DISINFACTS | Issue 2/2022

Digital protects better! Reduce the risk of infection with automated hand hygiene monitoring DISINFACTS ISSUE 02/2022

PRACTICE Fit for the future with automated solutions 04 Monkeypox, avian flu & Co. 12 New VAH requirement for hygienic hand disinfectants 17 STUDIES News from the world of science 16 Digital solutions from HARTMANN such as automated hand hygiene monitoring help to minimise the risk of infection in healthcare facilities: The disinfectant dispensers and employees are equipped with sensors and transponders for this purpose. The results are presented graphically in real time. FORUM CLEAN HOSPITALS DAY on 20.10. 06 Long-term consequences of nosocomial and other serious infections 08 “Patient room of the future” now as a study and real laboratory 13 POSTER Efficacies of disinfectants 10 KNOWLEDGE 200 years of Louis Pasteur 14

3 Editorial Dear readers, Digital applications can improve hygiene in many areas. For example, an automated hand hygiene monitoring system can provide you with reliable data on hand hygiene compliance in your facility. And in real time. We’ll introduce you to such a monitoring system on the following pages in this issue. There, you will also learn how NosoEx® – as this system is called – fits into our overall digital concept. Every 20 October, CLEAN HOSPITALS DAY reminds us that surface disinfection in hospitals and healthcare facilities must not be neglected. But there is still “a lot of room for improvement”, especially when it comes to hygienic cleaning of surfaces, says Dr. Marco Krewing in the interview in the middle of this magazine. As a representative of the HARTMANN SCIENCE CENTER, he attended the conference on the occasion of the day of action in Geneva – and also brought back solutions. Finally, we would like to remember a man whose 200th birthday is at the end of December this year: He was a universal scientist and researcher who revolutionised medicine and saved millions of lives. He also influenced the development of today‘s PAUL HARTMANN AG some 150 years ago. Without him, we would probably not be writing this editorial for you now. Do you already know who it is? Yours, Dr. Heide Niesalla Head of HARTMANN SCIENCE CENTER Dr. Henning Mallwitz Director Research & Development Dr. Heide Niesalla Dr. Henning Mallwitz

PRACTICE 4 Fit for the future with automated solutions Digital hygiene applications NosoEx® makes hand hygiene in hospitals transparent Hand hygiene is generally regarded as one of the key measures to prevent nosocomial infections. For this to be effective, not only must high-performance hand disinfectants be used, but all employees must also participate. However, the average hand hygiene compliance (HHC) in German hospitals is only between 41-55% [1] and is thus in any case in need of improvement. It is estimated that a 10% increase in HHC could reduce nosocomial infections by 6-15% [2, 3]. To improve HHC and thus combat nosocomial infections, the company GWA Hygiene GmbH from Stralsund has developed the digital application NosoEx®. Due to the common goal of combating nosocomial infections, HARTMANN and GWA Hygiene have entered into a partnership that enables HARTMANN to distribute NosoEx®. But what is NosoEx® actually? As a hand hygiene monitoring system, it records all hand disinfections in the clinic around the clock and Digitalisation in Germany has been advancing in leaps and bounds, and not just since the COVID-19 pandemic. Especially in the field of health and hygiene, numerous developments have been made in recent years that will be indispensable in the future. Therefore, as part of a holistic approach to preventing nosocomial infections, HARTMANN is increasingly relying on digital solutions such as the automatic hand hygiene monitoring NosoEx® and other mobile applications. makes the results available in intuitive dashboards. Since this is done automatically, the so-called Hawthorne effect – the change in behaviour that occurs through direct observation – is reduced. At the same time, situations that were previously difficult to observe (e.g. at night and on weekends) can be observed and new information (e.g. amount dispensed per hand disinfection) can be obtained. In addition, the system quickly identifies disinfectant dispensers with critical fill levels so that the containers can be replaced. This is made possible by sensors that are compatible with both wall and point-of-care dispensers and mobile bottles and detect all hand disinfectants. Optionally, transponders worn by ward staff can be used, which anonymously differentiate the data collected according to occupational groups (e.g. nurses, doctors, therapists). All data collected is transferred to a server in a certified computer centre in Germany, analysed and made available to the hospital in an online dashboard. 1. Sensor module 2. Transponder 3. Data Hub How NosoEx® works 1. Existing dispensers will be equipped with sensor modules and will automatically record all disinfections and dispensing quantities. 2. All employees will receive transponders that enable an analysis of hand disinfection behaviour by occupational group. 3. The data is transferred to a data hub and from there to a certified German data centre for evaluation.

