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Puhlmann D, Bergmann D, Besier S, Hogardt M, Wichelhaus TA, Langhans S, Hack D, Reinheimer C, Vehreschild MJGT, Jung J, Kempf VAJ. Analysis of Mould Exposure of Immunosuppressed Patients at a German University Hospital. Microorganisms 2023; 11:2652. [PMID: 38004663 PMCID: PMC10672964 DOI: 10.3390/microorganisms11112652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
Moulds are ubiquitous components of outdoor and indoor air and local conditions, temperature, humidity and season can influence their concentration in the air. The impact of these factors on mould exposure in hospitals and the resulting risk of infection for low to moderately immunocompromised patients is unclear. In the present retrospective analysis for the years 2018 to 2022, the monthly determined mould contamination of the outdoor and indoor air at the University Hospital Frankfurt am Main is compared with the average air temperature and the relative humidity. Mould infections (Aspergillus spp., Mucorales) of low to moderately immunosuppressed patients of a haematological-oncological normal ward were determined clinically according to the criteria of the European Organisation for Research and Treatment of Cancer (EORTC, Brussels, Belgium) and of the National Reference Centre for Surveillance of Nosocomial Infections (NRC-NI, Berlin, Germany). The data revealed that in the summer months (May-October), increased mould contamination was detectable in the outdoor and indoor air compared to the winter months (November-April). The mould levels in the patient rooms followed the detection rates of the outdoor air. Two nosocomial Aspergillus infections, one nosocomial Mucorales (Rhizopus spp.) infection (according to both NRC-NI and EORTC criteria) and five Aspergillus spp. infections (according to EORTC criteria) occurred in 4299 treated patients (resulting in 41,500 patient days). In our study, the incidence density rate of contracting a nosocomial mould infection (n = 3) was approximately 0.07 per 1000 patient days and appears to be negligible.
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Affiliation(s)
- Danuta Puhlmann
- Institute for Medical Microbiology and Infection Control, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (D.P.)
- University Centre of Competence for Infection Control of the State of Hesse, 60590 Frankfurt am Main, Germany
- University Centre for Infectious Diseases (UCI), University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Dominic Bergmann
- Institute for Medical Microbiology and Infection Control, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (D.P.)
- University Centre of Competence for Infection Control of the State of Hesse, 60590 Frankfurt am Main, Germany
- University Centre for Infectious Diseases (UCI), University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Silke Besier
- Institute for Medical Microbiology and Infection Control, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (D.P.)
- University Centre of Competence for Infection Control of the State of Hesse, 60590 Frankfurt am Main, Germany
- University Centre for Infectious Diseases (UCI), University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Michael Hogardt
- Institute for Medical Microbiology and Infection Control, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (D.P.)
- University Centre of Competence for Infection Control of the State of Hesse, 60590 Frankfurt am Main, Germany
- University Centre for Infectious Diseases (UCI), University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Thomas A. Wichelhaus
- Institute for Medical Microbiology and Infection Control, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (D.P.)
- University Centre of Competence for Infection Control of the State of Hesse, 60590 Frankfurt am Main, Germany
- University Centre for Infectious Diseases (UCI), University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Sabine Langhans
- Institute for Medical Microbiology and Infection Control, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (D.P.)
- University Centre of Competence for Infection Control of the State of Hesse, 60590 Frankfurt am Main, Germany
- University Centre for Infectious Diseases (UCI), University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Daniel Hack
- Institute for Medical Microbiology and Infection Control, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (D.P.)
- University Centre of Competence for Infection Control of the State of Hesse, 60590 Frankfurt am Main, Germany
- University Centre for Infectious Diseases (UCI), University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Claudia Reinheimer
- Institute for Medical Microbiology and Infection Control, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (D.P.)
- University Centre of Competence for Infection Control of the State of Hesse, 60590 Frankfurt am Main, Germany
- University Centre for Infectious Diseases (UCI), University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Maria J. G. T. Vehreschild
- Department for Internal Medicine II, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Jens Jung
- Department 1—Finance and Patient Services, University Hospital, 60590 Frankfurt am Main, Germany
| | - Volkhard A. J. Kempf
- Institute for Medical Microbiology and Infection Control, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (D.P.)
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Infection prevention requirements for the medical care of immunosuppressed patients: recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. GMS HYGIENE AND INFECTION CONTROL 2022; 17:Doc07. [PMID: 35707229 PMCID: PMC9174886 DOI: 10.3205/dgkh000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Germany, guidelines for hygiene in hospitals are given in form of recommendations by the Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention, "KRINKO"). The KRINKO and its voluntary work are legitimized by the mandate according to § 23 of the Infection Protection Act (Infektionsschutzgesetz, "IfSG"). The original German version of this document was published in February 2021 and has now been made available to the international professional public in English. The guideline provides recommendations on infection prevention and control for immunocompromised individuals in health care facilities. This recommendation addresses not only measures related to direct medical care of immunocompromised patients, but also management aspects such as surveillance, screening, antibiotic stewardship, and technical/structural aspects such as patient rooms, air quality, and special measures during renovations.
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Nock AM, Iversen L, Waidhas L, Zapf A, Seifert C, Petersen-Ewert C. A care-concept of community health nursing interventions for adults with chronic health conditions in an urban area: a study protocol of a randomized controlled field trial (CoSta study) (Preprint). JMIR Res Protoc 2022; 11:e37965. [PMID: 36170005 PMCID: PMC9557981 DOI: 10.2196/37965] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/01/2022] [Accepted: 07/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Implementing community health nursing programs is a new field of application in the primary health sector of Germany. Hence, there is limited evidence of effective community-based and nurse-led interventions with regard to the German health care system. International research findings are mostly not transferable. The Community Health Nursing in der Stadt (CoSta; ie, “Community Health Nursing in the City”) project is the first study that examines a community health nurse–led intervention for adults with chronic health conditions. Objective This study protocol describes the design and methods of a randomized controlled field trial that will investigate if a community health nurse–based intervention has an impact on health-related quality of life in adults with chronic conditions. Methods The study was designed as a randomized controlled trial that will be conducted under real-life conditions in the field. In a 4-month period, patients with at least 1 chronic International Classification of Diseases, Tenth Revision, diagnosis will be enrolled. Participants will be randomly allocated to an intervention group or a control group. The sample size was assumed based on an effect size of 0.50 with a significance level of .05, using a 2-sided (2-tailed), 2-sample unequal variance t test. The control group will be treated as usual. The intervention group will receive—in addition to the usual treatment—preventive home visits; consultations; and educative training, which will be offered by 2 community health nurses for up to 12 months. Both groups will be followed up at baseline, after 6 months, and after 12 months. The primary outcome measure is the mental component summary score from the 36-Item Short Form Health Survey after 12-months. Secondary patient outcomes will be included. The study received ethics approval from the Competence Health Center’s institutional review board at the University of Applied Sciences Hamburg (procedure number: 2020-14). Results The CoSta project was funded by the Federal Ministry of Education and Research Germany (contract number: 13FH019SX8). In total, 187 participants were recruited at the beginning of August 2021. Further, 92 were excluded and 94 were randomized. Data collection will be conducted until the end of 2022. Conclusions Our study will provide data with regard to the effectiveness of community nurse–led interventions that focus on the treatment of vulnerable adults with chronic health conditions in a community health center. In secondary analyses, the associations among influencing social factors (education, income, and employment) will be examined. We expect results that will help reduce the research-to-practice gap. Trial Registration German Clinical Trials Register DRKS00026164; https://tinyurl.com/yckxc5ut International Registered Report Identifier (IRRID) DERR1-10.2196/37965
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Affiliation(s)
- Annike Morgane Nock
- Department of Nursing and Management, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Linda Iversen
- Department of Nursing and Management, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Lukas Waidhas
- Department of Nursing and Management, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf, University Hamburg, Hamburg, Germany
| | - Caroline Seifert
- Institute of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf, University Hamburg, Hamburg, Germany
| | - Corinna Petersen-Ewert
- Department of Nursing and Management, Hamburg University of Applied Sciences, Hamburg, Germany
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Boone I, Rosner B, Lachmann R, D'Errico ML, Iannetti L, Van der Stede Y, Boelaert F, Ethelberg S, Eckmanns T, Stark K, Haller S, Wilking H. Healthcare-associated foodborne outbreaks in high-income countries: a literature review and surveillance study, 16 OECD countries, 2001 to 2019. Euro Surveill 2021; 26:2001278. [PMID: 34651575 PMCID: PMC8518306 DOI: 10.2807/1560-7917.es.2021.26.41.2001278] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 03/25/2021] [Indexed: 11/20/2022] Open
Abstract
BackgroundHealthcare-associated foodborne outbreaks (HA-FBO) may have severe consequences, especially in vulnerable groups.AimThe aim was to describe the current state of HA-FBO and propose public health recommendations for prevention.MethodsWe searched PubMed, the Outbreak Database (Charité, University Medicine Berlin), and hand-searched reference lists for HA-FBO with outbreak onset between 2001 and 2018 from Organisation for Economic Co-operation and Development (OECD) countries and HA-FBO (2012-2018) from the German surveillance system. Additionally, data from the European Food Safety Authority were analysed.ResultsThe literature search retrieved 57 HA-FBO from 16 OECD countries, primarily in the US (n = 11), Germany (n = 11) and the United Kingdom (n = 9). In addition, 28 HA-FBO were retrieved from the German surveillance system. Based on the number of outbreaks, the top three pathogens associated with the overall 85 HA-FBO were Salmonella (n = 24), norovirus (n = 22) and Listeria monocytogenes (n = 19). Based on the number of deaths, L. monocytogenes was the main pathogen causing HA-FBO. Frequently reported implicated foods were 'mixed foods' (n = 16), 'vegetables and fruits' (n = 15) and 'meat and meat products' (n = 10). Consumption of high-risk food by vulnerable patients, inadequate time-temperature control, insufficient kitchen hygiene and food hygiene and carriers of pathogens among food handlers were reported as reasons for HA-FBO.ConclusionTo prevent HA-FBO, the supply of high-risk food to vulnerable people should be avoided. Well working outbreak surveillance facilitates early detection and requires close interdisciplinary collaboration and exchange of information between hospitals, food safety and public health authorities.
