Search

In Germany, recommendations on infection prevention and control of current virus outbreaks are given as communications by the Association for Applied Hygiene e.V. (VAH) together with the joint Disinfectant Commission of the German Association for the Control of Virus Diseases e.V. (DVV) and the Society of Virology* (GfV). The DVV was founded in 1954 in response to the ongoing threat to the population from polio and was given its current name in 1977. The DVV is supported by the Federal Ministry of Health, the Ministries of Health of the Federal States, scientific societies, as well as social foundations and organisations. Private individuals cannot be members of the DVV. The Society of Virology e.V. (GfV) is a scientific society for all virological fields in Germany, Austria and Switzerland, and is thus the largest virological society in Europe. With numerous commissions, guidelines and statements, it is the authoritative contact for research, healthcare and politics. The joint commission "Virus Disinfection" of these scientific societies focuses on the efficacy of chemical disinfection procedures against viruses. The VAH bundles the expertise of scientific societies and experts on infection prevention and is particularly committed to the quality assurance of hygiene measures. With the VAH disinfectant list, the association provides the standard reference for the selection of high-quality disinfection procedures. This disinfectant list has a tradition of more than 60 years in Germany. The original German version of this document was published in August 2022 and has now been made available to the international professional public in English. The document contains recommendations on hygiene and disinfection measures for monkeypox virus infections. Disinfectants against monkeypox must have at least proven efficacy against enveloped viruses (active against enveloped viruses); products with the efficacy ranges "limited virucidal activity" and "virucidal" can also be used. The disinfectant list of the VAH or the disinfectant list of the Robert Koch Institute are available for the selection of products. Especially in the case of contamination with crust or scab material, it should be noted that protein contamination can have a protective or stabilising effect on monkeypox. Therefore, cleaning – before disinfection – should always be carried out in this situation. Preventive measures such as vaccination and hygiene in the vicinity of people with monkeypox must be taken to prevent transmission to small children, pregnant women or people with a pronounced immune deficiency. [ABSTRACT FROM AUTHOR]

The current pandemic caused by COVID-19 has underlined the importance of a joint effort and approach to ensure patient and health care worker safety in medical care throughout Europe. In addition, the recent flood disasters in Germany and other countries called for immediate joint action, in this case with regard to the prevention of water-borne infections. Environmental disasters will increase with consequences for hospitals and nursing homes. Cooperative efforts are needed for preventing and controlling associated infection outbreaks, new pathogens will appear and a geographic shift of infectious diseases previously not detected in certain areas has already been observed. This approach to infection prevention and control must entail structural as well as regulatory aspects. The principle of equal protection against infections in all European countries must be implemented. Prevention and control of infections, including nosocomial infections, infections caused by antibiotic-resistant bacteria as well as pandemics, need to be based on equal standards in all of Europe. Protection against infections and other public health risks in all European countries is the best guarantor for building trust and identification of citizens in our common Europe. Experts in the fields of hygiene, microbiology, infectiology and epidemiology have to pool the expertise on the prevention and control of infections from different European countries and define key targets for achieving a high standard of hygiene measures throughout Europe. The participants of the Rudolf Schülke Foundation International Symposium call for immediate action and priority to be given to the realization of the proposed 16-point plan. [ABSTRACT FROM AUTHOR]

In the past years infections caused by multidrug-resistant Gram-negative bacteria have dramatically increased in all parts of the world. This Martin Exner1 Sanjay Bhattacharya2 consensus paper is based on presentations, subsequent discussions Bärbel Christiansen3 and an appraisal of current literature by a panel of international experts invited by the Rudolf Schülke Stiftung, Hamburg. It deals with the epi- Jürgen Gebel1 demiology and the inherent properties of Gram-negative bacteria, elu- Peter Goroncy-Bermes4 cidating the patterns of the spread of antibiotic resistance, highlighting Philippe Hartemann5 reservoirs as well as transmission pathways and risk factors for infection, Peter Heegmortality, treatment and prevention options as well as the consequences 6 of their prevalence in livestock. Following a global, One Health approach Carola Ilschner1 and based on the evaluation of the existing knowledge about these Axel Kramer7 pathogens, this paper gives recommendations for prevention and infecElaine Larsontion control measures as well as proposals for various target groups to 8,9 tackle the threats posed by Gram-negative bacteria and prevent the spread and emergence of new antibiotic resistances. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: The Rudolf Schuelke Foundation addresses topics related to hygiene, infection prevention and public health. In this context a panel of scientists from various European countries discussed "The Role of Surface Disinfection in Infection Prevention". The most important findings and conclusions of this meeting are summarised in the present consensus paper. Aim: Although the relevance of surface disinfection is increasingly being accepted, there are still a number of issues which remain controversial. In particular, the following topics were addressed: Transferral of microbes from surface to patients as a cause of infection, requirements for surface disinfectants, biocidal resistance and toxicity, future challenges. Methods and findings: After discussion and review of current scientific literature the authors agreed that contaminated surfaces contribute to the transmission of pathogens and may thus pose an infection hazard. Targeted surface disinfection based on a risk profile is seen as an indispensable constituent in a multibarrier approach of universal infection control precautions. Resistance and cross-resistance depend on the disinfectant agent as well as on the microbial species. Prudent implementation of surface disinfection regimens tested to be effective can prevent or minimize adverse effects. Conclusions: Disinfection must be viewed as a holistic process. There is a need for defining standard principles for cleaning and disinfection, for ensuring compliance with these principles by measures such as written standard operating procedures, adequate training and suitable audit systems. Also, test procedures must be set up in order to demonstrate the efficacy of disinfectants including new application methods such as pre-soaked wipes for surface disinfection. [ABSTRACT FROM AUTHOR]

In Germany, recommendations on dealing with patients who are colonised with methicillin-resistant S. aureus (MRSA) for the inpatient sector have been published in 1999 by the Commission for Hospital Hygiene and Infection Prevention (KRINKO). Some challenges arise with regard to the practical implementation of the KRINKO recommendations. These challenges do not principally question the benefit of the recommendations but have come into criticism from users. In this commentary the German Society for Hospital Hygiene (DGKH) discusses some controversial issues and adds suggestions for unresolved problems regarding the infection control management of MRSA in healthcare settings. [ABSTRACT FROM AUTHOR]

Virtually no prevention strategy in hospital hygiene has been the focus of such frequent controversial discussions as the role of surface disinfection. Set against that background, the Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute founded a working group comprising members with divergent views of risk evaluation as regards the role of disinfection. This working group produced a most carefully drafted guideline on how to deal with various risk areas and also incorporated a new provision into the guideline, stating that: "Cleaning and disinfection procedures must be organized and implemented such that there is no increase in the microbial load or spread of facultatively pathogenic or pathogenic microorganisms on surfaces." Numerous studies have come to the conclusion that surface disinfection constitutes a basic infection control measure with which the spread of pathogens can be controlled. Conversely, when using only detergents such a form of control is not possible, something that must be taken into account in future when engaging in risk evaluation and formulating infection control measures. In view of the burgeoning trend in, for ex- ample, norovirus outbreaks, also in hospitals and nursing homes, such insights are of paramount importance and attest to the need for disinfection of surfaces and of areas with frequent hand and skin contacts. This discussion about the need for surface disinfection has, in addition to causing confusion among users, led to a decline in the willingness to accept hygienic practices, thus increasing the risk of occurrence of nosocomial infections as well as of antibiotic-resistant microorganisms. [ABSTRACT FROM AUTHOR]

