[The usage of protective gloves for routine disinfection of patient contact areas : An anonymous survey of work doctors and hygienists (infection control nurses, link nurses and physicians)]. / Einsatz von Schutzhandschuhen bei der routinemäßigen Desinfektion patientennaher Kontaktflächen : Befragung von Betriebsärzten, Hygienefachkräften und Hygienebeauftragten.

BACKGROUND: Disinfection, routinely carried out in healthcare facilities and known as "ongoing disinfection" or "untargeted disinfection", covers areas that are suspected of being contaminated with pathogen-containing material without being recognizable or visible in individual cases. The use of chemical resistant protective gloves is indispensable for surface disinfection. However, it is unclear if healthcare facilities set specific requirements regarding the selection and application of gloves. METHOD: The usage of protective gloves for routine disinfection of patient contact areas was assessed in an anonymous cross-sectional study. Work doctors and hygienists (infection control nurses, link nurses and physicians) were queried by questionnaire. RESULTS: Disposable gloves were predominantly used, in most cases largely in accordance with EN 374. The most common glove material was nitrile. Glove change was mostly reported between rooms. Reprocessing of reusable gloves is inconsistent. Several professions are responsible for selecting protective gloves. CONCLUSIONS: Procedures for glove selection and application for disinfection of contact surfaces vary between the surveyed institutions. Therefore, more attention has to be paid to these three aspects in the future and these must be included in the hygiene plans.

Epidemiology of multidrug resistant bacterial organisms and Clostridium difficile in German hospitals in 2014: Results from a nationwide one-day point prevalence of 329 German hospitals.

BACKGROUND: One important aspect in combatting resistance to antibiotics is to increase the awareness and knowledge by epidemiological studies. We therefore conducted a German-wide point-prevalence survey for multidrug resistant bacterial organisms (MDROs) and Clostridium difficile (CD) to assess the epidemiology and structure quality of infection control in German hospitals. METHOD: 1550 hospitals were asked to participate and to report surveillance data on the prevalence of Methicillin-resistant and Vancomycin resistant Staphylococcus aureus (MRSA, VRSA/GRSA), Vancomycin resistant Enterococcus faecalis/faecium (VRE), multiresistant strains of Escherichia coli (EC), Klebsiella spp. (KS), Enterobacter spp. (ES), Acinetobacter spp. (AB) and Pseudomonas spp. (PS). as well as CD infections. RESULTS: Surveys from 73,983 patients from 329 hospitals were eligible for analysis. MRSA was the most often reported pathogen (prevalence: 1.64 % [CI95: 1.46-1.82]), followed by 3 multidrug resistant EC (3MRGN-EC) (0.75 % [CI95: 0.60-0.89]), CD (0.74 % [CI95: 0.60-0.88]), VRE (0.25 % [CI95: 0.13-0.37]) und 3MRGN-KS (0.22 % [CI95: [0.15-0.29]). The majority of hospitals met the German recommendations for staffing with infection control personnel. CONCLUSION: The continuing increase in participating hospitals in this third survey in a row indicates a growing awareness to MDROs and our pragmatic approach. Our results confirm that MRSA, 3MRGN-EC, VRE and 3MRGN-KS remain the most prevalent MDROs in German hospitals.

Aldosterone and glomerular filtration--observations in the general population.

BACKGROUND: Increasing evidence suggests that aldosterone promotes renal damage. Since data on the association between aldosterone and renal function in the general population are sparse, we chose to address this issue. We investigated the associations between the plasma aldosterone concentration (PAC) or the aldosterone-to-renin ratio (ARR) and the estimated glomerular filtration rate (eGFR) in a sample of adult men and women from Northeast Germany. METHODS: A study population of 1921 adult men and women who participated in the first follow-up of the Study of Health in Pomerania was selected. None of the subjects used drugs that alter PAC or ARR. The eGFR was calculated according to the four-variable Modification of Diet in Renal Disease formula. Chronic kidney disease (CKD) was defined as an eGFR < 60 ml/min/1.73 m2. RESULTS: Linear regression models, adjusted for sex, age, waist circumference, diabetes mellitus, smoking status, systolic and diastolic blood pressures, serum triglyceride concentrations and time of blood sampling revealed inverse associations of PAC or ARR with eGFR (ß-coefficient for log-transformed PAC -3.12, p < 0.001; ß-coefficient for log-transformed ARR -3.36, p < 0.001). Logistic regression models revealed increased odds for CKD with increasing PAC (odds ratio for a one standard deviation increase in PAC: 1.35, 95% confidence interval: 1.06-1.71). There was no statistically significant association between ARR and CKD. CONCLUSION: Our study demonstrates that PAC and ARR are inversely associated with the glomerular filtration rate in the general population.

