Infection prevention, reimagined: Review of the HARTMANN SCIENCE CENTER (HSC) Symposium 2024 FORUM All presentations from the event are available on our website. All posters presented during the symposium are also available as PDF files on the website. The event was the continuation of HARTMANN‘s symposium series ‚Safety first - Rethinking infection prevention‘. The two-day symposium was a hybrid event. Most of the participants were online. The symposium was divided into three blocks covering ’Hand Hygiene, Surface Hygiene and Climate Protection & Sustainability‘. Hand hygiene 2.0 The first session focused on current and future challenges in hand hygiene: speakers covered a range of topics, from occupational safety aspects to practical problems in implementing recommendations and requirements for automated electronic systems to monitor compliance. Prof Dr Ojan Assadian (Wiener Neustadt Hospital, Austria) summed up the fundamental importance of hand hygiene for healthcare professionals in his presentation: ’If you work in healthcare, your hands are not your hands, they are medical devices.‘ Hygienist Prof Dr Swen Malte John (University of Osnabrück, Germany) contributed the following phrase to the topic of occupational safety, which all healthcare professionals should always keep in mind: ’Your skin is the most important two square metres of your life’. The third session focused on current and future challenges in hand hygiene: speakers covered a range of topics, from occupational safety aspects to practical problems in implementing recommendations and requirements for automated electronic systems to monitor compliance. Innovations in surface disinfection Another session of the symposium gave delegates an overview of the importance of innovation in surface hygiene. It became particularly clear that the practical testing of disinfectants needs to be constantly developed. Laboratory tests are not suitable for reflecting the ’complex reality in hospitals‘, said Head of the Department for Infection Prevention and Control (IPC) Prof Dr Johannes Knobloch (Medical Center Hamburg-Eppendorf (UKE)). Individual on-site tests are needed to reliably assess the efficacy of surface disinfectants. In view of new pathogens - keyword: ’next pandemic‘ - the development of new disinfectants is also essential, according to the speakers, possibly based on organic acids - or on light or plasma. Climate protection & sustainability The last session highlighted how ongoing climate change and the need for sustainable economic activity will change infection prevention: for example, climate change not only favours the spread of pathogens (e.g. West Nile virus, Usuntu virus) transmitted by mosquitoes in Europe. Higher temperatures in operating theatres also increase the incidence of surgical site infections (SSI), as demonstrated by Prof Dr Andreas Widmer (Basel, Switzerland). Speakers from Germany, Austria and Scotland showed that climate change mitigation in the healthcare sector does not stop at reducing CO2 emissions: hospitals should see ‚waste as a resource‘ and consider sustainability in every clinical decision, for example in the use of anaesthetic gases. Which factors will determine the success of effective infection prevention in the future? Is it mainly new active ingredients? Or is the key to more effective hand and surface hygiene more likely to lie in infrastructure improvements? What role can artificial intelligence play? What impact will climate change have? And what can we learn from past developments? These and other questions were discussed by international experts at the HARTMANN SCIENCE CENTER Symposium ‚Milestones in Infection Prevention and Control‘ in Hamburg in June. Look & Read: Here you will find all posters and presentations from the HSC Symposium https://www.hartmann-science-center.com/en/top-issues/events/hsc-symposium-2024 Skin hydration: CCI brings light into the darkness Müller1, Krewing1, Nowak2, Niesalla1, Gerdes2 1 HARTMANN SCIENCE CENTER, BODE Chemie, a company of the HARTMANN GROUP, Hamburg, Germany 2 BODE Chemie GmbH, a company of the HARTMANN GROUP, Hamburg, Germany Published in sofw journal in 2024 and presented at ICPIC 2023 Introduction Conclusion Contact HSC-AS@hartmann.info Acknowledgement The authors would like to thank Dr. Theresa Callaghan, Callaghan Consulting International Hamburg Germany, and Stephan Bielfeldt of SGS proderm for fruitful discussions. Methods A dermatologist assessed the skin of 20 subjects before (day 1) and after 2 weeks of product application (day 15). The subjects‘ skin improved