Principles of infection prevention and reprocessing in ENT endoscopy.

This article gives an overview on the principles of reprocessing of rigid and flexible endoscopes used in ENT units including structural and spatial requirements based on general and ENT-specific risks of infection associated with diagnostic and therapeutic endoscopy. The underlying legal principles as well as recommendations from scientific societies will be exemplified in order to give a practical guidance to the otorhinolaryngologist. Preliminary results of a small nation-wide survey on infection control standards based on data of 29 ENT practices in Germany reveal current deficits of varying degree concerning infection control management including reprocessing of endoscopes. The presented review aims to give support to the establishment of a structured infection control management program including the evaluation of results by means of a prospective surveillance.

Microbial contamination of manually reprocessed, ready to use ECG lead wire in intensive care units.

BACKGROUND: A number of studies have shown that non-critical medical devices can be contaminated with pathogens, including those resistant to antibiotics and thus become a potential vector for transmission. Electrocardiography (ECG) lead wire are non-critical medical device which are always attached on patient skin during their stay in intensive care unit (ICU). In view of the patient's critical conditions and exposure to invasive procedures, identification and prevention of possible risks are important to prevent infection in ICUs. OBJECTIVE: The objective of this study was to determine the presence of bacterial and fungal contamination on cleaned and disinfected reusable ECG lead wires in intensive care units in a hospital. METHODS: A total of 408 cleaned ECG lead wires from 93 bed-side ECG devices and 43 ECG lead wires from 5 portable ECG devices from 4 intensive care units (ICUs) and 1 post-anaesthesia care unit (PACU) were sampled. ECG lead wires were stirred in 0.89% NaCl with added neutralizer for 30 seconds. Samples of the solutions were cultured directly on blood agar. The remaining solution was cultured on blood agar after sterile filtration. The number of colony forming units (CFUs) was counted and the microorganisms were identified. RESULTS: More than half of examined ECG lead wires (n=232; 51.4%) were contaminated with >30 CFUs/mL sample of bacteria or with risk pathogens. Gram-positive bacteria were the most frequently isolated organisms; particularly, coagulase negative staphylococci (96%) and aerobic spore forming bacteria (71.2%). Compared to ICUs, PACU had significantly lower proportion of contaminated ECG lead wires (p<0.05). The proportion of contaminated ECG lead wires, as well as mean number of cfus per ECG lead wire, was also significantly lower among multi-wire ECG leads compared to single-wire ECG leads. CONCLUSIONS: Manually cleaned ECG lead wires may serve as a vector for transmission of nosocomial pathogens. The current reprocessing technique for ECG lead wires needs to be improved.

Is routine replacement of i.v. administration sets required after each change of intermittently administrated antibiotic infusions?

AIM: Manufacturers' instructions recommend changing the infusion line together with the infusion bottle after each administration. We investigated if the complete infusion line may be microbiologically contaminated after short-time antibiotic and rinse-solution application. METHOD: Immediately after the change of an infusion administration set after 72 hours the remaining antibiotic solution was inactivated with yolk and cultured on blood agar for 48 hours at 36°C to detect possible contaminants. RESULTS: Among 87 investigated samples no microbial growth was detected. One sample which hadn't any contact to antibiotics yielded 1 colony forming unit (cfu) of coagulase-negative staphylococci. These results suggest that in case of consecutive antibiotic-short- and rinse-infusions the infusion line may be in place up to 72 hours without contamination. This, however, may be only the case for infusion sets, which are in contact with antibiotics. If no antibiotic is administered, the infusion bottle and the infusion line must be renewed together for every change. To clarify this question into more detail, a larger consecutive study is required. CONCLUSION: I.v. administration sets without any contact to antibiotics must be changed together with their infusion bottle after administration. In case of consecutive antibiotic-short- and rinse-infusions our pilot study suggests using the i.v. administration sets for up to 72 hours without renewing it at every infusion-set exchange.

One-day point prevalence of emerging bacterial pathogens in four secondary and five tertiary care German hospitals - results from a pilot study of the German Society for Hospital Hygiene (Deutsche Gesellschaft für Krankenhaushygiene, DGKH).

