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Gebel J, Rausch M, Bienentreu K, Droop F, Eggers M, Gebel L, Gemein S, Hornei B, Ilschner C, Jacobshagen A, Kampf G, Papan C, Roesch K, Schmitz L, Suchomel M, Vossebein L, Mutters NT, Exner M. Evaluation of a microscale quantitative suspension test to determine the bactericidal and yeasticidal activity of glutaral - one step to improve sustainability in disinfectant testing. GMS Hyg Infect Control 2024; 19:Doc03. [PMID: 38404411 PMCID: PMC10884837 DOI: 10.3205/dgkh000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Aims To evaluate a newly developed microscale quantitative suspension test compared to the existing standard suspension test using determination of the bactericidal and yeasticidal activity of glutaral as one step to improve the sustainability of disinfectant testing. Methods The testing principles of the quantitative suspension test according to VAH method 9 (comparable to EN 13727) was used as a standard suspension test using 8.0 mL product test solution, 1.0 mL organic load and 1.0 mL test suspension. In addition, a micro-scale suspension test was performed in 96-well plates with 160 µL product test solution, 20 µL organic load and 20 µL test suspension. S. aureus ATCC 6538, P. aeruginosa ATCC 15442 and C. albicans ATCC 10231 were test organisms. Glutaral was tested at concentrations of 0.05%, 0.1%, 0.2% and 0.3% with exposure times of 1, 5 and 15 min. Polysorbate 80 (30 g/L), lecithin (9 g/L), L-histidine (1 g/L) and glycine (10 g/L) were used as validated neutralizers. After serial dilution of the disinfectant-neutralizer-mixture, plates were incubated for 48 h at 36°C (bacteria) or 72 hours at 30°C (C. albicans) and colony forming units (cfu) counted. The lg reduction was calculated as the difference between the results of the water control and the disinfectant at the end of the exposure time. All experiments were done in triplicate under clean conditions. Means of lg reduction were compared with the unpaired t-test, p<0.05 was considered to be significant. Results Sufficient bactericidal activity according the VAH test requirements of at least 5 lg was found with both methods in 16 data sets of 24 data sets in total, and insufficient bactericidal activity of less than 5 lg was found with both methods in 7 data sets. In one data set, the mean lg reduction was above 5 lg with the microscale method and <5 lg with the VAH method, with no significant difference between the data sets (p=0.3096; 0.2% glutaral, 1 min, P. aeruginosa). A sufficient yeasticidal activity of at least 4 lg was found with both methods in one data set, an insufficient yeasticidal activity of less than 4 lg was found with both methods in 8 data sets. With one exception, no significant differences were detected between the two methods below the efficacy threshold. Conclusions The microscale quantitative suspension test proved to provide results similar to those of VAH method 9 when the bactericidal and yeasticidal activity of glutaralwas evaluated, with 32 out of 33 evaluations yielding consistent results in terms of efficacy. Its suitability should be confirmed with additional bacterial species, additional biocidal active substances and in other laboratories.
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Affiliation(s)
- Jürgen Gebel
- Institute for Hygiene and Public Health, University Clinics Bonn, Bonn, Germany
- VAH – Association for Applied Hygiene c/o Institute for Hygiene and Public Health, Bonn, Germany
| | - Marvin Rausch
- Institute for Hygiene and Public Health, University Clinics Bonn, Bonn, Germany
- VAH – Association for Applied Hygiene c/o Institute for Hygiene and Public Health, Bonn, Germany
| | - Katja Bienentreu
- Institute for Hygiene and Public Health, University Clinics Bonn, Bonn, Germany
- VAH – Association for Applied Hygiene c/o Institute for Hygiene and Public Health, Bonn, Germany
| | - Felix Droop
- Institute for Hygiene and Public Health, University Clinics Bonn, Bonn, Germany
| | - Maren Eggers
- VAH – Association for Applied Hygiene c/o Institute for Hygiene and Public Health, Bonn, Germany
- Laboratory Prof. Gisela Enders MVZ GbR, Stuttgart, Germany
| | - Lea Gebel
- Institute for Hygiene and Public Health, University Clinics Bonn, Bonn, Germany
| | | | - Britt Hornei
- VAH – Association for Applied Hygiene c/o Institute for Hygiene and Public Health, Bonn, Germany
- Evangelisches Krankenhaus Oberhausen, Zentralbereich Krankenhaushygiene, Institut für Laboratoriumsmedizin und Klinische Mikrobiologie, Oberhausen
| | - Carola Ilschner
- Institute for Hygiene and Public Health, University Clinics Bonn, Bonn, Germany
- VAH – Association for Applied Hygiene c/o Institute for Hygiene and Public Health, Bonn, Germany
| | - Anja Jacobshagen
- VAH – Association for Applied Hygiene c/o Institute for Hygiene and Public Health, Bonn, Germany
- Federal Institute of Drugs and Medical Devices (BfArM) – Medical Devices Division, Bonn, Germany
| | - Günter Kampf
- University Medicine Greifswald, Greifswald, Germany
| | - Cihan Papan
- Institute for Hygiene and Public Health, University Clinics Bonn, Bonn, Germany
| | - Kira Roesch
- Institute for Hygiene and Public Health, University Clinics Bonn, Bonn, Germany
- VAH – Association for Applied Hygiene c/o Institute for Hygiene and Public Health, Bonn, Germany
| | - Luisa Schmitz
- Institute for Hygiene and Public Health, University Clinics Bonn, Bonn, Germany
| | - Miranda Suchomel
- VAH – Association for Applied Hygiene c/o Institute for Hygiene and Public Health, Bonn, Germany
- Institute for Hygiene and Applied Immunology, Medical University Vienna, Medical-technical Hygiene, Vienna, Austria
| | - Lutz Vossebein
- VAH – Association for Applied Hygiene c/o Institute for Hygiene and Public Health, Bonn, Germany
- Hochschule Niederrhein – Fachbereich Textil- und Bekleidungstechnik, Mönchengladbach, Germany
| | - Nico T. Mutters
- Institute for Hygiene and Public Health, University Clinics Bonn, Bonn, Germany
| | - Martin Exner
- Institute for Hygiene and Public Health, University Clinics Bonn, Bonn, Germany
- VAH – Association for Applied Hygiene c/o Institute for Hygiene and Public Health, Bonn, Germany
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2
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Freier L, Zacharias N, Gemein S, Gebel J, Engelhart S, Exner M, Mutters NT. Environmental Contamination and Persistence of Clostridioides difficile in Hospital Wastewater Systems. Appl Environ Microbiol 2023; 89:e0001423. [PMID: 37071016 PMCID: PMC10231184 DOI: 10.1128/aem.00014-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/28/2023] [Indexed: 04/19/2023] Open
Abstract
Clostridioides difficile produces an environmentally resistant dormant spore morphotype that infected patients shed to the hospital environment. C. difficile spores persist in clinical reservoirs that are not targeted by hospital routine cleaning protocols. Transmissions and infections from these reservoirs present a hazard to patient safety. This study aimed to assess the impact of patients acutely suffering from C. difficile-associated diarrhea (CDAD) on C. difficile environmental contamination to identify potential reservoirs. Twenty-three hospital rooms accommodating CDAD inpatients with corresponding soiled workrooms of 14 different wards were studied in a German maximum-care hospital. Additionally, four rooms that never accommodated CDAD patients were examined as negative controls. Stagnant water and biofilms from sinks, toilets, and washer disinfector (WD) traps as well as swabs from cleaned bedpans and high-touch surfaces (HTSs) were sampled. For detection, a culture method was used with selective medium. A latex agglutination assay and a Tox A/B enzyme-linked immunosorbent assay were performed with suspect colonies. Stagnant water and biofilms in hospital traps (29%), WDs (34%), and HTSs (37%) were found to be reservoirs for large amounts of C. difficile during the stay of CDAD inpatients that decreased but could persist 13 ± 6 days after their discharge (13%, 14%, and 9.5%, respectively). Control rooms showed none or only slight contamination restricted to WDs. A short-term cleaning strategy was implemented that reduced C. difficile in stagnant water almost entirely. IMPORTANCE Wastewater pipes are microbial ecosystems. The potential risk of infection emanating from the wastewater for individuals is often neglected, since it is perceived to remain in the pipes. However, sewage systems start with siphons and are thus naturally connected to the outside world. Wastewater pathogens do not only flow unidirectionally to wastewater treatment plants but also retrogradely, e.g., through splashing water from siphons to the hospital environment. This study focused on the pathogen C. difficile, which can cause severe and sometimes fatal diarrheas. This study shows how patients suffering from such diarrheas contaminate the hospital environment with C. difficile and that contamination persists in siphon habitats after patient discharge. This might pose a health risk for hospitalized patients afterward. Since this pathogen's spore morphotype is very environmentally resistant and difficult to disinfect, we show a cleaning measure that can almost entirely eliminate C. difficile from siphons.
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Affiliation(s)
- Lia Freier
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Nicole Zacharias
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Stefanie Gemein
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
- Reference Institute for Bioanalytics, Bonn, Germany
| | - Jürgen Gebel
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Steffen Engelhart
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Martin Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Nico T. Mutters
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
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3
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Krämer I, Goelz R, Gille C, Härtel C, Müller R, Orlikowsky T, Piening B, Schubert S, Simon A, Wolf K, Rösner B, Exner M. Good handling practice of parenterally administered medicines in neonatal intensive care units - position paper of an interdisciplinary working group. GMS Hyg Infect Control 2023; 18:Doc10. [PMID: 37261055 PMCID: PMC10227494 DOI: 10.3205/dgkh000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This position paper, developed by an interdisciplinary expert group of neonatologists, paediatric infectious disease physicians, clinical pharmacists and specialists for the prevention and control of nosocomial infections, describes the "Good handling practice of medicines parenterally administered to patients on NICUs". It takes equal account of patient safety and the specialties of neonatal intensive care regarding feasibility and proportionality. The overall concept is perceived as a "learning system", in which open communication within the health-care team relating to medication errors and critical incidents enables continuous development and improvement to ensure patient safety. In our opinion, pharmacists, who are responsible for the supply of ready-to-administer parenteral medicinal products for neonatal intensive care patients, as well as the hygiene staff responsible on site are integral parts of the interdisciplinary treatment team. Risks of the current clinical practice of parenteral treatment of NICU patients are discussed in detail and recommendations for safety-relevant procedures are given.
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Affiliation(s)
- Irene Krämer
- Department of Pharmacy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Rangmar Goelz
- Department of Neonatology, Tübingen University Children's Hospital, Tübingen, Germany
| | - Christian Gille
- Clinic for Neonatology, University Hospital for Paediatrics and Adolescent Medicine Heidelberg, Heidelberg, Germany
| | - Christoph Härtel
- University Hospital Würzburg, Department of Pediatrics, Würzburg, Germany
| | - Rachel Müller
- Pharmacy of Saarland University Hospital, Homburg, Germany
| | - Thorsten Orlikowsky
- Section of Neonatology and Paediatric Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Brar Piening
- Institute for Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Schubert
- Department of Pharmacy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
- Special interest group for Paediatric Pharmacy, German Society of Hospital Pharmacists (ADKA e.V.), Germany
| | - Arne Simon
- Paediatric Oncology and Haematology, Children's Hospital, Saarland University Hospital, Homburg, Germany
- German Society for Paediatric Infectiology, Berlin, Germany
| | - Katharina Wolf
- University Pharmacy, Tübingen University Hospital, Tübingen, Germany
| | - Bianka Rösner
- Charité – Universitätsmedizin Berlin, Centre for Gynaecology, Paediatrics and Adolescent Medicine, Clinic for Neonatology, Specialist Paediatric Intensive Care Nurse, Berlin, Germany
| | - Martin Exner
- Prevention and Outbreak Management/One health at the Institute of Hygiene and Public Health, WHO CC University Hospital Bonn for the Board of the German Society for Hospital Hygiene (DGKH), Bonn, Germany
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4
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Knobloch JK, Popp W, Exner M, Walger P, Kampf G. An FFP2 respirator mandate for healthcare workers to prevent transmission of SARS-CoV-2 lacks proportionality. J Hosp Infect 2022; 130:146-147. [PMID: 36150562 PMCID: PMC9487173 DOI: 10.1016/j.jhin.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022]
Affiliation(s)
- J K Knobloch
- Institute for Medical Microbiology, Virology and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - W Popp
- HyKoMed GmbH, Dortmund, Germany
| | - M Exner
- German Society of Hospital Hygiene, Berlin, Germany
| | - P Walger
- German Society of Hospital Hygiene, Berlin, Germany
| | - G Kampf
- University Medicine Greifswald, Greifswald, Germany.
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5
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Schuster D, Axtmann K, Holstein N, Felder C, Voigt A, Färber H, Ciorba P, Szekat C, Schallenberg A, Böckmann M, Zarfl C, Neidhöfer C, Smalla K, Exner M, Bierbaum G. Antibiotic concentrations in raw hospital wastewater surpass minimal selective and minimum inhibitory concentrations of resistant Acinetobacter baylyi strains. Environ Microbiol 2022; 24:5721-5733. [PMID: 36094736 DOI: 10.1111/1462-2920.16206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/10/2022] [Indexed: 01/12/2023]
Abstract
Antibiotics are essential for modern medicine, they are employed frequently in hospitals and, therefore, present in hospital wastewater. Even in concentrations, that are lower than the minimum inhibitory concentrations (MICs) of susceptible bacteria, antibiotics may exert an influence and select resistant bacteria, if they exceed the MSCs (minimal selective concentrations) of resistant strains. Here, we compare the MSCs of fluorescently labelled Acinetobacter baylyi strains harboring spontaneous resistance mutations or a resistance plasmid with antibiotic concentrations determined in hospital wastewater. Low MSCs in the μg/L range were measured for the quinolone ciprofloxacin (17 μg/L) and for the carbapenem meropenem (30 μg/L). A 24 h continuous analysis of hospital wastewater showed daily fluctuations of the concentrations of these antibiotics with distinctive peaks at 7-8 p.m. and 5-6 a.m. The meropenem concentrations were always above the MSC and MIC values of A. baylyi. In addition, the ciprofloxacin concentrations were in the range of the lowest MSC for about half the time. These results explain the abundance of strains with meropenem and ciprofloxacin resistance in hospital wastewater and drains.