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Affiliation(s)
- Idesbald Boone
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Bettina Rosner
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Raskit Lachmann
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Michele Luca D'Errico
- Istituto Superiore di Sanità, Department of Food Safety, Nutrition and Veterinary Public Health, Rome, Italy
| | - Luigi Iannetti
- Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise G. Caporale, National Reference Laboratory for Listeria monocytogenes, Teramo, Italy
| | | | | | - Steen Ethelberg
- Statens Serum Institut, Infectious Disease Epidemiology and Prevention, Copenhagen, Denmark
| | - Tim Eckmanns
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Klaus Stark
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Sebastian Haller
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Hendrik Wilking
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
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Löser CR, Dirschka T, Felcht M, Dippel E, Kevekordes S. Hygieneempfehlungen in der ambulanten Dermatochirurgie. J Dtsch Dermatol Ges 2021; 19:1165-1169. [PMID: 34390134 DOI: 10.1111/ddg.14499_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Christoph R Löser
- Hautklinik, Hauttumorzentrum, Klinikum Ludwigshafen gGmbH, Ludwigshafen
| | | | - Moritz Felcht
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim
| | - Edgar Dippel
- Hautklinik, Hauttumorzentrum, Klinikum Ludwigshafen gGmbH, Ludwigshafen
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Löser CR, Dirschka T, Felcht M, Dippel E, Kevekordes S. Hygiene recommendations for outpatient dermatosurgery. J Dtsch Dermatol Ges 2021; 19:1165-1168. [PMID: 34015186 DOI: 10.1111/ddg.14499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/22/2021] [Indexed: 11/30/2022]
Abstract
The German Infection Protection Act and country-specific laws demand appropriate measures to prevent nosocomial infections and propagation of pathogens, especially those with resistances. This also concerns outpatient surgery of the skin. Special focus is placed on hand hygiene, antiseptics, hygienic modes of operation and professional instrument reprocessing. Every dermatological institution that operates on an outpatient basis is obliged to organize and be responsible for its hygiene. The legal framework is regulated by various laws and regulations and must be observed.
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Affiliation(s)
- Christoph R Löser
- Department of Dermatology, Skin Tumor Center, Ludwigshafen Medical Center, Ludwigshafen, Germany
| | | | - Moritz Felcht
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Edgar Dippel
- Department of Dermatology, Skin Tumor Center, Ludwigshafen Medical Center, Ludwigshafen, Germany
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Döhla M, Jaensch A, Döhla C, Voigt A, Exner M, Färber H. [Lead in drinking water-an old problem, a new EU directive]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:501-508. [PMID: 33638024 PMCID: PMC8060204 DOI: 10.1007/s00103-021-03292-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lead pipes have been used in drinking water installations for a long time. Only since 1973 have their use in new buildings been strongly discouraged; nevertheless, they are still found in old buildings. Furthermore, lead-containing alloys are still used today in components such as fittings. This results in an avoidable pollution of drinking water. The health significance of this pollution is acknowledged by a reduction of the currently valid limit value from 10 µg/l to 5 µg/l by the new EU drinking water directive passed in 2020. This directive provides for a transition period of 15 years. OBJECTIVES The relevance of a stricter limit value for lead in drinking water will be evaluated based by the results of routine analyses, and the necessary public health measures to prevent exposure of vulnerable groups will be formulated. MATERIAL AND METHODS A retrospective analysis of routine samples from the city of Bonn, which an accredited drinking water laboratory had examined in the years 1997-2019, was performed. RESULTS Of the 16,060 samples analyzed, 75.36% were below the quantitative limit of quantification. The median of the quantifiable samples was above the future limit for lead in drinking water in each year considered. No effect of the last transition period of 10 years (2003-2013) could be detected. DISCUSSION Even though no systematic studies on lead pollution in German municipalities are available, the subject is still highly topical. Lead exposure from drinking water installations is a completely avoidable health risk, but it can only be regulated by consistent enforcement of the applicable rules by the health authorities. The health authorities must be adequately equipped in terms of personnel, material, and financial resources.
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Affiliation(s)
- Manuel Döhla
- Institut für Hygiene und Öffentliche Gesundheit, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
- Abteilung für Mikrobiologie und Krankenhaushygiene, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland.
- Postgraduales Studium "Toxikologie und Umweltschutz", Institut für Rechtsmedizin, Universität Leipzig, Leipzig, Deutschland.
| | - Andreas Jaensch
- Institut für Hygiene und Öffentliche Gesundheit, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Christin Döhla
- Institut für Hygiene und Öffentliche Gesundheit, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Alexander Voigt
- Institut für Hygiene und Öffentliche Gesundheit, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Martin Exner
- Institut für Hygiene und Öffentliche Gesundheit, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Harald Färber
- Institut für Hygiene und Öffentliche Gesundheit, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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Anforderungen an die Infektionsprävention bei der medizinischen Versorgung von immunsupprimierten Patienten. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:232-264. [PMID: 33394069 PMCID: PMC7780910 DOI: 10.1007/s00103-020-03265-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Hempel L, Piehler A, Pfaffl MW, Molnar J, Kirchner B, Robert S, Veloso J, Gandorfer B, Trepotec Z, Mederle S, Keim S, Milani V, Ebner F, Schweneker K, Fleischmann B, Kleespies A, Scheiber J, Hempel D, Zehn D. SARS-CoV-2 infections in cancer outpatients-Most infected patients are asymptomatic carriers without impact on chemotherapy. Cancer Med 2020; 9:8020-8028. [PMID: 33022856 PMCID: PMC7643635 DOI: 10.1002/cam4.3435] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022] Open
Abstract
Oncologic patients are regarded as the population most at risk of developing a severe course of COVID‐19 due to the fact that malignant diseases and chemotherapy often weaken the immune system. In the face of the ongoing SARS‐CoV‐2 pandemic, how particular patients deal with this infection remains an important question. In the period between the 15 and 26 April 2020, a total of 1227 patients were tested in one of seven oncologic outpatient clinics for SARS‐CoV‐2, regardless of symptoms, employing RT‐qPCR. Of 1227 patients, 78 (6.4%) were tested positive of SARS‐CoV‐2. Only one of the patients who tested positive developed a severe form of COVID‐19 with pneumonia (CURB‐65 score of 2), and two patients showed mild symptoms. Fourteen of 75 asymptomatic but positively tested patients received chemotherapy or chemo‐immunotherapy according to their regular therapy algorithm (±4 weeks of SARS‐CoV‐2 test), and 48 of 78 (61.5%) positive‐tested patients received glucocorticoids as co‐medication. None of the asymptomatic infected patients showed unexpected complications due to the SARS‐CoV‐2 infection during the cancer treatment. These data clearly contrast the view that patients with an oncologic disease are particularly vulnerable to SARS‐CoV‐2 and suggest that compromising therapies could be continued or started despite the ongoing pandemic. Moreover the relatively low appearance of symptoms due to COVID‐19 among patients on chemotherapy and other immunosuppressive co‐medication like glucocorticoids indicate that suppressing the response capacity of the immune system reduces disease severity.
