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The novel emergence of variant Creutzfeldt-Jakob disease (vCJD) in the United Kingdom in 1995/96 as a result of the transmission of bovine spongiform encephalopathy (BSE) agents from cattle to humans triggered a previously unprecedented crisis in Europe at the interface of animal health and human public health. This prompted Germany to reconsider, among other things, the practice of reprocessing medical devices with regard to the unconventional BSE/ vCJD pathogens, so-called prions (from “proteinaceous infectious particles”). In 2002, a vCJD task force set up with this objective presented recommendations for minimizing/reducing the risk of vCJD transmission through surgical instruments and other medical devices. According to these recommendations, routine reprocessing should combine at least two procedures that are also (at least partially) suitable for decontamination/inactivation of these pathogens if there is no identifiable risk of contamination with prions. In practice, this includes in particular careful cleaning (decontamination), preferably with alkaline detergents, and subsequent sterilization with moist heat (“steam sterilization”) at 134°C with a holding time of 5 minutes. The validation of the processes is of great importance. From today’s point of view, the central recommendations of the vCJD Task Force for medical device reprocessing have proven to be sustainable with good practicability. The effectiveness of the recommended measures against prions has been confirmed on a broad basis in numerous studies. In line with the paradigmatically high demands that prions place on hygiene in the reprocessing of medical devices, this effectiveness in practice extends simultaneously to conventional pathogens such as bacteria, viruses or fungi. In perspective, this also applies at least in part to potential new challenges, such as those that have been discussed for some time with regard to self-replicating protein particles of Alzheimer’s or Parkinson’s disease and other protein aggregation diseases. [ABSTRACT FROM AUTHOR]

Objective: This study aims to provide additional support for the equipment needed in hospitals and medical practices for reprocessing transvaginal ultrasound probes (TVUS) through an economic analysis comparing manual and automated reprocessing methods. A questionnaire survey was also conducted in hospitals and medical practices to analyze the current practice of TVUS reprocessing., Methods: The economic analysis compared four manual reprocessing methods using disinfection wipes and one automated device-based disinfection method using hydrogen peroxide vapor. The working times were measured with a stopwatch and complemented by passive working time (disinfection exposure time or machine cycle duration). The personnel costs for the working time were calculated and combined with the calculated acquisition and material costs to determine the total process costs., Results: The economic analysis revealed that machine disinfection is not only time-saving but also more cost-effective per reprocessing cycle compared to two manual methods using wipes for cleaning and disinfection, where the disinfectant is applied to the wipe before use. However, two methods using ready-to-use (rtu) disinfection wipes from a container were more cost-effective. It is important to note that all wipe disinfection methods would incur additional costs due to the lack of validation. The additional costs for validation could not be calculated due to a lack of experience, making a final cost assessment for wipe disinfection methods currently impossible.Despite extensive efforts to send the survey to hospitals and medical practices through three professional societies and attempts to acquire participants via a publication, only 35 institutions participated. Except for one case, all reprocessed manually. The survey revealed a deficit in knowledge regarding TVUS reprocessing. Manual reprocessing had not been validated despite national legal requirements existing since 2002., Conclusion: As long as manual reprocessing is not validated in all steps, only machine reprocessing is ethically acceptable for patient safety. Even if manual wipe disinfection is validated, machine reprocessing offers higher patient safety, since deviations from the validated SOP cannot be excluded during manual execution. Machine reprocessing should always be preferred for occupational safety reasons.Since the process costs for methods involving the application of the disinfectant to the wipe before disinfection were higher than for the machine method, the latter is preferred in this comparison. It is not possible to determine whether the overall process is economically superior to machine reprocessing because the cost calculation for rtu disinfection wipes does not include the entire process of reprocessing, including the legally required validation. Due to the better standardization of the machine reprocessing process, along with increased procedural, worker, and patient safety, machine reprocessing should be preferred regardless of process costs, especially if the economic difference is not significant. Additionally, avoiding disposable wipes is beneficial in terms of sustainability.The lack of knowledge regarding national legal requirements and recommendations for TVUS reprocessing is a reason why the principles of reprocessing were not adhered to in several practices. Therefore, it is necessary to convey the basic knowledge of reprocessing during medical studies, followed by further training during specialization. Persons tasked with reprocessing must have the required education or participate in specialized training to demonstrate current knowledge (§ 8 Sect. 7 Medical Device Regulation)., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024 Kiefner et al.)

When the emerging novel SARS-CoV‑2 virus first appeared in December 2019, neither specific therapeutic options nor vaccinations were available. The role of nonpharmaceutical interventions (NPIs) became of central importance. At the Robert Koch Institute, a multilayer strategy consisting of population-based and individual preventive measures to control the pandemic was developed, which built upon existing influenza pandemic plans as well as generic plans. This paper explains the recommended NPIs and illustrates the pharmaceutical approaches developed in parallel.Among others, general contact bans, providing material for infection prevention and control, ban of events, closing educational institutions, and restricting travel are counted among population-based measures. Additional individual preventive measures are necessary, e.g., keeping a minimum distance, reducing contacts, and wearing a mouth-nose covering as well as quarantine and isolation. Measures within the health system are based on recommendations of the Commission on Hospital Hygiene and Infection Protection (Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO)) and specified and implemented by professional societies. Since November 2020, an antiviral therapy with remdesivir and treatment with the glucocorticoid dexamethasone have been available as pharmaceutical interventions. Monoclonal antibodies are at this time not approved. Therapeutic anticoagulation is recommended.Recommendations are constantly adapted to the increasing knowledge on the pathogen and its means of transmission. A challenge is to strengthen the trust of the population. Many measures have to be applied on an individual basis in order to work together.

COVID-19 has been challenging our society since January 2020. Due to global travel, the new coronavirus has rapidly spread worldwide. This article aims to provide an overview of the challenges in implementing measures in the air and maritime transport sector from the perspective of the German Public Health Service (Öffentlicher Gesundheitsdienst, ÖGD). Significant events and measures for air and maritime transport between January and August 2020 were selected. Lessons learned are discussed.During the COVID-19 pandemic, the ÖGD has been operating in a field of tension between the dynamics of scientific knowledge, political decision-making, social acceptance and consent.There are specific challenges at points of entry such as airports and seaports. These include staff shortages and the need to implement measures with a high organisational effort at very short notice such as health authority passenger checks carried out on aircraft, the establishment of test centres at points of entry and control of compliance with quarantine measures. Aggravating the situation, passenger lists, which are necessary for effective contact tracing, are often not available or incomplete. There is also a lack of digital tools for contact tracing but also, for example, the exchange of personal data within the ÖGD. Further difficulties in outbreak management arise from the cramped conditions on board ships and from the potential psychological stress on crew members and passengers, which have not yet been sufficiently considered.In view of all these challenges, it is paramount to strengthen the German Public Health Service in general and at points of entry and to intensify the exchange between the national, federal state and local levels.