5 PRACTICE Sources: 1. Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI) (2016) Händehygiene in Einrichtungen des Gesundheitswesens. Bundesgesundheitsbl;59: 1189–1220. https://doi.org/10.1007/s00103-016-2416-6 2. Grayson ML et al. (2018) Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study. Lancet Infect Dis;18: 1269–1277. https://doi.org/10.1016/s1473-3099(18)30491-2 3. Sickbert-Bennett EE et al. (2016) Reduction of Healthcare-Associated Infections by Exceeding High Compliance with Hand Hygiene Practices. Emerg Infect Dis;22: 1628–1630. https://doi.org/10.3201/eid2209.151440 4. https://www.nrz-hygiene.de/KISS-Modul/KISS/HAND (retrieved on 08.09.2022) First joint NosoEx® study by HARTMANN and GWA Hygiene confirms success The NosoEx® system is already being used by a number of German healthcare facilities and was also tested in a first joint pilot study by the two partners HARTMANN and GWA Hygiene over a period of 7 months on two wards of the Bamberg Social Foundation. In order to generate meaningful comparative data, the control ward was only equipped with sensors on the dispensers, while the intervention ward received dispenser sensors as well as transponders differentiated according to occupational groups. In addition, a monitor in the ward room always showed the staff of the intervention ward their current NosoEx® data as feedback. The result: on the intervention ward, the number of hand disinfections increased by 11.2%, the amount dispensed per hand disinfection by 16.3% and the consumption of hand disinfectants by 23.2% compared to the control ward (see figure). Results of the staff survey (before and after comparison) also showed that two thirds of the respondents felt more motivated to follow up on their own hand hygiene due to NosoEx® and 77% were open to a permanent introduction of the system. Lena Schomakers, project manager for hospital hygiene and public health at the HTK Hygiene Technology Competence Centre in Bamberg, also spoke very positively about the system in an interview: “NosoEx® has a positive impact on the visibility of hygiene on the ward. I think that everyone was reminded of the importance of hand hygiene every day by the feedback monitor and the transponders. It would be even better if not only two wards, but a whole hospital were equipped with it. When everyone is in the same boat, the wards motivate each other.” That is why NosoEx® can be an important building block of a good HHC, she emphasised in conclusion. Since August 2022, the system has been gradually implemented by HARTMANN in interested clinics in Germany. Other pilot studies are also underway. Learn more about our digital solutions here: https://nosoex.com/en/home/ https://www.hartmann.info/en-corp/missioninfection-prevention/observe-my-hygienesop-empathy-is-key https://www.hartmann.info/en-corp/missioninfection-prevention/my-hygiene-sop-avirtual-assistant-for-better-care HARTMANN Hygiene Platform: Further digital modules round off hygiene monitoring As promising as the use of NosoEx® alone is, hygiene monitoring becomes even more interesting in combination with other applications. To combine these, users can use the HARTMANN Hygiene Platform, which currently combines the modules “Observe“ and “My Hygiene SOP“. With the Observe module, the HHC of the 5 moments of hand hygiene can be recorded and evaluated. For users in Germany, a direct interface to the surveillance module HAND-KISS of the National Reference Center for Surveillance of Nosocomial Infections (NRZ) allows for a fully comprehensive observation of hand hygiene. “My Hygiene SOP“ focuses on hygiene compliance in standard workflows. The visual representation of complex processes breaks them down into individual and practicable steps and brings them into a logical sequence. As a result, compliance with the individual steps can be observed, recorded and evaluated. The increased transparency thus makes it possible to derive targeted measures to prevent infection. Both “Observe“ and “My Hygiene SOP“ record the data anonymously, evaluate it automatically and present it graphically in a descriptive manner, thus saving a lot of time for the staff. Of course, we are working on bringing our digital solutions together on one platform in the future. Thanks to this platform, hygiene departments will be able to monitor and analyse the hygiene compliance of their hospitals in a comprehensive way in order to initiate targeted intervention measures if necessary. While the HARTMANN Hygiene Platform is already available for use in Germany, the Czech Republic and Slovakia, Austria, Switzerland, Spain, Hungary and the Netherlands will follow shortly with applications in their respective national languages. Increase in % Percentage increase intervention vs. control ward 25 20 15 10 5 0 HD: Hand disinfection; HDM: Hand disinfectant Number HD Amount dispensed per HD Consumption HDM