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Affiliation(s)
- Dominik Schuster
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Katharina Axtmann
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Niklas Holstein
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Carsten Felder
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Alex Voigt
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Harald Färber
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Patrick Ciorba
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Christiane Szekat
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Anna Schallenberg
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Matthias Böckmann
- Environmental Systems Analysis, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Christiane Zarfl
- Environmental Systems Analysis, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Claudio Neidhöfer
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Kornelia Smalla
- Julius Kühn-Institut, Federal Research Centre for Cultivated Plants, Institute for Epidemiology and Pathogen Diagnostics, Braunschweig, Germany
| | - Martin Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Gabriele Bierbaum
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
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6
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Eggers M, Exner M, Gebel J, Ilschner C, Rabenau HF, Schwebke I. Hygiene and disinfection measures for monkeypox virus infections. GMS Hyg Infect Control 2022; 17:Doc18. [PMID: 36531784 PMCID: PMC9727782 DOI: 10.3205/dgkh000421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In Germany, recommendations on infection prevention and control of current virus outbreaks are given as communications by the Association for Applied Hygiene e.V. (VAH) together with the joint Disinfectant Commission of the German Association for the Control of Virus Diseases e.V. (DVV) and the Society of Virology* (GfV). The DVV was founded in 1954 in response to the ongoing threat to the population from polio and was given its current name in 1977. The DVV is supported by the Federal Ministry of Health, the Ministries of Health of the Federal States, scientific societies, as well as social foundations and organisations. Private individuals cannot be members of the DVV. The Society of Virology e.V. (GfV) is a scientific society for all virological fields in Germany, Austria and Switzerland, and is thus the largest virological society in Europe. With numerous commissions, guidelines and statements, it is the authoritative contact for research, healthcare and politics. The joint commission "Virus Disinfection" of these scientific societies focuses on the efficacy of chemical disinfection procedures against viruses. The VAH bundles the expertise of scientific societies and experts on infection prevention and is particularly committed to the quality assurance of hygiene measures. With the VAH disinfectant list, the association provides the standard reference for the selection of high-quality disinfection procedures. This disinfectant list has a tradition of more than 60 years in Germany. The original German version of this document was published in August 2022 and has now been made available to the international professional public in English. The document contains recommendations on hygiene and disinfection measures for monkeypox virus infections. Disinfectants against monkeypox must have at least proven efficacy against enveloped viruses (active against enveloped viruses); products with the efficacy ranges "limited virucidal activity" and "virucidal" can also be used. The disinfectant list of the VAH or the disinfectant list of the Robert Koch Institute are available for the selection of products. Especially in the case of contamination with crust or scab material, it should be noted that protein contamination can have a protective or stabilising effect on monkeypox. Therefore, cleaning - before disinfection - should always be carried out in this situation. Preventive measures such as vaccination and hygiene in the vicinity of people with monkeypox must be taken to prevent transmission to small children, pregnant women or people with a pronounced immune deficiency.
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Affiliation(s)
- Maren Eggers
- Association for Applied Hygiene e.V. (VAH), Bonn, Germany,Society of Virology (GfV), Heidelberg, Germany,Disinfectant Commission of the German Association for the Control of Virus Diseases e.V. (DVV), Kiel, Germany,Labor Prof. Gisela Enders MVZ GbR, Stuttgart, Germany,*To whom correspondence should be addressed: Maren Eggers, Labor Prof. Gisela Enders MVZ GbR, Head of VirologyRosenbergstr. 85, 70193, Stuttgart, Germany, E-mail:
| | - Martin Exner
- Association for Applied Hygiene e.V. (VAH), Bonn, Germany,German Society of Hospital Hygiene (DGKH), Berlin, Germany,University Hospital Bonn, Bonn, Germany
| | - Jürgen Gebel
- Association for Applied Hygiene e.V. (VAH), Bonn, Germany,University Hospital Bonn, Bonn, Germany
| | - Carola Ilschner
- Association for Applied Hygiene e.V. (VAH), Bonn, Germany,University Hospital Bonn, Bonn, Germany
| | - Holger F. Rabenau
- Society of Virology (GfV), Heidelberg, Germany,Disinfectant Commission of the German Association for the Control of Virus Diseases e.V. (DVV), Kiel, Germany,University Hospital Frankfurt, Germany
| | - Ingeborg Schwebke
- Society of Virology (GfV), Heidelberg, Germany,Disinfectant Commission of the German Association for the Control of Virus Diseases e.V. (DVV), Kiel, Germany
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7
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Hurraß J, Golmohammadi R, Bujok S, Bork M, Thelen F, Wagner P, Exner D, Schönfeld C, Hornei B, Kampf G, Exner M. Explosive COVID-19 outbreak in a German nursing home and the possible role of the air ventilation system. J Hosp Infect 2022; 130:34-43. [PMID: 36179793 PMCID: PMC9513403 DOI: 10.1016/j.jhin.2022.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022]
Abstract
Background Most COVID-19 outbreaks in nursing homes are explained by transmission of SARS-CoV-2 from nurses or visitors. Methods and results We describe an outbreak with 64 of the 67 residents identified as COVID-19 cases within two weeks (34 in nursing block 1, 30 in nursing block 2), at least 32 of them had relevant symptoms of COVID-19. Thirteen of the residents’ deaths were associated with COVID-19. In addition, 27 of approximately 60 staff members were identified as COVID-19 cases, 23 of them had relevant symptoms. In none of the samples from residents or staff was a mutation of SARS-CoV-2 detected. Quarantine of the residents was already in force at the beginning of the outbreak. A common source among the staff was considered to be unlikely because the two nursing home blocks had no staff rotation and the staff had to wear FFP2 masks during contact with residents. Three months after the outbreak the RNA of SARS-CoV-2 was detected on 14 of 39 sampled indoor surfaces of the air ventilation system with Ct values between 34.9 and 41.9, but only at the air supply in the corridor (11 of 24 samples) and the air overflow in the door between the corridor and the residents’ rooms (three of 11 samples) but not at the air exhaust in the residents’ bathrooms. Conclusions The air ventilation system and an inversion weather situation three days before the first confirmed case may have enhanced viral spread inside the nursing home assuming that a common source with a high viral load had existed at the time of outbreak.
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Affiliation(s)
- Julia Hurraß
- Public Health Department Cologne, Department of Infection Control and Environmental Hygiene, Neumarkt 15-21, 50667 Köln, Germany.
| | - Roshanak Golmohammadi
- Public Health Department Cologne, Department of Infection Control and Environmental Hygiene, Neumarkt 15-21, 50667 Köln, Germany
| | - Steffen Bujok
- Public Health Department Cologne, Department of Infection Control and Environmental Hygiene, Neumarkt 15-21, 50667 Köln, Germany
| | - Manfred Bork
- Public Health Department Cologne, Department of Infection Control and Environmental Hygiene, Neumarkt 15-21, 50667 Köln, Germany
| | - Finn Thelen
- Public Health Department Cologne, Department of Infection Control and Environmental Hygiene, Neumarkt 15-21, 50667 Köln, Germany
| | - Pia Wagner
- Public Health Department Cologne, Department of Infection Control and Environmental Hygiene, Neumarkt 15-21, 50667 Köln, Germany
| | - Daniel Exner
- General, Visceral-, Thoracic and Vascular Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Christine Schönfeld
- EKO, Institute for Laboratory Medicine and Clinical Microbiology, Virchowstr. 20, 46047 Oberhausen, Germany
| | - Britt Hornei
- EKO, Institute for Laboratory Medicine and Clinical Microbiology, Virchowstr. 20, 46047 Oberhausen, Germany
| | - Günter Kampf
- University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| | - Martin Exner
- Institute for Hygiene and Public Health, University Bonn, Venusberg Campus 1, 53127 Bonn, Germany
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8
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Kramer A, Eggers M, Exner M, Hübner NO, Simon A, Steinmann E, Walger P, Zwicker P. Recommendation of the German Society of Hospital Hygiene (DGKH): Prevention of COVID-19 by virucidal gargling and virucidal nasal spray - updated version April 2022. GMS Hyg Infect Control 2022; 17:Doc13. [PMID: 35909651 PMCID: PMC9285112 DOI: 10.3205/dgkh000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The German Society of Hospital Hygiene develops guidelines, recommendations and standard operation procedures on a voluntary basis, published on the DGKH-website (https://www.krankenhaushygiene.de/). The original German version of this recommendation was published in April 2022 and has now been made available to the international professional public in English. Evaluating the current data on the efficacy of virucidal gargle/mouthwash solutions and nasal sprays against SARS-CoV-2 in vitro and in clinical trials, conducted with preventive or therapeutic objectives, recommendations are given for the prevention of COVID-19. The following areas are considered: Protection of the community when regional clusters or high incidences of infection become knownProtection of the community at low risk of infectionPre-exposure prophylaxis for the protection of healthcare workersPost-exposure prophylaxis.
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Affiliation(s)
- Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany,German Society of Hospital Hygiene, Berlin, Germany,*To whom correspondence should be addressed: Axel Kramer, , E-mail:
| | - Maren Eggers
- Labor Prof. Gisela Enders MVZ GbR, Stuttgart, Germany
| | - Martin Exner
- German Society of Hospital Hygiene, Berlin, Germany,Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Nils-Olaf Hübner
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany,German Society of Hospital Hygiene, Berlin, Germany,Central Unit for Infection Prevention and Control, University Medicine Greifswald, Greifswald, Germany
| | - Arne Simon
- Pediatric Oncology and Hematology, Children’s Hospital Medical Center, Saarland University Hospital, Homburg/Saar, Germany
| | - Eike Steinmann
- Institute of Hygiene and Microbiology, Department for Molecular & Medical Virology, Ruhr-University Bochum, Bochum, Germany
| | - Peter Walger
- German Society of Hospital Hygiene, Berlin, Germany,Bonn, Germany
| | - Paula Zwicker
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany,Section Clinical Antisepsis of the German Society of Hospital Hygiene, Berlin, Germany
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9
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Kramer A, Arvand M, Christiansen B, Dancer S, Eggers M, Exner M, Müller D, Mutters NT, Schwebke I, Pittet D. Ethanol is indispensable for virucidal hand antisepsis: memorandum from the alcohol-based hand rub (ABHR) Task Force, WHO Collaborating Centre on Patient Safety, and the Commission for Hospital Hygiene and Infection Prevention (KRINKO), Robert Koch Institute, Berlin, Germany. Antimicrob Resist Infect Control 2022; 11:93. [PMID: 35794648 PMCID: PMC9257567 DOI: 10.1186/s13756-022-01134-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The approval of ethanol by the Biocidal Products Regulation has been under evaluation since 2007. This follows concern over alcohol uptake from ethanol-based hand rubs (EBHR). If ethanol is classified as carcinogenic, mutagenic, or reprotoxic by the European Chemicals Agency (ECHA), then this would affect infection prevention and control practices. AIM A review was performed to prove that ethanol is toxicological uncritical and indispensable for hand antisepsis because of its unique activity against non-enveloped viruses and thus the resulting lack of alternatives. Therefore, the following main points are analyzed: The effectiveness of ethanol in hand hygiene, the evidence of ethanol at blood/tissue levels through hand hygiene in healthcare, and the evidence of toxicity of different blood/tissue ethanol levels and the non-comparability with alcoholic consumption and industrial exposure. RESULTS EBHR are essential for preventing infections caused by non-enveloped viruses, especially in healthcare, nursing homes, food industry and other areas. Propanols are effective against enveloped viruses as opposed to non-enveloped viruses but there are no other alternatives for virucidal hand antisepsis. Long-term ingestion of ethanol in the form of alcoholic beverages can cause tumours. However, lifetime exposure to ethanol from occupational exposure < 500 ppm does not significantly contribute to the cancer risk. Mutagenic effects were observed only at doses within the toxic range in animal studies. While reprotoxicity is linked with abuse of alcoholic beverages, there is no epidemiological evidence for this from EBHR use in healthcare facilities or from products containing ethanol in non-healthcare settings. CONCLUSION The body of evidence shows EBHRs have strong efficacy in killing non-enveloped viruses, whereas 1-propanol and 2-propanol do not kill non-enveloped viruses, that pose significant risk of infection. Ethanol absorbed through the skin during hand hygiene is similar to consumption of beverages with hidden ethanol content (< 0.5% v/v), such as apple juice or kefir. There is no risk of carcinogenicity, mutagenicity or reprotoxicity from repeated use of EBHR. Hence, the WHO Task Force strongly recommend retaining ethanol as an essential constituent in hand rubs for healthcare.
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Affiliation(s)
- Axel Kramer
- German Commission for Hospital Hygiene and Infection Prevention at the Robert-Koch Institute, Berlin, Germany. .,WHO Task Force Alcohol-Based Hand Rub, Zürich, Switzerland. .,Institute of Hygiene and Environmental Medicine University Medicine Greifswald, Walther-Rathenau-Straße 38, 17475, Greifswald, Germany.
| | - Mardjan Arvand
- Division Hospital Hygiene, Infection Prevention and Control, Robert-Koch Institute, Berlin, Germany
| | - Bärbel Christiansen
- German Commission for Hospital Hygiene and Infection Prevention at the Robert-Koch Institute, Berlin, Germany.,Department of Hospital Hygiene, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Stephanie Dancer
- Department of Microbiology, University Hospital Hairmyres, Glasgow, UK.,School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Maren Eggers
- Labor Prof. Dr. G. Enders MVZ GbR, Stuttgart, Germany
| | - Martin Exner
- German Commission for Hospital Hygiene and Infection Prevention at the Robert-Koch Institute, Berlin, Germany.,Institute of Hygiene and Public Health, University Hospital, Bonn, Germany
| | - Dieter Müller
- Department of Occupational Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Nico T Mutters
- German Commission for Hospital Hygiene and Infection Prevention at the Robert-Koch Institute, Berlin, Germany.,Institute of Hygiene and Public Health, University Hospital, Bonn, Germany
| | - Ingeborg Schwebke
- German Association for the Control of Virus Diseases (DVV e. V.), Berlin, Germany
| | - Didier Pittet
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva, Hospitals and Faculty of Medicine, Geneva, Switzerland
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10
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Döhla M, Schulte B, Wilbring G, Kümmerer BM, Döhla C, Sib E, Richter E, Ottensmeyer PF, Haag A, Engelhart S, Eis-Hübinger AM, Exner M, Mutters NT, Schmithausen RM, Streeck H. SARS-CoV-2 in Environmental Samples of Quarantined Households. Viruses 2022; 14:1075. [PMID: 35632816 PMCID: PMC9147922 DOI: 10.3390/v14051075] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 02/01/2023] Open
Abstract
The role of environmental transmission of SARS-CoV-2 remains unclear. Thus, the aim of this study was to investigate whether viral contamination of air, wastewater, and surfaces in quarantined households result in a higher risk for exposed persons. For this study, a source population of 21 households under quarantine conditions with at least one person who tested positive for SARS-CoV-2 RNA were randomly selected from a community in North Rhine-Westphalia in March 2020. All individuals living in these households participated in this study and provided throat swabs for analysis. Air and wastewater samples and surface swabs were obtained from each household and analysed using qRT-PCR. Positive swabs were further cultured to analyse for viral infectivity. Out of all the 43 tested adults, 26 (60.47%) tested positive using qRT-PCR. All 15 air samples were qRT-PCR-negative. In total, 10 out of 66 wastewater samples were positive for SARS-CoV-2 (15.15%) and 4 out of 119 surface samples (3.36%). No statistically significant correlation between qRT-PCR-positive environmental samples and the extent of the spread of infection between household members was observed. No infectious virus could be propagated under cell culture conditions. Taken together, our study demonstrates a low likelihood of transmission via surfaces. However, to definitively assess the importance of hygienic behavioural measures in the reduction of SARS-CoV-2 transmission, larger studies should be designed to determine the proportionate contribution of smear vs. droplet transmission.