U-shaped association between central body fat and the urinary albumin-to-creatinine ratio and microalbuminuria.

BACKGROUND: The prevalence of obese and overweight patients has increased dramatically worldwide. Both are common risk factors for chronic kidney disease (CKD) as indicated by a diminished estimated glomerular filtration rate (eGFR) or microalbuminuria. This study aimed to investigate whether anthropometric parameters [waist circumference (WC), waist-to-height ratio (WHtR) and body mass index (BMI)] are associated with renal function in a population-based study of Caucasian subjects. METHODS: Data from 3749 subjects (1825 women) aged 20 to 81 years from the Study of Health in Pomerania (SHIP) were analysed. Renal indices, including the urinary albumin-to-creatinine ratio (uACR), microalbuminuria, eGFR and CKD, were studied. Parameters of anthropometry (WC, WHtR and BMI) were categorised into sex-specific quintiles. RESULTS: Analysis of variance (ANOVA) models, adjusting for age, sex, type 2 diabetes mellitus and hypertension, revealed that a high and low WC or WHtR and low BMI were independently related to a higher uACR. Logistic regression models confirmed these results with respect to uACR and showed that subjects with a high or low WC or a high WHtR had increased odds of microalbuminuria. The ANOVA models revealed no relations of the investigated anthropometric parameters with eGFR. However, subjects with high values for these parameters had increased odds of CKD. CONCLUSIONS: Our results demonstrate U-shaped associations between markers of central fat distribution and uACR or microalbuminuria in the general population, suggesting that both obese and very thin subjects have a higher risk of renal impairment.

Fast approach for clarification of chromosomal aberrations by using LM-PCR and FT-CGH in leukaemic sample.

Chromosomal abnormalities, like deletions, amplifications, inversions or translocations, are recurrent features in haematological malignancies. However, the precise molecular breakpoints are frequently not determined. Here we describe a rapid analysis of genetic imbalances combining fine tiling comparative genomic hybridization (FT-CGH) and ligation-mediated PCR (LM-PCR). We clarified an inv(14)(q11q32) in a case of T cell acute lymphoblastic leukaemia with a breakpoint in the TRA/D in 68% of cells detected by fluorescence in situ hybridization. FT-CGH showed several mono- and biallelic losses within TRA/D. LM-PCR disclosed a TRA/D rearrangement on one allele. The other allele revealed an inv(14)(q11q32), joining TRDD2 at 21,977,000 of 14q11 together with the IGH locus at 105,948,000 and 3'-sequence of TRAC at 22,092,000 joined together with IGHV4-61 at 106,166,000. This sensitive approach can unravel complex chromosomal abnormalities in patient samples with a limited amount of aberrant cells and may lead to better diagnostic and therapeutic options.

Association between serum insulin-like growth factor I or IGF-binding protein 3 and estimated glomerular filtration rate: results of a population-based sample.

BACKGROUND: Insulin-like growth factor I (IGF-I), which is mostly carried in blood by IGF-binding protein 3 (IGFBP-3), was associated to the glomerular filtration rate and chronic kidney disease in a multiethnic study among US adults. The aim of the present study was to investigate whether serum IGF-I or IGFBP-3 are associated with estimated glomerular filtration rate (eGFR) in a population-based study of Caucasian adults. METHODS: Data from 4028 subjects (2048 women) aged 20 to 81 years from the Study of Health in Pomerania (SHIP) were analyzed. Total serum IGF-I and IGFBP-3 concentrations were determined by chemiluminescence immunoassays and categorized into sex- and age-specific quartiles. RESULTS: After adjusting for age, waist circumference and type 2 diabetes mellitus, analysis of variance (ANOVA) revealed inverse associations between serum IGF-I concentrations and eGFR in men as well as between serum IGFBP-3 concentrations and eGFR in men and women. Logistic regression analyses confirmed these findings and showed that high IGF-I or IGFBP-3 concentrations were associated with an increased risk of decreased eGFR (<60 mL/min/1.73 m2) in men or women. These relations became stronger when lower eGFR cut-offs were used for the analyses. CONCLUSION: Our data revealed associations of increased serum IGF-I concentrations and decreased eGFR in men but not in women and an association of increased serum IGFBP-3 concentrations and decreased eGFR in both sexes.