Background: Due to the high number of immunosuppressed and other predisposed patients hospitals have to control and ensure the microbiological water quality. The origin for the occurrence of pathogenic microorganisms in water pipes is the formation of biofilm. Methods: For the permanent control of water safety a water safety plan (WSP) was realized as recommended by the WHO following the principle "search and destroy". The WSP is based on an established HACCP concept due to the special focus. The most important measures include the concept for sample taking depending on patient risk. 3 different categories) are distinguished: risk area1 (high infection risk), risk 2 (moderate infection risk), and risk area 3 (not increased infection risk). Additionally to the threshold value of the German law for the quality of drinking water (TrinkwV) three more limiting values were defined (warning, alert, and worst case) for immediate risk adapted reaction. Additional attention has to be focussed on lavatory sinks, which are an open bacterial reservoir. Therefore continuous disinfecting siphons were installed as part of the WSP in high risk areas. If extended technical equipment is not available, especially for immunocompromised patients the following measures are easy to realize: boiled (or sun exposed) water for nursing procedures as well alimentary use, no showering. Results: Comparing data over 3 years the microbial water quality was significantly improved resulting in no new case of nosocomial Legionella pneumoniae and decrease in neonatal sepsis. Conclusion: According to average situations with highly contaminated water system the management must be defined with implementation of water task force, immediate providing of special equipment, information of patients and staff and control of the water quality, an example for successful decontamination of the hospital within 24 hours is given. [ABSTRACT FROM AUTHOR]

Objective: Vancomycin-resistant enterococci (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 preven- tion 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 H2O2-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 H2O2-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, re- spectively, 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. In vitro disinfectant testing did not reveal any superiority of H2O2 over glucoprotamin. No effect on the VRE prevalence in patients' rectal screening materials was observed. Conclusion: Though Glucoprotamin and H2O2 were in vitro equally effective against VRE, the prevalence of VRE in ICU environment at UHF de- creased after implementation of H2O2-containig wipes. This might be due to multiple factors, of which we consider the impact of the Hawthorne effect to be the strongest. Success of infection control strategies might depend on the compliance of the persons critically in- volved. Transparent information on infection control strategies is sug- gested to increase compliance and should therefore be considered both in daily infection control and outbreak management. [ABSTRACT FROM AUTHOR]

Aim: Two test methods for surface disinfection (phase 2, step 2) – the Wiperator method (ASTM standard E2967-15) and the 4-field test (EN 16615) – were compared using a disinfectant solution based on qua- ternary ammonium compounds and a ready-to-use alcohol-based wipe. As test organisms, Staphylococcus aureus and Pseudomonas aeru- ginosa were used. Results: While the 4-field test is a manual method and better reflects the process in practice, with the Wiperator, the wiping process is better controlled because it is an automated procedure. A comparison of the effects of both methods on the target log10-reduction of S. aureus and P. aeruginosa indicates a statistically significant difference between the two test methods (Mann-Whitney U-Test. S. aureus: 0 (Umin)<4 (Ucrit); n1=8, n2=8, p=0.001; 2-sided. P. aeruginosa: 24 (Umin)<26 (Ucrit); n1=11, n 2=10, p=0.025, 2-sided). In addition, the results indicate that the wipe used has a major influence on the success of the disinfection process. Discussion: Both methods are suitable for efficacy studies of surface disinfectants, yet they differ in some aspects. Additionally our data indicate a statistically significant difference between the two test methods. Conclusion: Efficiency testing of surface disinfection is a complex process that depends on many different parameters. Since the 4-field test better reflects the practice, it makes sense to stick to this test procedure, taking into account that the EN 16615 was approved by CEN TC 216 in 2015 after method validation ring trials. [ABSTRACT FROM AUTHOR]

Background: Nosocomial infections caused by antibiotic-resistant pathogens demonstrate the continued need for preventive hygiene management strategies. Information and training of patients in their personal hygiene is a current requirement of the German Society for Hospital Hygiene, and is recommended by the Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention beim Robert-Koch Institut, KRINKO) at the Robert Koch Institute. Aim: The aim of this study was to evaluate patients' existing knowledge of hygiene and their motivation to actively participate in preventive hygiene measures. Methods: This study included 445 inpatients at the Polyclinic for Surgery of University Hospital Bonn. Subjects were interviewed over a 6-month period using a questionnaire comprising 21 questions on the topic of hygiene. Results: The majority of patients rated their subjective level of knowledge as intermediate (41%), 25% as poor and 35% as high. The respondents rated the active inclusion of patients in hygiene practices as highly rel- evant, and were willing to actively contribute to infection prevention, whereby the patients considered hand washing and hand disinfection in particular as important starting points. 78% of the respondents wanted more information on hygiene, particularly on wound and food hygiene. Targeted hygiene education provided by hospital staff had a positive effect on the patients' subjective level of information, as well as on their confidence in physicians and nursing staff. Previous information via television or radio had a negative impact on the patients' subjective information level and on their confidence in hospital staff. Conclusion: Most surgically treated patients are motivated to actively contribute to preventive hygiene measures. This represents an additional and important option for applying hospital hygiene more effectively and, above all, closer to the patient. Information and education should preferably be performed by healthcare professionals. [ABSTRACT FROM AUTHOR]

During the time period from April 2012 to May 2013, 13 newborns (1 - 4 weeks old) and one child in a paediatric hospital ward in Germany were colonized with an extended spectrum betalactamase (ESBL) producing Klebsiella oxytoca (CTX-M-15). A microbiological source-tracking analysis, including human and environmental samples, was carried out to identify the source and transmission pathways of the K. oxytoca clone. In addition, different hygienic intervention methods were evaluated. Isolates of the K. oxytoca strains were detected in the detergent drawer and on the rubber door seal of a domestic washer-extractor machine, used in the same ward to wash laundry of the newborns as well as in two sinks. These strains were typed using PFGE and multi-locus sequence typing (MLST). The environmental findings were compared with those of the human strains and the isolates detected on the clothing. The results showed that the strains were identical using both techniques, (ST201 and pulse-field-gel-electrophoresis [PFGE] type-00531, a clone specific to this hospital and not previously isolated in Germany), emphasizing the washing machine as a reservoir and fomite for the transmission of these multidrug-resistant bacteria (MDR). After the washing machine had been taken out of use, no further colonizations were detected over a following 4-year period. [ABSTRACT FROM AUTHOR]

This position paper, developed by an interdisciplinary expert group of neonatologists, paediatric infectious disease physicians, clinical pharmacists and specialists for the prevention and control of nosocomial infections, describes the "Good handling practice of medicines parenterally administered to patients on NICUs". It takes equal account of patient safety and the specialties of neonatal intensive care regarding feasibility and proportionality. The overall concept is perceived as a "learning system", in which open communication within the health-care team relating to medication errors and critical incidents enables continuous development and improvement to ensure patient safety. In our opinion, pharmacists, who are responsible for the supply of ready-to-administer parenteral medicinal products for neonatal intensive care patients, as well as the hygiene staff responsible on site are integral parts of the interdisciplinary treatment team. Risks of the current clinical practice of parenteral treatment of NICU patients are discussed in detail and recommendations for safety-relevant procedures are given. [ABSTRACT FROM AUTHOR]