6 FORUM CLEAN HOSPITALS DAY on 20.10. “Proper cleaning is active protection against infection!” When it comes to protecting against nosocomial infections, the entire hospital is called upon. CLEAN HOSPITALS DAY on 20 October therefore advocates for improved hospital hygiene. There is still “a lot of room for improvement“, especially in the hygienic cleaning of surfaces, says microbiologist Dr. Marco Krewing. As a representative of the HARTMANN SCIENCE CENTER (HSC), the expert in surface hygiene took part in the “Clean Hospitals Day International Conference“, which was held in Geneva on the awareness day. Dr Krewing, the CLEAN HOSPITALS Initiative is campaigning for improvements in the field of hospital cleaning, among other things. Is hygienic cleaning still underestimated in the healthcare sector? “We are already on the right track when it comes to cleaning our hands and hand disinfection. It has become part of people’s minds now and it is also done frequently and well. However, surface disinfection is still neglected. The health risk from poor surface hygiene should not be underestimated; many pathogens can remain infectious on surfaces for a very long time. In this case and for many other pathogens, the following applies: Proper cleaning is active protection against infection! Surface hygiene is only one component of the entire CLEAN HOSPITALS Initiative, but if you already have good compliance with hand hygiene, surface hygiene is the area in which a great increase in safety for patients and staff can be achieved with a just a few simple measures. In short, there is often still room for improvement in surface disinfection!” The CLEAN HOSPITALS Initiative has a global commitment. Is there a need for global cleaning standards? “It is important to have generally recognised cleaning standards in the healthcare sector. Gladly also on an international level. Gladly also on worldwide. Recommendations developed by experts ensure that no important measures are forgotten and that everyone is on the same level everywhere.” Then the standards would only have to be implemented everywhere, right? “Yes, that is an important point. The CLEAN HOSPITALS Initiative has developed a questionnaire that asks hospitals worldwide about the current state of affairs. However, putting standards into practice – filling them with life – is a challenge that must be tackled individually in the hospitals. With cleaning staff, who often come from many different countries, language is often a problem. Illustrative posters have proven to be very helpful because, for many, pictures are easier to understand than words. We at the HARTMANN SCIENCE CENTER are constantly developing such posters. But CLEAN HOSPITALS, with its global reach, has completely different possibilities. This is another reason why we are involved in the initiative. In order for the cooperation between the cleaning staff and the hygiene specialists to be successful, good communication is fundamentally important. Which surfaces should be cleaned and how? That should be clear to everyone. An open error culture is also crucial: forgotten surfaces or wrong dosages should be able to be addressed without fear. Otherwise, nothing will change!” Dr. Marco Krewing, Applied Scientist at HARTMANNSCIENCECENTER CLEAN HOSPITALS Initiative: Visit the website and learn more about the importance of hospitals as health environments! https://cleanhospitals.com 20.10.2022 DAY

7 FORUM The international CLEAN HOSPITALS Initiative was founded in 2018. Partners from science, industry, non-governmental organisations and government agencies work together in it. The aim is to increase hygiene in the hospital environment and improve the visibility of the hospital environment in patient care. CLEAN HOSPITALS is an independent source of information for both hygiene professionals and the general public. The initiative conducts research on surface cleaning and produces training and certification programmes as well as evidence-based recommendations. HARTMANN supports the CLEAN HOSPITALS Initiative as a participating partner. As a leading manufacturer of products for hand and surface disinfection, skin care and skin antisepsis, we are fully committed to the goal of infection prevention. At CLEAN HOSPITALS, HARTMANN is involved in the “Mapping Guidelines” working group and works with partners to prepare position papers and recommendations for issues where existing guidelines are ambiguous. In the “Transposable Model” working group, we are working on the development of an analysis tool for hospital hygiene. HARTMANN and the international CLEAN HOSPITALS Initiative w fewer healthcare- associated infections w interdisciplinary exchange w better health and safety at work w less antibiotic resistance Working group “Mapping Guidelines“ Goal: Close knowledge gaps / resolve professional conflicts w model for the analysis of the hygiene situation w help with planning improvements w identify key factors for hygiene Standards Working group “Transposable Model“ Goal: An analysis tool for hospital cleaning

FORUM 8 Long-term consequences of nosocomial and other serious infections Sick despite recovery Nosocomial infections (NI) are a serious problem in the health sector, causing not only great suffering for those affected, but also high costs. It is not without reason that a number of hygiene measures are aimed at preventing NI from the outset. However, while some attention is paid to the acute problem, e.g. through targeted detection of NI, many of those affected remain severely impaired long after their official recovery and yet are hardly noticed by the public. At present, meaningful data are mainly available on sepsis survivors [1-3], but other infections can also have serious long-term consequences, as the example of long COVID shows. High morbidity among sepsis survivors Sepsis is a life-threatening disease that still kills one in five people as a direct consequence, even in Germany [4]. Although it is known that sepsis survivors often struggle with severe longterm consequences, these consequences are not sufficiently documented in Germany. Fleischmann-Struzek et al. have now impressively shown how many people are actually affected in a retrospective cohort study based on the health insurance data of 23 million AOK policyholders [1]. The study showed that 74.3% of all survivors – i.e. almost three quarters – received a further diagnosis in the first year after overcoming an acute illness, most of them of a medical nature. The situation did not improve much in the second and third year after that [1]. Sepsis, bloodstream infections and pneumonia shorten longterm survival Mortality after surviving sepsis is also alarmingly high: Fleischmann-Struzek et al. found mortality rates of 30.7% in the first, 14.6% in the second and 13.2% in the third post-sepsis year [1]. But even bloodstream infections per se (with or without sepsis) increase the subsequent risk of death, as an Australian cohort study showed: Here, the 5-year survival of patients with a positive culture for Gram-negative bacteria was 52% compared to 65% without a positive culture [2]. And surviving nosocomial pneumonia also have a similarly drastic effect on 5-year survival as sepsis [5].