Age- and sex-specific reference limits for creatinine, cystatin C and the estimated glomerular filtration rate.

BACKGROUND: Early detection of patients with chronic kidney disease is of great importance. This study developed reference limits for serum creatinine and serum cystatin C concentrations and for the estimated glomerular filtration rate (eGFR) in healthy subjects from the general population aged 25-65 years. METHODS: This study defined a reference population including 985 subjects from the first follow-up of the Study of Health in Pomerania. Serum creatinine was measured with a modified kinetic Jaffé method. Serum cystatin C was measured with a nephelometric assay. The eGFR was calculated from serum creatinine according to the Cockcroft-Gault (eGFR(CG)) and the Modification of Diet in Renal Disease (eGFR(MDRD)) equation, respectively, as well as from serum cystatin C according to the formula by Larsson (eGFR(Larsson)). Non-parametric quantile regression was used to estimate the reference limits. For serum creatinine and serum cystatin C the 95th percentile and for eGFR(CG), eGFR(MDRD) and eGFR(Larsson) the 5th percentile were selected as reference limits. All data was weighted to reflect the age- and sex-structure of the German population in 2008. RESULTS: The reference limits for serum creatinine (men: 1.11-1.23 mg/dL; women: 0.93-1.00 mg/dL) and serum cystatin C levels (men: 0.92-1.04 mg/L; women: 0.84-1.02 mg/L) increased with advancing age. The reference limits for eGFR decreased with increasing age (eGFR(CG) men: 106.0-64.7 mL/min, women 84.4-57.9 mL/min; eGFR(MDRD) men: 82.5-62.2 mL/min/1.73 m², women 75.0-58.2 mL/min/1.73 m²; eGFR(Larsson) men: 85.5-72.9 mL/min, women 94.5-75.7 mL/min). CONCLUSIONS: This study presents age- and sex-specific reference limits for five measures of renal function based on quantile regression models.

Molecular characterization of a novel chromosomal translocation t(12;14)(q23;q11.2) in T-lymphoblastic lymphoma between the T-cell receptor delta-deleting elements (TRDREC and TRAJ61) and the hypothetical gene C12orf42.

Chromosomal aberrations have diagnostic, prognostic, and therapeutic relevance in hematologic malignancies. By combining fine-tiling comparative genomic hybridization (FT-CGH) and ligation-mediated PCR (LM-PCR), we established a fast, robust approach to precisely characterize chromosomal breakpoints. Using this approach, we clarified at the molecular level novel chromosomal translocation t(12;14)(q23;q11.2) in T-lymphoblastic lymphoma. The translocation occurred during the deletional rearrangement of the T-cell receptor delta gene (TRD), which is a pivotal step in T cell differentiation toward the alpha/beta vs. the gamma/delta lineage. We found that this rearrangement disrupted the hypothetical gene C12orf42 and brought the Achaete-scute complex homolog 1 gene into proximity of the TRA enhancer, which encodes a member of the basic helix-loop-helix family of transcription factors and is overexpressed in thyroid and lung cancers.

Active Integration of Patients into Infection Control, as perceived by Health Care Professionals: Results of the AHOI Pilot Study.