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Affiliation(s)
| | | | - Michael W Pfaffl
- Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, Technical University of Munich, Munich, Germany
| | | | - Benedikt Kirchner
- Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, Technical University of Munich, Munich, Germany
| | - Sebastian Robert
- Fraunhofer Institute of Optronics, System Technologies, and Image Exploitation IOSB, Karlsruhe, Germany
| | - Julia Veloso
- Fraunhofer Institute of Optronics, System Technologies, and Image Exploitation IOSB, Karlsruhe, Germany
| | | | | | | | - Sabine Keim
- Department of Obstetrics, Helios Clinic Pasing, München, Germany
| | | | | | | | | | | | | | | | - Dietmar Zehn
- Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, Technical University of Munich, Munich, Germany
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Lachmann R, Halbedel S, Adler M, Becker N, Allerberger F, Holzer A, Boone I, Falkenhorst G, Kleta S, Al Dahouk S, Stark K, Luber P, Flieger A, Wilking H. Nationwide outbreak of invasive listeriosis associated with consumption of meat products in health care facilities, Germany, 2014-2019. Clin Microbiol Infect 2020; 27:1035.e1-1035.e5. [PMID: 32979571 DOI: 10.1016/j.cmi.2020.09.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/27/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Invasive listeriosis is a severe foodborne infection caused by Listeria(L.)monocytogenes. The aim of this investigation was to verify and describe a molecular cluster of listeriosis patients and identify factors leading to this outbreak. METHODS Whole genome sequencing and core genome multilocus sequence typing were used for subtyping L. monocytogenes isolates from listeriosis cases and food samples in Germany. Patient interviews and investigational tracing of foodstuffs offered in health-care facilities (HCF), where some of the cases occurred, were conducted. RESULTS We identified a German-wide listeriosis outbreak with 39 genetically related cases occurring between 2014 and 2019. Three patients died as a result of listeriosis. After identification of HCF in different regions of Germany for at least 13 cases as places of exposure, investigational tracing of food supplies in six prioritized HCF revealed meat products from one company (X) as a commonality. Subsequently the outbreak strain was analysed in six isolates from ready-to-eat meat products and one isolate from the production environment of company X. No further Sigma1 cases were detected after recall of the meat products from the market and closure of company X (as of August 2020). CONCLUSIONS Interdisciplinary efforts including whole genome sequencing, epidemiological investigations in patients and investigational tracing of foods were essential to identify the source of infections, and thereby prevent further illnesses and deaths. This outbreak underlines the vulnerability of hospitalized patients for foodborne diseases, such as listeriosis. Food producers and HCF should minimize the risk of microbiological hazards when producing, selecting and preparing food for patients.
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Affiliation(s)
- Raskit Lachmann
- FG35 Division of Gastrointestinal Infections, Zoonoses and Tropical Infections, Robert Koch Institute, Berlin, Germany.
| | - Sven Halbedel
- FG11 Division of Enteropathogenic Bacteria and Legionella, Consultant Laboratory for Listeria, Robert Koch Institute, Wernigerode, Germany
| | - Marlen Adler
- German Federal Institute for Risk Assessment, Berlin, Germany
| | - Natalie Becker
- Federal Office of Consumer Protection and Food Safety, Berlin, Germany
| | | | - Alexandra Holzer
- FG35 Division of Gastrointestinal Infections, Zoonoses and Tropical Infections, Robert Koch Institute, Berlin, Germany
| | - Idesbald Boone
- FG35 Division of Gastrointestinal Infections, Zoonoses and Tropical Infections, Robert Koch Institute, Berlin, Germany
| | - Gerhard Falkenhorst
- FG35 Division of Gastrointestinal Infections, Zoonoses and Tropical Infections, Robert Koch Institute, Berlin, Germany
| | - Sylvia Kleta
- German Federal Institute for Risk Assessment, Berlin, Germany
| | | | - Klaus Stark
- FG35 Division of Gastrointestinal Infections, Zoonoses and Tropical Infections, Robert Koch Institute, Berlin, Germany
| | - Petra Luber
- Federal Office of Consumer Protection and Food Safety, Berlin, Germany
| | - Antje Flieger
- FG11 Division of Enteropathogenic Bacteria and Legionella, Consultant Laboratory for Listeria, Robert Koch Institute, Wernigerode, Germany
| | - Hendrik Wilking
- FG35 Division of Gastrointestinal Infections, Zoonoses and Tropical Infections, Robert Koch Institute, Berlin, Germany
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Anforderungen der Hygiene an abwasserführende Systeme in medizinischen Einrichtungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:484-501. [DOI: 10.1007/s00103-020-03118-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Hygienemaßnahmen zur Prävention der Infektion durch Enterokokken mit speziellen Antibiotikaresistenzen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:1310-1361. [DOI: 10.1007/s00103-018-2811-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Tuberkulose und andere durch Luft übertragbare Infektionserkrankungen: Krankenhaushygiene zur Vermeidung und Eindämmung. PRAKTISCHE KRANKENHAUSHYGIENE UND UMWELTSCHUTZ 2018. [PMCID: PMC7123702 DOI: 10.1007/978-3-642-40600-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Die Tuberkulose (TB) gehört weltweit zu den am häufigsten auftretenden Infektionskrankheiten und wird fast ausschließlich über die Luft (aerogen) übertragen. Nachdem in Deutschland die Lungentuberkulosefallzahlen über Jahre hinweg stagnierten, ist seit 2013 wieder ein Anstieg der Inzidenzen zu verzeichnen (RKI 2016). Als Ursache hierfür werden die aktuellen demographischen Entwicklungen (Migration und Mobilität) gesehen. Die Kenntnis der epidemiologischen Situation ist von zentraler Bedeutung, um bei Vorliegen der Verdachtsdiagnose Tuberkulose sowie der Einbeziehung einer möglichen Resistenzproblematik frühzeitig adäquate krankenhaushygienische Maßnahmen einzuleiten. Als aerogen übertragbar werden auch die Aspergillose sowie Masern, Windpocken und Herpes zoster eingestuft (CDC 2007). Die Aspergillose ist eine relativ seltene, aber häufig letal verlaufende Pilzinfektion, die überwiegend bei immunsupprimierten Patienten auftritt. Krankenhaushygienische Schutzmaßnahmen können die Risiken einer Exposition und somit das Erkrankungsrisiko minimieren. Die zentralen Maßnahmen zur Kontrolle und Prävention von aerogen übertragbaren Infektionen sind Gegenstand dieses Kapitels.
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Dettenkofer M, Frank U, Just HM, Lemmen S, Scherrer M. Isolierungsmaßnahmen. PRAKTISCHE KRANKENHAUSHYGIENE UND UMWELTSCHUTZ 2018. [PMCID: PMC7123004 DOI: 10.1007/978-3-642-40600-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Die Kenntnis des infektionsspezifischen Übertragungsweges einer Erkrankung ist die entscheidende Voraussetzung zur Festlegung sinnvoller, d. h. effektiver Präventionsmaßnahmen, zu denen auch heute noch die räumliche Isolierung von Patienten gehört. Die in der Vergangenheit empfohlenen pauschalen Maßnahmen, die weder den Übertragungsweg noch die Virulenz eines Infektionserregers angemessen berücksichtigten, führten oftmals zu erkennbarer Überisolierung, mit der Folge, dass in der täglichen Praxis notwendige Isolierungsmaßnahmen eher nachlässig gehandhabt wurden. Die Konsequenzen waren vermeidbare Kontaktinfektionen in Kliniken. Andererseits birgt die Unterbringung in einem Isolierzimmer die Gefahr einer schlechteren medizinischen wie pflegerischen Versorgung und damit einer Gefährdung des Patienten. Erreger- und maßnahmenbezogene Isolierkriterien mit disziplinierter Befolgung erforderlicher Verhaltensregeln seitens aller Beschäftigten, der isolierten Patienten und ihrer Besucher sind die Voraussetzung einer erfolgreichen Vermeidung von Infektionsübertragungen. Die Vermeidung unnötiger Isolierungsmaßnahmen spart erhebliche Kosten, reduziert die Belastung von Ärzten wie Pflegekräften und damit die Gefahr der Noncompliance bei essenziellen Präventionsmaßnahmen wie Händedesinfektion und andere Maßnahmen der Basishygiene.