Antibiotics are essential for modern medicine, they are employed frequently in hospitals and, therefore, present in hospital wastewater. Even in concentrations, that are lower than the minimum inhibitory concentrations (MICs) of susceptible bacteria, antibiotics may exert an influence and select resistant bacteria, if they exceed the MSCs (minimal selective concentrations) of resistant strains. Here, we compare the MSCs of fluorescently labelled Acinetobacter baylyi strains harboring spontaneous resistance mutations or a resistance plasmid with antibiotic concentrations determined in hospital wastewater. Low MSCs in the μg/L range were measured for the quinolone ciprofloxacin (17 μg/L) and for the carbapenem meropenem (30 μg/L). A 24 h continuous analysis of hospital wastewater showed daily fluctuations of the concentrations of these antibiotics with distinctive peaks at 7–8 p.m. and 5–6 a.m. The meropenem concentrations were always above the MSC and MIC values of A. baylyi. In addition, the ciprofloxacin concentrations were in the range of the lowest MSC for about half the time. These results explain the abundance of strains with meropenem and ciprofloxacin resistance in hospital wastewater and drains. [ABSTRACT FROM AUTHOR]

Background: The approval of ethanol by the Biocidal Products Regulation has been under evaluation since 2007. This follows concern over alcohol uptake from ethanol-based hand rubs (EBHR). If ethanol is classified as carcinogenic, mutagenic, or reprotoxic by the European Chemicals Agency (ECHA), then this would affect infection prevention and control practices. Aim: A review was performed to prove that ethanol is toxicological uncritical and indispensable for hand antisepsis because of its unique activity against non-enveloped viruses and thus the resulting lack of alternatives. Therefore, the following main points are analyzed: The effectiveness of ethanol in hand hygiene, the evidence of ethanol at blood/tissue levels through hand hygiene in healthcare, and the evidence of toxicity of different blood/tissue ethanol levels and the non-comparability with alcoholic consumption and industrial exposure. Results: EBHR are essential for preventing infections caused by non-enveloped viruses, especially in healthcare, nursing homes, food industry and other areas. Propanols are effective against enveloped viruses as opposed to non-enveloped viruses but there are no other alternatives for virucidal hand antisepsis. Long-term ingestion of ethanol in the form of alcoholic beverages can cause tumours. However, lifetime exposure to ethanol from occupational exposure < 500 ppm does not significantly contribute to the cancer risk. Mutagenic effects were observed only at doses within the toxic range in animal studies. While reprotoxicity is linked with abuse of alcoholic beverages, there is no epidemiological evidence for this from EBHR use in healthcare facilities or from products containing ethanol in non-healthcare settings. Conclusion: The body of evidence shows EBHRs have strong efficacy in killing non-enveloped viruses, whereas 1-propanol and 2-propanol do not kill non-enveloped viruses, that pose significant risk of infection. Ethanol absorbed through the skin during hand hygiene is similar to consumption of beverages with hidden ethanol content (< 0.5% v/v), such as apple juice or kefir. There is no risk of carcinogenicity, mutagenicity or reprotoxicity from repeated use of EBHR. Hence, the WHO Task Force strongly recommend retaining ethanol as an essential constituent in hand rubs for healthcare. [ABSTRACT FROM AUTHOR]

The role of environmental transmission of SARS-CoV-2 remains unclear. Thus, the aim of this study was to investigate whether viral contamination of air, wastewater, and surfaces in quarantined households result in a higher risk for exposed persons. For this study, a source population of 21 households under quarantine conditions with at least one person who tested positive for SARS-CoV-2 RNA were randomly selected from a community in North Rhine-Westphalia in March 2020. All individuals living in these households participated in this study and provided throat swabs for analysis. Air and wastewater samples and surface swabs were obtained from each household and analysed using qRT-PCR. Positive swabs were further cultured to analyse for viral infectivity. Out of all the 43 tested adults, 26 (60.47%) tested positive using qRT-PCR. All 15 air samples were qRT-PCR-negative. In total, 10 out of 66 wastewater samples were positive for SARS-CoV-2 (15.15%) and 4 out of 119 surface samples (3.36%). No statistically significant correlation between qRT-PCR-positive environmental samples and the extent of the spread of infection between household members was observed. No infectious virus could be propagated under cell culture conditions. Taken together, our study demonstrates a low likelihood of transmission via surfaces. However, to definitively assess the importance of hygienic behavioural measures in the reduction of SARS-CoV-2 transmission, larger studies should be designed to determine the proportionate contribution of smear vs. droplet transmission. [ABSTRACT FROM AUTHOR]

The German Society of Hospital Hygiene develops guidelines, recommendations and standard operation procedures on a voluntary basis, published on the DGKH-website (https://www.krankenhaushygiene.de/). The original German version of this recommendation was published in April 2022 and has now been made available to the international professional public in English. Evaluating the current data on the efficacy of virucidal gargle/mouthwash solutions and nasal sprays against SARS-CoV-2 in vitro and in clinical trials, conducted with preventive or therapeutic objectives, recommendations are given for the prevention of COVID-19. The following areas are considered: Protection of the community when regional clusters or high incidences of infection become known Protection of the community at low risk of infection Pre-exposure prophylaxis for the protection of healthcare workers Post-exposure prophylaxis [ABSTRACT FROM AUTHOR]

Abstract: The world-wide deployment of cruise liners and naval units has caused an increased need for the disinfection of drinking water. The main cause for this is the unknown quality of drinking water in foreign harbours – besides the formation of bio-films due to the climatically disadvantageous conditions in the operational area. Water conduits on board are currently disinfected with calcium hypochlorite in case of microbiological contamination. Chemical and physical analyses after disinfection with calcium hypochlorite have shown that organic by-products consisting of trihalomethanes develop in considerable amounts during disinfection. Furthermore, the method is susceptible to handling errors and thus often leads to insufficient disinfection results. Hitherto, the use of other disinfection methods allowed by government regulations, especially chlorine dioxide, is not widely spread. Unlike disinfection with calcium hypochlorite, chlorine dioxide does not lead to the formation of trihalomethanes. Typical disinfection by-products (DBP) are the anions chlorite and chlorate, which are formed in oxidative processes. The formation conditions of these anions have not yet been elucidated. For this reason, the probability of the generation of inorganic by-products after disinfection with chlorine dioxide has been determined, and their occurrence in drinking water on board has been examined with respect to a possible correlation between water quality and the formation of chlorate and chlorite. Therefore, a chromatographic method was developed and validated in order to determine the periodical development of chlorate and chlorite from chorine dioxide in purified water at different pH-values as well as in actual drinking water samples from water conduits on board. The formation of the by-products chlorite and chlorate after disinfection with chlorine dioxide is influenced neither by pH-value nor by chemical properties of the disinfected water. Considering the examined conditions, chlorine dioxide is suitable for usage on board due to its simple handling and the low potential of producing by-products. [Copyright &y& Elsevier]