9 FORUM Follow-up care can improve prognosis Given the severity of such illnesses, it is surprising that the majority of survivors do not receive any subsequent rehabilitation measures. This was shown in a German study based on health insurance data of almost 84,000 patients who survived septic shock, sepsis or a severe infection between 2009 and 2016 [3]. Most of the survivors were discharged from hospital directly home or to home care, while only 14.5% went into rehabilitation after septic shock, 6.3% after sepsis and only 3.3% after severe infection [3]. However, rehabilitative measures seem to be effective, as they reduced the 5-year mortality rate by up to 8% in the study [3]. The burden of disease due to long COVID will only become apparent in the coming years Regarding the rehabilitative care of people who experience longterm impairments after a COVID-19 infection – regardless of its severity – there is still no uniform approach in Germany. It is assumed that up to 40% still have clinically relevant symptoms after a SARS-CoV-2 infection at least a fewweeks tomonths after the acute phase [6]. The limitations are manifold and range from general fatigue, shortness of breath or neurological problems to the worsening or development of diabetes [6]. Multidisciplinary approaches to functional recovery are therefore urgently needed and should, of course, also be developed for survivor of other severe infectious diseases. Sources: 1. Fleischmann-Struzek C et al. (2021) Epidemiology and Costs of Postsepsis Morbidity, Nursing Care Dependency, and Mortality in Germany, 2013 to 2017. JAMA Netw Open;4: e2134290. https://doi.org/10.1001/jamanetworkopen.2021.34290 2. McNamara JF et al. (2022) Long term sepsis readmission, mortality and cause of death following Gram negative bloodstream infection: a propensity matched observational linkage study. Int J Infect Dis;114: 34-44. https://doi. org/10.1016/j.ijid.2021.10.047 3. Rahmel T et al. (2020) Long-term mortality and outcome in hospital survivors of septic shock, sepsis, and severe infections: The importance of aftercare. PLoS One;15: e0228952. https://doi.org/10.1371/journal.pone.0228952 4. https://www.deutschland-erkennt-sepsis.de/#zahlenfakten (retrieved on 01.09.2022) 5. Dick A et al. (2012) Long-term survival and healthcare utilization outcomes attributable to sepsis and pneumonia. BMC Health Serv Res;12: 432. https://doi. org/10.1186/1472-6963-12-432 6. Bornstein SR et al. (2022). Long-COVID, Metabolic and Endocrine Disease. Horm Metab Res;54: 562–566. https://doi.org/10.1055/a-1878-9307 74.3 % 65.8 % 59.4 % 70.9 % 61.3 % 55.0 % 17.9 % 12.8 % 12.2 % 18.5 % 9.8 % 9.8 % Proportion of affected patients with new diagnoses in the 1st/2nd/3rd year after sepsis 100 % 90 % 80 % 70 % 60 % 50 % 40 % 30 % 20 % 10 % 0 % 1-12 months 13-24 months 25-36 months New diagnosis of any kind Medical Psychological Cognitive

Learn more here Efficacies of disinfectants: Bacteria Bacteria Gram-negative Bacteria Gram-positive Bacterial endospores Mycobacteria HSC EN 09.22 Bacteria bactericidal spectrum of efficacy E. coli (Gram -) P. aeruginosa (Gram -) MRSA (Gram +) Examples: Mycobacteria tuberculocidal mycobactericidal Tuberculosis pathogens Example: All mycobacteria (incl. tuberculosis pathogens) spectrum of efficacy M. tuberculosis Examples of spore- forming bacteria: sporicidal All spores (incl. spores) Bacterial spores sporicidal against spores spectrum of efficacy B. subtilis B. cereus (vegetative cells) (vegetative cells) Inner membrane Nucleus Mycolic acid layer Outer membrane Cell wall Membrane is easy to destroy. Difficult for disinfectant to destroy. Cell wall Multilayer envelope Proteins Inner membrane Outer lipid layer is destroyed by the disinfectant. Membrane Spore envelope Protein layer Proteins Proteins are no longer functional after disinfection. All bacterias excl. mycobacteria Outer lipid layer

