Background: Nonsterile gloves (NSG) are often overused, while the emphasis should lie in hand hygiene (HH). Furthermore, improper HH leads to contamination of NSG in glove boxes. The aim of this study was to compare microbial loads on hands from health-care workers (HCW) after HH to NSG and to study the influ-ence of position and filling level of glove boxes on contamination rates. Methods: Fingerprints on agar plates were made from randomly chosen HCWs directly after HH. Plates were incubated and colony-forming units counted. NSG taken from glove boxes were also sampled. Filling level and position (horizontal vs vertical) of the glove boxes were recorded. Results: Median colony-forming units count was similar for hands after HH (N = 107, median 1, IQR 5) and NSG (N = 185, median 1, IQR 2, P-value .33). Only few samples in both groups showed growth of pathogenic bacteria. Neither the filling level (P-value .76), nor the position of the glove box (P-value .68) had an influence on NSG contamination. Conclusion: Microbial loads of hands after HH are comparable to NSG. Filling level or position of the glove box did not influence glove contamination. Whether similar microbial counts translate into comparable nosocomial infection rates warrants further research. (c) 2021 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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.

Dezentrale Desinfektionsmittel-Dosiergeräte (DDG) erleichtern die korrekte Durchführung der Flächendesinfektion in medizinischen Einrichtungen. Da die Geräteleitungen verkeimen können, sollte die aus den Geräten entnommene Desinfektionsmittellösung regelmässig mikrobiologisch überprüft werden. Das methodische Vorgehen bei der Abnahme und Untersuchung der Lösung ist allerdings bisher nicht allgemein standardisiert. Variable Punkte sind die Abnahme nach Vorlauf versus als Erstschwallprobe, die Enthemmung des Desinfektionsmittels (sofort oder erst im Labor) und die anzuwendenden Grenzwerte für verschiedene Keimspezies. Wir schlagen anhand eigener Erfahrungen ein einfaches Vorgehen für die Routineprüfung ohne speziellen Anlass vor, stellen die damit gewonnenen Ergebnisse vor und diskutieren alternative Optionen bei anlassbezogener Prüfung, z. B. bei Ausbrüchen.

In the past years infections caused by multidrug-resistant Gram-negative bacteria have dramatically increased in all parts of the world. This consensus paper is based on presentations, subsequent discussions and an appraisal of current literature by a panel of international experts invited by the Rudolf Schülke Stiftung, Hamburg. It deals with the epidemiology and the inherent properties of Gram-negative bacteria, elucidating the patterns of the spread of antibiotic resistance, highlighting reservoirs as well as transmission pathways and risk factors for infection, mortality, treatment and prevention options as well as the consequences of their prevalence in livestock. Following a global, One Health approach and based on the evaluation of the existing knowledge about these pathogens, this paper gives recommendations for prevention and infection control measures as well as proposals for various target groups to tackle the threats posed by Gram-negative bacteria and prevent the spread and emergence of new antibiotic resistances.

In developing hygiene strategies, in recent years, the major focus has been on the hands as the key route of infection transmission. However, there is a multitude of lesser-known and underestimated reservoirs for microorganisms which are the triggering sources and vehicles for outbreaks or sporadic cases of infection. Among those are water reservoirs such as sink drains, fixtures, decorative water fountains and waste-water treatment plants, frequently touched textile surfaces such as private curtains in hospitals and laundry, but also transvaginal ultrasound probes, parenteral drug products, and disinfectant wipe dispensers. The review of outbreak reports also reveals Gram-negative and multiple-drug resistant microorganisms to have become an increasingly frequent and severe threat in medical settings. In some instances, the causative organisms are particularly difficult to identify because they are concealed in biofilms or in a state referred to as viable but nonculturable, which eludes conventional culture media-based detection methods. There is an enormous preventative potential in these insights, which has not been fully tapped. New and emerging pathogens, novel pathogen detection methods, and hidden reservoirs of infection should hence be given special consideration when designing the layout of buildings and medical devices, but also when defining the core competencies for medical staff, establishing programmes for patient empowerment and education of the general public, and when implementing protocols for the prevention and control of infections in medical, community and domestic settings.