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Affiliation(s)
- Manuel Döhla
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
- Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, Rübenacher Straße 170, 56072 Koblenz, Germany
| | - Bianca Schulte
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (B.S.); (B.M.K.); (E.R.); (P.F.O.); (A.M.E.-H.)
| | - Gero Wilbring
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
| | - Beate Mareike Kümmerer
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (B.S.); (B.M.K.); (E.R.); (P.F.O.); (A.M.E.-H.)
| | - Christin Döhla
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
| | - Esther Sib
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
| | - Enrico Richter
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (B.S.); (B.M.K.); (E.R.); (P.F.O.); (A.M.E.-H.)
| | - Patrick Frank Ottensmeyer
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (B.S.); (B.M.K.); (E.R.); (P.F.O.); (A.M.E.-H.)
| | - Alexandra Haag
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
| | - Steffen Engelhart
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
| | - Anna Maria Eis-Hübinger
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (B.S.); (B.M.K.); (E.R.); (P.F.O.); (A.M.E.-H.)
| | - Martin Exner
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
| | - Nico Tom Mutters
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
| | - Ricarda Maria Schmithausen
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
| | - Hendrik Streeck
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (B.S.); (B.M.K.); (E.R.); (P.F.O.); (A.M.E.-H.)
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11
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Döhla M, Schulte B, Wilbring G, Kümmerer BM, Döhla C, Sib E, Richter E, Ottensmeyer PF, Haag A, Engelhart S, Eis-Hübinger AM, Exner M, Mutters NT, Schmithausen RM, Streeck H. SARS-CoV-2 in Environmental Samples of Quarantined Households. Viruses 2022. [PMID: 35632816 DOI: 10.1101/2020.05.28.20114041] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
The role of environmental transmission of SARS-CoV-2 remains unclear. Thus, the aim of this study was to investigate whether viral contamination of air, wastewater, and surfaces in quarantined households result in a higher risk for exposed persons. For this study, a source population of 21 households under quarantine conditions with at least one person who tested positive for SARS-CoV-2 RNA were randomly selected from a community in North Rhine-Westphalia in March 2020. All individuals living in these households participated in this study and provided throat swabs for analysis. Air and wastewater samples and surface swabs were obtained from each household and analysed using qRT-PCR. Positive swabs were further cultured to analyse for viral infectivity. Out of all the 43 tested adults, 26 (60.47%) tested positive using qRT-PCR. All 15 air samples were qRT-PCR-negative. In total, 10 out of 66 wastewater samples were positive for SARS-CoV-2 (15.15%) and 4 out of 119 surface samples (3.36%). No statistically significant correlation between qRT-PCR-positive environmental samples and the extent of the spread of infection between household members was observed. No infectious virus could be propagated under cell culture conditions. Taken together, our study demonstrates a low likelihood of transmission via surfaces. However, to definitively assess the importance of hygienic behavioural measures in the reduction of SARS-CoV-2 transmission, larger studies should be designed to determine the proportionate contribution of smear vs. droplet transmission.
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Affiliation(s)
- Manuel Döhla
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, Rübenacher Straße 170, 56072 Koblenz, Germany
| | - Bianca Schulte
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Gero Wilbring
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Beate Mareike Kümmerer
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Christin Döhla
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Esther Sib
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Enrico Richter
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | | | - Alexandra Haag
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Steffen Engelhart
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Anna Maria Eis-Hübinger
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Martin Exner
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Nico Tom Mutters
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ricarda Maria Schmithausen
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Hendrik Streeck
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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12
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Wessendorf L, Richter E, Schulte B, Schmithausen RM, Exner M, Lehmann N, Coenen M, Fuhrmann C, Kellings A, Hüsing A, Jöckel KH, Streeck H. Dynamics, outcomes and prerequisites of the first SARS-CoV-2 superspreading event in Germany in February 2020: a cross-sectional epidemiological study. BMJ Open 2022; 12:e059809. [PMID: 35387836 PMCID: PMC8987213 DOI: 10.1136/bmjopen-2021-059809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The first German SARS-CoV-2 outbreak was a superspreading event in Gangelt, North Rhine-Westphalia, during indoor carnival festivities called 'Kappensitzung' (15 February 2020). We determined SARS-CoV-2 RT-PCR positivity rate, SARS-CoV-2-specific antibodies, and analysed the conditions and dynamics of superspreading, including ventilation, setting dimensions, distance from infected persons and behavioural patterns. DESIGN In a cross-sectional epidemiological study (51 days postevent), participants were asked to give blood, pharyngeal swabs and complete self-administered questionnaires. SETTING The SARS-CoV-2 superspreading event took place during festivities in the small community of Gangelt in February 2020. This 5-hour event included 450 people (6-79 years of age) in a building of 27 m × 13.20 m × 4.20 m. PARTICIPANTS Out of 450 event participants, 411 volunteered to participate in this study. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome: infection status (determined by IgG ELISA). SECONDARY OUTCOME symptoms (determined by questionnaire). RESULTS Overall, 46% (n=186/404) of participants had been infected, and their spatial distribution was associated with proximity to the ventilation system (OR 1.39, 95% CI 0.86 to 2.25). Risk of infection was highly associated with age: children (OR 0.33, 95% CI 0.267 to 0.414) and young adults (age 18-25 years) had a lower risk of infection than older participants (average risk increase of 28% per 10 years). Behavioural differences were also risk associated including time spent outside (OR 0.55, (95% CI 0.33 to 0.91) or smoking (OR 0.32, 95% CI 0.124 to 0.81). CONCLUSIONS Our findings underline the importance of proper indoor ventilation for future events. Lower susceptibility of children/young adults indicates their limited involvement in superspreading.
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Affiliation(s)
| | - Enrico Richter
- Institute of Virology, University Hospital Bonn, Bonn, Germany
| | - Bianca Schulte
- Institute of Virology, University Hospital Bonn, Bonn, Germany
| | | | - Martin Exner
- Department of Hygiene, University Hospital Bonn, Bonn, Germany
| | - Nils Lehmann
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Duisburg, Germany
| | - Martin Coenen
- Clinical Study Core Unit, Study Center Bonn (SZB), Rheinische Friedrich Wilhelms Universitat Bonn, Bonn, Germany
| | - Christine Fuhrmann
- Clinical Study Core Unit, Study Center Bonn (SZB), Rheinische Friedrich Wilhelms Universitat Bonn, Bonn, Germany
| | - Angelika Kellings
- Clinical Study Core Unit, Study Center Bonn (SZB), Rheinische Friedrich Wilhelms Universitat Bonn, Bonn, Germany
| | - Anika Hüsing
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Duisburg, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Duisburg, Germany
| | - Hendrik Streeck
- Institute of Virology, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research, Braunschweig, Niedersachsen, Germany
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13
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Kehl K, Schallenberg A, Szekat C, Albert C, Sib E, Exner M, Zacharias N, Schreiber C, Parčina M, Bierbaum G. Dissemination of carbapenem resistant bacteria from hospital wastewater into the environment. Sci Total Environ 2022; 806:151339. [PMID: 34740643 DOI: 10.1016/j.scitotenv.2021.151339] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
Infections with antibiotic resistant pathogens threaten lives and cause substantial costs. For effective interventions, knowledge of the transmission paths of resistant bacteria to humans is essential. In this study, carbapenem resistant bacteria were isolated from the wastewater of a maximum care hospital during a period of two years, starting in the patient rooms and following the sewer system to the effluent of the wastewater treatment plant (WWTP). The bacteria belonged to six different species and 44 different sequence types (STs). The most frequent STs, ST147 K. pneumoniae (blaNDM/blaOXA-48) and ST235 P. aeruginosa (blaVIM) strains, were present at nearly all sampling sites from the hospital to the WWTP effluent. After core genome multi-locus sequence typing (cgMLST), all ST147 K. pneumoniae strains presented a single epidemiological cluster. In contrast, ST235 P. aeruginosa formed five cgMLST clusters and the largest cluster contained the strain from the WWTP effluent, indicating without doubt, a direct dissemination of both high-risk clones into the environment. Thus, there are - at least two - possible transmission pathways to humans, (i) within the hospital by contact with the drains of the sanitary installations and (ii) by recreational or irrigation use of surface waters that have received WWTP effluent. In conclusion, remediation measures must be installed at both ends of the wastewater system, targeting the drains of the hospital as well as at the effluent of the WWTP.
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Affiliation(s)
- Katja Kehl
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Germany
| | - Anja Schallenberg
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Germany
| | - Christiane Szekat
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Germany
| | - Cathrin Albert
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Germany
| | - Esther Sib
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Germany
| | - Martin Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Nicole Zacharias
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Christiane Schreiber
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Marjio Parčina
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Germany
| | - Gabriele Bierbaum
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Germany.
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14
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Gemein S, Andrich R, Christiansen B, Decius M, Exner M, Hunsinger B, Imenova E, Kampf G, Koburger-Janssen T, Konrat K, Martiny H, Meckel M, Mutters NT, Pitten FA, Schulz S, Schwebke I, Gebel J. Efficacy of five “sporicidal” surface disinfectants against Clostridioides difficile spores in suspension tests and 4-field tests. J Hosp Infect 2022; 122:140-147. [DOI: 10.1016/j.jhin.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/03/2022] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
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15
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Ludwig KU, Schmithausen RM, Li D, Jacobs ML, Hollstein R, Blumenstock K, Liebing J, Słabicki M, Ben-Shmuel A, Israeli O, Weiss S, Ebert TS, Paran N, Rüdiger W, Wilbring G, Feldman D, Lippke B, Ishorst N, Hochfeld LM, Beins EC, Kaltheuner IH, Schmitz M, Wöhler A, Döhla M, Sib E, Jentzsch M, Borrajo JD, Strecker J, Reinhardt J, Cleary B, Geyer M, Hölzel M, Macrae R, Nöthen MM, Hoffmann P, Exner M, Regev A, Zhang F, Schmid-Burgk JL. LAMP-Seq enables sensitive, multiplexed COVID-19 diagnostics using molecular barcoding. Nat Biotechnol 2021; 39:1556-1562. [PMID: 34188222 PMCID: PMC8678193 DOI: 10.1038/s41587-021-00966-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/26/2021] [Indexed: 02/06/2023]
Abstract
Frequent testing of large population groups combined with contact tracing and isolation measures will be crucial for containing Coronavirus Disease 2019 outbreaks. Here we present LAMP-Seq, a modified, highly scalable reverse transcription loop-mediated isothermal amplification (RT-LAMP) method. Unpurified biosamples are barcoded and amplified in a single heat step, and pooled products are analyzed en masse by sequencing. Using commercial reagents, LAMP-Seq has a limit of detection of ~2.2 molecules per µl at 95% confidence and near-perfect specificity for severe acute respiratory syndrome coronavirus 2 given its sequence readout. Clinical validation of an open-source protocol with 676 swab samples, 98 of which were deemed positive by standard RT-qPCR, demonstrated 100% sensitivity in individuals with cycle threshold values of up to 33 and a specificity of 99.7%, at a very low material cost. With a time-to-result of fewer than 24 h, low cost and little new infrastructure requirement, LAMP-Seq can be readily deployed for frequent testing as part of an integrated public health surveillance program.