#1 #2 #3 EN 13727 & EN 14348 & EN 17126* | Suspension test Phase 2 / Step 1: bactericidal, tuberculocidal, mycobactericidal, sporicidal against , sporicidal * * EN 1500 | Hygienic hand disinfection Phase 2 / Step 2: bactericidal EN 12791 | Surgical hand disinfection Phase 2 / Step 2: bactericidal EN 16615 | Carrier test (4-field-test) Phase 2 / Step 2: bactericidal ... the mixture is culti- vated in a petri dish. The bacterial colonies are counted. An effective disinfectant should have inactivated a particular number of bacteria. Hands of subjects are artificially contaminatedwith an innocous test The hands are washed with soap. After drying, the finger tips are sampled (#1). After drying, the finger tips are sampled (#1). Performance of a hygenic hand disinfection with the product tested (30-60 sec.). Performance of a surgical hand disinfection with the product tested (1-5 min). The finger tips are sampled again (#2). A glove is put on one hand... After 3 hours the the glove is removed and the hand sampled (#3). … while the other hand is sampled (#2). The bacterial colonies are counted. An effective disinfectant should at least be equally effective as a reference alcohol after 60 sec. application time. The bacterial colonies are counted. An effective disinfectant should at least be equally effective as a reference alcohol after 3 min application time. Test methods of disinfectants: Bacteria Specific test pathogens together with an organic challenge (protein, and if necessary blood) are mixed with the disinfectant. * only surfaces The bottomside of a standardized weight is equipped with a disinfectant-soaked wipe. Subsequently, the fields are wiped with the weight. #1 #2 #3 #4 After a definded time... The bacterial colonies are counted. An effective disinfectant should have inactivated a particular number of bacteria. #1 #2 #3 #4 Specific test pathogens together with an organic challenge are applied to the first field. Surface Hands HSC EN 09.22 #1 #2 #1 #2 #3 pathogen.

PRACTICE 12 The monkeypox virus (Orthopoxvirus simiae) is an enveloped virus of the genus Orthopoxvirus. To prevent transmission in healthcare facilities, good hand hygiene with at least a limited virucidal hand disinfectant is recommended. It is also advisable to change gloves according to the indications. In addition, an FFP2 mask and personal protective equipment (PPE) should be worn when caring for sick persons. Disinfectants with at least a limited virucidal spectrum of activity should also be used for surface disinfection. Since viruses can remain infectious on surfaces for a long time, it is essential to observe the exposure times. Find out more at: https://www.hartmann-science-center.com/en/top-issues/monkeypox Monkeypox: limited virucidal disinfectants are sufficient – viruses persist for a long time Always up to date Monkeypox, avian flu & Co. Which disinfectants are most effective against the currently widespread infectious diseases? All relevant information on monkeypox, avian flu or coronavirus, as well as on the efficacy of disinfectants can be found by hygiene professionals from the healthcare and veterinary sectors on the HARTMANN SCIENCE CENTER (HSC) website. We have compiled the most important news for you here. Bird flu (correct name: avian influenza) is an infectious disease in birds caused by viruses. Wild waterfowl are the natural reservoir host. Only in exceptional cases – exposure to a high infectious dose – these viruses can cause illness in humans. However, under certain circumstances, this can lead to a serious or even fatal course of the disease. According to the Friedrich Loeffler Institute (FLI), which is responsible for animal health, 934 cases of infected wild birds and 31 outbreaks in poultry and farmed birds were reported in Germany from January to July this year. The current disease season of 2021/22 is the largest ever observed in Europe, according to the European Centre for Disease Control (ECDC). The virus is particularly widespread in coastal areas. The risk of introduction into poultry farms and bird populations is considered particularly high in these regions. For chemical disinfection, agents with proven efficacy in the limited virucidal or virucidal range should be used. Avian flu: High risk on the coasts – Optimise biosecurity in poultry farms Another animal disease that is currently rampant in Europe is African swine fever (ASF). Only wild and domestic pigs are affected. However, ASF is not a zoonosis, i.e. it is not an infectious disease that can be transmitted between animals and humans. The causative agent is an Asfi virus (an enveloped double-stranded DNA virus). It is transmitted through direct contact with infected animals or carcasses, by ingesting food waste or pork products or preparations. There are also indirect routes of transmission (vehicles, contaminated equipment including hunting equipment, agricultural equipment and machinery, clothing). For prevention, the German Veterinary Medical Association (DVG) advises using disinfectants that are recommended in the DVG list of disinfectants for animal husbandry (in column 7b for limited virucidal activity). African swine fever: No danger for humans – Preventive disinfection recommended