in terms of parameters such as erythema, dryness, and scaling. Other parameters such as fissures, papules, pustules, edema, vesicles, and weeping were not observed at beginning and end of the study. The skin hydration of the test subjects was measured at the beginning of the study before use of the product (day 1), and 30 min after the last use as well as 3 h later (day 15). To investigate the long-term effect, the measurements were repeated the next day (day 16). CCI uses fingerprint sensor technology to measure and visualise skin hydration. Better skin hydration leads to brighter images. The image above shows the CCI images of one subject over the course of the study. Corneometry - the current gold standard method - was used to confirm the CCI results. Healthy skin is fundamental to hand hygiene, the most effective infection control measure in healthcare facilities1. Therefore, skin-friendly hand disinfectants are essential for skin health, especially for professional users. An intuitive, illustrative and more compelling way of assessing and presenting positive product attributes could encourage compliance with hand hygiene. The aim of this study was to establish a new method to assess and illustrate skin hydration in comparison to conventional corneometry: Capacitive Contact Imaging (CCI)2 Capacitive Contact Imaging (CCI) is based on fingerprint sensor technology. 256×300 individual measurements (pixels) of the skin permittivity are recorded by generating electric fields, which are influenced by the water content of the top layer of the skin. The electric field values are then converted to skin hydration values and illustrative visualisations. Study design • two week exploratory open-label, randomised study • 24 test persons (60% females, 40% males) with healthy or unhealthy skin • 20 product applications per day (Sterillium® foam extra care) • assessment of following parameters on Day 1, 15, and 16: • skin hydration (corneometer) • skin permittivity and hydration (CCI) • tolerability assessment by dermatologist and test persons (day 1 and day 15) • Skin hydration assessment by CCI yielded equivalent results to conventional gold standard corneometry. • CCI has the added benefit of visualising skin hydration. The product tested showed a consistent skin hydrating effect and very good tolerability with repeated use. • The good tolerability was also confirmed by the dermatologist and by the subjects‘ self-assessment. Capacitive Contact Imaging Results number of test subjects Erythema Day 1 Day 15 9 Scaling Day 1 Day 15 4 Dryness Day 1 Day 15 3 no findings very slightly slightly moderate References [1] WHO Guidelines on Hand Hygiene in Health Care. 2009. [2] Imhof, Biox Systems Ltd, „Stratum corneum hyfration measurement using capacitance contact imaging“. 2017. good skin hydration valley in the skin low skin hydration skin CCI: skin hydration [au]* 10 CCI corneo -meter 20 30 Day 1 baseline Day 15 30 min Day 15 3 hours Day 16 corneometer: skin hydration [au]* 20 40 60 *arbitrary units Insights from electronic hand hygiene monitoring Senges1, Herzer2, Norkus2, Krewing1, Mattner3,4, Rose3, Gebhardt2, Mattner3, Niesalla1 1 HARTMANN SCIENCE CENTER, BODE Chemie GmbH, a company of the HARTMANN GROUP, Hamburg, Germany 2 GWA Hygiene GmbH, Stralsund, Germany 3 Institute for Hygiene, Cologne Merheim Medical Centre, University Witten-Herdecke, Cologne, Germany 4 Institute of Rural Studies, Johann Heinrich von Thünen Institute, Braunschweig, Germany Published in IPIP 2024 Introduction Conclusion Acknowledgement The authors would like to thank Lisa Naumann and Cornelius Breitenbach for assistance with data analysis and Thomas Kant for support with project management. Methods In this retrospective study, hand disinfections on wall-mounted dispensers (WMDs) and point-of- care dispensers (POCs) were recorded with NosoEx®. • 211 days • 9 German hospitals • 17 wards • 6 intensive care units (ICU) • 3 intermediate care units (IMC) • 3 orthopaedic and general surgery • 2 neurology • 3 ‘other‘ • 931,446 disinfections Hand hygiene is considered the single most important intervention in the prevention of healthcare-associated infections. However, despite decades of effort, hand hygiene compliance, i.e. performing hand disinfection correctly and at the right moment, is still a global problem. Electronic monitoring tools could provide new insights into healthcare worker behaviour by allowing every hand disinfection to be recorded 24 hours a day, 7 days a week, without an omnipresent observer to influence behaviour. Together with GWA Hygiene