Wenn neutropenische Patienten eine bakterielle Sepsis entwickeln, ist diese potenziell lebensbedrohlich. Deshalb müssen eine adäquate mikrobiologische Diagnostik und spezifische Therapie so schnell wie möglich initiiert werden. Die Arbeitsgemeinschaft Infektionen in der Hämatologie und Onkologie, eine Fachgruppe der Deutschen Gesellschaft für Hämatologie und medizinische Onkologie (DGHO), hat kürzlich ihre Leitlinien hierzu aktualisiert.

Background: Bacterial endotoxin is known to act as a potent trigger of disseminated coagulation and septic shock. During clinical antibiotic treatment, endotoxin may be released from Gram-negative bacteria. It is known that antibiotic classes differ in their ability to induce endotoxin release. Aim: It was the aim of this study to test the endotoxin-liberating potential of different antibiotics with activity against Escherichia coli and Bacteroides fragilis.Methods: In vitro test models were used to evaluate the endotoxin-liberating potential of moxifloxacin, a 4th-generation quinolone with antianaerobic activity. Bacteria were exposed to moxifloxacin at 2×, 10× and 50× the minimal inhibitory concentration. Endotoxin release was measured by enzyme-linked immunosorbent and Limulus amoebocyte lysate assays. Comparator drugs were ceftazidime and imipenem, i.e. antibiotics with known high and low endotoxin-liberating potential, respectively. As a parameter for biological responses to endotoxin, the release of proinflammatory cytokines (tumor necrosis factor-α, interleukin-1β) from monocytes/macrophages was quantified with bioassays. Results: In all test systems, release of endotoxin during exposure of bacteria to moxifloxacin was minimal or low and comparable with that of imipenem. Conclusions: Moxifloxacin has a low potential to cause endotoxin-mediated detrimental clinical effects. Concerning its endotoxin-releasing properties, moxifloxacin appears to be a choice equivalent to the carbapenems.

Obwohl sich das Erregerspektrum nosokomialer Infektionen auf Intensivstationen in den letzten beiden Jahrzehnten erheblich verändert hat, ist die Bedeutung des klassischen nosokomialen Infektionskeims Pseudomonas (P.) aeruginosa nahezu unverändert geblieben. Der Erreger ist heute in den meisten Statistiken der zweithäufigste bei Beatmungspneumonien isolierte Mikroorganismus. Bei Septikämien, Harnwegsinfektionen und chirurgischen Wundinfektionen nimmt P. aeruginosa die dritte oder vierte Position in der Erregerhäufigkeit ein. Während in der Vergangenheit horizontale Transmissionen als hauptsächlicher Infektionsweg angesehen wurden, mehren sich seit etwa 10 Jahren die Hinweise, dass ein wesentlicher Anteil der P. aeruginosa-Isolate von Intensivpatienten aus dem Leitungswasser der Intensivstation stammt. Eine Reihe von in den letzten Jahren hierzu durchgeführten Studien, in denen die Infektionswege mittels molekularer Typisierungsverfahren analysiert wurden, werden in der vorliegenden Übersichtsarbeit vorgestellt. Die Daten zeigen, dass bis zu 50% (in einer Studie sogar 92%) der nosokomialen P. aeruginosa-Akquisitionen durch Übertragungen aus dem Leitungswasser entstehen. Drei neuere Studien belegen zudem, dass durch Ausschaltung der Erregerquelle Wasser eine signifikante Reduktion von P. aeruginosa-Infektionen auf der Intensivstation erreicht werden kann.

BACKGROUND:Endemic infections because of Pseudomonas aeruginosa were observed on a surgical intensive care unit (ICU) for a period of >24 months. Tap water probing revealed persistent colonization of all ICU water taps with a single P aeruginosa clonotype.METHODS:Water outlets of the ICU were equipped with disposable point-of-use water filters, changed in weekly and, later, 2-week intervals. To delineate the effect of the filters, 4 study approaches were followed: (1) a descriptive analysis of the incidence of P aeruginosa colonizations and infections, (2) microbiologic examinations of tap water before and after installation of the filters, (3) a comparative cohort analysis of representative patient samples from the prefilter and postfilter time periods, and (4) an analysis of general ward variables for the 2 periods.RESULTS:(1) The mean monthly rate (+/-SD) of P aeruginosa infection/colonization episodes was 3.9 +/- 2.4 in the prefilter and 0.8 +/- 0.8 in the postfilter period. P aeruginosa colonizations were reduced by 85% (P < .0001) and invasive infections by 56% (P < .0003) in the postfilter period. (2) Microbiologic examinations of tap water revealed growth of P aeruginosa in 113 of 117 (97%) samples collected during the prefilter period, compared with 0 of 52 samples taken from filter-equipped taps. (3) In the comparative cohort analysis, a number of patient-related variables were significantly associated with P aeruginosa colonization/infection. Considering these variables in a multivariate analysis, belonging to the postfilter cohort was the factor most strongly associated with a reduced risk of P aeruginosa positivity (relative risk, 0.04; P = .0002). (4) General ward variables such as bed occupancy, personnel-to-patient ratio, or microbiologic culturing density did not differ significantly between the 2 periods.CONCLUSION:Taking into account various patient-related and general ward variables, point-of-use water filtration was associated with a significant reduction of chronically endemic P aeruginosa colonizations/infections on a surgical ICU.