Abstract: Childhood hypersensitivity pneumonitis (HP) is often associated with exposure to antigens in the home environment. We describe a case of HP associated with indoor hydroponics in a 14-year-old girl. Water samples from hydroponics revealed Aureobasidium pullulans as the dominant fungal micro-organism (104 CFU/ml). The diagnosis is supported by the existence of serum precipitating antibodies against A. pullulans, lymphocytic alveolitis on bronchoalveolar lavage (BAL) fluid, a corresponding reaction on a lung biopsy, and the sustained absence of clinical symptoms following the removal of hydroponics from the home. We conclude that hydroponics should be considered as potential sources of fungal contaminants when checking for indoor health complaints. [Copyright &y& Elsevier]

In the opinion of the medical societies of hygiene and pediatrics undersigning the present statement, the analyses published to date regarding transmission of SARS-CoV-2 and the course of CoVid-19 show that children play a much less significant role in the spread of the virus than do adults. According to the findings available to date, not only do children and adolescents less frequently fall ill with CoVid-19, they also generally become less severely ill than do adults. The vast majority of infections in children and adolescents are asymptomatic or oligosymptomatic. Even the first analyses from China demonstrated that children and ad- olescents play a subordinate role in the transmission of the virus – not only to other children and adolescents, but also to adults. Taking into account regional infection rates and available resources, daycare centers, kindergartens and elementary schools promptly should be reopened. For children, this should be possible without excessive restrictions, such as clustering into very small groups, implementation of barrier precautions, maintaining appropriate distance from others or wearing masks. A factor more decisive than individual group size is the issue of sustaining the constancy of respective group members and the avoidance of intermixing. Children can be taught basic rules of hygiene such as handwashing and careful hygiene behavior when coming into contact with others during mealtimes and/or when using sanitary facilities. Independent of the prevention measures implemented for children and adolescents, the protection of teachers, educators and caregivers is crucial, (e.g., the maintenance of appropriate distance from others, use of medical masks, situation-dependent hand disinfection, when necessary, supported by regular pool testing). Children over the age of 10 and adolescents up to school graduation age are more capable of actively understanding and conforming to specific hygiene rules. For this group, maintaining appropriate distance from others (1.5 meters), wearing a mouth-and-nose protection (whenever they are not sitting in their assigned classroom seats) and consistent education regarding the basic rules of infection prevention may provide increased options for normalizing teaching activities. Children and adolescents suspected of infection with SARS-CoV-2 should be tested immediately in order to either confirm or rule out such an infection. Evidence of individual infections in children or students must not automatically lead to the closure of the entire daycare center or school. A detailed analysis of the chain of infection is a prerequisite for a balanced approach to infection control. The opening of schools and children's facilities should be accompanied by specifically structured,model surveillance studies that further clarify outstanding questions about infectious disease events and hygiene control. These prospective, concomitant examinations will be essential Germany for the purpose of evaluating and verifying the effectiveness of the required hygiene measures. [ABSTRACT FROM AUTHOR]

Nach Ansicht der unterzeichnenden Hygiene- und Pädiatrie-Fachgesellschaften zeigen die bislang veröffentlichten Analysen über die Ausbrei- tungsdynamik von SARS-CoV-2 und die Verläufe von CoVid-19, dass Kinder im Vergleich zu Erwachsenen eine deutlich untergeordnetere Rolle in der Verbreitung des Virus einnehmen. Kinder und Jugendliche erkranken nach den bislang vorliegenden Erkenntnissen nicht nur seltener, sondern auch im Falle einer Infektion in der Regel weniger schwer als Erwachsene. Die übergroße Mehrzahl der Infektionen im Kindes- und Jugendalter verläuft asymptomatisch oder oligosymptomatisch. Zusätzlich belegen bereits die ersten Analysen aus China, dass Kinder und Jugendliche bei der Virusübertragung auf andere Kinder und Jugendliche, aber auch auf Erwachsene eine untergeordnete Rolle spielen. Kitas, Kindergärten und Grundschulen sollen zeitnah – unter Berücksichtigung der regionalen Neuinfektionsrate und der vorhandenen Ka- pazitäten – wieder eröffnet werden. Dies ist auf Seiten der Kinder ohne massive Einschränkungen, zu denen z.B. Kleinstgruppenbildung und Barriereschutzmaßnahmen wie Abstandswahrung und Maskentragen gehören würden, möglich. Entscheidender als die individuelle Gruppen- größe ist die Frage der nachhaltigen Konstanz der jeweiligen Gruppe und Vermeidung von Durchmischungen. Kinder können in Grundregeln der Hygiene wie Händewaschen und achtsames Hygieneverhalten im Umgang miteinander, beim Essen und in den Sanitäreinrichtungen spielerisch und kindgerecht unterwiesen werden. Unabhängig von den bei Kindern und Jugendlichen umgesetzten Präventionsmaßnahmen ist der Schutz des Lehr-, Erziehungs- und Betreuungspersonals ganz entscheidend (Abstandswahrung untereinander, Mund-Nasen-Schutz, situationsabhängige Möglichkeit zur Händedesinfektion, ggfls. unter- stützt durch regelmäßige Pooltestung). Kinder im Alter über 10 Jahre und Jugendliche bis zum Schulabschluss können aktiver in konkrete Hygieneregeln einbezogen werden. Hier erlauben eine weitgehende Abstandswahrung (1,5 m), das Tragen einer Mund-Nasen-Bedeckung solange die Schüler nicht an dem ihnen zugewiesenen Platz sitzen) und die konsequente Erziehung in den Grundregeln der tion größere Spielräume für eine Normalisierung des Unterrichtsbetriebes. Kinder und Jugendliche mit V.a. eine SARS-CoV-2-Infektion sollen unverzüglich untersucht werden, um eine solche Infektion zu sichern oder auszuschließen. Der Nachweis einzelner Infektionen bei Kindern oder Schülern darf nicht automatisch zur erneuten Schließung der gesamten Kita oder Schule führen. Eine detaillierte Analyse der Infektionskette ist Voraussetzung für ein abgewogenes Infektionsmanagement. Die Öffnung der Schulen und Kindereinrichtungen sollte durch strukturierte wissenschaftliche Surveillance-Untersuchungen exemplarisch begleitet werden, die die noch offenen Fragen zum infektiologischen Geschehen und Hygienemanagement weitergehend abklären. Diese prospektiven und begleitenden Untersuchungen sind essentiell, um die Wirksamkeit der bereits jetzt geforderten Hygienemaßnahmen zu evaluieren und zu verifizieren. [ABSTRACT FROM AUTHOR]

Due to the promising results of a previous study of the performance of the novel MPN method (Legiolert™/Quanti-Tray®) compared to ISO 11731-2, this study was performed to compare Legiolert for Legionella pneumophila with the German regulatory requirements methods ISO 11731-2 (100 ml membrane filtration) and ISO 11731 (1 ml direct plating) for the enumeration of L. pneumophila and Legionella spp. from potable water. Data from a multi-laboratory study according to ISO 17994 showed that Legiolert yielded on average higher counts of L. pneumophila than the ISO 11731-2 method, but the comparison with ISO 11731 was inconclusive due to the number of samples needing to be tested. Likewise, comparisons of the MPN method for 100 ml to the highest result of either ISO 11731 or ISO 11731-2 according to Federal Environmental Agency recommendation (2012) yielded no conclusive difference, regardless of whether non-pneumophila species of Legionella were included in the evaluation. The MPN method has a high specificity for L. pneumophila of 97.9% which compares favourably to the specificity of 95.3% quoted for ISO 11731. The new method represents a significant improvement in the enumeration of L. pneumophila from drinking water and related samples. [ABSTRACT FROM AUTHOR]