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Affiliation(s)
- Markus Dettenkofer
- Gesundheitsverbund Landkreis Konstanz, Institut für Krankenhaushygiene & Infektionsprävention, Radolfzell, Germany
| | - Uwe Frank
- Sektion Krankenhaus- und Umwelthygiene, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Sebastian Lemmen
- Zentralbereich für Krankenhaushygiene, Universitätsklinikum Aachen, Aachen, Germany
| | - Martin Scherrer
- Stabsstelle Techn. Krankenhaushygiene, Universitätsklinikum Heidelberg, Heidelberg, Germany
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15
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Mellinghoff SC, Panse J, Alakel N, Behre G, Buchheidt D, Christopeit M, Hasenkamp J, Kiehl M, Koldehoff M, Krause SW, Lehners N, von Lilienfeld-Toal M, Löhnert AY, Maschmeyer G, Teschner D, Ullmann AJ, Penack O, Ruhnke M, Mayer K, Ostermann H, Wolf HH, Cornely OA. Primary prophylaxis of invasive fungal infections in patients with haematological malignancies: 2017 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO). Ann Hematol 2017; 97:197-207. [PMID: 29218389 PMCID: PMC5754425 DOI: 10.1007/s00277-017-3196-2] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 11/22/2017] [Indexed: 12/20/2022]
Abstract
Immunocompromised patients are at high risk of invasive fungal infections (IFI), in particular those with haematological malignancies undergoing remission-induction chemotherapy for acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS) and recipients of allogeneic haematopoietic stem cell transplants (HSCT). Despite the development of new treatment options in the past decades, IFI remains a concern due to substantial morbidity and mortality in these patient populations. In addition, the increasing use of new immune modulating drugs in cancer therapy has opened an entirely new spectrum of at risk periods. Since the last edition of antifungal prophylaxis recommendations of the German Society for Haematology and Medical Oncology in 2014, seven clinical trials regarding antifungal prophylaxis in patients with haematological malignancies have been published, comprising 1227 patients. This update assesses the impact of this additional evidence and effective revisions. Our key recommendations are the following: prophylaxis should be performed with posaconazole delayed release tablets during remission induction chemotherapy for AML and MDS (AI). Posaconazole iv can be used when the oral route is contraindicated or not feasible. Intravenous liposomal amphotericin B did not significantly decrease IFI rates in acute lymphoblastic leukaemia (ALL) patients during induction chemotherapy, and there is poor evidence to recommend it for prophylaxis in these patients (CI). Despite substantial risk of IFI, we cannot provide a stronger recommendation for these patients. There is poor evidence regarding voriconazole prophylaxis in patients with neutropenia (CII). Therapeutic drug monitoring TDM should be performed within 2 to 5 days of initiating voriconazole prophylaxis and should be repeated in case of suspicious adverse events or of dose changes of interacting drugs (BIItu). General TDM during posaconazole prophylaxis is not recommended (CIItu), but may be helpful in cases of clinical failure such as breakthrough IFI for verification of compliance or absorption.
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Affiliation(s)
- Sibylle C Mellinghoff
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany. .,Department I of Internal Medicine, German Centre for Infection Research (DZIF), University Hospital of Cologne, University of Cologne, Cologne, Germany.
| | - Jens Panse
- Department of Oncology, Haematology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Nael Alakel
- Department I of Internal Medicine, Haematology and Oncology, University Hospital Dresden, Dresden, Germany
| | - Gerhard Behre
- Division of Haematology and Oncology, Leipzig University Hospital, Leipzig, Germany
| | - Dieter Buchheidt
- Department of Internal Medicine-Haematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Maximilian Christopeit
- Department of Stem Cell Transplantation, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Justin Hasenkamp
- Clinic for Haematology and Medical Oncology with Department for Stem Cell Transplantation, University Medicine Göttingen, Göttingen, Germany
| | - Michael Kiehl
- Department I for Internal Medicine, Klinikum Frankfurt (Oder), Frankfurt (Oder), Germany
| | - Michael Koldehoff
- Department of Bone Marrow Transplantation, West German Cancer Centre, University Hospital of Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Stefan W Krause
- Department V for Internal Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Nicola Lehners
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Annika Y Löhnert
- Department I of Internal Medicine, German Centre for Infection Research (DZIF), University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Georg Maschmeyer
- Department of Haematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Daniel Teschner
- Department of Haematology, Medical Oncology, and Pneumology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Andrew J Ullmann
- Department II of Internal Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Olaf Penack
- Department for Haematology, Oncology and Tumour immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Ruhnke
- Department of Haematology and Oncology, Paracelsus-Kliniken Osnabrück, Osnabrück, Germany
| | - Karin Mayer
- Department III of Internal Medicine, University Hospital Bonn, Bonn, Germany
| | - Helmut Ostermann
- Department of Haematology and Oncology, University of Munich, Munich, Germany
| | - Hans-H Wolf
- Department IV of Internal Medicine, University Hospital Halle, Halle, Germany
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Department I of Internal Medicine, German Centre for Infection Research (DZIF), University Hospital of Cologne, University of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
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16
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Wiesmüller GA, Heinzow B, Aurbach U, Bergmann KC, Bufe A, Buzina W, Cornely OA, Engelhart S, Fischer G, Gabrio T, Heinz W, Herr CEW, Kleine-Tebbe J, Klimek L, Köberle M, Lichtnecker H, Lob-Corzilius T, Merget R, Mülleneisen N, Nowak D, Rabe U, Raulf M, Seidl HP, Steiß JO, Szewzyk R, Thomas P, Valtanen K, Hurrass J. Kurzfassung der AWMF-Leitlinie medizinisch klinische Diagnostik bei Schimmelpilzexposition in Innenräumen. ALLERGO JOURNAL 2017. [DOI: 10.1007/s15007-017-1382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Furtwängler R, Schlotthauer U, Gärtner B, Graf N, Simon A. Nosocomial legionellosis and invasive aspergillosis in a child with T-lymphoblastic leukemia. Int J Hyg Environ Health 2017; 220:900-905. [PMID: 28529020 PMCID: PMC7106519 DOI: 10.1016/j.ijheh.2017.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 12/30/2022]
Abstract
Invasive aspergillosis of the lungs and the central nervous system and Legionella pneumophilia serotype 1 infection of the lungs were diagnosed in a 22-month old child during inpatient induction treatment for T-lymphoblastic leukemia. Environmental investigations i.e. samples from the hospital water system did not reveal any Legionella. The patient may have been exposed to waterborne pathogens despite terminal water filtration due to a technical device to release residual tap water from the hose after showering. A sodium chloride nose spray was found to be contaminated with the A. fumigatus isolate of the patient.
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Affiliation(s)
- Rhoikos Furtwängler
- Pediatric Oncology and Hematology, Children's Hospital, Saarland University and Saarland University Medical Centre, Homburg, Germany
| | - Uwe Schlotthauer
- Institutes and State Laboratory of Medical Microbiology and Hygiene, Saarland University and Saarland University Medical Centre, Homburg, Germany
| | - Barbara Gärtner
- Institutes and State Laboratory of Medical Microbiology and Hygiene, Saarland University and Saarland University Medical Centre, Homburg, Germany
| | - Norbert Graf
- Pediatric Oncology and Hematology, Children's Hospital, Saarland University and Saarland University Medical Centre, Homburg, Germany
| | - Arne Simon
- Pediatric Oncology and Hematology, Children's Hospital, Saarland University and Saarland University Medical Centre, Homburg, Germany.