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Affiliation(s)
- Kerstin U. Ludwig
- Institute of Human Genetics, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Ricarda M. Schmithausen
- Institute of Hygiene and Public Health, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - David Li
- Broad Institute of MIT and Harvard, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Max L. Jacobs
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany,Center for Molecular Biology of Heidelberg University (ZMBH), Heidelberg, Germany
| | - Ronja Hollstein
- Institute of Human Genetics, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Katja Blumenstock
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Jana Liebing
- Institute of Experimental Oncology, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Mikołaj Słabicki
- Broad Institute of MIT and Harvard, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Division of Translational Medical Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Amir Ben-Shmuel
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Ofir Israeli
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Shay Weiss
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Thomas S. Ebert
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Nir Paran
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Wibke Rüdiger
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Gero Wilbring
- Institute of Hygiene and Public Health, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - David Feldman
- Department of Biochemistry and Institute for Protein Design, University of Washington, Seattle, WA 98195, USA
| | - Bärbel Lippke
- Institute of Human Genetics, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Nina Ishorst
- Institute of Human Genetics, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany.,Institute of Anatomy, Division of Neuroanatomy, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Lara M. Hochfeld
- Institute of Human Genetics, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Eva C. Beins
- Institute of Human Genetics, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Ines H. Kaltheuner
- Institute of Structural Biology, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Maximilian Schmitz
- Institute of Structural Biology, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Aliona Wöhler
- Department of General, Visceral and Thoracic Surgery, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
| | - Manuel Döhla
- Institute of Hygiene and Public Health, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany.,Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
| | - Esther Sib
- Institute of Hygiene and Public Health, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Marius Jentzsch
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Jacob D. Borrajo
- Broad Institute of MIT and Harvard, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jonathan Strecker
- Broad Institute of MIT and Harvard, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Julia Reinhardt
- Institute of Experimental Oncology, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Brian Cleary
- Broad Institute of MIT and Harvard, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Matthias Geyer
- Institute of Structural Biology, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Rhiannon Macrae
- Broad Institute of MIT and Harvard, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Markus M. Nöthen
- Institute of Human Genetics, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany.,Genomics Research Group, Department of Biomedicine, University of Basel, Switzerland
| | - Martin Exner
- Institute of Hygiene and Public Health, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany
| | - Aviv Regev
- Broad Institute of MIT and Harvard, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Klarman Cell Observatory, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Howard Hughes Medical Institute, Cambridge, MA 02139, USA.,Current address: Genentech, 1 DNA Way, South San Francisco, CA, USA
| | - Feng Zhang
- Broad Institute of MIT and Harvard, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Howard Hughes Medical Institute, Cambridge, MA 02139, USA
| | - Jonathan L. Schmid-Burgk
- Broad Institute of MIT and Harvard, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn and University Hospital Bonn, 53127 Bonn, Germany,Correspondence to:
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16
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Exner M, Christiansen B, Cocconi R, Friedrich A, Hartemann P, Heeg P, Heudorf U, llschner C, Kramer A, Merkens W, Oltmanns P, Pitten F, Sonntag HG, Steinhauer K, Tsakris A, Valinteliene R, Voynova-Georgieva V. A European approach to infection prevention and control goals. GMS Hyg Infect Control 2021; 16:Doc29. [PMID: 34956821 PMCID: PMC8662745 DOI: 10.3205/dgkh000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The current pandemic caused by COVID-19 has underlined the importance of a joint effort and approach to ensure patient and health care worker safety in medical care throughout Europe. In addition, the recent flood disasters in Germany and other countries called for immediate joint action, in this case with regard to the prevention of water-borne infections. Environmental disasters will increase with consequences for hospitals and nursing homes. Cooperative efforts are needed for preventing and controlling associated infection outbreaks, new pathogens will appear and a geographic shift of infectious diseases previously not detected in certain areas has already been observed. This approach to infection prevention and control must entail structural as well as regulatory aspects. The principle of equal protection against infections in all European countries must be implemented. Prevention and control of infections, including nosocomial infections, infections caused by antibiotic-resistant bacteria as well as pandemics, need to be based on equal standards in all of Europe. Protection against infections and other public health risks in all European countries is the best guarantor for building trust and identification of citizens in our common Europe. Experts in the fields of hygiene, microbiology, infectiology and epidemiology have to pool the expertise on the prevention and control of infections from different European countries and define key targets for achieving a high standard of hygiene measures throughout Europe. The participants of the Rudolf Schülke Foundation International Symposium call for immediate action and priority to be given to the realization of the proposed 16-point plan.
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Affiliation(s)
- Martin Exner
- Institute of Hygiene and Public Health, Bonn University Hospital, Bonn, Germany,*To whom correspondence should be addressed: Martin Exner, Universitätsklinikum Bonn, Präventions- und Ausbruchsmanagement/One Health, Venusberg-Campus 1, Gebäude 63, 53127 Bonn, Germany, E-mail:
| | - Bärbel Christiansen
- Department of Internal Hygiene, Schleswig-Holstein University Hospital, Kiel, Germany
| | - Roberto Cocconi
- Azienda Sanitaria, Universitaria Integrata di Undine, Udine, Italy
| | | | - Philippe Hartemann
- Departement Environnement et Santé Publique S.E.R.E.S., Faculté de Médecine, Nancy, France
| | - Peter Heeg
- Senior Consultant in Hygiene and Infection Control, Ammerbuch, Germany
| | - Ursel Heudorf
- Public Health Department, City of Frankfurt, Frankfurt, Germany
| | - CaroIa llschner
- Institute of Hygiene and Public Health, Bonn University Hospital, Bonn, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | | | - Frank Pitten
- IKI - Institut für Krankenhaushygiene & Infektionskontrolle GmbH, Gießen, Germany
| | - Hans-Günther Sonntag
- Institute of Hygiene and Medical Microbiology, University of Heidelberg, Heidelberg, Germany
| | | | - Athanassios Tsakris
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Rolanda Valinteliene
- Visuomenes sveikatos technologiju centro vadove, Higienos institutas, Vilnius, Lithuania
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17
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Döhla M, Döhla C, Exner M. Future challenges in hospital hygiene and public health due to air-associated health hazards. Eur J Public Health 2021. [PMCID: PMC8574869 DOI: 10.1093/eurpub/ckab165.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Issue In recent decades, hospital hygiene has focused on effective control strategies against contact or waterborne transmissions. Outside operating theatres or infection wards, airborne pathogens have played a minor role so far. For public health, the airborne route of transmission also played a subordinate role. Apart from bioterrorism, the focus here is more on chemical and physical hazards. In future, air-associated health hazards will increase. Besides airborne pathogens, examples include insects, heatwaves, particulate matter as well as pollen, mould and radon. Description of the problem No attention has been paid to systematic risk regulation of the transmission mode air. Hospital hygiene is ‘micro-level public health' with a particularly vulnerable population. The experience of hospital hygiene measures can help to develop appropriate public health interventions. Which air hygiene measures have we taken to counter SARS-CoV-2 and how can these be more efficient in the future? Results In response to SARS-CoV-2, face masks were introduced. This has reduced the risk of transmission both in hospitals and in public, but has not completely prevented indirect transmission through aerosols indoors. Ventilation rules further reduced the risk of transmission, but were not applicable everywhere. Since most buildings do not have central air filtration units, the use of decentralised air filters increased, with unknown relevance. Lessons Breathing air cannot be substituted. Therefore, air hygiene is a primary prevention and needs to become more structured to be effective against future air-associated health hazards. Future construction projects for hospitals and public buildings must be adapted to prevention of air-associated health hazards. Hazard and risk analyses, technical, organisational and personal control measures, their monitoring and an incident management should be combined into an ‘Air Safety Plan' as part of a hygiene plan for hospitals and the public. Key messages Breathing air is increasingly polluted by natural or anthropogenic chemical, biological and physical influences and thus becomes a carrier of health hazards, especially for vulnerable groups. Since air cannot be replaced, primary preventive air hygiene based on “Air Safety Plans” will be important in the future as an efficient measure against air-associated hazards such as SARS-CoV-2.
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Affiliation(s)
- M Döhla
- Department for Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
- Institute for Hygiene and Public Health, University of Bonn, Bonn, Germany
| | - C Döhla
- Institute for Hygiene and Public Health, University of Bonn, Bonn, Germany
| | - M Exner
- Institute for Hygiene and Public Health, University of Bonn, Bonn, Germany
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18
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Paul G, Meißner A, Neuneier J, Neuschmelting V, Grau S, Yagdiran A, Scheyerer MJ, Malin JJ, Suárez I, Lehmann C, Exner M, Wiesmüller GA, Higgins PG, Seifert H, Fätkenheuer G, Zweigner J, Jung N. Outbreak of Pseudomonas aeruginosa infections after CT-guided spinal injections. J Hosp Infect 2021; 116:1-9. [PMID: 34298033 DOI: 10.1016/j.jhin.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Meningitis and spinal infections with Gram-negative bacteria after local injections for treatment of chronic back pain are rare. This study investigated an outbreak of Pseudomonas aeruginosa infections following computed tomography (CT)-guided spinal injections (SI). METHODS A case was defined as a spinal infection or meningitis with P. aeruginosa after SI between 10th January and 1st March 2019 in the same outpatient clinic. Patients without microbiological evidence of P. aeruginosa but with a favourable response to antimicrobial therapy active against P. aeruginosa were defined as probable cases. FINDINGS Twenty-eight of 297 patients receiving CT-guided SI during the study period developed meningitis or spinal infections. Medical records were available for 19 patients. In 15 patients, there was microbiological evidence of P. aeruginosa, and four patients were defined as probable cases. Two of 19 patients developed meningitis, while the remaining 17 patients developed spinal infections. The median time from SI to hospital admission was 8 days (interquartile range 2-23 days). Patients mainly presented with back pain (N=18; 95%), and rarely developed fever (N=3; 16%). Most patients required surgery (N=16; 84%). Seven patients (37%) relapsed and one patient died. Although the source of infection was not identified microbiologically, documented failures in asepsis when performing SI probably contributed to these infections. CONCLUSIONS SI is generally considered safe, but non-adherence to asepsis can lead to deleterious effects. Spinal infections caused by P. aeruginosa are difficult to treat and have a high relapse rate.
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Affiliation(s)
- G Paul
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany.
| | - A Meißner
- Department of Hospital Hygiene and Infection Control, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - J Neuneier
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - V Neuschmelting
- Centre for Neurosurgery, Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - S Grau
- Centre for Neurosurgery, Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - A Yagdiran
- Department of Orthopaedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - M J Scheyerer
- Department of Orthopaedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - J J Malin
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - I Suárez
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - C Lehmann
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - M Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - G A Wiesmüller
- Abteilung Infektions- and Umwelthygiene, Gesundheitsamt der Stadt Köln, Germany
| | - P G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - H Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - G Fätkenheuer
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - J Zweigner
- Department of Hospital Hygiene and Infection Control, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - N Jung
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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19
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Zacharias N, Haag A, Brang-Lamprecht R, Gebel J, Essert SM, Kistemann T, Exner M, Mutters NT, Engelhart S. Corrigendum to "Air filtration as a tool for the reduction of viral aerosols" [Sci. Total Environ. 772 (2021) 144956]. Sci Total Environ 2021; 775:146775. [PMID: 33836892 DOI: 10.1016/j.scitotenv.2021.146775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Nicole Zacharias
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Alexandra Haag
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Regina Brang-Lamprecht
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jürgen Gebel
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Sarah M Essert
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Thomas Kistemann
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Martin Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Nico T Mutters
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Steffen Engelhart
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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20
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Exner M, Bhattacharya S, Gebel J, Goroncy-Bermes P, Hartemann P, Heeg P, Ilschner C, Kramer A, Ling ML, Merkens W, Oltmanns P, Pitten F, Rotter M, Schmithausen RM, Sonntag HG, Steinhauer K, Trautmann M. Reply to the letter to the editor by R. Papke. GMS Hyg Infect Control 2021; 16:Doc23. [PMID: 34354902 PMCID: PMC8299058 DOI: 10.3205/dgkh000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Martin Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Jürgen Gebel
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Philippe Hartemann
- Departement Environnement et Santé Publique S.E.R.E.S., Faculté de Médecine, Nancy, France
| | - Peter Heeg
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Germany
| | - Carola Ilschner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Moi Lin Ling
- Infection Prevention & Control, Singapore General Hospital, Singapore
| | | | | | - Frank Pitten
- IKI - Institut für Krankenhaushygiene & Infektionskontrolle GmbH, Gießen, Germany
| | | | | | - Hans-Günther Sonntag
- Institute of Hygiene and Medical Microbiology, University of Heidelberg, Germany
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21
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Zacharias N, Haag A, Brang-Lamprecht R, Gebel J, Essert SM, Kistemann T, Exner M, Mutters NT, Engelhart S. Air filtration as a tool for the reduction of viral aerosols. Sci Total Environ 2021; 772:144956. [PMID: 33571771 DOI: 10.1016/j.scitotenv.2021.144956] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/02/2020] [Accepted: 12/31/2020] [Indexed: 06/12/2023]
Abstract
For testing the effectiveness of air purification devices in regard to the reduction of virus-containing aerosols, a test method involving test viruses has been lacking until now. The use of bacteriophages (phiX174 phages) is a method to test the efficiency of air purification devices under experimental conditions. Using air purifiers with a HEPA filter H14, a 4.6-6.1 Log reduction of test viruses can be achieved if bacteriophages are directly aerosolised into the air purifier, which corresponds to a reduction of 99.9974-99.9999%. Due to the complexity and individuality of air flow, an experimental approach was used in which all outside influences were minimised. The experimental setup was practical and chosen to project a scenario of direct transmission by an emitting source to a recipient. The experiments were performed with and without the air purifier at a distance of 0.75 m and 1.5 m each. Using the air purifier at a setting of 1000 m3/h, the concentration of the phiX174 phages in the air could be reduced by 2.86 Log (mean value). Nevertheless, the experiments without the air purifier showed a similar reduction rate of 2.61 Log (mean value) after 35 min. The concentration of phiX174 phages in the air could be additionally reduced up to 1 log step (maximum value) by the use of the air purifier in comparison to the experiments without. Distance was shown to be an important factor for risk reduction.
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Affiliation(s)
- Nicole Zacharias
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Alexandra Haag
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Regina Brang-Lamprecht
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jürgen Gebel
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Sarah M Essert
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Thomas Kistemann
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Martin Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Nico T Mutters
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Steffen Engelhart
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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22
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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23
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Döhla M, Jaensch A, Döhla C, Voigt A, Exner M, Färber H. Erratum zu: Blei im Trinkwasser – ein altes Problem, eine neue EU-Richtlinie. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:509. [PMID: 33755771 DOI: 10.1007/s00103-021-03314-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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24
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Kramer A, Eggers M, Hübner NO, Walger P, Steinmann E, Exner M. Virucidal gargling and virucidal nasal spray. GMS Hyg Infect Control 2021; 16:Doc02. [PMID: 33520603 PMCID: PMC7818657 DOI: 10.3205/dgkh000373] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Maren Eggers
- Labor Prof. Gisela Enders MVZ GbR, Stuttgart, Germany
| | - Nils-Olaf Hübner
- Central Unit for Infection Prevention and Control, University Medicine Greifswald, Greifswald, Germany
- German Society of Hospital Hygiene, Berlin, Germany
| | - Peter Walger
- German Society of Hospital Hygiene, Berlin, Germany
- Internal Intensive Medicine and Infectiology, Evangelic Clinics Bonn, Johanniter-Krankenhaus, Bonn, Germany
| | - Eike Steinmann
- Institute of Hygiene and Microbiology, Department for Molecular & Medical Virology, Ruhr-University Bochum, Bochum, Germany
| | - Martin Exner
- German Society of Hospital Hygiene, Berlin, Germany
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
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Schreiber C, Zacharias N, Essert SM, Wasser F, Müller H, Sib E, Precht T, Parcina M, Bierbaum G, Schmithausen RM, Kistemann T, Exner M. Clinically relevant antibiotic-resistant bacteria in aquatic environments - An optimized culture-based approach. Sci Total Environ 2021; 750:142265. [PMID: 33182186 DOI: 10.1016/j.scitotenv.2020.142265] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/04/2020] [Accepted: 09/06/2020] [Indexed: 06/11/2023]
Abstract
The emergence of antibiotic-resistant clinically relevant facultative pathogenic bacteria in the environment has become one of the most important global health challenges. Antibiotic-resistant bacteria (ARB) have been found in surface waters and wastewater treatment plants. Drinking water guidelines and the EU bathing water directive 2006/7/EC include the surveillance of defined microbiological parameters on species level, while the monitoring of ARB is missing in all existing guidelines. However, standardized methods for the detection of ARB exist for clinical investigations of human materials only. They are based on cultivation on selective agar plates. These methods cannot be used directly for environmental samples, because of the high amount and diversity of bacterial background flora which interferes with the detection of human-relevant ARB. The aim of this study was to introduce a proposal for future normative standard operation procedures, with international relevance, for the culture-based detection of clinically-relevant antibiotic resistant bacteria in aquatic environmental samples like wastewater and surface water: gram-negative bacteria resistant against 3rd generation cephalosporins (ESBL) and against carbapenems (CARBA), gram-positive vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). The final adaptation of standardized cultivation methods included increasing the standard incubation temperature from 36 °C to 42 °C, which effectively inhibits the environmental background flora on agar plates while the desired target species survive. This enables the detection of target species in suitable sample volumes. Putative target colonies which belong to the remaining background flora had to be excluded by morphological and physiological differentiation. Therefore, a time and cost optimized testing scheme with good performance was developed, which allows an effective exclusion of non-target isolates in samples. Depending on the target species and sample type, sensitivity of up to 100% is achieved, and specificity ranges from 91.1% to 99.7%, while the positive predictive value, negative predicted value and accuracy rate are always >90%.