The recommendations of the German Robert Koch Institute, concerning microbiological screening of newly admitted hospital patients for MRSA colonization, referred to specific risk groups such as patients admitted from long-term care facilities. New literature data indicate that a general MRSA screening policy of all incoming patients may be a cost-effective measure in intensive care units of large tertiary care hospitals.

Background: Germany has witnessed increasing national methicillin-resistant Staphylococcus aureus (MRSA) rates during the past 2 decades. In our 900-bed tertiary care community hospital, a similar increase was noted during the period from 1994 to 2002, although single-room isolation and decolonization therapy were the standard of care.Methods: An intensified infection control program aimed at the reduction of nosocomial MRSA transmissions was developed in 2002 and translated into clinical practice in 2003. Essential components of the program were a detailed written MRSA standard, acquisition of signal-colored isolation gowns and storage carts facilitating the use of separate supplies for MRSA patients, intensified surveillance and feedback of MRSA data, "flagging" of formerly positive MRSA patients, and a general MRSA screening policy for all newly admitted patients on the surgical intensive care unit (ICU). The effect of the program was monitored by continuous surveillance of MRSA cases on all wards. The transmission index was defined as the ratio between secondary and "imported" MRSA cases.Results: Comparing the preintervention (2002) and postintervention (2005-2006) periods, the total number of MRSA patients, MRSA rates on the ICUs, and invasive MRSA infections on the ICUs were reduced. The MRSA transmission index fell from 2.1 (2002) to 0.8 (2006). The rate of deep incisional and organ/space infections due to MRSA occurring after orthopedic surgery was lowered from 0.74 to 0.15%.Conclusions: Our data indicate that the efficacy of single-room isolation and decolonization therapy can be strongly enhanced by means of a multicomponent, comprehensive MRSA control program. The program was effective despite an increasing "import" of new MRSA cases. Programs of this type may be suited to achieve a downward turn of MRSA figures in Germany.

In der Pädiatrie wurden Venenverweilkanülen bislang vielfach mit verdünnter Heparinlösung gespült. Da derzeit keine Präparate mit fertig konfektioniertem verdünntem Heparin mehr auf dem Markt sind, stellt sich die Frage, ob eine Spülung mit physiologischer Kochsalzlösung ausreicht.

Nosokomiale Infektionen stellen eine der häfigsen Komplikationen intensivmedizinischer Behandlung dar. Je nach Art der Intensivstation (operativ, konservativ) und Liegedauer der Patienten treten Infektionen in 20–60 % der Behandlungen auf. Nach einwöchiger Liegedauer steigt der Anteil der mit Antibiotika behandelten Patienten auf operativen Intensivstationen auf > 80 %; umgekehrt macht der Antibiotikaverbrauch auf Intensivstationen in Schwerpunkt- und Tertiärversorgungszentren meist etwa die Hälfte des gesamten Verbrauchs einer Klinik aus. Die Prävention und Behandlung von Infektionen auf der Intensivstation haben daher nicht zuletzt auch aus krankenhausökonomischer Sicht große Bedeutung.