Carbapenem antibiotics constitute the mainstay therapy of nosocomial infections with extended spectrum beta-lactamase producing Gram-negative bacteria; however, resistance against these compounds is increasing. This study was designed to demonstrate that carbapenemase-producing bacteria are disseminated from hospitals into the environment. To this end, resistant bacteria were isolated from a clinical/urban and from a rural catchment system in Germany in 2016/17. The study followed the dissemination of resistant bacteria from the wastewater through the wastewater treatment plant (WWTP) into the receiving surface waters. The bacteria were cultivated on selective agar and characterized by antibiotic testing, real-time PCR targeting carbapenemase genes and typing. Bacteria with resistance to third generation cephalosporins were isolated from all sample sites. 134 isolates harboring carbapenemase genes encoding VIM, NDM and OXA-48 and 26 XDR (extensively drug-resistant) strains with susceptibility to only one or two antibiotics were isolated from the clinical/urban system. The rural system yielded eight carbapenemase producers and no XDR strains. In conclusion, clinical wastewaters were charged with a high proportion of multidrug resistant bacteria. Although most of these bacteria were eliminated during wastewater treatment, dissemination into surface waters is possible as single carbapenemase producers were still present in the effluent of the WWTP. [ABSTRACT FROM AUTHOR]

Between 1 August and 6 September 2013, an outbreak of Legionnaires' disease (LD) with 78 cases confirmed by positive urinary antigen tests occurred in Warstein, North Rhine-Westphalia, Germany. Legionella (L.) pneumophila, serogroup (Sg) 1, monoclonal antibody (mAb) subgroup Knoxville, sequence type (ST) 345, was identified as the epidemic strain. This strain was isolated from seven patients. To detect the source of the infection, epidemiological typing of clinical and environmental strains was performed in two consecutive steps. First, strains were typed by monoclonal antibodies. Indistinguishable strains were further subtyped by sequence-based typing (SBT) which is the internationally recognized standard method for epidemiological genotyping of L. pneumophila. In an early stage of the outbreak investigation, many environmental isolates were found to belong to the mAb subgroup Knoxville, but to two different STs, namely to ST 345, the epidemic strain, and to ST 600. A majority of environmental isolates belonged to ST 600 whereas the epidemic ST 345 strain was less common in environmental samples. To rapidly distinguish both Knoxville strains, we applied a novel typing method based on DNA-hybridization on glass chips. The new assay can easily and rapidly discriminate L. pneumophila Sg 1 strains. Thus, we were able to quickly identify the sources harboring the epidemic strain, i.e., two cooling towers of different companies, the waste water treatment plants (WWTP) of the city and one company as well as water samples of the river Wester and its branches. [ABSTRACT FROM AUTHOR]

Colonization of livestock with bacteria resistant to antibiotics is considered a risk for the entry of drug-resistant pathogens into the food chain. For this reason, there is a need for novel concepts to address the eradication of drug-resistant commensals on farms. In the present report, we evaluated the decontamination measures taken on a farm contaminated with methicillin-resistant Staphylococcus aureus (MRSA) and Enterobacteriaceae expressing extended-spectrum β-lactamases (ESBL-E). The decontamination process preceded the conversion from piglet breeding to gilt production. Microbiological surveillance showed that the decontamination measures eliminated the MRSA and ESBL-E strains that were detected on the farm before the complete removal of pigs, cleaning and disinfection of the stable, and construction of an additional stable meeting high-quality standards. After pig production was restarted, ESBL-E remained undetectable over 12 months, but MRSA was recovered from pigs and the environment within the first 2 days. However, spa (Staphylococcus aureus protein A gene) typing revealed acquisition of an MRSA strain (type t034) that had not been detected before decontamination. Interestingly, we observed that a farmworker who had been colonized with the prior MRSA strain (t2011) acquired the new strain (t034) after 2 months. In summary, this report demonstrates that decontamination protocols similar to those used here can lead to successful elimination of contaminating MRSA and ESBL-E in pigs and the stable environment. Nevertheless, decontamination protocols do not prevent the acquisition of new MRSA strains. [ABSTRACT FROM AUTHOR]

Colonization of livestock with bacteria resistant to antibiotics is considered a risk for the entry of drug-resistant pathogens into the food chain. For this reason, there is a need for novel concepts to address the eradication of drug-resistant commensals on farms. In the present report, we evaluated the decontamination measures taken on a farm contaminated with methicillin-resistant Staphylococcus aureus (MRSA) and Enterobacteriaceae expressing extended-spectrum β-lactamases (ESBL-E). The decontamination process preceded the conversion from piglet breeding to gilt production. Microbiological surveillance showed that the decontamination measures eliminated the MRSA and ESBL-E strains that were detected on the farm before the complete removal of pigs, cleaning and disinfection of the stable, and construction of an additional stable meeting high-quality standards. After pig production was restarted, ESBL-E remained undetectable over 12 months, but MRSA was recovered from pigs and the environment within the first 2 days. However, spa (Staphylococcus aureus protein A gene) typing revealed acquisition of an MRSA strain (type t034) that had not been detected before decontamination. Interestingly, we observed that a farmworker who had been colonized with the prior MRSA strain (t2011) acquired the new strain (t034) after 2 months. In summary, this report demonstrates that decontamination protocols similar to those used here can lead to successful elimination of contaminating MRSA and ESBL-E in pigs and the stable environment. Nevertheless, decontamination protocols do not prevent the acquisition of new MRSA strains. [ABSTRACT FROM AUTHOR]

Livestock-associated bacteria with resistance to two or more antibiotic drug classes have heightened our awareness for the consequences of antibiotic consumption and spread of resistant bacterial strains in the veterinary field. In this study we assessed the prevalence of concomitant colonization with livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) and enterobacteriaceae expressing extended-spectrum betalactamases (ESBL-E) in farms at the German-Dutch border region. Nasal colonization of pigs with MRSA (113/547 (20.7%)) was less frequent than rectal colonization with ESBL-E (163/540 (30.2%)). On the individual farm level MRSA correlated with ESBL-E recovery. The data further provide information on prevalence at different stages of pig production, including abattoirs, as well as in air samples and humans living and working on the farms. Notably, MRSA was detected in stable air samples of 34 out of 35 pig farms, highlighting air as an important MRSA transmission reservoir. The majority of MRSA isolates, including those from humans, displayed tetracycline resistance and spa types t011 and t034 characteristic for LA-MRSA, demonstrating transmission from pigs to humans. ESBL-E positive air samples were detected on 6 out of 35 farms but no pig-to-human transmission was found. Detection of ESBL-E, e.g. mostly Escherichia coli with CTX-M-type ESBL, was limited to these six farms. Molecular typing revealed transmission of ESBL-E within the pig compartments; however, related strains were also found on unrelated farms. Although our data suggest that acquisition of MRSA and ESBL-E might occur among pigs in the abattoirs, MRSA and ESBL-E were not detected on the carcasses. Altogether, our data define stable air (MRSA), pig compartments (ESBL-E) and abattoir waiting areas (MRSA and ESBL-E) as major hot spots for transmission of MRSA and/or ESBL-E along the pig production chain. [ABSTRACT FROM AUTHOR]

