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GMS Krankenhhyg Interdiszip. 2010; 5(2): Doc14.
Published online 2010 September 21. doi:  10.3205/dgkh000157
PMCID: PMC2951101

New possibilities and strategies in the combat against healthcare associated and community based infection – primary prevention and use of non-antibiotic based antimicrobial alternatives

Neue Möglichkeiten und Strategien in der Bekämpfung Health Care assoziierter und in der Bevölkerung auftretender Infektionen – Primärprävention und Einsatz antimikrobieller Alternativen anstelle von Antibiotika

Axel Kramer,*,1 Ojan Assadian,1 and Working Section for Clinical Antiseptic of the German Society for Hospital Hygiene

Editorial

This second issue of GMS Hospital Hygiene underlines the character of the online journal as an interdisciplinary journal of the German Society for Hospital Hygiene in its effort to strengthen prevention of infection. The main focus of this issue is the potential for prevention of infection for community based populations and for patients and medical staff including methods and strategies such as the clinical use of antiseptics as an alternative treatment possibility to antibiotics, a study on the prevention of mite allergy, investigation of the effects of stress on the antioxidative potential, and a screening method for quality control of plasma sources for medical use.

The main topic of all articles of this issue is prevention of healthcare associated infection using various methods. In a joint consensus recommendation of the working group of the German Society for Hospital Hygiene and the German Society for Anaesthesiology and Intensive Medicine basics and principles of Infection Prevention in ventilation anaesthesia using breathing filter systems are highlighted.

Although in Germany it is estimated that annually some 30,000 to 50,000 bite wounds occur and about 1–2% of all emergency admissions to hospitals are based on bite incidences, there is no uniform standard of care for such wounds. To close this gap, a recommendation for the prevention of postoperative wound infections in the surgical treatment of bite wounds has been developed.

In an analysis of 798 MRSA cases over a period of seven years in a university hospital the authors found a significantly increased risk for MRSA infection in male patients. Gender specific risk factors for MRSA infection or carriage have been investigated scantly and the presented data has not been known yet. The study could confirm an increased risk for intensive care patients and a 4 times longer length of hospital stay for MRSA patients.

The next article shows that disinfection of all surfaces in a cardiac operation theatre with a mixed flow ventilation in addition to removable of medical devices and inventory or covering with sterile surgical drapes improved the room air quality from a clean room class C to a clean room class B. Taking these principles into account, obeying strict surface disinfection and control of particle shedders might improve surgical outcomes further.

Antimicrobial impregnation of objects of the daily living but also of surfaces, textiles and clothing in the medical setting are at increasing attention. In the light of the associated risks, for each product and product group a careful risk benefit assessment must be conducted, including the assessment for the need of antimicrobial impregnation. Results of a risk benefit assessment for antimicrobial paramedic coats and jackets including investigation of the microbial contamination of paramedic uniforms in emergency services with and without silver treats are presented. The results showed no microbiological advantage for the silver textile.

Although iodine-impregnated incision drapes are antiseptic and effectively reduce microbial wound contamination, the investigation of the potential to reduced surgical site infections (SSIs) by using iodine-impregnated incision drapes will require large sample sizes to show any difference. This is because of the string antimicrobial effect and the low SSI rate.

While contamination of both, computer keyboard and mouse occurs trough inadequate hand hygiene and contaminated input devices might become source for transmission of micro-organisms, little is known if and which micro-organisms are found and released from cooling fans in laptops. A recent investigation, however, could not retrive any significant number of micro-organisms from laptop cooling fans, which might be explained by the high temperatures inside the laptops (up to 73°C) and at the outlet blower (still up to 56°C).

In the early phase after stem cell transplantation due to high risk of infection it is essential to administer prophylactic antibiotics. Because of the toxic side effects and the risk for selection of resistant micro-organisms as well as costs, aminoglycosides were omitted completely from the empirical antibiotic regime in a study cohort of stem cell transplant patients. The authors could observe no adverse effects or any increase in the rate of infection or mortality rates.

A new guideline for the diagnosis of latent tuberculosis infection in health workers recommends interferon-gamma release assays (IGRA) as a diagnostic tool. In order to assess the essay’s diagnostic accuracy, parallel to the routine occupational health examination for tuberculosis the conversion- and reversion rates were analysed. Implications for diagnostic tests before the start of a chemoprevention therapy are discussed.

So far there is no practicable and toxicologically acceptable method to disinfect or decontaminate bed mites from mattresses without interrupting the use of the bed. It is known that so called “hygiene wood” shows effects against mites. The effectiveness and the influence of timber filled with chips of hygienic mattress pad were investigated on the content of mite antigen Der p1 and examined the health status in 32 individuals. The use of hygiene wood mattress toppers significantly decreased concentration of the house dust mite antigen. In addition, allergy symptoms were significantly reduced in all individually and subjective well-being increased.

Regular exercise is a beneficial health measure. In extremes, however, competitive sports might increase release of free radicals due to the high physical stress, resulting in a decrease in antioxidant potential. This relationship could be confirmed in a present study. To compensate this effect, a special antioxidant diet might be effective.

The application of tissue Tolerable plasma (TTP) on the surface of human body is gaining increased importance for wound treatment. To ensure reliable and reproducible findings in the examination of plasma, plasma sources must validated for their biological activity in addition to sole determination of their physical parameters. For this, a simple screening method is presented using freshly inoculated agar plates with test bacteria.

This issue represents a cross section of methodological and practical developments in hygiene. Our hope is that the results and implications of the selected articles will be useful for professionals in clinical practice and will augment and support further interdisciplinary collaboration in medicine. The key message of all contributions is that any decision regarding the selection and implementation of strategies and measures of prevention of infection can only be made on the basis of knowledge, experience and evidence. This journal’s issue therefore is intended to provide assistance in various infection prevention and control topics and shall highlight that all measures need to be examined critically and with regard to practical aspects.


Articles from GMS Krankenhaushygiene interdisziplinär are provided here courtesy of German Medical Science