13 FORUM “Patient rooms of the future” now as a study and real laboratory From prototype to demonstrator Fromnowon, themodel of the “patient roomof the future” will be used in Braunschweig, Germany, to optimise the infection-preventive accommodation of patients. As an industrial partner, HARTMANN supported the research project both financially and actively with expertise – and contributed, among other things, an innovative disinfectant dispenser to the new room. Since the end of August 2022, the “patient room of the future“ has been on the grounds of the Braunschweig Municipal Hospital as a study and real laboratory. The walk-in one-to-one model of a two-bed hospital room is the result of a joint project funded by the German Federal Ministry of Education and Research (BMBF) in which architects, designers, molecular biologists and physicians, among others, were involved. The aim of the project, which began in 2016 and is entitled KARMIN (for “Krankenhaus, Architektur, Mikrobiom und Infektion”), was to minimise the risk of pathogen transmission through intelligent room planning and to realise the prototype of a hospital double room that is equipped in a way that makes sense in terms of infection prophylaxis. The prototype was built as a demonstrator and presented at the Berlin “World Health Summit“ in 2020. Demonstrator as a test laboratory The patient room demonstrator that has now been set up in Braunschweig will be used as a research and study laboratory in the coming years. For example, it will be used to test care, treatment and cleaning scenarios for training clinical staff. There are also plans to further optimise furnishing elements, the room layout, lighting, materials and surfaces. HARTMANN and KARMIN: PoC dispensers and explanatory videos HARTMANN has been an industrial partner of the project through BODE Chemie since 2018. In order to be able to combine high hygiene standards and sensible care processes, details such as the position of the hand disinfectant dispensers also played an important role in the design of the future-oriented patient room. Among other things, HARTMANN is represented in the demonstrator with the Eurospender 3 flex. It can be attached directly to the point of care in the immediate vicinity of the patients, for example on the bed or on the trolley. The expertise of the HARTMANN specialists was also incorporated into the positioning of the hand disinfectant dispensers permanently installed on the walls (including Eurospender Safety plus). In order to sensitise patients and visitors to the importance of hand hygiene, three motivating explanatory videos were made available. They were integrated into the bedside infotainment systems.

KNOWLEDGE 14 Louis Pasteur made the world a better place. The Frenchman’s findings revolutionised medicine, saved millions of lives and inspired generations of researchers. And about 150 years ago, he gave an entrepreneur in distant Heidenheim the decisive business idea: it changed surgery forever. Universal researcher and first infectiologist 200 years of Louis Pasteur When little Louis took his first breath in the French provinces on 27 December 1822, microorganisms were already known. The idea that these tiny “microbes”, visible only with the aid of a microscope, could be dangerous to a living being like us humans, however, was not shared by experts. Medical scholars preferred to adhere to the idea that diseases were spread via “miasmas” – foul odours and vapours from the earth. When Louis Pasteur died on 28 September 1895, he had dispelled such misconceptions and established new theories, not only in medicine. The chemist: mirror-image isomers Even though Louis Pasteur is often referred to as a “chemist” in encyclopaedias, like almost all natural scientists of his time, he was actually a polymath. In any case, the first scientific spurs he earned as a young researcher belong to chemistry: today, Pasteur is considered the founder of stereochemistry. While examining tartaric acid crystals in the late 1840s, he discovered that there were two variants whose shapes behaved like an image and a mirror image of each other. The food chemist: from fermentation to microbiology On behalf of his sponsors, the research talent then turned to more applied issues from 1850 onwards: In the coming years, he worked on fermentation processes in beer, wine and vinegar and the production of alcohol. In doing so, he looked deeply and thoroughly into the test tube and thus laid the foundation for microbiology. His groundbreaking discovery at the time: fermentation is a consequence of the activity of living microorganisms and not an abiotic process. Specific microorganisms are responsible for each type of fermentation. The source of these microorganisms is the air. In addition, he was the first to describe a metabolic regulation: depending on the availability of oxygen, yeast fungi switch from oxidative to anaerobic pathways when breaking down carbohydrates (today’s name: Pasteur effect). The preserver: Pasteurisation of foodstuffs In the German-speaking world, Louis Pasteur is best known today for a process for preserving liquid foods: pasteurisation, named after him. In this process, the food is heated to 60 to 90 degrees for a few seconds and then cooled again. The process is the logical consequence of the knowledge he gained during his fermentation studies: Unlike sterilisation, the spores of microorganisms are not killed, but the vegetative forms of most pathogenic germs are. The veterinarian: caterpillars, cows, germs... From 1865 onwards, Pasteur turned his attention to living multicellular organisms on behalf of the government. He researched silkworms. These insects, which were economically very important at the time, had several diseases. One of them, Pasteur had discovered, was transmitted faecal-orally. He had thus found the subject of his life: the study of transmissible diseases. Since he already knew that microbes were responsible for fermentation, he wondered whether they might also cause diseases. And indeed: he proved that “the bacterium contains the infection” with anthrax, a plague affecting cows and sheep, and by 1880 he had drafted the concept of infectious diseases: the “germ theory of diseases”. The vaccination visionary: air-drying against rabies How could such diseases be combated? Pasteur was familiar with the principle of vaccination: After all, Edward Jenner had already “invented” smallpox vaccination in 1796. Silkworm