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Wiesmüller GA, Heinzow B, Aurbach U, Bergmann KC, Bufe A, Buzina W, Cornely OA, Engelhart S, Fischer G, Gabrio T, Heinz W, Herr CEW, Kleine-Tebbe J, Klimek L, Köberle M, Lichtnecker H, Lob-Corzilius T, Merget R, Mülleneisen N, Nowak D, Rabe U, Raulf M, Seidl HP, Steiß JO, Szewszyk R, Thomas P, Valtanen K, Hurraß J. Abridged version of the AWMF guideline for the medical clinical diagnostics of indoor mould exposure: S2K Guideline of the German Society of Hygiene, Environmental Medicine and Preventive Medicine (GHUP) in collaboration with the German Association of Allergists (AeDA), the German Society of Dermatology (DDG), the German Society for Allergology and Clinical Immunology (DGAKI), the German Society for Occupational and Environmental Medicine (DGAUM), the German Society for Hospital Hygiene (DGKH), the German Society for Pneumology and Respiratory Medicine (DGP), the German Mycological Society (DMykG), the Society for Pediatric Allergology and Environmental Medicine (GPA), the German Federal Association of Pediatric Pneumology (BAPP), and the Austrian Society for Medical Mycology (ÖGMM). ALLERGO JOURNAL INTERNATIONAL 2017; 26:168-193. [PMID: 28804700 PMCID: PMC5533814 DOI: 10.1007/s40629-017-0013-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This article is an abridged version of the AWMF mould guideline "Medical clinical diagnostics of indoor mould exposure" presented in April 2016 by the German Society of Hygiene, Environmental Medicine and Preventive Medicine (Gesellschaft für Hygiene, Umweltmedizin und Präventivmedizin, GHUP), in collaboration with the above-mentioned scientific medical societies, German and Austrian societies, medical associations and experts. Indoor mould growth is a potential health risk, even if a quantitative and/or causal relationship between the occurrence of individual mould species and health problems has yet to be established. Apart from allergic bronchopulmonary aspergillosis (ABPA) and mould-caused mycoses, only sufficient evidence for an association between moisture/mould damage and the following health effects has been established: allergic respiratory disease, asthma (manifestation, progression and exacerbation), allergic rhinitis, hypersensitivity pneumonitis (extrinsic allergic alveolitis), and increased likelihood of respiratory infections/bronchitis. In this context the sensitizing potential of moulds is obviously low compared to other environmental allergens. Recent studies show a comparatively low sensitizing prevalence of 3-10% in the general population across Europe. Limited or suspected evidence for an association exist with respect to mucous membrane irritation and atopic eczema (manifestation, progression and exacerbation). Inadequate or insufficient evidence for an association exist for chronic obstructive pulmonary disease, acute idiopathic pulmonary hemorrhage in children, rheumatism/arthritis, sarcoidosis and cancer. The risk of infection posed by moulds regularly occurring indoors is low for healthy persons; most species are in risk group 1 and a few in risk group 2 (Aspergillus fumigatus, A. flavus) of the German Biological Agents Act (Biostoffverordnung). Only moulds that are potentially able to form toxins can be triggers of toxic reactions. Whether or not toxin formation occurs in individual cases is determined by environmental and growth conditions, above all the substrate. In the case of indoor moisture/mould damage, everyone can be affected by odour effects and/or mood disorders. However, this is not a health hazard. Predisposing factors for odour effects can include genetic and hormonal influences, imprinting, context and adaptation effects. Predisposing factors for mood disorders may include environmental concerns, anxiety, condition, and attribution, as well as various diseases. Risk groups to be protected particularly with regard to an infection risk are persons on immunosuppression according to the classification of the German Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention, KRINKO) at the Robert Koch- Institute (RKI) and persons with cystic fibrosis (mucoviscidosis); with regard to an allergic risk, persons with cystic fibrosis (mucoviscidosis) and patients with bronchial asthma should be protected. The rational diagnostics include the medical history, physical examination, and conventional allergy diagnostics including provocation tests if necessary; sometimes cellular test systems are indicated. In the case of mould infections the reader is referred to the AWMF guideline "Diagnosis and Therapy of Invasive Aspergillus Infections". With regard to mycotoxins, there are currently no useful and validated test procedures for clinical diagnostics. From a preventive medicine standpoint it is important that indoor mould infestation in relevant dimension cannot be tolerated for precautionary reasons. With regard to evaluating the extent of damage and selecting a remedial procedure, the reader is referred to the revised version of the mould guideline issued by the German Federal Environment Agency (Umweltbundesamt, UBA).
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Affiliation(s)
- Gerhard A. Wiesmüller
- Institute for Occupational Medicine and Social Medicine, University Hospital, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Infection Control and Environmental Hygiene, Cologne Health Authority, Neumarkt 15–21, 50667 Cologne, Germany
| | - Birger Heinzow
- Formerly: Regional Social Security Authorities (LAsD) for Schleswig-Holstein, Kiel, Germany
| | - Ute Aurbach
- Department of Microbiology and Mycology, Dr. Wisplinghoff Laboratory, Cologne, Germany
| | | | - Albrecht Bufe
- Experimental Pneumology, Ruhr University, Bochum, Germany
| | - Walter Buzina
- Institute for Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Oliver A. Cornely
- Department I for Internal Medicine and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Steffen Engelhart
- Institute for Hygiene and Public Health, Bonn University Hospital, Bonn, Germany
| | - Guido Fischer
- Baden-Württemberg Regional Health Authorities at the Regional Council Stuttgart, Stuttgart, Germany
| | - Thomas Gabrio
- Formerly: Baden-Württemberg Regional Health Authorities at the Regional Council in Stuttgart, Stuttgart, Germany
| | - Werner Heinz
- Medical Clinic and Outpatient Clinic II with Special Focus on Infectiology, Würzburg University Hospital, Würzburg, Germany
| | - Caroline E. W. Herr
- Bavarian Office for Health and Food Safety, Munich, Germany
- Adj. Prof. “Hygiene and Environmental Medicine”, Ludwig-Maximilian University, Munich, Germany
| | | | - Ludger Klimek
- Wiesbaden Centre for Rhinology and Allergology, Wiesbaden, Germany
| | - Martin Köberle
- Clinic and Outpatient Clinic for Dermatology and Allergology am Biederstein, Technical University of Munich, Munich, Germany
| | - Herbert Lichtnecker
- Medical Institute for Environmental and Occupational Medicine MIU GmbH, Erkrath, Germany
| | | | - Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | | | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Member of the German Centre for Lung Research, Munich University Hospital, Munich, Germany
| | - Uta Rabe
- Centre for Allergology and Asthma, Johanniter Hospital im Fläming Treuenbrietzen GmbH, Treuenbrietzen, Germany
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Hans Peter Seidl
- Formerly: Chair of Microbiology and Clinic and Outpatient Clinic for Dermatology and Allergology am Biederstein, Technical University of Munich, Munich, Germany
| | - Jens-Oliver Steiß
- Centre for Pediatric and Adolescent Medicine, University Hospital Gießen and Marburg GmbH, Gießen, Germany
- Specialist Practice for Allergology and Pediatric Pneumology, Fulda, Germany
| | - Regine Szewszyk
- FG (specialist field) II 1.4 Microbiological Risks, Federal Environmental Agency, Berlin, Germany
| | - Peter Thomas
- Department and Outpatient Clinic for Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - Kerttu Valtanen
- FG (specialist field) II 1.4 Microbiological Risks, Federal Environmental Agency, Berlin, Germany
| | - Julia Hurraß
- Department of Infection Control and Environmental Hygiene, Cologne Health Authority, Neumarkt 15–21, 50667 Cologne, Germany
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19
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Hurraß J, Heinzow B, Aurbach U, Bergmann KC, Bufe A, Buzina W, Cornely OA, Engelhart S, Fischer G, Gabrio T, Heinz W, Herr CEW, Kleine-Tebbe J, Klimek L, Köberle M, Lichtnecker H, Lob-Corzilius T, Merget R, Mülleneisen N, Nowak D, Rabe U, Raulf M, Seidl HP, Steiß JO, Szewszyk R, Thomas P, Valtanen K, Wiesmüller GA. Medical diagnostics for indoor mold exposure. Int J Hyg Environ Health 2016; 220:305-328. [PMID: 27986496 DOI: 10.1016/j.ijheh.2016.11.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 01/24/2023]
Abstract
In April 2016, the German Society of Hygiene, Environmental Medicine and Preventative Medicine (Gesellschaft für Hygiene, Umweltmedizin und Präventivmedizin (GHUP)) together with other scientific medical societies, German and Austrian medical societies, physician unions and experts has provided an AWMF (Association of the Scientific Medical Societies) guideline 'Medical diagnostics for indoor mold exposure'. This guideline shall help physicians to advise and treat patients exposed indoors to mold. Indoor mold growth is a potential health risk, even without a quantitative and/or causal association between the occurrence of individual mold species and health effects. Apart from the allergic bronchopulmonary aspergillosis (ABPA) and the mycoses caused by mold, there is only sufficient evidence for the following associations between moisture/mold damages and different health effects: Allergic respiratory diseases, asthma (manifestation, progression, exacerbation), allergic rhinitis, exogenous allergic alveolitis and respiratory tract infections/bronchitis. In comparison to other environmental allergens, the sensitizing potential of molds is estimated to be low. Recent studies show a prevalence of sensitization of 3-10% in the total population of Europe. The evidence for associations to mucous membrane irritation and atopic eczema (manifestation, progression, exacerbation) is classified as limited or suspected. Inadequate or insufficient evidence for an association is given for COPD, acute idiopathic pulmonary hemorrhage in children, rheumatism/arthritis, sarcoidosis, and cancer. The risk of infections from indoor molds is low for healthy individuals. Only molds that are capable to form toxins can cause intoxications. The environmental and growth conditions and especially the substrate determine whether toxin formation occurs, but indoor air concentrations are always very low. In the case of indoor moisture/mold damages, everyone can be affected by odor effects and/or impairment of well-being. Predisposing factors for odor effects can be given by genetic and hormonal influences, imprinting, context and adaptation effects. Predisposing factors for impairment of well-being are environmental concerns, anxieties, conditioning and attributions as well as a variety of diseases. Risk groups that must be protected are patients with immunosuppression and with mucoviscidosis (cystic fibrosis) with regard to infections and individuals with mucoviscidosis and asthma with regard to allergies. If an association between mold exposure and health effects is suspected, the medical diagnosis includes medical history, physical examination, conventional allergy diagnosis, and if indicated, provocation tests. For the treatment of mold infections, it is referred to the AWMF guidelines for diagnosis and treatment of invasive Aspergillus infections. Regarding mycotoxins, there are currently no validated test methods that could be used in clinical diagnostics. From the perspective of preventive medicine, it is important that mold damages cannot be tolerated in indoor environments.