OBJECTIVE: Medical professionals have a key role in active patient involvement in infection control and prevention (ICP). ICP of hospital-associated infections is critical for patient safety and requires targeted integration of patients and their relatives. The possibilities of proper involvement are identified, tested and realized in the innovative AHOI project. Its acronym stands for Activation, Help, Open communication and Infection prevention. The project is based on the three dimensions acceptance, empowerment and adherence. The results presented here are from a health-care professional (HCP) focused part of a pilot study to implement AHOI intervention. This section aimed at the HCPs' evaluation of the intervention material, their perception and acceptance of the adherence and empowerment of patients, as well as the perception of their and colleagues' own behavior. METHODS: The cross-sectional survey was conducted with a questionnaire at two surgical wards of a third-level hospital for 14 weeks. All HCPs with contact to patients were entitled to voluntarily participate in the study. AHOI instruments such as visual reminder, videos for patients and the AHOI-box were implemented on the wards. Additionally, the ward personnel received a psychological and practical train-the-trainer curriculum. RESULTS: Sixty-nine questionnaires were handed out and 29 returns were analyzed. The results show a strong identification and acceptance of HCPs with their role in the AHOI project. No additional workload was perceived by implementing AHOI. Teaching of medical professionals and information materials are seen as good supports. HCPs are empowering hygienic behavior in patients and colleagues. HCPs observed increasing adherence of patients. CONCLUSION: HCPs positively perceived acceptance, support and identification with the ideas of the AHOI project. Therefore, since HCPs are key for patients and their relatives, AHOI intervention seems to be a feasible instrument and aid in implementing national and international recommendations for hygienic behavior.

Active involvement of patients and relatives improves subjective adherence to hygienic measures, especially selfreported hand hygiene: Results of the AHOI pilot study.

Background: The prevention of nosocomial infections requires participation from the patients themselves. In the past, however, patients have been apprehensive to point out hygiene-relevant behaviour to the personnel.In the project AHOI, the possibilities of active patient involvement in infection prevention are identified, tested and realized. The goal is a prevention strategy based upon three dimensions: "adherence", "empowerment" and "acceptance". "AHOI" stands for the "Activation of patients, persons in need of care and care givers for a Hygiene-conscious participatiOn in Infection control". Results from the AHOI pilot study on the implementation of a multimodal intervention bundle are reported. Methods: In 2017, a two-stage patient survey was conducted on two surgical wards for 14 weeks. In addition to the intervention bundle, acceptance, adherence and empowerment regarding individual hygiene behaviour and perception were evaluated. The bundle included an AHOI-welcome-box with an informational and entertaining brochure and supportive incentives. Furthermore, multiple visual materials like video presentations for patients' bedside TV, posters and visual reminders in the patients' bedrooms and sanitary facilities were installed. Results: 179 respondents were surveyed at admission, 139 at discharge and 133 at both time points. Almost all respondents wanted to contribute to infection control. The AHOI project was well accepted by patients. Two-thirds wanted to be more involved. More than a third expected a negative response from staff after pointing out hygiene deficiencies. Four respondents observed a deficiency in hygiene with healthcare personnel and reported a very positive reaction once this was communicated to the personnel. More than four-fifths of the respondents felt well integrated and adequately informed post intervention. The feeling of active involvement correlated significantly with subjective participation and adherence to hygienic measures, especially self-reported hand disinfection. Conclusion: The results demonstrated that the required inclusion of patients in infection control is possible with AHOI. Active involvement of patients and relatives is associated with improvements in adherence to infection prevention measures.

Potential of innovations in hygiene management - a managerial perspective.

Background: Assessment of the current situation is crucial before introducing innovative infection prevention measures. According to the literature, hospital managers should take on the role of "power promoters" in adopting infection prevention measures due to their position and decision-making authority. However, there is no empirical evidence for whether or not this assumption is valid. This paper reports German hospital managers' perceptions of current challenges in infection prevention and control and innovative prevention measures. We analysed the managerial promoters and barriers of adopting innovations in order to derive recommendations for improving the innovation process in hospitals using the novel AHOI-approach to actively involve patients and their relatives in anti-infection measures. Methods: All 3877 medical, nursing and administrative managers of German hospitals were invited to participate in an online survey. The first set of questions intended to determine their perception of problems of hygiene management in their institution and in particular in the interaction with patients and their relatives. The second set of questions was asked to identify potential challenges and barriers to combating nosocomial infections and involving patients and their relatives in infection prevention. Results: Two hundred six managers from German hospitals participated in the survey. Transmission of pathogens was seen as the main problem in the inpatient area, especially in acute care hospitals and stationary geriatric care. Barriers to the implementation of novel infection prevention concepts were primarily perceived as lack of time and refinancing by health insurance providers. The surveyed hospital managers assessed that the active involvement of patients and their relatives in infection prevention could strengthen the infection prevention of their institution. Conclusions: Hospital managers are open to innovative hygiene interventions. In particular, they welcome the active involvement of patients and their relatives in infection prevention. Therefore, financial and institutional barriers, such as insufficient funding of hygiene management, must be overcome.