In this study, the performance of a new most probable number (MPN) test (Pseudalert®/Quanti-Tray®) for the enumeration of Pseudomonas aeruginosa from hospital waters was compared with both international and national membrane filtration-based culture methods for P. aeruginosa: ISO 16266:2006 and UK The Microbiology of Drinking Water - Part 8 (MoDW Part 8), which both use Pseudomonas CN agar. The comparison based on the calculation of mean relative differences between the two methods was conducted according to ISO 17994:2014. Using both routine hospital water samples (80 from six laboratories) and artificially contaminated samples (192 from five laboratories), paired counts from each sample and the enumeration method were analysed. For routine samples, there were insufficient data for a conclusive assessment, but the data do indicate at least equivalent performance of Pseudalert®/Quanti-Tray®. For the artificially contaminated samples, the data revealed higher counts of P. aeruginosa being recorded by Pseudalert®/Quanti-Tray®. The Pseudalert®/Quanti-Tray® method does not require confirmation testing for atypical strains of P. aeruginosa, saving up to 6 days of additional analysis, and has the added advantage of providing confirmed counts within 24-28 hours incubation compared to 40-48 hours or longer for the ISO 16266 and MoDW Part 8 methods. [ABSTRACT FROM AUTHOR]

Case report of a very serious drinking water incident putting up to 50,000 inhabitants of a town near Bonn in North Rhine-Westphalia, Germany at risk. A concentrated solution of highly alkaline water by sodium hydroxide was accidentally washed into the town's drinking water at a pumping station and increased the pH-value of the water to 12. Residents who came into contact with the contaminated water immediately had a toxic reaction. The incident was detected by complaints from customers and after that was stopped within several hours. The pipes were flushed and the customers were warned not to use the water till the all clear. After this immediate management there was an investigation and the cause of the incident was detected as an accidental release of accumulated sodium hydroxide (NaOH) solution. The lack of a network alarm system and the automatic cut-off mechanisms as deficiencies in the design of the station were rectified by the water company immediately after the incident. [ABSTRACT FROM AUTHOR]

This prospective, multinational study was conducted in 20 homes in eight cities or regions in different countries to determine the level of microbiological contamination of common surfaces and items, and investigate the attitudes and perceptions of householders towards cleaning and hygiene. Environmental Health Practitioners took eight standardised swabs in each home. The swabs were cultured for a range of micro-organisms. Householders (n=160) were also interviewed regarding their cleaning habits and perceptions of hygiene. Overall, 28% of surfaces or items tested in the study had ‘moderate bacterial growth’ or ‘heavy bacterial growth’. Kitchen cloths were the most contaminated items, with 86% having moderate bacterial growth or heavy bacterial growth; kitchen taps were the second most contaminated items, with 52% having moderate bacterial growth or heavy bacterial growth. High proportions (>50%) of kitchen cloths contained coliforms, Enterobacteriaceae and Pseudomonas spp. The visual appearance of surfaces and items frequently (30%) did not correspond to their level of contamination with micro-organisms. The majority of householders (65%) cleaned to make the house ‘look clean, smell nice and remove germs’; however, householders’ perceptions of the cleanliness of their homes frequently did not correspond to microbiological reality. In conclusion, further research and education are needed regarding hygiene in the home. [ABSTRACT FROM AUTHOR]

Abstract: In Germany, protozoal parasites are detected frequently in surface waters. This study aims to assess the parasitological pollution in a river course and two of its tributaries under regular weather conditions. Cryptosporidium was detected in 67% of all samples. The median concentration was 4oocysts/100l. Giardia lamblia were detected in 90% of the samples. The median concentration of G. lamblia was 22 cysts/100l and increased significantly following the river course. A statistically significant correlation was found between both parasites and the faecal indicators Clostridium perfringens and Escherichia coli. The intermittent occurrence of Cryptosporidium in the streams investigated was ascribed primarily to diffuse pollution, particularly during rainfall events. The relatively frequent detection of G. lamblia derived mainly from sewage treatment plants. The pathogen concentrations observed present a relevant public health risk as the river is used for recreational activities and agricultural purposes. [Copyright &y& Elsevier]

In the summer of 2010, parenteral nutrition (PN) admixtures were administered to neonates in the Pediatric Department of the University Medical Center Mainz that provoked severe clinical sequelae. Contamination of a dummy infusion with Enterobacter cloacae and Escherichia hermannii was detected on the day of the incident, and the same isolates were subsequently grown from all PN admixtures as well as from the parent amino acid solution from which the admixtures had been prepared. Quantitative microbiological analyses paired with the determination of endotoxin concentrations enabled the conclusion to be reached that the amino acid solution had represented the primary source of contamination, which must have occurred in the distant past and may have derived from passage of the bacteria through a crack in the glass container. The findings have large implications, and the approaches employed should become of value when similar incidents occur again in the future. [ABSTRACT FROM AUTHOR]

Hand hygiene is one of the most important measures to prevent transmission of infectious agents and plays a major role in prevention of infection in any type of healthcare setting. While requirements for the efficacy of hand disinfectants are defined in European testing norms such as the EN 1500 for hygienic hand disinfection or EN 12791 for surgical hand preparation, no specific recommendations for hand rub dispensers and liquid soap dispensers have been given yet. Therefore, the intention of the present recommendation on soap and hand rub dispensers in healthcare facilities is to close this gap and to enhance future improvement of dispenser functionality and design. Regardless of manufacture and design of a hand rub or liquid soap dispensers the following requirements shall be met in healthcare facilities: Triggering the dispensermust be possible without using hands. Sensoror elbow-operated dispensers both fulfill this requirement. Dispensers must be only refillable in a modality where the content, be it a hand rub or liquid soap, cannot be contaminated. This is achieved best by using replaceable cartridge systems. Refilling through "top-up" must not be possible. The disperser should allow usage of different types of cartridges made by different manufacturers. Dispensers must be operated andmaintained such that amicrobial contamination of the pump nozzle may easily be avoided. It must be possible to identify the products used in a dispenser easily and without any manipulation. Identifying the type of product, be it a hand rub or a liquid soap, as well as reading the product's name and critical manufacturers' warnings must be possible at any time. The disperser must allow identification of the level of the used product without any further manipulation at any time. The design of the dispenser must allow easy cleaning and disinfection the outside and inside of the dispenser. The manufacturer of the dispenser must provide the user with information on applicable chemicals and cleaning products. It must be possible to reprocess the dispenser and all of its permanent parts by applying machine based thermal disinfection at an A0-value of minimum 60 (e.g. 80°C/1 minute). Automatically portioning dispensers shall not fail during 200 hubs. The maximal allowed failure rate shall not exceed 1% (2 out of 200 consecutive hubs). A dispenser used for alcohol based hand rubs must allow keeping the alcohol concentration constant over a time period of 3 months. The maximum acceptable decrease in the concentration of the alcohol shall not exceed 5%. Liquid soap and hand rub dispensers with single-use pumps, ideally already mounted on the cartridge and to be discharged with the empty cartridge, are preferable. If pumps are used on the next consecutive cartridge, the manufacturer must provide the user with a detailed introduction for cleansing and reprocessing before further use. Because of forensic reasons it is recommended to place a good readable sign on the dispenser indicating e.g. "Apply alcohol based hand rubs only on the hand! Do not drink, avoid spraying into the eye or application on mucous membranes". It is regarded as an additional benefit, if the dispenser is able to document the consumption of hand rub or the frequency of hubs either mechanically or electronically. [ABSTRACT FROM AUTHOR]