15 Jenner did not know why this worked. Nor that viruses were the triggers. Pasteur‘s ground-breaking idea: microbes were the triggers. And these could be changed and weakened! Pasteur had been convinced of this since Charles Darwin had explained in 1859 that living beings can adapt, that they are changeable. And the visionary was right: by air-drying samples of infected tissue, he succeeded in weakening the pathogens to a level suitable for vaccination. In this way, he and his colleagues developed the first vaccines against anthrax, fowl cholera and, in 1885, against rabies, which is fatal for humans. The hygienist: Hands off! The knowledge of the dangers of pathogenic microbes also influenced his own behaviour: The late Pasteur is said to have avoided shaking hands for fear of bacteria. He cleaned his dishes before eating. His summer house in Arbois in the French region of Jura (now a museum) reveals other hygiene innovations that were not standard at the time: hot and cold running water and a bathtub. Pasteur also promoted antiseptic work early on in the professional world. The driving force: Pasteur and the HARTMANN GROUP The discoveries and ideas of Louis Pasteur also had a decisive influence on the development of the HARTMANN GROUP. Paul Hartmann (1812-1884), the son of our company founder Ludwig von Hartmann, converted his father’s spinning mill into a dressing material factory. One of his partners was the English surgeon Joseph Lister. Inspired by Pasteur’s findings that wound infections are often caused by germs in the air, Lister developed the first antiseptic wound dressing in the 1870s. For this purpose, he soaked wound dressings in carbolic acid. In England, however, this was viewed with scepticism and rejected. Not so in Heidenheim: Paul Hartmann recognised the potential. Together with Lister, he developed cost-effective carbolic gauze. It was later to be described as “the greatest turn in the history of surgery”. KNOWLEDGE “If I had the honour of being a surgeon, I would never insert an instrument of any kind into the human body without exposing it to boiling water, or better still, a flame, and then quickly cooling it down before the operation”. Louis Pasteur (1822-1895)

16 STUDIES The threat of antimicrobial resistance (AMR) is steadily increasing all over the world. In cooperation with the Antimicrobial Resistance Collaborators, the Robert Koch Institute recently compiled an overview that illustrates the disease burden caused by AMR in the G7 countries and points to the global threat [1]. It is clear that the further spread of AMR can only be combated through joint international efforts, as the World Antimicrobial Awareness Week (WAAW) and the European Antibiotic Awareness Day (EAAD) emphasise every year in November. For an overview, please see: https://doi.org/10.25646/10217 Brief information: News from the world of science Sources: 1. Antimicrobial Resistance Collaborators Institute for Health Metrics and Evaluation & Robert Koch-Institut. Antimikrobielle Resistenzen: Krankheitslast in G7- Staaten und weltweit. EIN DRINGENDER AUFRUF ZUM HANDELN. Robert Koch-Institut; 2022. 2. WHO (2009) WHO Guidelines on Hand Hygiene in Health Care. 3. Sassenrath C et al. (2022) The impact of activating an empathic focus during COVID19 on healthcare workers motivation for hand hygiene compliance in moments serving the protection of others: a randomized controlled trial study. Z Gesundh Wiss: 1–5. 4. Diefenbacher S et al. (2022). Differences in observed and self-reported compliance with the 5 moments for hand hygiene as a function of healthcare workers‘ empathy. J Hosp Infect: S0195-6701(22)00223-7. Antimicrobial resistance: Act NOW! Good hand hygiene compliance (HHC) in healthcare facilities helps to prevent nosocomial COVID-19 infections. In order to protect patients in direct contact, the “BEFORE“ situations of the “5 moments“ [2] are particularly important. However, these of all things are often not sufficiently taken into account. A recent study therefore examined, with the help of a randomised online survey, to what extent the HHC of health professionals changes when they imagine the effects of a SARS-CoV-2 infection – either on themselves or others [3]. The result: those who focused on others attributed higher importance to HHC in “BEFORE“ moments than when they focused on themselves. Empathy-based interventions could thus be used in the future to improve patient safety. Empathic focus improves hand hygiene to protect patients from COVID-19 Another recent study also examined the influence of empathy on hand hygiene compliance (HHC) in “BEFORE“ moments – albeit independently of COVID-19. This study assessed the relationship between moment-specific HHC rates and health workers‘ empathy through observation and selfassessment questionnaires, both individually and at ward level [4]. It was found that wards and staff with higher empathy levels showed the highest HHC in the allimportant “BEFORE“ moments [2], while lower empathy was associated with lower HHC rates [4]. Interestingly, HHC did not differ significantly between different empathy levels at “AFTER“ moments [4]. Thus, it might be useful to develop empathy-based interventions specifically for “BEFORE“ moments. The article is available free of charge at: https://doi.org/10.1016/j.jhin.2022.07.008 Empathy is also important for hand hygiene compliance in general Read the full article free of charge at: https://doi.org/10.1007/s10389-022-01725-z Learn more about WAAW and EAAD: https://bit.ly/eaad_waaw_en