GmbH, the HARTMANN SCIENCE CENTER analysed a large number of disinfections recorded with the NosoEx® monitoring system to determine how often hands are disinfected, how much disinfectant is used and where dispensers are used. Our analysis of hand disinfections recorded by NosoEx® showed that dispenser use is influenced by ward type and workflow. While hand disinfection is most frequent in ICU and IMC wards, these wards also use the least amount of disinfectant per disinfection. Where wound care or other aseptic procedures are a primary activity, dispensers should be located close to the patient. While the highest numbers of disinfections per patient day were observed on ICU and IMC wards, these wards also used the lowest volume of disinfectant per disinfection. In general, larger amounts of disinfectant were used per disinfection in the POC dispensers. Results Volume used per disinfection at WMDs (left boxes) and POCs (right, pale boxes). The recommended volume (3 mL) is indicated by a dashed line. wall-mounted dispenser hallway patient room bathroom ICU surgical ICU ICU other neurology orthopaedic/ surgical IMC ward type 8 6 4 2 0 volume per disinfection [mL] 10 disinfections per patient day 80 60 40 20 0 In normal ICUs, dispensers are most commonly used in hallways, and in surgical ICUs they are more commonly used in patient rooms. Hand rub dispensers in corridors can be conveniently used on the go, and frequent hand disinfection in patient rooms in surgical ICUs may be due to intensive care activities, such as contact with open wounds. Frequency of dispenser use on wards, indicated by dot size. Contact HSC-AS@hartmann.info Sustainable fibres for surface disinfection Krewing1, Noderer2, Harms2, Rodriguez-Diaz2, Linke2 1 HARTMANN SCIENCE CENTER, BODE Chemie GmbH, a company of the HARTMANN GROUP, Hamburg, Germany 2 BODE Chemie GmbH, a company of the HARTMANN GROUP, Hamburg, Germany ahead of publication Defying Gravity In flowpacks with pre-soaked disinfectant wipes, two forces are continuously acting that are mainly responsible for the distribution of the liquid within the wipe stack: Gravity, which pulls the disinfectant downwards, and the capillary forces of the wipe fibres, which distribute the liquid equally in all directions. The downward acting forces add up, so that when flowpacks are stored over a long period of time, the liquid sinks and the first wipes are not as wet as the last ones. If the first wipes are not soaked properly, can sufficient antimicrobial efficacy be guaranteed? Fibre lint woes, hidden foes Decades ago, lints of cloths entering surgical sites represented a risk for patient safety by interfering with the healing process1,2. Particles of few micrometer were identified as causing agent of infections and health risks2. Nowadays, fibres in the healthcare sector are sufficiently free from linting. The transformation to more sustainable healthcare requires the use of new materials, such as cellulose-based wipes in surface disinfection, which could reawaken problems like linting that were thought to have been solved. Method: The liquid from flowpacks of pre-soaked disinfection wipes was squeezed out. The liquid was filtered using a pore size of 0.45 µm. The filters were dried over night and then photographed. The weight of the filters was determined before the filtering and after drying and the difference calculated. Method: Flowpacks with wipes based on cellulose fibres or PET fibres and pre-soaked with either a low-alcohol disinfectant or an organic acid-based disinfectant were stored with the lid upwards for three days. Afterwards, the weight of each wipe was determined. At least three independent replicates were performed and are shown here as dots. The average is illustrated as line, the 95% confidence interval as pale band. Capillary forces are stronger in cellulose-based fibres and thus, the difference in weight of the first wipe and the last is only 2.4 g, compared to 8.4 g for PET-based fibres. Method: The antimicrobial efficacy of disinfectant wipes i.a. depends on the degree of impregnation. The first wipes in a flowpack are less impregnated than the last wipes. To ensure sufficient antimicrobial efficacy, the very first wipe from the flowpacks, stored with the lid up for three days, was subjected to an EN 16615 efficacy test (4-field test). Both the cellulose-based wipe and the PET-based wipe passed the norm. PET-based wipes, pre-soaked with lowalcohol disinfectant ∆weight = 8.4 g Cellulose-based wipes, pre-soaked with organic acid-based disinfectant wipe weight [g] 5 10 15 20 wipe 20 40 