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Affiliation(s)
- Julia Hurraß
- Abteilung Infektions- und Umwelthygiene, Gesundheitsamt der Stadt Köln, Germany.
| | - Birger Heinzow
- Formerly: Landesamt für soziale Dienste (LAsD) Schleswig-Holstein, Kiel, Germany
| | - Ute Aurbach
- Abteilung Mikrobiologie und Mykologie, Labor Dr. Wisplinghoff, Köln, Germany
| | | | - Albrecht Bufe
- Experimentelle Pneumologie, Ruhr-Universität Bochum, Germany
| | - Walter Buzina
- Institut für Hygiene, Mikrobiologie und Umweltmedizin, Medizinische Universität Graz, Austria
| | - Oliver A Cornely
- Klinik I für Innere Medizin, ZKS Köln und Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Universität zu Köln, Germany
| | - Steffen Engelhart
- Institut für Hygiene und Öffentliche Gesundheit, Universitätsklinikum Bonn, Germany
| | - Guido Fischer
- Landesgesundheitsamt Baden-Württemberg im Regierungspräsidium Stuttgart, Germany
| | - Thomas Gabrio
- Formerly: Landesgesundheitsamt Baden-Württemberg im Regierungspräsidium Stuttgart, Germany
| | - Werner Heinz
- Medizinische Klinik und Poliklinik II, Schwerpunkt Infektiologie, Universitätsklinikum Würzburg, Germany
| | - Caroline E W Herr
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, München, Germany; Ludwig-Maximilians-Universität München, apl. Prof. "Hygiene und Umweltmedizin", Germany
| | | | - Ludger Klimek
- Zentrums für Rhinologie und Allergologie, Wiesbaden, Germany
| | - Martin Köberle
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Germany
| | | | | | - Rolf Merget
- Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung, Institut der Ruhr-Universität Bochum (IPA), Germany
| | | | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Mitglied Deutsches Zentrum für Lungenforschung, Klinikum der Universität München, Germany
| | - Uta Rabe
- Zentrum für Allergologie und Asthma, Johanniter-Krankenhaus im Fläming Treuenbrietzen GmbH, Treuenbrietzen, Germany
| | - Monika Raulf
- Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung, Institut der Ruhr-Universität Bochum (IPA), Germany
| | - Hans Peter Seidl
- Formerly: Lehrstuhl für Mikrobiologie sowie Dermatologische Klinik der Technischen Universität München, Germany
| | - Jens-Oliver Steiß
- Zentrum für Kinderheilkunde und Jugendmedizin, Universitätsklinikum Gießen und Marburg GmbH, Gießen, Germany
| | - Regine Szewszyk
- Umweltbundesamt, FG II 1.4 Mikrobiologische Risiken, Berlin, Germany
| | - Peter Thomas
- Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität München, Germany
| | - Kerttu Valtanen
- Umweltbundesamt, FG II 1.4 Mikrobiologische Risiken, Berlin, Germany
| | - Gerhard A Wiesmüller
- Abteilung Infektions- und Umwelthygiene, Gesundheitsamt der Stadt Köln, Germany; Institut für Arbeitsmedizin und Sozialmedizin, Medizinische Fakultät der RWTH Aachen, Germany
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Tramsen L, Salzmann-Manrique E, Bochennek K, Klingebiel T, Reinhardt D, Creutzig U, Sung L, Lehrnbecher T. Lack of Effectiveness of Neutropenic Diet and Social Restrictions as Anti-Infective Measures in Children With Acute Myeloid Leukemia: An Analysis of the AML-BFM 2004 Trial. J Clin Oncol 2016; 34:2776-83. [PMID: 27269945 PMCID: PMC5019758 DOI: 10.1200/jco.2016.66.7881] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although nonpharmacologic anti-infective measures are widely used in children treated for acute myeloid leukemia (AML), there is little evidence of their effectiveness. PATIENTS AND METHODS We analyzed infectious complications in children during intensive treatment of AML according to the AML-BFM 2004 trial and surveyed sites on institutional standards regarding recommended restrictions of social contacts (six items), pets (five items), and food (eight items). A scoring system was developed with a restriction score for each item. Multivariable Poisson regression adjusted for sex, age, weight group, risk stratification, and prophylactic antibiotics was used to estimate the impact of the restrictions on the incidence ratios of fever of unknown origin, bacteremia, pneumonia, and gastroenteritis. RESULTS Data on recommendations of nonpharmacologic anti-infective measures and infectious complications were available in 339 patients treated in 37 institutions. Analyses did not demonstrate a significant benefit of any of the restrictions regarding food, social contacts, and pets on the risk of fever, bacteremia, pneumonia, and gastroenteritis. In contrast, age, weight group, risk stratification, and nonabsorbable antibiotics had some influence on infections complications. CONCLUSION The lack of effectiveness of dietary restrictions and restrictions regarding social contacts and pets should result in reconsideration of anti-infective policies.
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Affiliation(s)
- Lars Tramsen
- Lars Tramsen, Emilia Salzmann-Manrique, Konrad Bochennek, Thomas Klingebiel, and Thomas Lehrnbecher, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt; Dirk Reinhardt, Medical Center, University of Essen, Essen; Ursula Creutzig, Children's Hospital, Hannover Medical School, Hannover, Germany; and Lillian Sung, The Hospital for Sick Children, Toronto, Canada
| | - Emilia Salzmann-Manrique
- Lars Tramsen, Emilia Salzmann-Manrique, Konrad Bochennek, Thomas Klingebiel, and Thomas Lehrnbecher, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt; Dirk Reinhardt, Medical Center, University of Essen, Essen; Ursula Creutzig, Children's Hospital, Hannover Medical School, Hannover, Germany; and Lillian Sung, The Hospital for Sick Children, Toronto, Canada
| | - Konrad Bochennek
- Lars Tramsen, Emilia Salzmann-Manrique, Konrad Bochennek, Thomas Klingebiel, and Thomas Lehrnbecher, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt; Dirk Reinhardt, Medical Center, University of Essen, Essen; Ursula Creutzig, Children's Hospital, Hannover Medical School, Hannover, Germany; and Lillian Sung, The Hospital for Sick Children, Toronto, Canada
| | - Thomas Klingebiel
- Lars Tramsen, Emilia Salzmann-Manrique, Konrad Bochennek, Thomas Klingebiel, and Thomas Lehrnbecher, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt; Dirk Reinhardt, Medical Center, University of Essen, Essen; Ursula Creutzig, Children's Hospital, Hannover Medical School, Hannover, Germany; and Lillian Sung, The Hospital for Sick Children, Toronto, Canada
| | - Dirk Reinhardt
- Lars Tramsen, Emilia Salzmann-Manrique, Konrad Bochennek, Thomas Klingebiel, and Thomas Lehrnbecher, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt; Dirk Reinhardt, Medical Center, University of Essen, Essen; Ursula Creutzig, Children's Hospital, Hannover Medical School, Hannover, Germany; and Lillian Sung, The Hospital for Sick Children, Toronto, Canada
| | - Ursula Creutzig
- Lars Tramsen, Emilia Salzmann-Manrique, Konrad Bochennek, Thomas Klingebiel, and Thomas Lehrnbecher, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt; Dirk Reinhardt, Medical Center, University of Essen, Essen; Ursula Creutzig, Children's Hospital, Hannover Medical School, Hannover, Germany; and Lillian Sung, The Hospital for Sick Children, Toronto, Canada
| | - Lillian Sung
- Lars Tramsen, Emilia Salzmann-Manrique, Konrad Bochennek, Thomas Klingebiel, and Thomas Lehrnbecher, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt; Dirk Reinhardt, Medical Center, University of Essen, Essen; Ursula Creutzig, Children's Hospital, Hannover Medical School, Hannover, Germany; and Lillian Sung, The Hospital for Sick Children, Toronto, Canada
| | - Thomas Lehrnbecher
- Lars Tramsen, Emilia Salzmann-Manrique, Konrad Bochennek, Thomas Klingebiel, and Thomas Lehrnbecher, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt; Dirk Reinhardt, Medical Center, University of Essen, Essen; Ursula Creutzig, Children's Hospital, Hannover Medical School, Hannover, Germany; and Lillian Sung, The Hospital for Sick Children, Toronto, Canada.