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Affiliation(s)
- Christiane Schreiber
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Nicole Zacharias
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Sarah M Essert
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Felix Wasser
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Heike Müller
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Esther Sib
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Tabea Precht
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Marijo Parcina
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Gabriele Bierbaum
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ricarda M Schmithausen
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Thomas Kistemann
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Martin Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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26
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Exner M, Bhattacharya S, Gebel J, Goroncy-Bermes P, Hartemann P, Heeg P, Ilschner C, Kramer A, Ling ML, Merkens W, Oltmanns P, Pitten F, Rotter M, Schmithausen RM, Sonntag HG, Steinhauer K, Trautmann M. Chemical disinfection in healthcare settings: critical aspects for the development of global strategies. GMS Hyg Infect Control 2020; 15:Doc36. [PMID: 33520601 PMCID: PMC7818848 DOI: 10.3205/dgkh000371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Chemical disinfection is an indispensable means of preventing infection. This holds true for healthcare settings, but also for all other settings where transmission of pathogens poses a potential health risk to humans and/or animals. Research on how to ensure effectiveness of disinfectants and the process of disinfection, as well as on when, how and where to implement disinfection precautions is an ongoing challenge requiring an interdisciplinary team effort. The valuable resources of active substances used for disinfection must be used wisely and their interaction with the target organisms and the environment should be evaluated and monitored closely, if we are to reliable reap the benefits of disinfection in future generations. In view of the global threat of communicable diseases and emerging and re-emerging pathogens and multidrug-resistant pathogens, the relevance of chemical disinfection is continually increasing. Although this consensus paper pinpoints crucial aspects for strategies of chemical disinfection in terms of the properties of disinfectant agents and disinfection practices in a particularly vulnerable group and setting, i.e., patients in healthcare settings, it takes a comprehensive, holistic approach to do justice to the complexity of the topic of disinfection.
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Affiliation(s)
- Martin Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Jürgen Gebel
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Philippe Hartemann
- Departement Environnement et Santé Publique S.E.R.E.S., Faculté de Médecine, Nancy, France
| | - Peter Heeg
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Germany
| | - Carola Ilschner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Moi Lin Ling
- Infection Prevention & Control, Singapore General Hospital, Singapore
| | | | | | - Frank Pitten
- IKI – Institut für Krankenhaushygiene & Infektionskontrolle GmbH, Gießen, Germany
| | | | | | - Hans-Günther Sonntag
- Institute of Hygiene and Medical Microbiology, University of Heidelberg, Germany
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27
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Günther T, Czech‐Sioli M, Indenbirken D, Robitaille A, Tenhaken P, Exner M, Ottinger M, Fischer N, Grundhoff A, Brinkmann MM. SARS-CoV-2 outbreak investigation in a German meat processing plant. EMBO Mol Med 2020; 12:e13296. [PMID: 33012091 PMCID: PMC7646008 DOI: 10.15252/emmm.202013296] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 01/09/2023] Open
Abstract
We describe a multifactorial investigation of a SARS-CoV-2 outbreak in a large meat processing complex in Germany. Infection event timing, spatial, climate and ventilation conditions in the processing plant, sharing of living quarters and transport, and viral genome sequences were analyzed. Our results suggest that a single index case transmitted SARS-CoV-2 to co-workers over distances of more than 8 m, within a confined work area in which air is constantly recirculated and cooled. Viral genome sequencing shows that all cases share a set of mutations representing a novel sub-branch in the SARS-CoV-2 C20 clade. We identified the same set of mutations in samples collected in the time period between this initial infection cluster and a subsequent outbreak within the same factory, with the largest number of confirmed SARS-CoV-2 cases in a German meat processing facility reported so far. Our results indicate climate conditions, fresh air exchange rates, and airflow as factors that can promote efficient spread of SARS-CoV-2 via long distances and provide insights into possible requirements for pandemic mitigation strategies in industrial workplace settings.
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Affiliation(s)
- Thomas Günther
- Heinrich Pette InstituteLeibniz Institute for Experimental VirologyHamburgGermany
| | - Manja Czech‐Sioli
- Institute for Medical Microbiology, Virology and HygieneUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Daniela Indenbirken
- Heinrich Pette InstituteLeibniz Institute for Experimental VirologyHamburgGermany
| | - Alexis Robitaille
- Heinrich Pette InstituteLeibniz Institute for Experimental VirologyHamburgGermany
| | | | - Martin Exner
- Institute of Hygiene and Public HealthUniversity of BonnBonnGermany
| | | | - Nicole Fischer
- Institute for Medical Microbiology, Virology and HygieneUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Adam Grundhoff
- Heinrich Pette InstituteLeibniz Institute for Experimental VirologyHamburgGermany
| | - Melanie M Brinkmann
- Viral Immune Modulation Research GroupHelmholtz Centre for Infection ResearchBraunschweigGermany
- Institute of GeneticsTechnische Universität BraunschweigBraunschweigGermany
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28
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Günther T, Czech-Sioli M, Indenbirken D, Robitaille A, Tenhaken P, Exner M, Ottinger M, Fischer N, Grundhoff A, Brinkmann MM. SARS-CoV-2 outbreak investigation in a German meat processing plant. EMBO Mol Med 2020. [PMID: 33012091 DOI: 10.2139/ssrn.3654517] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
We describe a multifactorial investigation of a SARS-CoV-2 outbreak in a large meat processing complex in Germany. Infection event timing, spatial, climate and ventilation conditions in the processing plant, sharing of living quarters and transport, and viral genome sequences were analyzed. Our results suggest that a single index case transmitted SARS-CoV-2 to co-workers over distances of more than 8 m, within a confined work area in which air is constantly recirculated and cooled. Viral genome sequencing shows that all cases share a set of mutations representing a novel sub-branch in the SARS-CoV-2 C20 clade. We identified the same set of mutations in samples collected in the time period between this initial infection cluster and a subsequent outbreak within the same factory, with the largest number of confirmed SARS-CoV-2 cases in a German meat processing facility reported so far. Our results indicate climate conditions, fresh air exchange rates, and airflow as factors that can promote efficient spread of SARS-CoV-2 via long distances and provide insights into possible requirements for pandemic mitigation strategies in industrial workplace settings.
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Affiliation(s)
- Thomas Günther
- Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - Manja Czech-Sioli
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniela Indenbirken
- Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - Alexis Robitaille
- Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | | | - Martin Exner
- Institute of Hygiene and Public Health, University of Bonn, Bonn, Germany
| | | | - Nicole Fischer
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adam Grundhoff
- Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - Melanie M Brinkmann
- Viral Immune Modulation Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
- Institute of Genetics, Technische Universität Braunschweig, Braunschweig, Germany
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29
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Sib E, Lenz-Plet F, Barabasch V, Klanke U, Savin M, Hembach N, Schallenberg A, Kehl K, Albert C, Gajdiss M, Zacharias N, Müller H, Schmithausen RM, Exner M, Kreyenschmidt J, Schreiber C, Schwartz T, Parčina M, Bierbaum G. Bacteria isolated from hospital, municipal and slaughterhouse wastewaters show characteristic, different resistance profiles. Sci Total Environ 2020; 746:140894. [PMID: 32763594 DOI: 10.1016/j.scitotenv.2020.140894] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
Multidrug-resistant bacteria cause difficult-to-treat infections and pose a risk for modern medicine. Sources of multidrug-resistant bacteria include hospital, municipal and slaughterhouse wastewaters. In this study, bacteria with resistance to 3rd generation cephalosporins were isolated from all three wastewater biotopes, including a maximum care hospital, municipal wastewaters collected separately from a city and small rural towns and the wastewaters of two pig and two poultry slaughterhouses. The resistance profiles of all isolates against clinically relevant antibiotics (including β-lactams like carbapenems, the quinolone ciprofloxacin, colistin, and trimethoprim/sulfamethoxazole) were determined at the same laboratory. The bacteria were classified according to their risk to human health using clinical criteria, with an emphasis on producers of carbapenemases, since carbapenems are prescribed for hospitalized patients with infections with multi-drug resistant bacteria. The results showed that bacteria that pose the highest risk, i. e., bacteria resistant to all β-lactams including carbapenems and ciprofloxacin, were mainly disseminated by hospitals and were present only in low amounts in municipal wastewater. The isolates from hospital wastewater also showed the highest rates of resistance against antibiotics used for treatment of carbapenemase producers and some isolates were susceptible to only one antibiotic substance. In accordance with these results, qPCR of resistance genes showed that 90% of the daily load of carbapenemase genes entering the municipal wastewater treatment plant was supplied by the clinically influenced wastewater, which constituted approximately 6% of the wastewater at this sampling point. Likewise, the signature of the clinical wastewater was still visible in the resistance profiles of the bacteria isolated at the entry into the wastewater treatment plant. Carbapenemase producers were not detected in slaughterhouse wastewater, but strains harboring the colistin resistance gene mcr-1 could be isolated. Resistances against orally available antibiotics like ciprofloxacin and trimethoprim/sulfamethoxazole were widespread in strains from all three wastewaters.
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Affiliation(s)
- Esther Sib
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany; Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Franziska Lenz-Plet
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Vanessa Barabasch
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Ursula Klanke
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Mykhailo Savin
- Institute of Animal Sciences, University of Bonn, Bonn, Germany
| | - Norman Hembach
- Karlsruhe Institute of Technology (KIT), Institute of Functional Interfaces (IFG), Microbiology/Molecular Biology Department, Karlsruhe, Germany
| | - Anna Schallenberg
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Katja Kehl
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Cathrin Albert
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Mike Gajdiss
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Nicole Zacharias
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Heike Müller
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | | | - Martin Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Judith Kreyenschmidt
- Institute of Animal Sciences, University of Bonn, Bonn, Germany; Department of Fresh Produce Logistics, Hochschule Geisenheim University, Geisenheim, Germany
| | - Christiane Schreiber
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Thomas Schwartz
- Karlsruhe Institute of Technology (KIT), Institute of Functional Interfaces (IFG), Microbiology/Molecular Biology Department, Karlsruhe, Germany
| | - Marijo Parčina
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Gabriele Bierbaum
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany.
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30
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Kampf G, Exner M, Schwebke I, Gebel J. Ethanol is indispensable and safe as a biocidal active substance for hand disinfection. J Hosp Infect 2020; 108:205-206. [PMID: 33220347 DOI: 10.1016/j.jhin.2020.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Affiliation(s)
- G Kampf
- University Medicine Greifswald, Institute for Hygiene and Environmental Medicine, Greifswald, Germany.
| | - M Exner
- University Bonn, Institute for Hygiene and Public Health, Bonn, Germany
| | | | - J Gebel
- University Bonn, Institute for Hygiene and Public Health, Bonn, Germany
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31
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Streeck H, Schulte B, Kümmerer BM, Richter E, Höller T, Fuhrmann C, Bartok E, Dolscheid-Pommerich R, Berger M, Wessendorf L, Eschbach-Bludau M, Kellings A, Schwaiger A, Coenen M, Hoffmann P, Stoffel-Wagner B, Nöthen MM, Eis-Hübinger AM, Exner M, Schmithausen RM, Schmid M, Hartmann G. Infection fatality rate of SARS-CoV2 in a super-spreading event in Germany. Nat Commun 2020; 11:5829. [PMID: 33203887 DOI: 10.1101/2020.05.04.20090076] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/14/2020] [Indexed: 05/20/2023] Open
Abstract
A SARS-CoV2 super-spreading event occurred during carnival in a small town in Germany. Due to the rapidly imposed lockdown and its relatively closed community, this town was seen as an ideal model to investigate the infection fatality rate (IFR). Here, a 7-day seroepidemiological observational study was performed to collect information and biomaterials from a random, household-based study population. The number of infections was determined by IgG analyses and PCR testing. We found that of the 919 individuals with evaluable infection status, 15.5% (95% CI:[12.3%; 19.0%]) were infected. This is a fivefold higher rate than the reported cases for this community (3.1%). 22.2% of all infected individuals were asymptomatic. The estimated IFR was 0.36% (95% CI:[0.29%; 0.45%]) for the community and 0.35% [0.28%; 0.45%] when age-standardized to the population of the community. Participation in carnival increased both infection rate (21.3% versus 9.5%, p < 0.001) and number of symptoms (estimated relative mean increase 1.6, p = 0.007). While the infection rate here is not representative for Germany, the IFR is useful to estimate the consequences of the pandemic in places with similar healthcare systems and population characteristics. Whether the super-spreading event not only increases the infection rate but also affects the IFR requires further investigation.
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Affiliation(s)
- Hendrik Streeck
- Institute of Virology, University Hospital, University of Bonn, Bonn, Germany.