Abstract: Numerous investigations have demonstrated efficiencies of different disinfection methods, but until now only little is known about long-term effects on community compositions of drinking water biofilms. Changes in the community structure, especially regrowth of hygienically relevant microorganisms could be critical for the drinking water quality. In this study the long-term effect of disinfection methods on biofilm communities in drinking water systems was analysed. Old drinking water biofilms grown in silicone tubes were exposed to different preparations of disinfectants (free chlorine, chlorine dioxide, hydrogen peroxide combined with fruit acid, silver and silver with peracetic acid, respectively) and subsequently further exposed in the original drinking water. The comparison of the treated and regrown biofilm populations with untreated ones by the DNA-fingerprinting method denaturing gradient gel electrophoresis (DGGE) revealed a considerable population shift caused by the disinfectants. The disinfection methods induced a selection pressure on the biofilm populations depending on the composition and concentrations. The similarities between the treated and untreated biofilms were generally low. Compared to preparations with peracetic acid the disinfection with hydrogen peroxide and silver resulted in higher similarities of the treated and untreated biofilms, but the microbial diversity increased. It can be concluded that the disinfectants have a major impact on the drinking water biofilm communities and that possibly the intervention selects persisters and microorganisms, which can live on the residuals of the dead biofilm cells. For the evaluation of the efficiency of disinfection methods in drinking water installations it is necessary not only to consider reduction of certain bacteria but also to pay attention to the biofilm community. [Copyright &y& Elsevier]

Abstract: The following recommendations are derived from a systematic analysis of 34 Serratia marcescens outbreaks described in 27 publications from neonatal and pediatric intensive care units (NICU, PICU), in which genotyping methods were used to confirm or exclude clonality. The clinical observation of two or more temporally related cases of nosocomial S. marcescens infection should raise the suspicion of an outbreak, particularly in the NICU or PICU setting. Since colonized or infected patients represent the most important reservoir for cross transmission, hygienic barrier precautions (contact isolation/cohortation, the use of gloves and gowns in addition to strictly performed hand disinfection, enhanced environmental disinfection) should immediately be implemented and staff education given. Well-planned sampling of potential environmental sources should only be performed when these supervised barrier precautions do not result in containment of the outbreak. The current strategy of empiric antibiotic treatment should be reevaluated by a medical microbiologist or an infectious disease specialist. Empiric treatment of colonized children should use combination therapy informed by in vitro susceptibility data; in this context the high propensity of S. marcescens to cause meningitis and intracerebral abscess formation should be considered. In vitro susceptibility patterns do not reliably prove or exclude the clonality of the outbreak isolate. Genotyping of the isolates by pulse-field gel electrophoresis or PCR-based methods should be performed, but any interventions to interrupt further nosocomial spread should be carried out without waiting for the results. [Copyright &y& Elsevier]

An interdisciplinary working group from the German Society of Hospital Hygiene (DGKH) and the German Society for Anaesthesiology and Intensive Care (DGAI) worked out the following recommendations for infection prevention during anaesthesia by using breathing system filters (BSF). The BSF shall be changed after each patient. The filter retention efficiency for airborne particles is recommended to be >99% (II). The retention performance of BSF for liquids is recommended to be at pressures of at least 60 hPa (=60 mbar) or 20 hPa above the selected maximum ventilation pressure in the anaesthetic system. The anaesthesia breathing system may be used for a period of up to 7 days provided that the functional requirements of the system remain unchanged and the manufacturer states this in the instructions for use. The breathing system and the manual ventilation bag are changed immediately after the respective anaesthesia if the following situation has occurred or it is suspected to have occurred: Notifiable infectious disease involving the risk of transmission via the breathing system and the manual bag, e.g. tuberculosis, acute viral hepatitis, measles, influenza virus, infection and/or colonisation with a multi-resistant pathogen or upper or lower respiratory tract infections. In case of visible contamination e.g. by blood or in case of defect, it is required that the BSF and also the anaesthesia breathing system is changed and the breathing gas conducting parts of the anaesthesia ventilator are hygienically reprocessed. Observing of the appropriate hand disinfection is very important. All surfaces of the anaesthesia equipment exposed to hand contact must be disinfected after each case. [ABSTRACT FROM AUTHOR]

An interdisciplinary working group from the German Society of Hospital Hygiene (DGKH) and the German Society for Anaesthesiology and Intensive Care (DGAI) worked out the following recommendations for infection prevention during anaesthesia by using breathing system filters (BSF). The BSF shall be changed after each patient. The filter retention efficiency for airborne particles is recommended to be >99% (II). The retention performance of BSF for liquids is recommended to be at pressures of at least 60 hPa (=60 mbar) or 20 hPa above the selected maximum ventilation pressure in the anaesthetic system. The anaesthesia breathing system may be used for a period of up to 7 days provided that the functional requirements of the system remain unchanged and the manufacturer states this in the instructions for use. The breathing system and the manual ventilation bag are changed immediately after the respective anaesthesia if the following situation has occurred or it is suspected to have occurred: Notifiable infectious disease involving the risk of transmission via the breathing system and the manual bag, e.g. tuberculosis, acute viral hepatitis, measles, influenza virus, infection and/or colonisation with a multi-resistant pathogen or upper or lower respiratory tract infections. In case of visible contamination e.g. by blood or in case of defect, it is required that the BSF and also the anaesthesia breathing system is changed and the breathing gas conducting parts of the anaesthesia ventilator are hygienically reprocessed. Observing of the appropriate hand disinfection is very important. All surfaces of the anaesthesia equipment exposed to hand contact must be disinfected after each case. [ABSTRACT FROM AUTHOR]