60 80 ∆weight = 2.4 g gravity capillary forces in sum required reduction according to EN 16615 S. aureus P. aeruginosa E. hirae C. albicans log10 reduction 2 4 5 6 >6.2 >6.2 >5.2 >5.2 >5.9 >5.8 >4.0 >4.0 PET low-alcohol Bacillol® 30 Sensitive Tissues cellulose (type 1) low-alcohol Bacillol® 30 Sensitive green Tissues cellulose (type 1) organic acids Bacillol® Zero Tissues cellulose (type 2) low-alcohol competitor wipe material disinfectant product x-fold increase in linting 2 1 4 3 5 Cellulose wipes have a smaller difference in impregnation level between the first and the last wipe than PET wipes. However, the following applies to HARTMANN flowpacks: They are effective from the first to the last wipe. PET-based non-woven wipes for surface disinfection are in use for decades and have proofed to be sufficiently lint-free for their specific field of application. Modern wipes made from sustainable cellulosebased fibres can have a similar good performance. However, cellulose-based wipes containing layers of pulp release a visible amount of lints; this could pose health risks and should be observed with caution. References [1] Tinker et al. (1974). Ann Surg. 180(6):831-5. [2] Janoff et al. (1984). Am J Surg. 147(5):598-600. 5.6x 1.8x 1.1x 1.0x illustration of the wipe cross section fibres pulp Contact HSC-AS@hartmann.info EN 17430: Virucidal hygienic hand disinfection Kolbe1, Bolten1, Niesalla2, Mönch1 1 BODE Chemie, a company of the HARTMANN GROUP, Hamburg, Germany 2 HARTMANN SCIENCE CENTER, BODE Chemie GmbH, a company of the HARTMANN GROUP, Hamburg, Germany Presented at DGKH Congress 2024 Introduction Conclusion Claim overview Contact microbiology@bode-chemie.de Methods EN 17430 Virucidal hygienic hand disinfection Phase 2, Step 2 Hands are artificially contaminated with the surrogate murine norovirus. 1 After drying, the finger tips are sampled (prevalue). 2 Finger tips are sampled again (postvalue). 4 Hand disinfection is performed with the test product for 30-60 sec. 3 Number of viruses before and after disinfection is counted. In order to be effective, the disinfectant must not be statistically inferior to a reference of 2x 3 mL 70% (v/v) ethanol for 2x 30 sec. All tested products were sufficiently effective against murine norovirus with 3 mL in 30 seconds. The observed reductions were significantly higher than with the reference (70% v/v ethanol). Hand disinfectants based on propanols also showed a sufficient log10 reduction and were not inferior to the reference. Hygienic hand disinfection is the most important measure for preventing healthcare-associated infections and, thus, the proven reduction of microorganisms on the hands is essential for clinical practice. With EN 1500, a practical test for hygienic hand disinfection has existed since 1998. However, efficacy tests in accordance with EN 1500 only include bactericidal efficacy. A practical test for efficacy against other microorganisms did not previously exist. In May 2024, the new standard EN 17430 for virucidal hygienic hand disinfection (phase 2, step 2) was published. As a manufacturer of hand disinfectants, BODE Chemie GmbH, a company of the HARTMANN GROUP, has already carried out efficacy tests in accordance with prEN 17430:2022-09 in an accredited laboratory. The efficacy of all tested products has been successfully proven. The efficacy test for virucidal hygienic hand disinfection is another relevant step towards more patient safety. With the presented tests, we confirmed the sufficient reduction in the viral load on hands through our products and made a valuable contribution to infection protection. Results log10 reduction 1 reference (2x 3 mL ethanol for 2x 30 sec) 2 3 4 45 g propan-2-ol* 30 g propan-1-ol 0.2 g MES * all quantities based on 100 g 45 g propan-2-ol 30 g propan-1-ol 85 g ethanol 95 g ethanol 2.08 2.53 1.85 2.42 2.12 2.70 2.30 2.90 disinfectant Based on the results from tests according to EN 14476, 3 mL of a hand disinfectant (85 g ethanol) were tested for 30 and for 15 seconds. Even within this short rub-in time, the disinfectant was superior to the reference, which was used for 60 seconds. log10 reduction 1 reference (2x 3 mL ethanol for 2x 30 sec) 2 3 4 30 sec 15 sec 2.12 2.64 1.76 2.41 disinfectant suspension test phase 2, step 1 virucidal hygienic hand disinfection phase 2, step 2 EN 17430 EN 14476 Virucidal activity against enveloped viruses Vacciniavirus Limited spectrum virucidal activity Adenovirus, murine norovirus Virucidal activity Poliovirus, adenovirus, murine norovirus 4
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