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Braunschweig, Germany.
| | - Bianca Schulte
- Institute of Virology, University Hospital, University of Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Braunschweig, Germany
| | - Beate M Kümmerer
- Institute of Virology, University Hospital, University of Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Braunschweig, Germany
| | - Enrico Richter
- Institute of Virology, University Hospital, University of Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Braunschweig, Germany
| | - Tobias Höller
- Clinical Study Core Unit, Study Center Bonn (SZB), University Hospital, University of Bonn, Bonn, Germany
| | - Christine Fuhrmann
- Clinical Study Core Unit, Study Center Bonn (SZB), University Hospital, University of Bonn, Bonn, Germany
| | - Eva Bartok
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Braunschweig, Germany
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital, University of Bonn, Bonn, Germany
| | - Ramona Dolscheid-Pommerich
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Braunschweig, Germany
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital, University of Bonn, Bonn, Germany
| | - Moritz Berger
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital, University of Bonn, Bonn, Germany
| | - Lukas Wessendorf
- Institute of Virology, University Hospital, University of Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Braunschweig, Germany
| | - Monika Eschbach-Bludau
- Institute of Virology, University Hospital, University of Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Braunschweig, Germany
| | - Angelika Kellings
- Clinical Study Core Unit, Study Center Bonn (SZB), University Hospital, University of Bonn, Bonn, Germany
| | - Astrid Schwaiger
- Biobank Core Unit, University Hospital, University of Bonn, Bonn, Germany
| | - Martin Coenen
- Clinical Study Core Unit, Study Center Bonn (SZB), University Hospital, University of Bonn, Bonn, Germany
| | - Per Hoffmann
- Institute of Human Genetics, University Hospital, University of Bonn, Bonn, Germany
| | - Birgit Stoffel-Wagner
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Braunschweig, Germany
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital, University of Bonn, Bonn, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University Hospital, University of Bonn, Bonn, Germany
| | - Anna M Eis-Hübinger
- Institute of Virology, University Hospital, University of Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Braunschweig, Germany
| | - Martin Exner
- Institute for Hygiene and Public Health, University Hospital, University of Bonn, Bonn, Germany
| | | | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital, University of Bonn, Bonn, Germany
| | - Gunther Hartmann
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Braunschweig, Germany.
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital, University of Bonn, Bonn, Germany.
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32
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Simon A, Huebner J, Berner R, Munro APS, Exner M, Huppertz HI, Walger P. Measures to maintain regular operations and prevent outbreaks of SARS-CoV-2 in childcare facilities or schools under pandemic conditions and co-circulation of other respiratory pathogens. GMS Hyg Infect Control 2020; 15:Doc22. [PMID: 32974120 PMCID: PMC7492754 DOI: 10.3205/dgkh000357] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
After the lockdown and the end of the summer holidays, day-cares and schools need to be reopened and (despite the continued circulation of the new coronavirus SARS-CoV-2) kept open. The need for opening up arises from the right of children to education, participation, support and care. This is possible if appropriate hygiene measures are implemented and community transmission remains stable. In addition, the safety of educators, teachers and carers must be a priority and needs to be addressed by appropriate measures. Finally, the needs of families must also be taken into account. The following document describes in detail how these objectives can be achieved.
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Affiliation(s)
- Arne Simon
- Pediatric Oncology and Hematology, Children's Hospital Medical Center, University Clinics, Homburg, Germany
| | - Johannes Huebner
- Division of Pediatric Infectious Diseases, Dr. von Hauner Children's Hospital, Munich University Hospital, Munich, Germany
| | - Reinhard Berner
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Alasdair P S Munro
- NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Martin Exner
- Institute of Hygiene and Public Health, University of Bonn, Bonn, Germany
| | | | - Peter Walger
- German Society of Hospital Hygiene, Berlin, Germany
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33
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Häring A, Heudorf U, Exner M, Pitten FA, Waidmann O, Hack D, Kempf VAJ, Reinheimer C. Impact of surface disinfection with hydrogen peroxide on the prevalence of vancomycin-resistant enterococci (VRE) in hospital wards. GMS Hyg Infect Control 2020; 15:Doc13. [PMID: 32685357 PMCID: PMC7336168 DOI: 10.3205/dgkh000348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: Vancomycin-resistant enterococci (VRE) are of major concern in infection control. Although broad infection control actions to check VRE have been implemented, VRE remain part of daily infection prevention in clinical settings. Cleaning procedures in the inanimate ward environment might play a key role in controlling VRE. In order to optimize infection control management at University Hospital Frankfurt, Germany (UHF), this study evaluates the impact of H2O2-containing cleaning wipes compared to Glucoprotamin containing wipes on VRE prevalence in intensive care wards. Methods: Retrospective analyses were conducted of the VRE prevalence on environmental materials obtained from three intensive care units (ICU) at UHF for 17 months prior to (T1) and during the 25 months after (T2) the implementation of H2O2-containing cleaning wipes from January 2016 to June 2019. The bactericidal power of the two disinfectants against VRE was compared using the 4-field test according to EN 16615 (2015). Results: At T1 and T2, n=666 and n=710 environmental samples, respectively, were obtained. At T1, 24.2% (n=161/666; 95% confidence interval: 21.0–27.6) and at T2, 6.9% (n=49/710; 5.1–9.0) samples were positive for VRE. In vitro disinfectant testing did not reveal any superiority of H2O2 over glucoprotamin. No effect on the VRE prevalence in patients’ rectal screening materials was observed. Conclusion: Though Glucoprotamin and H2O2 were in vitro equally effective against VRE, the prevalence of VRE in ICU environment at UHF decreased after implementation of H2O2-containig wipes. This might be due to multiple factors, of which we consider the impact of the Hawthorne effect to be the strongest. Success of infection control strategies might depend on the compliance of the persons critically involved. Transparent information on infection control strategies is suggested to increase compliance and should therefore be considered both in daily infection control and outbreak management.
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Affiliation(s)
- Anna Häring
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ursel Heudorf
- Public Health Department of the City of Frankfurt am Main, Germany
| | - Martin Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Germany
| | | | - Oliver Waidmann
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Daniel Hack
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Competence for Infection Control Frankfurt - Giessen - Marburg, Frankfurt am Main, Germany
| | - Volkhard A J Kempf
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Competence for Infection Control Frankfurt - Giessen - Marburg, Frankfurt am Main, Germany
| | - Claudia Reinheimer
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Competence for Infection Control Frankfurt - Giessen - Marburg, Frankfurt am Main, Germany
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Walger P, Heininger U, Knuf M, Exner M, Popp W, Fischbach T, Trapp S, Hübner J, Herr C, Simon A. Children and adolescents in the CoVid-19 pandemic: Schools and daycare centers are to be opened again without restrictions. The protection of teachers, educators, carers and parents and the general hygiene rules do not conflict with this. GMS Hyg Infect Control 2020; 15:Doc11. [PMID: 32547911 PMCID: PMC7273848 DOI: 10.3205/dgkh000346] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the opinion of the medical societies of hygiene and pediatrics undersigning the present statement, the analyses published to date regarding transmission of SARS-CoV-2 and the course of CoVid-19 show that children play a much less significant role in the spread of the virus than do adults. According to the findings available to date, not only do children and adolescents less frequently fall ill with CoVid-19, they also generally become less severely ill than do adults. The vast majority of infections in children and adolescents are asymptomatic or oligosymptomatic. Even the first analyses from China demonstrated that children and adolescents play a subordinate role in the transmission of the virus – not only to other children and adolescents, but also to adults. Taking into account regional infection rates and available resources, daycare centers, kindergartens and elementary schools promptly should be reopened. For children, this should be possible without excessive restrictions, such as clustering into very small groups, implementation of barrier precautions, maintaining appropriate distance from others or wearing masks. A factor more decisive than individual group size is the issue of sustaining the constancy of respective group members and the avoidance of intermixing. Children can be taught basic rules of hygiene such as handwashing and careful hygiene behavior when coming into contact with others during mealtimes and/or when using sanitary facilities. Independent of the prevention measures implemented for children and adolescents, the protection of teachers, educators and caregivers is crucial, (e.g., the maintenance of appropriate distance from others, use of medical masks, situation-dependent hand disinfection, when necessary, supported by regular pool testing). Children over the age of 10 and adolescents up to school graduation age are more capable of actively understanding and conforming to specific hygiene rules. For this group, maintaining appropriate distance from others (1.5 meters), wearing a mouth-and-nose protection (whenever they are not sitting in their assigned classroom seats) and consistent education regarding the basic rules of infection prevention may provide increased options for normalizing teaching activities. Children and adolescents suspected of infection with SARS-CoV-2 should be tested immediately in order to either confirm or rule out such an infection. Evidence of individual infections in children or students must not automatically lead to the closure of the entire daycare center or school. A detailed analysis of the chain of infection is a prerequisite for a balanced approach to infection control. The opening of schools and children’s facilities should be accompanied by specifically structured, model surveillance studies that further clarify outstanding questions about infectious disease events and hygiene control. These prospective, concomitant examinations will be essential for the purpose of evaluating and verifying the effectiveness of the required hygiene measures.
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Affiliation(s)
- Peter Walger
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Ulrich Heininger
- German Academy for Pediatric and Adolescent Medicine (DAKJ), Berlin, Germany
| | - Markus Knuf
- German Academy for Pediatric and Adolescent Medicine (DAKJ), Berlin, Germany
| | - Martin Exner
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Walter Popp
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Thomas Fischbach
- Professional Association of Pediatricians in Germany (bvkj e.V.), Cologne, Germany
| | - Stefan Trapp
- Professional Association of Pediatricians in Germany (bvkj e.V.), Cologne, Germany
| | - Johannes Hübner
- German Society for Pediatric Infectious Diseases (DGPI), Berlin, Germany
| | - Caroline Herr
- Society of Hygiene, Environmental and Public Health Sciences (GHUP), Munich, Germany
| | - Arne Simon
- German Society for Pediatric Infectious Diseases (DGPI), Berlin, Germany
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Jacobshagen A, Gemein S, Exner M, Gebel J. Test methods for surface disinfection: comparison of the Wiperator ASTM standard E2967-15 and the 4-field test EN 16615. GMS Hyg Infect Control 2020; 15:Doc04. [PMID: 32547904 PMCID: PMC7273320 DOI: 10.3205/dgkh000339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aim: Two test methods for surface disinfection (phase 2, step 2) – the Wiperator method (ASTM standard E2967-15) and the 4-field test (EN 16615) – were compared using a disinfectant solution based on quaternary ammonium compounds and a ready-to-use alcohol-based wipe. As test organisms, Staphylococcusaureus and Pseudomonasaeruginosa were used. Results: While the 4-field test is a manual method and better reflects the process in practice, with the Wiperator, the wiping process is better controlled because it is an automated procedure. A comparison of the effects of both methods on the target log10-reduction of S. aureus and P. aeruginosa indicates a statistically significant difference between the two test methods (Mann-Whitney U-Test. S. aureus: 0 (Umin)<4 (Ucrit); n1=8, n2=8, p=0.001; 2-sided. P. aeruginosa: 24 (Umin)<26 (Ucrit); n1=11, n2=10, p=0.025, 2-sided). In addition, the results indicate that the wipe used has a major influence on the success of the disinfection process. Discussion: Both methods are suitable for efficacy studies of surface disinfectants, yet they differ in some aspects. Additionally our data indicate a statistically significant difference between the two test methods. Conclusion: Efficiency testing of surface disinfection is a complex process that depends on many different parameters. Since the 4-field test better reflects the practice, it makes sense to stick to this test procedure, taking into account that the EN 16615 was approved by CEN TC 216 in 2015 after method validation ring trials.
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Affiliation(s)
- Anja Jacobshagen
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Stefanie Gemein
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany.,VAH c/o Institute for Hygiene and Public Health, University Hospital Bonn AöR, Bonn, Germany
| | - Martin Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany.,VAH c/o Institute for Hygiene and Public Health, University Hospital Bonn AöR, Bonn, Germany
| | - Jürgen Gebel
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany.,VAH c/o Institute for Hygiene and Public Health, University Hospital Bonn AöR, Bonn, Germany
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Exner DP, Stoffels ME, Exner M, Engelhart S, Kalff JC, Schmithausen RM. Questionnaire based evaluation of the motivation of surgically treated patients to participate in preventative hygiene measures. GMS Hyg Infect Control 2020; 15:Doc01. [PMID: 32047720 PMCID: PMC6997801 DOI: 10.3205/dgkh000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Nosocomial infections caused by antibiotic-resistant pathogens demonstrate the continued need for preventive hygiene management strategies. Information and training of patients in their personal hygiene is a current requirement of the German Society for Hospital Hygiene, and is recommended by the Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention beim Robert-Koch Institut, KRINKO) at the Robert Koch Institute. Aim: The aim of this study was to evaluate patients’ existing knowledge of hygiene and their motivation to actively participate in preventive hygiene measures. Methods: This study included 445 inpatients at the Polyclinic for Surgery of University Hospital Bonn. Subjects were interviewed over a 6-month period using a questionnaire comprising 21 questions on the topic of hygiene. Results: The majority of patients rated their subjective level of knowledge as intermediate (41%), 25% as poor and 35% as high. The respondents rated the active inclusion of patients in hygiene practices as highly relevant, and were willing to actively contribute to infection prevention, whereby the patients considered hand washing and hand disinfection in particular as important starting points. 78% of the respondents wanted more information on hygiene, particularly on wound and food hygiene. Targeted hygiene education provided by hospital staff had a positive effect on the patients’ subjective level of information, as well as on their confidence in physicians and nursing staff. Previous information via television or radio had a negative impact on the patients’ subjective information level and on their confidence in hospital staff. Conclusion: Most surgically treated patients are motivated to actively contribute to preventive hygiene measures. This represents an additional and important option for applying hospital hygiene more effectively and, above all, closer to the patient. Information and education should preferably be performed by healthcare professionals.