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Simon A, Furtwängler R, Graf N, Laws HJ, Voigt S, Piening B, Geffers C, Agyeman P, Ammann RA. Surveillance of bloodstream infections in pediatric cancer centers - what have we learned and how do we move on? GMS HYGIENE AND INFECTION CONTROL 2016; 11:Doc11. [PMID: 27274442 PMCID: PMC4886351 DOI: 10.3205/dgkh000271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Pediatric patients receiving conventional chemotherapy for malignant disease face an increased risk of bloodstream infection (BSI). Since BSI may represent an acute life-threatening event in patients with profound immunosuppression, and show further negative impact on quality of life and anticancer treatment, the prevention of BSI is of paramount importance to improve and guarantee patients' safety during intensive treatment. The great majority of all pediatric cancer patients (about 85%) have a long-term central venous access catheter in use (type Broviac or Port; CVAD). Referring to the current surveillance definitions a significant proportion of all BSI in pediatric patients with febrile neutropenia is categorized as CVAD-associated BSI. This state of the art review summarizes the epidemiology and the distinct pathogen profile of BSI in pediatric cancer patients from the perspective of infection surveillance. Problems in executing the current surveillance definition in this patient population are discussed and a new concept for the surveillance of BSI in pediatric cancer patients is outlined.
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Affiliation(s)
- Arne Simon
- Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Rhoikos Furtwängler
- Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Norbert Graf
- Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Hans Jürgen Laws
- Klinik für Pädiatrische Onkologie, Hämatologie und Immunologie, Universitätskinderklinik, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Sebastian Voigt
- Klinik für Pädiatrie m. S. Onkologie / Hämatologie / Stammzelltransplantation, Charité – Universitätsmedizin Berlin, Germany
| | - Brar Piening
- Institut für Hygiene und Umweltmedizin, Charité – Universitätsmedizin Berlin, Germany
| | - Christine Geffers
- Institut für Hygiene und Umweltmedizin, Charité – Universitätsmedizin Berlin, Germany
| | - Philipp Agyeman
- Pädiatrische Infektiologie und Pädiatrische Hämatologie-Onkologie, Universitätsklinik für Kinderheilkunde, Inselspital, Bern, Switzerland
| | - Roland A. Ammann
- Pädiatrische Infektiologie und Pädiatrische Hämatologie-Onkologie, Universitätsklinik für Kinderheilkunde, Inselspital, Bern, Switzerland
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Külpmann R, Christiansen B, Kramer A, Lüderitz P, Pitten FA, Wille F, Zastrow KD, Lemm F, Sommer R, Halabi M. Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings - Guideline of the German Society for Hospital Hygiene (DGKH). GMS HYGIENE AND INFECTION CONTROL 2016; 11:Doc03. [PMID: 26958457 PMCID: PMC4766922 DOI: 10.3205/dgkh000263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Since the publication of the first "Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems) in hospitals" (http://www.krankenhaushygiene.de/informationen/fachinformationen/leitlinien/12) in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section "Ventilation and air conditioning technology" attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care.
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Affiliation(s)
| | | | - Axel Kramer
- German Society for Hospital Hygiene (DGKH), Berlin, Germany; Working Group Hygiene in Hospital and Practice, Association of the Scientific Medical Societies (AWMF), Germany
| | - Peter Lüderitz
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Frank-Albert Pitten
- German Society for Hospital Hygiene (DGKH), Berlin, Germany; Working Group Hygiene in Hospital and Practice, Association of the Scientific Medical Societies (AWMF), Germany
| | - Frank Wille
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | | | - Regina Sommer
- Austrian Society of Hygiene, Microbiology and Preventive Medicine (ÖGHMP), Vienna, Austria
| | - Milo Halabi
- Austrian Society of Hygiene, Microbiology and Preventive Medicine (ÖGHMP), Vienna, Austria
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Infektionsschutz und spezielle Hygienemaßnahmen in klinischen Disziplinen. KRANKENHAUS- UND PRAXISHYGIENE 2016. [PMCID: PMC7152143 DOI: 10.1016/b978-3-437-22312-9.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Busch J, Trierweiler-Hauke B. Hygiene auf der IMC-Station. PFLEGEWISSEN INTERMEDIATE CARE 2016. [PMCID: PMC7124074 DOI: 10.1007/978-3-662-49511-7_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Im Kapitel Hygiene auf der IMC-Station wird dargelegt, dass die Einhaltung von Hygienemaßnahmen nach den neuesten wissenschaftlichen Erkenntnissen zu den Basismaßnahmen einer jeden IMC-Station gehört. Neben den Standard-Hygienemaßnahmen einer IMC-Station werden die besonderen Aspekte der hygienischen Körperpflege beschrieben. Die erforderlichen Interventionen zur Vermeidung von Katheterinfektionen werden begründet. Die Vorbereitung, Anlage und Pflege der Katheter werden detailliert dargestellt, sodass jeder Lernende dies als Handlungsanweisung verwenden kann und dem Erfahrenen eine Detailprüfung ermöglicht wird. Wichtige Aspekte der Wund-, Drainagen- und Stomapflege werden besprochen und eine Kurzübersicht zur Pflege von Patienten mit MRE gegeben.
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Affiliation(s)
- Jutta Busch
- Campus Kiel, UKSH Akademie gemeinnützige GmbH, Kiel, Germany
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Infektionsprävention im Rahmen der Pflege und Behandlung von Patienten mit übertragbaren Krankheiten. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58:1151-70. [DOI: 10.1007/s00103-015-2234-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Lehrnbecher T, Sung L. Anti-infective prophylaxis in pediatric patients with acute myeloid leukemia. Expert Rev Hematol 2014; 7:819-30. [PMID: 25359519 DOI: 10.1586/17474086.2014.965140] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Pediatric patients undergoing treatment for acute myeloid leukemia (AML) are at high risk for infectious complications, predominantly due to Gram-negative bacteria, viridans group streptococci and fungal pathogens. In order to prevent infections in these patients, most institutions have implemented a number of non-pharmacological approaches to supportive care. In addition, antibiotic prophylaxis reduces bacterial infection, but may increase the emergence of resistance. Antifungal prophylaxis is generally recommended for children with AML. Whereas the use of hematopoietic growth factors has not resulted in improved survival, the efficacy of prophylactic granulocyte transfusions has to be determined.
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Affiliation(s)
- Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Children's Hospital, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany
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Abstract
Joint punctures and injections are a widely used approach to obtain a differential diagnostic assessment for the formation of a treatment concept for recurrent joint effusions, to exclude a periprosthetic infection in painful and loosened endoprostheses before a planned revision, to assign the origin of pain symptoms to a specific joint or to provide a treatment for arthritis of any kind. In all medical fields the standardization of processes has progressed. Therefore, for joint punctures there are standards relating to the implementation and hygiene of intra-articular punctures or injections in order to prevent the occurrence of complications, such as joint infections.
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Affiliation(s)
- S Arnold
- Orthopädische Universitätsklinik Friedrichsheim gGmbH, Marienburgstraße 2, 60528, Frankfurt am Main, Deutschland,
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RSV Outbreak Investigation Team *. Contributing and Terminating Factors of a Large RSV Outbreak in an Adult Hematology and Transplant Unit. PLOS CURRENTS 2014; 6:ecurrents.outbreaks.3bc85b2a508d205ecc4a5534ecb1f9be. [PMID: 25687181 PMCID: PMC4169394 DOI: 10.1371/currents.outbreaks.3bc85b2a508d205ecc4a5534ecb1f9be] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In January 2012, an increase of respiratory syncytial virus (RSV) infections on an adult hematology and transplant unit in a German university hospital was detected. We investigated the outbreak to assess its timing and extent and to identify risk factors for transmission. METHODS We tested and typed patient samples pro- and retrospectively for RSV. We conducted a cohort and a case-control study. A confirmed outbreak case had laboratory-diagnosed, nosocomially-acquired RSV infection. Possible outbreak cases had pneumonia but were not laboratory-confirmed. RESULTS Of 53 outbreak cases, 36 (68%) were confirmed and 17 (32%) possible. Retrospective testing and chart review dated the beginning of the outbreak to November 2011. Patients with community-acquired RSV infection were identified when the community epidemic began in January 2012. In multivariable analysis (controlling for contact with medical personnel, hygiene behaviour and age) patients with active social behaviour were more at risk for RSV infection (odds ratio 23.8, 95% confidence interval, 1.3 to 434.9; p-value, 0.03). Confirmed outbreak cases were more likely than controls to have been accomodated together with a confirmed or possible case before their onset of illness (OR 9.3, 95%CI: 2.1-85.1; p<0.001). Control measures, including isolation of every patient in the unit, initiated until the end of January terminated the outbreak. CONCLUSIONS Epidemiological investigations revealed co-accomodation with a case-patient and active social behaviour as likely risk factors for RSV infection. Awareness of and vigorous testing for respiratory viruses in immunosuppressed hospitalised patients is necessary to timely detect cases with outbreak potential. Isolation of patients with respiratory infectious illnesses is crucial to prevent the continuation or occurrence of outbreaks.