Abstract: Constructed wetlands have been promoted in recent literature for use in rural communities in developed as well as in developing countries as an appropriate technology to be handled with low operational maintenance costs. Within a joint project supported by BMBF (Project No O2WA0107 and No 02WA0108) research was done concerning the sanitation effect of constructed wetlands on wastewater effluents. This article will focus on the detection and the removal of cysts of Cryptosporidium parvum and Giarda lamblia, those being the most frequently identified pathogenic protozoan parasites worldwide with increasing medical and economical consequences. Two plants, one installed in 2000 as a pilot plant at Langenreichenbach near Leipzig (Saxony, Germany), the other one in routine operation since 1993 in a training center at the town of Belzig (Brandenburg, Germany) were tested for three years. Detection methods from the US EPA (ICR Protozoan Method for Detecting Giardia Cysts and Cryptosporidium Oocysts in Water by a Fluorescent Antibody Procedure (EPA/814-B-95-003;) were employed in order to assess protozoal and bacterial reduction in the wastewater passing through different combinations of filter beds and fillings. Removal of cysts of Cryptosporidium and Giardia spp. turned out to be a 2log reduction in all plants. The most effective structural element was a two-stage combination of filter beds leading to the highest removal efficiency both for the protozoan and the bacterial indicator organisms. Also, washed sand (0-2mm grain size) in the filter bed proved to be most effective filter material; the planted reed (phragmites spp.) or willow (salix spp.), however, turned out to be of minor importance for the filtering activity. [Copyright &y& Elsevier]

Abstract: In this matched cohort study, clinical data from 43 paediatric cancer patients with bloodstream infection (BSI) were compared with 43 thoroughly matched control patients without BSI. BSI led to a median additional length of inpatient treatment of 12 days (IQR 8.5–16 days; P<0.001), accounting for median additional expenses of €4400 (IQR, €3145–5920) per case [6.970 US Dollar (IQR 4.938–9.294)]. Thus, BSI substantially increased financial resources required for inpatient treatment. These data compiled from a paediatric cancer unit may be utilized to estimate the cost–benefit ratio of targeted preventive measures. [Copyright &y& Elsevier]

Abstract: Different land use patterns were investigated for their potential as non-point sources of coliphage emissions into surface waters. Water samples were taken regularly at five locations in the upper reaches of the river Swist, Germany. Samples of surface and subsurface run-off were taken within the same catchment area after rainfall events using a newly developed device that made it possible to collect current concentrations of the effluent compounds. The water quality was examined for the occurrence of somatic coliphages and F+-specific RNA-bacteriophages as well as for various bacteria over the period of a hydrological year. The potential of various bacteria as indicators for the occurrence of phages was evaluated using statistical correlations. The load of coliphages varied depending on the land use type, but it did not differ as much as the bacterial parameters. River sections in intensively used areas turned out to be more contaminated than in less intensively used regions. The concentrations of phages from surface and subsurface run-off in most samples were quite low for all land use types and did not show conspicuous variations of surface and subsurface run-off within one land use type. Therefore, high concentrations of phages in river water cannot be explained only by non-point effluent from open ground. Following consideration of the statistical results, conventional indicator bacteria seem not to be reliable indicator organisms for coliphages and subsequently for human pathogen viruses. The detected concentrations of coliphages in several water samples of river sections surrounded by intensively used areas underpin an existing health risk in the use of river water for e.g. recreational activities or irrigation. [Copyright &y& Elsevier]

Several outbreaks of Pseudomonas aeruginosa have been published in neonatal and pediatric patients, but no systematic analysis is available. Medline and outbreak-database search, systematic analysis of outbreak reports (confirmed by genotyping). Twenty-four studies were included. Outbreaks caused by P. aeruginosa resulted in high morbidity (median clinical infection rate: 68%; range: 0–100%), mortality (median 27%; 0–100%) and resource consumption in neonatal and pediatric inpatient facilities. In most cases, these outbreaks indicate certain breaches in basic hygienic practices or are due to the persistence of P. aeruginosa in environmental vectors and reservoirs (tap water, medical devices, and fomites). The majority of the reported isolates displayed multi-resistance to first-line antibiotics. The clinical observation of two or more temporally related cases of nosocomial P. aeruginosa infections should raise the suspicion of an outbreak particularly in high-risk pediatric patient populations (neonatal intensive care unit, pediatric intensive care unit, oncology) and when the isolate displays resistance to two or more first-line antibiotics. Strict hygienic barrier precautions should immediately be implemented, re-educated and supervised. Well-planned environmental culturing should be performed, paying special attention to water, water outlets, sinks and other wet areas, to identify environmental reservoirs. A water safety plan based on the WHO Guidelines for Drinking Water Quality must be introduced. The current strategy of empiric antibiotic treatment should be investigated by an infectious diseases' specialist. Genotyping of the isolates by pulse-field gel electrophoresis should be performed, but any interventions to interrupt further nosocomial spread should be carried out without waiting for the results. [ABSTRACT FROM AUTHOR]

Abstract: Six sewage treatment plants (STP) were investigated over a 12-month period in order to measure the microbiological load of untreated municipal wastewater and to evaluate the removal efficiencies of different treatment systems. The STP investigated can be classified into three categories: bigger plants with tertiary treatment, smaller plants with enhanced secondary treatment, and very small compact facilities. The plants studied had a considerable quantitative impact on the hydrology of the catchment area; consequently, it was anticipated that the microbiological load of the effluent would also be significant. Eighty samples were taken from the influent and effluent of the STP, regardless of weather conditions, and several bacterial and two parasitological parameters were analysed. The average microbiological reduction of each STP was dependent on its capacity and treatment procedures and varied between 1.9 and 3.5log10. Small compact facilities had a significantly lower removal efficiency (2.0±1log10) and discharged treated wastewater with a poorer microbiological quality compared to larger plants with tertiary treatment or with enhanced secondary treatment (⩾2.8log10). Final sand filtration and extensive intermediate settling considerably improved the overall microbiological removal efficiency. During the study period, the microbiological water quality of the receiving water course was not significantly impaired by the discharge of any of the investigated plants; however, the compact facilities showed critical treatment deficiencies. In particular, the reduction of Giardia cysts was insufficient (<1.5log10) compared to that of the bigger plants (>3.0log10). In order to quantify the overall impact of microbiological loads on the receiving watercourse in this catchment area, it is also necessary to assess the pollution from combined sewer overflow basins and diffuse pollution. This will be considered in subsequent studies. [Copyright &y& Elsevier]

Abstract: Background: Nosocomially acquired respiratory syncytial virus infections (RSV-NI) may cause serious problems in hospitalized paediatric patients. Hitherto, prospectively collected representative data on RSV-NI from multicenter studies in Germany are limited. Methods: The DMS RSV Ped database was designed for the prospective multicenter documentation and analysis of clinically relevant aspects of the management of inpatients with RSV-infection. The study covered six consecutive seasons (1999–2005); the surveillance took place in 14 paediatric hospitals in Germany. Results: Of the 1568 prospectively documented RSV-infections, 6% (n=90) were NI and 94% (n=1478) were community acquired (CA). A significantly higher proportion in the NI group displayed additional risk factors like prematurity, chronic lung disease, mechanical ventilation (med. history), congenital heart disease, and neuromuscular impairment. Of all NI, 55% occurred in preterms (30.6% of all RSV-infections in preterms with severe chronic lung disease of prematurity were NI). Illness severity as well as the total mortality, but not the attributable mortality was significantly higher in the NI group. In the multivariate analysis, NI was significantly associated with the combined outcome ‘complicated course of disease’. Conclusion: This is the first prospective multicenter study from Germany, which confirms the increased risk of a severe clinical course in nosocomially acquired RSV-infection. Of great concern is the high rate of (preventable) NI in preterms, in particular in those with severe chronic lung disease or with mechanical ventilation due to other reasons. [Copyright &y& Elsevier]