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Affiliation(s)
- Daniel Philipp Exner
- Clinic for General, Visceral, Vascular and Thoracic Surgery, University Hospital Bonn, Bonn, Germany
| | | | - Martin Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Steffen Engelhart
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Jörg Christoph Kalff
- Clinic for General, Visceral, Vascular and Thoracic Surgery, University Hospital Bonn, Bonn, Germany
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Voigt AM, Zacharias N, Timm C, Wasser F, Sib E, Skutlarek D, Parcina M, Schmithausen RM, Schwartz T, Hembach N, Tiehm A, Stange C, Engelhart S, Bierbaum G, Kistemann T, Exner M, Faerber HA, Schreiber C. Association between antibiotic residues, antibiotic resistant bacteria and antibiotic resistance genes in anthropogenic wastewater - An evaluation of clinical influences. Chemosphere 2020; 241:125032. [PMID: 31622887 DOI: 10.1016/j.chemosphere.2019.125032] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/12/2019] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Abstract
The high use of antibiotics in human and veterinary medicine has led to a wide spread of antibiotics and antimicrobial resistance into the environment. In recent years, various studies have shown that antibiotic residues, resistant bacteria and resistance genes, occur in aquatic environments and that clinical wastewater seems to be a hot spot for the environmental spread of antibiotic resistance. Here a representative statistical analysis of various sampling points is presented, containing different proportions of clinically influenced wastewater. The statistical analysis contains the calculation of the odds ratios for any combination of antibiotics with resistant bacteria or resistance genes, respectively. The results were screened for an increased probability of detecting resistant bacteria, or resistance genes, with the simultaneous presence of antibiotic residues. Positive associated sets were then compared, with regards to the detected median concentration, at the investigated sampling points. All results show that the sampling points with the highest proportion of clinical wastewater always form a distinct cluster concerning resistance. The results shown in this study lead to the assumption that ciprofloxacin is a good indicator of the presence of multidrug resistant P. aeruginosa and extended spectrum β-lactamase (ESBL)-producing Klebsiella spec., Enterobacter spec. and Citrobacter spec., as it positively relates with both parameters. Furthermore, a precise relationship between carbapenemase genes and meropenem, regarding the respective sampling sites, could be obtained. These results highlight the role of clinical wastewater for the dissemination and development of multidrug resistance.
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Affiliation(s)
- A M Voigt
- Institute for Hygiene and Public Health, University Hospital Bonn, Medical Faculty University of Bonn, Venusberg-Campus 1, Building 63, 53127, Bonn, Germany.
| | - N Zacharias
- Institute for Hygiene and Public Health, University Hospital Bonn, Medical Faculty University of Bonn, Venusberg-Campus 1, Building 63, 53127, Bonn, Germany
| | - C Timm
- Institute for Hygiene and Public Health, University Hospital Bonn, Medical Faculty University of Bonn, Venusberg-Campus 1, Building 63, 53127, Bonn, Germany
| | - F Wasser
- Institute for Hygiene and Public Health, University Hospital Bonn, Medical Faculty University of Bonn, Venusberg-Campus 1, Building 63, 53127, Bonn, Germany
| | - E Sib
- Institute for Hygiene and Public Health, University Hospital Bonn, Medical Faculty University of Bonn, Venusberg-Campus 1, Building 63, 53127, Bonn, Germany
| | - D Skutlarek
- Institute for Hygiene and Public Health, University Hospital Bonn, Medical Faculty University of Bonn, Venusberg-Campus 1, Building 63, 53127, Bonn, Germany
| | - M Parcina
- Institute of Immunology, Medical Microbiology and Parasitology, University Hospital Bonn, Medical Faculty University of Bonn, Venusberg-Campus 1, Building 63, 53127, Bonn, Germany
| | - R M Schmithausen
- Institute for Hygiene and Public Health, University Hospital Bonn, Medical Faculty University of Bonn, Venusberg-Campus 1, Building 63, 53127, Bonn, Germany
| | - T Schwartz
- Karlsruhe Institute of Technology (KIT), Institute of Functional Interfaces (IFG), Microbiology/Molecular Biology Department, Hermann-von-Helmholtz Platz 1, 76344, Eggenstein-Leopoldshafen, Germany
| | - N Hembach
- Karlsruhe Institute of Technology (KIT), Institute of Functional Interfaces (IFG), Microbiology/Molecular Biology Department, Hermann-von-Helmholtz Platz 1, 76344, Eggenstein-Leopoldshafen, Germany
| | - A Tiehm
- DVGW-Technologiezentrum Wasser (TZW), Karlsruher Straße 84, 76139, Karlsruhe, Germany
| | - C Stange
- DVGW-Technologiezentrum Wasser (TZW), Karlsruher Straße 84, 76139, Karlsruhe, Germany
| | - S Engelhart
- Institute for Hygiene and Public Health, University Hospital Bonn, Medical Faculty University of Bonn, Venusberg-Campus 1, Building 63, 53127, Bonn, Germany
| | - G Bierbaum
- Institute of Immunology, Medical Microbiology and Parasitology, University Hospital Bonn, Medical Faculty University of Bonn, Venusberg-Campus 1, Building 63, 53127, Bonn, Germany
| | - T Kistemann
- Institute for Hygiene and Public Health, University Hospital Bonn, Medical Faculty University of Bonn, Venusberg-Campus 1, Building 63, 53127, Bonn, Germany
| | - M Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Medical Faculty University of Bonn, Venusberg-Campus 1, Building 63, 53127, Bonn, Germany
| | - H A Faerber
- Institute for Hygiene and Public Health, University Hospital Bonn, Medical Faculty University of Bonn, Venusberg-Campus 1, Building 63, 53127, Bonn, Germany
| | - C Schreiber
- Institute for Hygiene and Public Health, University Hospital Bonn, Medical Faculty University of Bonn, Venusberg-Campus 1, Building 63, 53127, Bonn, Germany
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Popp W, Alefelder C, Bauer S, Daeschlein G, Geistberger P, Gleich S, Herr C, Hübner NO, Jatzwauk L, Kohnen W, Külpmann R, Lemm F, Loczenski B, Spors J, Walger P, Wehrl M, Zastrow KD, Exner M. Air quality in the operating room: Surgical site infections, HVAC systems and discipline - position paper of the German Society of Hospital Hygiene (DGKH). GMS Hyg Infect Control 2019; 14:Doc20. [PMID: 32047719 PMCID: PMC6997799 DOI: 10.3205/dgkh000335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In recent years, there has been an ongoing discussion about the value of laminar airflow (LAF=low turbulence displacement ventilation) in the operating room for prevention of surgical site infections (SSI). Some publications, e.g., from the WHO, issued the demand to no longer build LAF ceilings in operating rooms. The present statement deals critically with this position and justifies the use of LAF ceilings in different ways: Many of the papers cited by the WHO and others for the case against LAF do not provide reliable data.The remaining studies which might be used for answering the question give quite different results, also in favor of LAF.The size of the LAF ceiling in many studies is not given or mostly too small in comparison to actual technical requirements.LAF in different countries can mean quite different techniques (e.g., the US in comparison to Germany) so that the results of studies that do not take this into account may not be comparable.LAF has positive effects in terms of reducing particulate and bacterial load, associated with increased airflow in the surgical working area. A reduction of carcinogenic substances in the air may also be assumed, which would increase workers' safety. Thus, this paper recommends building LAF ceilings in the future as well, depending on the operations intended. Further, this paper gives an overview of possible reasons for surgical site infections and highlights the importance of discipline in the operating theatre.
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Affiliation(s)
- Walter Popp
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | - Sonja Bauer
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | | | - Sabine Gleich
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Caroline Herr
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | - Lutz Jatzwauk
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | | | | | | | - Jörg Spors
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Peter Walger
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Markus Wehrl
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | - Martin Exner
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
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Steul K, Exner M, Heudorf U. [Personal preconditions for the prevention of nosocomial infections-guidelines of the German Commission for Hospital Hygiene and Infection Prevention (KRINKO), federal state hygiene regulations in Germany, and compliance by hospitals in Frankfurt am Main]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:329-340. [PMID: 30783685 DOI: 10.1007/s00103-019-02896-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
According to the amendment of the Infection Protection Act (2011), § 23, 8, all federal states in Germany had to pass their own hospital hygiene regulations, in which the need for hygiene specialists in a hospital is defined.This publication explains in its first part the differences between the nationwide Commission for Hospital Hygiene and Infection Prevention (KRINKO) regulations and the hygiene regulations of the different federal states (Hesse, Bavaria, etc.). All federal states - with the exception of Hesse (Hessian Hygiene Regulation, HHygVO) - refer to the relevant expert recommendations of KRINKO.In a second part of this publication, we highlight differences between KRINKO and HHygVO with the example of hospitals in the city of Frankfurt. In 2017, all Frankfurt hospitals had the necessary hygiene specialists (authorized hygiene practitioners, infection control nurses, authorized hygiene care nurses). However, the need for hospital hygienists could not be met, because there is an insufficient number of physician specialists for hospital hygiene available in Germany.The hospitals cannot solve this problem on their own - a political, superordinate decision and regulation must be made, i. e. by regulation and financial support for the advanced training of post-graduate physicians in hygiene. This is important since only experienced hospital hygienists can instruct or supervise hygiene specialists-in-training.
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Affiliation(s)
- Katrin Steul
- Abteilung Infektiologie und Hygiene, Gesundheitsamt der Stadt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt am Main, Deutschland.
| | - Martin Exner
- Institut für Hygiene und öffentliche Gesundheit, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Ursel Heudorf
- Abteilung Infektiologie und Hygiene, Gesundheitsamt der Stadt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt am Main, Deutschland
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Gemein S, Gebel J, Christiansen B, Martiny H, Vossebein L, Brill FHH, Decius M, Eggers M, Koburger-Janssen T, Meckel M, Werner S, Hunsinger B, Selhorst T, Kampf G, Exner M. Interlaboratory reproducibility of a test method following 4-field test methodology to evaluate the susceptibility of Clostridium difficile spores. J Hosp Infect 2019; 103:78-84. [PMID: 31199936 DOI: 10.1016/j.jhin.2019.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/21/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sporicidal surface disinfection is recommended to control transmission of Clostridium difficile in healthcare facilities. EN 17126 provides a method to determine the sporicidal activity in suspension and has been approved as a European standard. In addition, a sporicidal surface test has been proposed. AIM To determine the interlaboratory reproducibility of a test method for evaluating the susceptibility of a C. difficile spore preparation to a biocidal formulation following the 4-field test (EN 16615 methodology). METHODS Nine laboratories participated. C. difficile NCTC 13366 spores were used. Glutaraldehyde (1% and 6%; 15 min) and peracetic acid (PAA; 0.01% and 0.04%; 15 min) were used to determine the spores' susceptibility in suspension in triplicate. FINDINGS One-percent glutaraldehyde revealed a mean decimal log10 reduction of 1.03 with variable results in the nine laboratories (0.37-1.49) and a reproducibility of 0.38. The effect of 6% glutaraldehyde was stronger (mean: 2.05; range: 0.96-4.29; reproducibility: 0.86). PAA revealed similar results. An exemplary biocidal formulation based on 5% PAA was used at 0.5% (non-effective concentration) and 4% (effective concentration) to determine the sporicidal efficacy (4-field test) under clean conditions in triplicate with a contact time of 15 min. When used at 0.5% it demonstrated an overall log10 reduction of 2.68 (range: 2.35-3.57) and at 4% of 4.61 (range: 3.82-5.71). The residual contamination on the three primarily uncontaminated test fields was <50 cfu/25 cm2 in one out of nine laboratories (0.5%) and in seven out of nine laboratories (4%). CONCLUSION The interlaboratory reproducibility seems to be robust.
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Affiliation(s)
- S Gemein
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany; VAH Ring Trial Steering Gremium of the Association for Applied Hygiene (VAH), Bonn, Germany.
| | - J Gebel
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany; VAH Ring Trial Steering Gremium of the Association for Applied Hygiene (VAH), Bonn, Germany; Disinfectant Commission 4+4-Group of the Association for Applied Hygiene (VAH), Bonn, Germany
| | - B Christiansen
- Disinfectant Commission 4+4-Group of the Association for Applied Hygiene (VAH), Bonn, Germany; ZE Medizinaluntersuchungsamt und Hygiene, University Hospital Schleswig Holstein, Kiel, Germany
| | - H Martiny
- VAH Ring Trial Steering Gremium of the Association for Applied Hygiene (VAH), Bonn, Germany; Disinfectant Commission 4+4-Group of the Association for Applied Hygiene (VAH), Bonn, Germany
| | - L Vossebein
- Disinfectant Commission 4+4-Group of the Association for Applied Hygiene (VAH), Bonn, Germany; University of Applied Sciences Niederrhein, Mönchengladbach, Germany
| | - F H H Brill
- Dr Brill + Partner GmbH, Institut für Hygiene und Mikrobiologie, Hamburg, Germany
| | - M Decius
- ZE Medizinaluntersuchungsamt und Hygiene, University Hospital Schleswig Holstein, Kiel, Germany
| | - M Eggers
- Labor Prof. Gisela Enders MVZ GbR, Stuttgart, Germany
| | | | - M Meckel
- IKI Institut für Krankenhaushygiene und Infektionskontrolle GmbH, Gießen, Germany
| | - S Werner
- HygCen Germany GmbH, Schwerin, Germany
| | - B Hunsinger
- VAH Ring Trial Steering Gremium of the Association for Applied Hygiene (VAH), Bonn, Germany
| | - T Selhorst
- Institut für Tierwissenschaften, Präventives Gesundheitsmanagement, University Bonn, Germany
| | - G Kampf
- Institute for Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - M Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
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Niebel D, Hornung T, Schmithausen R, Rothe H, Parcina M, Wenzel J, Exner M, Bieber T. [Facial necrosis caused by orthopoxvirus : Differential diagnosis and dermatohistopathological correlation of infectious facial ulcers]. Hautarzt 2019; 70:715-722. [PMID: 31076814 DOI: 10.1007/s00105-019-4409-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article reports the remarkable course of a facial ulcer in a patient receiving prednisolone for Crohn's disease. Based on the initially unclear origin of the ulcer the patient received a triple anti-infective treatment (antiviral, antibiotic, antimycotic) but the lesion showed a rapid progression. An orthopoxvirus infection could be verified later by extensive diagnostics and relevant differential diagnoses could be ruled out. Extensive necrotic changes were observed in the first weeks resulting in cicatricial healing after months. Human cowpox infections have been repeatedly reported in Germany and are a relevant zoonosis. Cats and rodents are main carriers. The differential diagnoses include infections caused by other bacterial, mycobacterial, mycotic and parasitic agents that are thoroughly discussed here both clinically and histopathologically. Especially cutaneous leishmaniasis must be named as the incidence is continuously rising. With inadequate treatment infectious facial ulcers may give rise to life-threatening complications and extensive disfiguring scarring, therefore treatment must be initiated in a timely manner.