Correction to: Susceptibility of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) to chlorhexidine digluconate, octenidine dihydrochloride, polyhexanide, PVP-iodine and triclosan in comparison to hospital-acquired MRSA (HA-MRSA) and community-aquired MRSA (CA-MRSA): a standardized comparison.

[This corrects the article DOI: 10.1186/s13756-019-0580-9.].

Susceptibility of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) to chlorhexidine digluconate, octenidine dihydrochloride, polyhexanide, PVP-iodine and triclosan in comparison to hospital-acquired MRSA (HA-MRSA) and community-aquired MRSA (CA-MRSA): a standardized comparison.

Background: Recent publications have raised concerns of reduced susceptibilities of clinical bacterial isolates towards biocides. This study presents a comparative investigation of the susceptibility of livestock-associated Methicillin-resistant Staphylococcus aureus (LA-MRSA), hospital-acquired MRSA (HA-MRSA) and community-aquired MRSA (CA-MRSA) to the commonly used antiseptics chlorhexidine (CHX), octenidine (OCT), polyhexanide (PHMB), PVP-iodine (PVP-I) and triclosan (TCX) based on internationally accepted standards. Methods: In total, 28 (18 LA-, 5 HA- and 5 CA) genetically characterized MRSA strains representing a broad spectrum of hosts, clonal complexes and spa-types, as well as the reference methicillin-sensitive Staphylococcus aureus (MSSA) strain ATCC 6538, were selected. Minimal inhibitory concentration (MIC) and minimal microbicidal concentration (MBC) were determined in accordance with DIN 58940-7, 58940-8 and DIN EN ISO 20776-1. The microbicidal efficacy was determined in accordance with DIN EN 1040. Results: Results from the MIC/MBC and quantitative suspension tests revealed differences between antiseptic substances but not between epidemiological groups of MRSA strains. OCT and PHMB were the most active substances with a minimal MIC of 1 mg/L, followed by CHX (2 mg/L), TCX (32 mg/L) and finally PVP-I (1024 mg/L). The MSSA reference strain showed a tendency to a higher susceptibility compared to the MRSA strains. Conclusions: This investigation of the susceptibility of a range of LA-, HA- and CA-MRSA strains using standardized conditions gave no indication that LA-MRSA strains are less susceptible to commonly used antiseptics compared to HA- and CA-MRSA strains.

Costs of outpatient and inpatient MRSA screening and treatment strategies for patients at elective hospital admission - a decision tree analysis.

Background: Nosocomial infections are among the most common complications in hospitals. A major part is caused by multidrug-resistant organisms (MDRO). MRSA is still the most prominent and frequent MDRO. The early detection of carriers of multidrug-resistant bacteria is an effective measure to reduce nosocomial infections caused by MDRO. For patients who are planning to go to the hospital, an outpatient screening for MDRO and pre-hospital decolonization is recommended. However, the effectiveness of such pre-admission MDRO management in preparation for a planned hospital stay has not yet been sufficiently scientifically examined from an economic perspective. Methods: A decision tree will be used to develop scenarios for MDRO screening and treatment in the context of the outpatient and inpatient sectors using MRSA-positive patients as an example. Subsequently, the expected costs for the respective strategy are presented. Results: The decision tree analysis shows that the expected costs of outpatient MRSA management are €8.24 and that of inpatient MRSA management are €672.51. Conclusion: The forward displacement of the MRSA screening to the ambulatory sector and any subsequent outpatient decolonization for patients with a planned hospitalization is the most cost-effective strategy and should become a standard benefit. Excluding opportunity costs, the expected costs of inpatient MRSA management are €54.94.