The epidemiology of Pseudomonas aeruginosa infections and colonizations was studied prospectively on a 12-bed medical intensive care unit. Patients were monitored for P. aeruginosa colonization by performing throat swabs or tracheal aspirates on admission and weekly thereafter over a period of 6 months. Cultures of possibly infected sites were taken as clinically indicated. Water samples from all patient care-related tap water outlets were collected in 2-weekly intervals and examined for the presence of P. aeruginosa. Strains isolated from patients and water samples were analysed by serotyping and random amplified polymorphic DNA polymerase chain reaction (RAPD-PCR) typing. During the 6-month period, 60 of 143 (42%) water samples contained P. aeruginosa at various levels ranging from 1 to >100 colony-forming units per 100ml sample. Genotypically, water samples contained 8 different clonotypes. Nine patients had infections due to P. aeruginosa and 7 patients were colonized. Isolates from patients showed a similar distribution of genotypes as did tap water isolates, and strains of identical genotype as patient strains had been isolated previously from tap water outlets in 8 out of 16 (50%) infection or colonization episodes. However, patients also harboured strains not previously isolated from tap water. Thus, in addition to tap water, other environmental or unknown reservoirs appeared to play a role for the epidemiology of P. aeruginosa infections on this ward. However, because tap water played a significant role for strain transmissions, we conclude that intensified water site care is justified.

Background. Until recently, commercially available preparations of diluted heparin were often used for intermittent flushing of indwelling venous catheters in pediatric patients. Because such dilute heparin preparations have been withdrawn from the German market, the question of whether flushing with physiological saline can serve the same purpose has arisen.Patients and methods. Randomized studies comparing the effects of intermittent flushing of peripheral venous cannulas with dilute heparin and with physiological saline in newborns and children were evaluated. Studies evaluating the influence of continuous heparin infusions were analyzed separately. Endpoints were the proportion of obstructed catheters or mean catheter lifetime.Results. The randomized, prospective trials evaluating intermittent flushing showed no benefit of heparin over saline in terms of the mean catheter lifetime. In contrast, 5 studies examining the effect of a small amount of heparin added to every i.v. solution during continuous infusion therapy showed that the duration of catheter patency was significantly longer than without added heparin. Heparin concentrations of 0.25 IU or higher in the infusion fluids were effective. Because the methods used in the studies evaluating intermittent heparin flushing varied widely, further strictly controlled scientific studies of this topic are warranted.

in spite of the significant changes in the spectrum of organisms causing intensive care unit (ICU)-associated infections, Pseudomonas aeruginosa has held a nearly unchanged position in the rank order of pathogens causing ICU-related infections during the last 4 decades. Horizontal transmissions between patients have long been considered the most frequent source of P aeraginosa colonizations/infections. The application of molecular typing methods made it possible, during the last similar to 7 years, to idencify ICU tap water as a significant source of exogenous P aeruginosa isolates, A review of prospective studies published between 1998 and 2005 showed that between 9.7% and 68.1% of randomly taken tap water samples on different types of ICUs were positive for P aeruginosa and between 14.2% and 50% of infection/colonization episodes in patients were due to genotypes found in ICU water. Faucets are easily accessable for preventive measures, and the installation of single-use filters on ICU water outlets appears to be an effective concept to reduce water-to-patient transmissions of this important nosocomial pathogen.

OBJECTIVE:To study the association between infection and faucet contamination in a surgical intensive care unit (SICU). DESIGN:Prospective cohort study. SETTING:One SICU and 12 peripheral wards. PATIENTS:From 45 patients colonized or infected with P. aeruginosa, 87 positive isolates were collected. INTERVENTIONS:P. aeruginosa also was found in 150 of 259 (58%) tap water samples taken from patient rooms. MEASUREMENTS AND MAIN RESULTS:Clonal relationships between patient and tap water isolates were established by random amplification of polymorphic DNA-polymerase chain reaction. A long-time contamination (144 wks) with a single specific genotype for each of the faucets in our SICU was observed. Additional genotypes found in tap water from these faucets were only isolated over short periods of time. P. aeruginosa was shown to reside in single faucets and did not originate from the supplying mains. In 15 of 45 patients (33%), P. aeruginosa genotypes were identical to those from the faucets in the patient rooms. In six other patients, the same genotype was found in faucets from neighboring rooms. Faucets served as the source of infection for patients in 35% of cases, and on the other hand a retrograde contamination of faucets by patients was observed in 15% of cases. CONCLUSIONS:Tap water from faucets contaminated with P. aeruginosa plays an important role in the propagation of this pathogen among patients. A high number of transmissions were shown to occur both from faucet to patient and from patient to faucet. Our SICU served as an epicenter for the spread of P. aeruginosa to peripheral wards. It appears prudent to follow strict hygienic precautions such as wearing gloves and performing thorough alcoholic rub disinfection of hands after patient care and after hand washing at locations known to harbor.