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Affiliation(s)
- Dennis Niebel
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Thorsten Hornung
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Ricarda Schmithausen
- Institut für Hygiene und Öffentliche Gesundheit, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Hanna Rothe
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Marijo Parcina
- Institut für Medizinische Mikrobiologie und Immunologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Jörg Wenzel
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Martin Exner
- Institut für Hygiene und Öffentliche Gesundheit, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Thomas Bieber
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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42
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Sib E, Voigt AM, Wilbring G, Schreiber C, Faerber HA, Skutlarek D, Parcina M, Mahn R, Wolf D, Brossart P, Geiser F, Engelhart S, Exner M, Bierbaum G, Schmithausen RM. Antibiotic resistant bacteria and resistance genes in biofilms in clinical wastewater networks. Int J Hyg Environ Health 2019; 222:655-662. [PMID: 30905579 DOI: 10.1016/j.ijheh.2019.03.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/25/2019] [Accepted: 03/13/2019] [Indexed: 01/09/2023]
Abstract
Increasing isolation rates of resistant bacteria in the last years require identification of potential infection reservoirs in healthcare facilities. Especially the clinical wastewater network represents a potential source of antibiotic resistant bacteria. In this work, the siphons of the sanitary installations from 18 hospital rooms of two German hospitals were examined for antibiotic resistant bacteria and antibiotic residues including siphons of showers and washbasins and toilets in sanitary units of psychosomatic, haemato-oncological, and rehabilitation wards. In addition, in seven rooms of the haemato-oncological ward, the effect of 24 h of stagnation on the antibiotic concentrations and MDR (multi-drug-resistant) bacteria in biofilms was evaluated. Whereas no antibiotic residues were found in the psychosomatic ward, potential selective concentrations of piperacillin, meropenem and ciprofloxacin were detected at a rehabilitation ward and ciprofloxacin and trimethoprim were present at a haemato-oncology ward. Antibiotic resistant bacteria were isolated from the siphons of all wards, however in the psychosomatic ward, only one MDR strain with resistance to piperacillin, third generation cephalosporins and quinolones (3MRGN) was detected. In contrast, the other two wards yielded 11 carbapenemase producing MDR isolates and 15 3MRGN strains. The isolates from the haemato-oncological ward belonged mostly to two specific rare sequence types (ST) (P. aeruginosa ST823 and Enterobacter cloacae complex ST167). In conclusion, clinical wastewater systems represent a reservoir for multi-drug-resistant bacteria. Consequently, preventive and intervention measures should not start at the wastewater treatment in the treatment plant, but already in the immediate surroundings of the patient, in order to minimize the infection potential.
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Affiliation(s)
- E Sib
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - A M Voigt
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - G Wilbring
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - C Schreiber
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - H A Faerber
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - D Skutlarek
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - M Parcina
- Institute of Immunology, Medical Microbiology and Parasitology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - R Mahn
- Medical Clinic III, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - D Wolf
- Medical Clinic III, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany; University Clinic V, Department Hematology and Oncology, Medical University Innsbruck, Christoph-Probst-Platz Innrain 52, 6020, Innsbruck, Austria
| | - P Brossart
- Medical Clinic III, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - F Geiser
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - S Engelhart
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - M Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - G Bierbaum
- Institute of Immunology, Medical Microbiology and Parasitology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - R M Schmithausen
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
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43
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Caicedo C, Rosenwinkel KH, Exner M, Verstraete W, Suchenwirth R, Hartemann P, Nogueira R. Legionella occurrence in municipal and industrial wastewater treatment plants and risks of reclaimed wastewater reuse: Review. Water Res 2019; 149:21-34. [PMID: 30445393 DOI: 10.1016/j.watres.2018.10.080] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/26/2018] [Accepted: 10/27/2018] [Indexed: 05/22/2023]
Abstract
Wastewater treatment plants (WWTPs) have been identified as confirmed but until today underestimated sources of Legionella, playing an important role in local and community cases and outbreaks of Legionnaires' disease. In general, aerobic biological systems provide an optimum environment for the growth of Legionella due to high organic nitrogen and oxygen concentrations, ideal temperatures and the presence of protozoa. However, few studies have investigated the occurrence of Legionella in WWTPs, and many questions in regards to the interacting factors that promote the proliferation and persistence of Legionella in these treatment systems are still unanswered. This critical review summarizes the current knowledge about Legionella in municipal and industrial WWTPs, the conditions that might support their growth, as well as control strategies that have been applied. Furthermore, an overview of current quantification methods, guidelines and health risks associated with Legionella in reclaimed wastewater is also discussed in depth. A better understanding of the conditions promoting the occurrence of Legionella in WWTPs will contribute to the development of improved wastewater treatment technologies and/or innovative mitigation approaches to minimize future Legionella outbreaks.
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Affiliation(s)
- C Caicedo
- Leibniz University Hannover, Institute for Sanitary Engineering and Waste Management, Hannover, 30167, Germany.
| | - K-H Rosenwinkel
- Leibniz University Hannover, Institute for Sanitary Engineering and Waste Management, Hannover, 30167, Germany
| | - M Exner
- University of Bonn, Institute for Hygiene and Public Health, Bonn, Germany
| | - W Verstraete
- Ghent University, CMET, Ghent, and Avecom, Wondelgem, Belgium
| | - R Suchenwirth
- Public Health Office of Lower Saxony, Hannover, Germany
| | - P Hartemann
- Faculty of Medicine, Department of Environment and Public Health, Nancy University-CHU Nancy, Vandoeuvre Les Nancy, France
| | - R Nogueira
- Leibniz University Hannover, Institute for Sanitary Engineering and Waste Management, Hannover, 30167, Germany.
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44
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Gebel J, Gemein S, Kampf G, Pidot SJ, Buetti N, Exner M. Isopropanol at 60% and at 70% are effective against 'isopropanol-tolerant' Enterococcus faecium. J Hosp Infect 2019; 103:e88-e91. [PMID: 30711531 DOI: 10.1016/j.jhin.2019.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/28/2019] [Indexed: 02/06/2023]
Abstract
The bactericidal activity of isopropanol was determined against Enterococcus faecium ATCC 6057, ST 796 (isopropanol-tolerant strain) and Enterococcus hirae ATCC 10541 (EN 13727). Isopropanol at 60% and 70% were effective (≥5.38 log10-reduction) in 15 s against all strains but 23% isopropanol was not (<0.99 log10-reduction in ≤15 min). Isopropanol at 70% was tested against E. faecium in the four-field test. Eight millilitres was not effective enough in 1 min (<5 log10-reduction), whilst 16 mL was effective (≥5.85 log10-reduction). Healthcare workers can be reassured that 60% and 70% isopropanol with an appropriate volume are effective against E. faecium.
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Affiliation(s)
- J Gebel
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - S Gemein
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - G Kampf
- Institute for Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - S J Pidot
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Victoria 3010, Australia
| | - N Buetti
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
| | - M Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
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45
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Voigt AM, Faerber HA, Wilbring G, Skutlarek D, Felder C, Mahn R, Wolf D, Brossart P, Hornung T, Engelhart S, Exner M, Schmithausen RM. The occurrence of antimicrobial substances in toilet, sink and shower drainpipes of clinical units: A neglected source of antibiotic residues. Int J Hyg Environ Health 2019; 222:455-467. [PMID: 30622005 DOI: 10.1016/j.ijheh.2018.12.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/22/2018] [Accepted: 12/31/2018] [Indexed: 12/18/2022]
Abstract
Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference. To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02 μg·L-1 to a maximum of 79 mg·L-1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.
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Affiliation(s)
- A M Voigt
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - H A Faerber
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
| | - G Wilbring
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - D Skutlarek
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - C Felder
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - R Mahn
- Medical Clinic, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - D Wolf
- Medical Clinic, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany; University Clinic V, Dpt. Hematology and Oncology, Medical University Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - P Brossart
- Medical Clinic, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - T Hornung
- Clinic and Polyclinic for Dermatology and Allergology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - S Engelhart
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - M Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - R M Schmithausen
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
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46
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Hoffmann J, Exner M, Bremicker K, Stumpp P, Stepan H. Diagnostik des unteren Uterinsegments bei Status nach Sectio – Erkenntnisse aus einer 3T MRT Studie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- J Hoffmann
- Universität Leipzig, Geburtsmedizin, Leipzig, Deutschland
| | - M Exner
- Universität Leipzig, Diagnostische und Interventionelle Radiologie, Leipzig, Deutschland
| | - K Bremicker
- Universität Leipzig, Diagnostische und Interventionelle Radiologie, Leipzig, Deutschland
| | - P Stumpp
- Universität Leipzig, Diagnostische und Interventionelle Radiologie, Leipzig, Deutschland
| | - H Stepan
- Universität Leipzig, Geburtsmedizin, Leipzig, Deutschland
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47
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Kämpfer P, Glaeser SP, Packroff G, Behringer K, Exner M, Chakraborty T, Schmithausen RM, Doijad S. Lelliottia aquatilis sp. nov., isolated from drinking water. Int J Syst Evol Microbiol 2018; 68:2454-2461. [PMID: 29932385 DOI: 10.1099/ijsem.0.002854] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Five beige-pigmented, oxidase-negative bacterial isolates, 6331-17T, 6332-17, 6333-17, 6334-17 and 9827-07, isolated either from a drinking water storage reservoir or drinking water in 2006 and 2017 in Germany, were examined in detail applying by a polyphasic taxonomic approach. Cells of the isolates were rod-shaped and Gram-stain-negative. Comparison of the 16S rRNA gene sequences of these five isolates showed highest sequence similarities to Lelliottia amnigena (99.98 %) and Lelliottia nimipressuralis (99.99 %). Multilocus sequence analyses based on concatenated partial rpoB, gyrB, infB and atpD sequences confirmed the clustering of these isolates with Lelliottia species, but also revealed a clear distinction to the closest related type strains. Analysis of the genome sequences of these isolates indicated >70 % in silico DNA-DNA hybridization and high average nucleotide identities between strains. Nevertheless, they showed only <70 and <95 % similarity to the type strains of these two Lelliottia species. The fatty acid profiles of these isolates were very similar and consisted of the major fatty acids C16:0, C17 : 0cyclo, C15 : 0iso 2-OH/C16 : 1ω7c and C18 : 1ω7c. In addition, physiological/biochemical tests revealed high phenotypic similarity to each other. These cumulative data indicate that these isolates represent a novel Lelliottia species, for which the name Lelliottia aquatilis sp. nov. is proposed, with strain 6331-17T (=CCM 8846T=CIP 111609T=LMG 30560T) as the type strain.
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Affiliation(s)
- Peter Kämpfer
- 1Institut für Angewandte Mikrobiologie, Universität Giessen, Giessen, Germany
| | - Stefanie P Glaeser
- 1Institut für Angewandte Mikrobiologie, Universität Giessen, Giessen, Germany
| | | | - Katja Behringer
- 3Institute for Hygiene and Public Health, University Hospital Bonn, Germany
| | - Martin Exner
- 3Institute for Hygiene and Public Health, University Hospital Bonn, Germany
| | - Trinad Chakraborty
- 4Institute for Medical Microbiology, Justus-Liebig University Giessen, German Centre for Infection Research Site Giessen-Marburg-Langen, Giessen, Germany
| | | | - Swapnil Doijad
- 4Institute for Medical Microbiology, Justus-Liebig University Giessen, German Centre for Infection Research Site Giessen-Marburg-Langen, Giessen, Germany
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48
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Hoffmann J, Exner M, Bremicker K, Stumpp P, Stepan H. Mögliche Antworten auf alte Fragen: Eine MRT-Studie des unteren Uterinsegments. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1660604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- J Hoffmann
- Universität Leipzig, Abteilung für Geburtsmedizin
| | - M Exner
- Universität Leipzig, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie
| | - K Bremicker
- Universität Leipzig, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie
| | - P Stumpp
- Universität Leipzig, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie
| | - H Stepan
- Universität Leipzig, Abteilung für Geburtsmedizin
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49
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Hoffmann J, Exner M, Bremicker K, Stepan H. Evaluation der Diagnostik des unteren Uterinsegments bei Status nach Sectio mittels MRT. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1645913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- J Hoffmann
- Universität Leipzig, Abteilung für Geburtsmedizin, Liebigstrasse 20a, 04103 Leipzig
| | - M Exner
- Universität Leipzig, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Liebigstrasse 20, 04103 Leipzig
| | - K Bremicker
- Universität Leipzig, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Liebigstrasse 20, 04103 Leipzig
| | - H Stepan
- Universität Leipzig, Abteilung für Geburtsmedizin, Liebigstrasse 20a, 04103 Leipzig
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50
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Müller H, Sib E, Gajdiss M, Klanke U, Lenz-Plet F, Barabasch V, Albert C, Schallenberg A, Timm C, Zacharias N, Schmithausen RM, Engelhart S, Exner M, Parcina M, Schreiber C, Bierbaum G. Dissemination of multi-resistant Gram-negative bacteria into German wastewater and surface waters. FEMS Microbiol Ecol 2018; 94:4963742. [DOI: 10.1093/femsec/fiy057] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/05/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Heike Müller
- University of Bonn, University Hospital, Institute for Hygiene and Public Health, 53105 Bonn, Sigmund-Freud-Str. 25, Germany
| | - Esther Sib
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Mike Gajdiss
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Ursula Klanke
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Franziska Lenz-Plet
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Vanessa Barabasch
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Cathrin Albert
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Anna Schallenberg
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Christian Timm
- University of Bonn, University Hospital, Institute for Hygiene and Public Health, 53105 Bonn, Sigmund-Freud-Str. 25, Germany
| | - Nicole Zacharias
- University of Bonn, University Hospital, Institute for Hygiene and Public Health, 53105 Bonn, Sigmund-Freud-Str. 25, Germany
| | - Ricarda Maria Schmithausen
- University of Bonn, University Hospital, Institute for Hygiene and Public Health, 53105 Bonn, Sigmund-Freud-Str. 25, Germany
| | - Steffen Engelhart
- University of Bonn, University Hospital, Institute for Hygiene and Public Health, 53105 Bonn, Sigmund-Freud-Str. 25, Germany
| | - Martin Exner
- University of Bonn, University Hospital, Institute for Hygiene and Public Health, 53105 Bonn, Sigmund-Freud-Str. 25, Germany
| | - Marijo Parcina
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Christiane Schreiber
- University of Bonn, University Hospital, Institute for Hygiene and Public Health, 53105 Bonn, Sigmund-Freud-Str. 25, Germany
| | - Gabriele Bierbaum
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
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