Infection control perception and behavior: a question of sex and gender? Results of the AHOI feasibility study.

PURPOSE: Infections, in particular with multidrug-resistant organisms, are a burden for inpatient and outpatient care and the whole community. The pathogens "roam" with patients and their relatives, forming an epidemiological bridge between different care facilities. Patients could play an important role in infection control, given that they are properly involved. The AHOI project stands for the Activation of patients, people in need of care, and care-providers for a Hygiene-conscious participatiOn in Infection prevention. To this end, a multimodal intervention bundle was developed and subjected to a feasibility study at a university hospital. Our goal was to clarify whether sex- and gender-specific characteristics are relevant in the field of infection prevention. MATERIALS AND METHODS: AHOI was tested with a cross-sectional design and a cross-media communication strategy at two surgical wards of a university hospital. Interventions included patient information brochures and motivational materials, reminders, and two video presentations. A welcome box with information material and two questionnaires was given to every inpatient. The patients were instructed to complete the questionnaires at the beginning and at the end of their stay. RESULTS: A sample size of 133 inpatients who completed questionnaires at the beginning and end of hospitalization was analyzable. The analysis produced a differentiated picture of the perception and reaction behavior of the sexes. Women had a more negative expectation of the response of doctors. In addition, there were differences in the perception of the positioning of disinfectant dispensers and cleaning processes as well as in satisfaction with the general cleanliness. For all subjects mentioned above, the differences were significant at least at the P-value 0.05. CONCLUSION: The AHOI study shows sex differences in hygiene perception and behavior. Measures to improve patient safety by involving patients in infection control must take these differences into account.

Occurrence of ESBL-Producing Escherichia coli in Livestock and Farm Workers in Mecklenburg-Western Pomerania, Germany.

In recent years, extended-spectrum ß-lactamases (ESBL) producing bacteria have been found in livestock, mainly as asymptomatic colonizers. The zoonotic risk for people working in close contact to animal husbandry has still not been completely assessed. Therefore, we investigated the prevalence of ESBL-producing Escherichia spp. in livestock animals and workers to determine the potential risk for an animal-human cross-transmission.In Mecklenburg-Western Pomerania, northeast Germany, inguinal swabs of 73 individuals with livestock contact from 23 different farms were tested for ESBL-producing Escherichia spp. Two pooled fecal samples per farm of animal origin from 34 different farms (17 pig farms, 11 cattle farms, 6 poultry farms) as well as cloacal swabs of 10 randomly selected broilers or turkeys were taken at each poultry farm. For identification, selective chromogenic agar was used after an enrichment step. Phenotypically ESBL-producing isolates (n = 99) were tested for CTX-M, OXA, SHV and TEM using PCR, and isolates were further characterized using multilocus sequence typing (MLST). In total, 61 diverse isolates from different sources and/or different MLST/PCR results were acquired. Five farm workers (three from cattle farms and two from pig farms) harbored ESBL-producing E. coli. All human isolates harbored the CTX-M ß-lactamase; TEM and OXA ß-lactamases were additionally detected in two, resp. one, isolates. ESBL-producing Escherichia spp. were found in fecal samples at pig (15/17), cattle (6/11) and poultry farms (3/6). In total, 70.6% (24/36) of the tested farms were ESBL positive. Furthermore, 9 out of 60 cloacal swabs turned out to be ESBL positive. All isolated ESBL-producing bacteria from animal sources were E. coli, except for one E. hermanii isolate. CTX-M was the most prevalent ß-lactamase at cattle and pig farms, while SHV predominated in poultry. One human isolate shared an identical MLST sequence type (ST) 3891 and CTX-M allele to the isolate found in the cattle fecal sample from the same farm, indicating a zoonotic transfer. Two other pairs of human-pig and human-cattle E. coli isolates encoded the same ESBL genes but did not share the same MLST ST, which may indicate horizontal resistance gene transfer. In summary, the study shows the high prevalence of ESBL-producing E.coli in livestock in Mecklenburg- Western Pomerania and provides the risk of transfer between livestock and farm workers.