OBJECTIVE: Data on the prevalence of emerging bacterial pathogens like extended-spectrum-lactamase-building (ESBL) Gram negative organisms, multiresistant Pseudomonas and Acinetobacter species or toxin-building Clostridium difficile in German hospitals are sparse. To provide data for different regions in Germany, a one-day point prevalence study with five tertiary care hospitals and four secondary care hospitals was conducted on the 10(th) of February 2010. METHOD: For participating hospitals, the level of care (primary/secondary/tertiary), staffing with infection prevention personnel, availability of a MRSA-screening, microbiological support and the prevalence of five emerging bacterial pathogens in intensive care, surgical and medical wards was assessed by questionnaire. RESULTS: Overall, 3411 patients were included. In tertiary hospitals, the following prevalences were given: MRSA 1.8%, ESBL E. coli 0.45%, ESBL Klebsiella spp. 0.41%, multiresistant Pseudomonas 0.53%, multiresistant Acinetobacter species 0.15%, VRE 0.49% und Clostridium difficile 1.01%. In secondary hospitals, as prevalences resulted for MRSA 3.48%, ESBL E. coli 0.4%, ESBL Klebsiella spp. 0.4%, multiresistant Pseudomonas 0%, multiresistant Acinetobacter species 0%, VRE 0.13% und Clostridium difficile 1.34%. DISCUSSION: The prevalence of MRSA found is comparable to other prevalence studies published in the last years, but remarkably higher than reported by the German National Surveillance System (KISS). As no prevalence data for other pathogens as MRSA could be found, only data from the ITS-KISS are available for comparison. Again, the prevalences found in the present study are much higher than reported by the KISS. Whether this is by chance or indicates a systematic underreporting in the KISS remains unclear. CONCLUSION: The results from this one day point prevalence study show that prevalences of emerging bacterial pathogens differ markedly between regions, departments and hospitals. This can be explained by regional, methodical and other difference associated with the level of care provided by these hospitals. Still, the prevalences found fit well to other prevalence studies from the last years but are remarkably higher than to be expected by the KISS. As questionnaire-based one-day prevalence studies have been shown to be inexpensive and feasible, such studies, using a fixed day and protocol, should be extendedly used in the future to collect representative data for Germany. By such initiatives, scientific societies as the DGKH can take part in collecting valuable epidemiological data of emerging bacterial pathogens.

Impact of surface disinfection and sterile draping of furniture on room air quality in a cardiac procedure room with a ventilation and air-conditioning system (extrusion airflow, cleanroom class 1b (DIN 1946-4)).

In a cardiac procedure room, ventilated by a ventilation and air-conditioning system with turbulent mixed airflow, a protection zone in the operating area could be defined through visualization of airflows. Within this protection zone, no turbulence was detectable in the room air.Under the given conditions, disinfection of all surfaces including all furniture and equipment after the last operation and subsequent draping of furniture and all equipment that could not be removed from the room with sterile surgical drapes improved the indoor room air quality from cleanroom class C to cleanroom class B. This also allows procedures with elevated requirements to be performed in room class 1b.

[Successful decolonisation of MRSA-positive patients]. / Sanierung von MRSA-positiven Patienten.

The increasing number of patients colonised or infected with methicillin-resistant Staphylococcus aureus (MRSA) is one of the major clinical and epidemiological problems worldwide. Besides the consistent prevention of further spread of resistant strains, decolonisation of MRSA carriers is crucial to curb the problem. Today, a wide range of highly effective, well-tolerated and relatively cost-effective antiseptics and disinfectants as well as a permanently increasing knowledge about colonization routes and critical points in therapy is available. Nevertheless, the prospects for sustainable decolonisation of carriers has been often evaluated as disappointing, in the past. This shows that a successful, sustainable decolonisation can only succeed if the antiseptic treatment is embedded in a sound overall concept. This article is meant to assist in finding safe, effective and successful decolonisation regimes for inpatient and outpatient MRSA-carriers based on current literature and authors' experience.