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Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014. [DOI: 10.1007/s00103-014-1980-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Busch J, Trierweiler-Hauke B. Hygiene auf der IMC-Station. PFLEGEWISSEN INTERMEDIATE CARE 2013. [PMCID: PMC7122968 DOI: 10.1007/978-3-642-30001-1_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Laut Aussage des Bundesgesundheitsministeriums im Juli 2011 erkranken in Deutschland jährlich 400.000–600.000 Menschen an einer Krankenhausinfektion. Schätzungsweise zwischen 7.500 und 15.000 Menschen sterben jährlich an einer Krankenhausinfektion. 20–30% der Infektionen könnten durch die Einhaltung von Hygienemaßnahmen vermieden werden (BMG 2012).
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Simon A, Christiansen B. Zur Fortentwicklung der Arbeiten bei den Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:1427-31. [DOI: 10.1007/s00103-012-1550-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Lehrnbecher T, Aplenc R, Rivas Pereira F, Lassaletta A, Caselli D, Kowalczyk J, Chisholm J, Sung L. Variations in non-pharmacological anti-infective measures in childhood leukemia--results of an international survey. Haematologica 2012; 97:1548-52. [PMID: 22419572 DOI: 10.3324/haematol.2012.062885] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Standardization in clinical practice may lead to improved outcomes. Unfortunately, little is known about the variability of non-pharmacological anti-infective measures in children with cancer. DESIGN AND METHODS A web-based survey assessed institutional recommendations regarding restrictions of social contacts, pets and food and instructions on wearing face masks in public for children with standard- risk acute lymphoblastic leukemia and acute myeloid leukemia during intensive chemotherapy. RESULTS A total of 336 institutions in 27 countries responded to the survey (range, 1-76 institutions per country; overall response rate 61%). Most institutions recommend that patients with acute myeloid leukemia avoid indoor public places and daycare, kindergarten and school, whereas recommendations for patients with acute lymphoblastic leukemia differ considerably by institution. In terms of restrictions related to pets, there was a wide variability between institutions for both acute lymphoblastic and acute myeloid leukemia patients. Most, but not all institutions do not allow children with either acute lymphoblastic or acute myeloid leukemia to eat raw meat, raw seafood or unpasteurized milk. Whereas most institutions do not routinely recommend that patients with acute lymphoblastic leukemia wear face masks in public, advice on this matter varies for patients with acute myeloid leukemia. CONCLUSIONS The survey demonstrates that there is a wide variation in recommendations on non-pharmacological anti-infective measures between different institutions, countries and continents. This information may be used to encourage harmonization of supportive care practices and future clinical trials.
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Hübner NO, Fleßa S, Haak J, Wilke F, Hübner C, Dahms C, Hoffmann W, Kramer A. Can the Hazard Assessment and Critical Control Points (HACCP) system be used to design process-based hygiene concepts? GMS KRANKENHAUSHYGIENE INTERDISZIPLINAR 2011; 6:Doc24. [PMID: 22242105 PMCID: PMC3252658 DOI: 10.3205/dgkh000181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recently, the HACCP (Hazard Analysis and Critical Control Points) concept was proposed as possible way to implement process-based hygiene concepts in clinical practice, but the extent to which this food safety concept can be transferred into the health care setting is unclear. We therefore discuss possible ways for a translation of the principles of the HACCP for health care settings. While a direct implementation of food processing concepts into health care is not very likely to be feasible and will probably not readily yield the intended results, the underlying principles of process-orientation, in-process safety control and hazard analysis based counter measures are transferable to clinical settings. In model projects the proposed concepts should be implemented, monitored, and evaluated under real world conditions.
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Affiliation(s)
- N-O Hübner
- Institute for Hygiene and Environmental Medicine, University of Greifswald, Greifswald, Germany
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[Experience with prevention and control of legionellosis in Germany : plea for proactive risk management]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:699-708. [PMID: 21626374 DOI: 10.1007/s00103-011-1286-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Legionellosis is meanwhile the most important specific water-associated infectious disease in developed countries, which is completely preventable, if water distribution systems are correctly planned and operated. This assumes clear criteria for risk regulation and for verification, including microbiological monitoring for Legionella. There are different reactive and proactive strategies in the USA and in Europe. The common premises for prevention and control of legionellosis in Germany, relevant facts for risk regulation, experience in Germany toward proactive risk regulation, and the current approach of the amended drinking water ordinance are discussed. The article concludes with a short discussion of the controversial approaches for the prevention of legionellosis in Germany.
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Teich N, Klugmann T, Tiedemann A, Holler B, Mössner J, Liebetrau A, Schiefke I. Vaccination coverage in immunosuppressed patients: results of a regional health services research study. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:105-11. [PMID: 21412507 DOI: 10.3238/arztebl.2011.0105] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 07/16/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with chronic inflammatory diseases are at elevated risk of infections that can be prevented by vaccination. This elevated risk is due not just to these patients' primary illnesses, but also to the immunosuppressive treatment that they often receive. We studied the vaccination rate in a random sample of patients with two types of inflammatory bowel disease (IBD), namely, Crohn's disease and ulcerative colitis. In particular, we asked unvaccinated patients why they had re-fused the vaccine. METHODS From April to September 2009, we gave a 38-item questionnaire to 203 consecutive patients with IBD (57% with Crohn's disease, 63% female, median age 36 years) who had not received vaccination counseling for at least one year, and inspected the patients' vaccination cards. We compared the findings to the current recommendations of the German Federal Standing Committee on Vaccination (Ständige Impfkommission). RESULTS 83% of the patients had a vaccination card. Substantial deficiencies in vaccination were found. Only 67% of the patients had been immunized against tetanus in the previous 10 years, and only 21% against pertussis. Only 28% were vaccinated against seasonal influenza in 2008, and only 9% had ever received anti-pneumococcal vaccine. A subgroup analysis in which we compared 39 patients taking TNF-blockers to 67 patients who never had any type of immunosuppressive treatment revealed no difference in vaccination rates. 80% of all patients said they were willing to receive all of the officially recommended vaccinations. 22% of all patients said they avoided vaccinations for fear of side effects, while 15% said they did so because their immune system was supposedly "not intact", and 9% because they feared vaccination would worsen their IBD. CONCLUSION In this random sample, the vaccination rate fell far behind the recommendations. In particular, there was a marked discrepancy between patients' willingness to be vaccinated and the actual provision of vaccination. These findings imply that physicians need to be more aware of the possibly inadequate vaccination state of their immunosuppressed patients.
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Simon A, Tutdibi E, von Müller L, Gortner L. Beatmungsassoziierte Pneumonie bei Kindern. Monatsschr Kinderheilkd 2011. [DOI: 10.1007/s00112-010-2303-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Daeschlein G, Fetouh Yassin AA, Franke A, Kramer A, Schaal KP. Unusual infections: Femoral abscess due to Nocardia abscessus in a patient suffering from metastatic peripheral bronchial carcinoma and hygienic consequences. GMS KRANKENHAUSHYGIENE INTERDISZIPLINAR 2011; 6:Doc03. [PMID: 22242084 PMCID: PMC3252651 DOI: 10.3205/dgkh000160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
During the course of a peripheral bronchial carcinoma with pulmonary and cerebral metastases a femoral abscess developed in a 49 year-old patient after radio- and chemotherapy. A bacterial strain, which was isolated four times from a deep wound of the left thigh was tentatively identified as a member of the genus Nocardia on the basis of selected phenotypic and chemotaxonomic characteristics. The isolate was confirmed to belong to Nocardia abscessus by 16S rRNA gene sequencing. This species had previously been described as the causative agent of soft tissue infections. Although rare, nocardia soft tissue infections as complication of systemic nocardiosis are typical air born infections of immuncompromised patients and need specific attention. Infection prevention can be realized by restriction of soil and aerosol (builder's dust) together with antibiotic intervention (oral administration of trimethoprim/sulfamethoxazole).
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Affiliation(s)
- Georg Daeschlein
- Department of Dermatology, University Medicine Greifswald, Greifswald, Germany
- *To whom correspondence should be addressed: Georg Daeschlein, Department of Dermatology, University Medicine Greifswald, Sauerbruchstrasse, 17475 Greifswald, Germany, Phone: 0049 (0)834/866770, Fax: 0049 (0)3834/866772, E-mail:
| | | | - Andreas Franke
- Specialist Hospital for Pulmonary Medicine and Chest Surgery (FLT) Berlin-Buch, Berlin, Germany
| | - Axel Kramer
- Institute for Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Klaus-Peter Schaal
- Institute for Medical Microbiology and Immunology of the University of Bonn, Bonn, Germany
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