommendations, a new recommendation was established by experts in hygiene and by management of rehabilitation clinics in the region.Current studies in Germany as well as in France exhibit the same prevalence of MDRO patients in rehabilitation units as well as in acute care clinics. Transmission occurs mainly via hand contact during patient care or medical therapy in critically ill patients with high maintenance. However, the risk of transmissions in patients with great mobility is not increased. Hence, good standard hygiene, especially good hand hygiene both in staff and patients, is the key method to prevent transmission. Isolation or other restriction of mobility does not seem necessary. These data formed the basis of the newly established recommendation, which sets out in a clearly laid-out and tabular manner the standard hygiene procedures necessary for safe rehabilitation of all patients and the additional measures necessary for rehabilitation of MDRO-patients. The recommendation provides guidance and thus will enable a better rehabilitation of MDRO-patients., (© Georg Thieme Verlag KG Stuttgart · New York.)

Besides mites, filamentous fungi and yeasts play an important role as domestic allergens. Among different allergen avoidance strategies the efficacy of synthetic mattress encasings has been demonstrated for the reduction of house dust mites. Whether these synthetic encasings are also able to reduce the growth of fungi on the mattress under domestic conditions has not been assessed so far. To determine if the fungal growth on mattresses can be reduced by the use of synthetic encasings we assessed the fungal colonisation of mattresses covered either by conventional cotton encasings or by polyurethane encasings impermeable to particles > 3 mum. Within a 12-month period dust samples were obtained from the mattresses. Fungal quantities were measured by counting colonies on agar plates incubated at 20 degrees C and 37 degrees C. The counts of fungi were significantly higher on mattresses with cotton encasings. Penicillium spp. and Aspergillus spp. were isolated most frequently. Therefore the application of synthetic encasings with similar properties to the encasings used in this investigation is recommended as part of an allergen avoidance strategy for patients sensitised to fungal allergens.

Cetylpyridinium chloride, (CPC, CAS 123-03-5) as active ingredient of antiseptic oral mouthrinses has a broad antimicrobial spectrum with a rapid bactericidal effect on gram-positive pathogens and a fungicide effect on yeasts in particular. There are gaps in its effectiveness against gram-negative pathogens and mycobacteria. Application of CPC at a concentration of 0.05% as a mouthrinse results in an immediate reduction in bacterial counts of 2.0 to 2.5 log steps (which is adequate to > 99%). This reverts to about 1 log step (= 90%) 1 h after application. The ability of CPC to inhibit plaque and thereby reduce gingivitis is assured. In comparison to chlorhexidine, CPC has a lower residual effect, and as a result a lesser effect against plaque and gingivitis. The efficacy of CPC against oropharyngeal candidiasis is assured. CPC mouthrinses can significantly reduce infectious aerosols in dental practice, thereby protecting both staff and the patient. The balance of intra-oral bacterial flora is not disturbed even in the case of relatively long-term use of CPC (up to six weeks). Taking these properties into consideration, CPC may be considered as an alternative active ingredient in the case of chlorhexidine intolerance in the treatment and prevention of bacterial or fungal disorders of the oropharyngeal cavity. It is also of interest as an element for combination in the development of new types of oropharyngeal antiseptics.

Antimicrobial substances are used for many prophylactic and therapeutic reasons in the oral cavity. They are used as mouthrinses, for the irrigation of specific oral locations, in form of gels, or varnishes. Different antimicrobial agents are available and some preparations are complex compositions of these compounds. Although it has been proven that several agents are suited to achieve a considerable reduction of oral microorganisms many questions concerning the clinical benefit are yet to be answered. This report summarises the evidence of the efficacy of oral antiseptics (especially chlorhexidine, pvp-iodine, and Listerine) depending on different indications, which is the basis for clinical and practical recommendations.

Background and Objective: We investigated if the colonisation of new mattresses with house dust mites, bacteria, and fungi could be reduced by using synthetic mattress covers as compared to common cotton covers., Patients/methods: 84 healthy volunteers were assigned to two groups. Group A (n = 43) received the cotton covers, group B (n = 41) the synthetic covers which were made of a polyester microfaser with a polyurethane surface layer (Pro-Tex, Germed, Schwarzenbek, Germany)., Results: The mite antigen concentration after six months was significantly lower in group B. Three months after the start of the study counts of bacteria and moulds were significantly higher in group A compared to group B., Conclusions: It can be recommended that patients suffering from an allergy to mites or moulds may reduce their domestic allergen exposure by using the synthetic mattress covers tested in this study. Since cotton covers are very likely to become colonised by bacteria and moulds, they must be cleaned periodically (at least every 2nd-3d month).

Background and Objective: Complaints of well-being and health after moving in a new or redeveloped building occur quite frequently. If these complaints persist for several months and are indicated by the majority of occupants, an examination of the air quality is required. However, the interpretation of these data can be difficult since different recommendations but no threshold limit values for the indoor contamination with volatile organic compounds (VOC's) exist., Patients and Methods: This report presents a case with serious health complaints (14 males, average age 40.4 years; 44 females, average age 37.9 years) after moving in a completely redeveloped building. Complaints of well-being and health were investigated by a standardised questionnaire and compared with a control group (11 males, average age 41.4 years; 12 females, average age 33.3 years). The VOC-contamination was analysed by various measurements., Results: Two months after moving into the building a total VOC-concentration of 2000-3000 micrograms/m3 was registered, after 10 months the concentration decreased to 900-1300 micrograms/m3 due to intense airing. The following symptoms showed the clearest differences between exposed persons and the control group: soreness of throat (odds ratio: 10.72; 95%-confidence interval: 1.46-465.2), irritations of mucous membranes (OR: 10.45; 95%-CI: 1.43-453.8), headache (OR: 9.9; 95%-CI: 1.35-430.9) and increased weariness (OR: 7.55; 95%-CI: 1.55-71.2). As a consequence extensive redevelopment measures were initiated., Conclusion: Contamination of the indoor air with 900 micrograms/m3 VOC's (total value) can induce serious complaints of well-being and health. Rooms with VOC-concentrations > 1200-1500 micrograms/m3 are not suited for regular stay of unprotected people.