17 PRACTICE In this issue of DISINFACTS, you will find a double-sided poster on the topic “Effectiveness of disinfectants“. After focusing on viral efficacy in the last issue, the second poster gives an overview of the efficacy of disinfectants against bacteria. On the top of our poster, you can see the differences between Gram-negative and Gram-positive bacteria, as well as mycobacteria and bacterial spores. Poster series Topic: Efficacies of disinfectants – TODAY: Bacteria In addition, you can also see the different effect spectra for these. You will find the corresponding test methods below. In the next issue, you will find a poster on the topic of efficacies against yeasts and fungi.You can also download the current poster as a PDF file from our website at any time and print it out yourself. Download here: bit.ly/poster_bacteria_efficacies NewVAH requirement for hygienic hand disinfectants Volume information required for listing In November 2021, the Disinfectants Commission of the Association for Applied Hygiene (VAH) in Germany published a new requirement to indicate the volume when listing hygienic hand disinfectants [1]. This additional information serves the purpose of transparencyand facilitates the selection of suitable hand disinfectants for users [2]. In the meantime, the information has been integrated into the listings. Why is the volume now specified? In the test reports submitted by the manufacturers, quantities have increasingly been specified that deviate from the previously proven 3 ml and specify 4-6 ml per hygienic hand disinfection. However, hygienic hand disinfection is only effective if the quantity specified by the manufacturer is used and the hands are completely wetted for the exposure time. The established quantity for hygienic hand disinfection is 3 ml*. The work processes and dispenser systems in healthcare facilities are geared to this. Changing the established amount of 3 ml, for example to 2 x 3 ml, increases the effort for the staff as well as the consumption and the costs of the hand disinfectants. In addition, a more difficult application can have an impact on hand hygiene compliance and thus on patient safety. The volume specification, which will now be gradually implemented for new applications and recertifications, allows users to immediately recognise which hand disinfectants have the required efficacy and meet the applicable requirements. Good to know: Sterillium®, Sterillium® classic pure and Sterillium® med are already certified according to the new specification and listed in the VAH list with 3 ml in 30 seconds for hygienic hand disinfection [2]. Sources: 1. Desinfektionsmittel-Kommission im VAH (2021) Volumenangabe bei der Listung von hygienischen Händedesinfektionsmitteln. Hyg Med 46: 242–243. (Updated: 1 November 2021). https://vah-online.de/files/download/vah-mitteilungen/VAH%20Volumenangabe_Haendedesinfektion_HM_11_21.pdf (retrieved on 31.08.2022) 2. https://vah-liste.mhp-verlag.de/ (retrieved on 31.08.2022) * Volume dependent on testing according to EN 1500 Use hand disinfectants safely. Always read the label and product information before use. [Please amend in accordance with local requirements (e.g. law of advertising, product status, CLP labelling)] HARTMANN SCIENCE CENTER hartmann-science-center.com Expert advice Our experts will advise you on our products and on topics related to disinfection, hygiene and infection protection. science-center@hartmann.info Tel.: +49 (0)40 - 54 00 6 -111

We wish you a good start into a successful and healthy 2023! HARTMANN is supporting you. DISINFACTS is published on behalf of BODE Chemie GmbH – A company of the HARTMANN GROUP, Hamburg www.hartmann-science-center.com www.hartmann.info Editorial team: HARTMANN SCIENCE CENTER Text: Dr. Julia Dittmann, Arnd Petry Design: Beling Agentur für visuelle Kommunikation, Hamburg Print: Kabel Druck, Hamburg Picture credits: Title, p. 2/3, IStockphoto/Beling Grafikdesign; p. 8/9: IStockphoto; p. 10/11: LeFee; p. 12: RKI/IStockphoto p.13: Projekt KARMIN/InfectControl, Bildquelle: IKE/Tom Bauer 2020; p. 14/15: BODE/IStockphoto/Wikimedia Commons; p. 16/17: IStockphoto/ Marco Grundt