DISINFACTS Mission accepted: Sustainability in health protection
EDITORIAL 03 FORUM Review of the HSC Symposium 2024 04 This was our BODE-year 2024 06 HARTMANN at the Freiburg Hygiene Congress 16 Preventing infections: the main campaigns 20 Summit meeting on hygiene management 22 TRIGOS-Award 2024 for sustainable Bacillol® Zero wipes 23 KNOWLEDGE Resistance or tolerance? 05 Systematic skin care: Proven quality in modern packaging 14 Latest white paper shows how sustainabilty can be achieved 23 Healthcare-associated infections (HAI) in Europe 28 GBD data on COVID-19 pandemic 29 NEWS Robert Koch Award for Hospital Hygiene and Infection Prevention 2024 18 PRACTICE Bacillol® Zero Tissues & Bacillol® 30 Sensitive Tissues in the BIG PACK 08 BODE acts sustainably 10 Professional germ protection for household, school and co 24 PREVENTIA® Surgical Irrigation in use 26 POSTER Spread of tropical infectious pathogens 12 STUDIES EN 1500 in 15 seconds? 19 DATES & EVENTS 30 Content Sustainable production – our contribution to future generations
Editorial DISINFACTS 2|2024 Dr. Heide Niesalla 2024 is coming to an end. It has been a special year for us. Together with you, we have looked back on a successful century of company history: 100 years of BODE Chemie with amazing progress in hand and surface hygiene. Reason enough to look back on our anniversary year in this issue of DISINFACTS. At the same time, in view of the unmistakable global changes in the environment, we are looking ahead with focus: at HARTMANN, we also see environmental protection as health protection. Our goal is is to be carbon neutral by 2050. In this issue, you can read how we intend to achieve this. With the new Bacillol® Zero Tissues, we have already ushered in a new - sustainable - era in surface disinfection a year ago. As you can see, the product family is growing. This is sustainable growth, if you will, and it should set a precedent. The tests carried out by an independent testing laboratory, which we present in this issue, also deliver exemplary results: We wanted to know if two hand disinfectants in our range would meet the efficacy requirements of the EN 1500 test standard at a shortened exposure time of 15 seconds. As you can see, this latest issue of DISINFACTS is full of news and ideas. They will help us to ensure that health and environmental protection are considered equally important goals. In this way, we can achieve both: protection against infection for patients, care recipients and carers, and a healthy environment for our children and grandchildren. Get inspired! Yours Dr. Heide Niesalla Head of HARTMANN SCIENCE CENTER 3
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
How are resistance, tolerance and the like defined? ’Tolerance‘ refers to the ability of micro-organisms to survive temporary exposure to normally lethal concentrations of an antimicrobial agent. This may or may not be inherited. Rather, the transient nature of the ability needs to be emphasised. This means that prolonged exposure to an agent could kill tolerant bacteria. Resistance, on the other hand, is the inherited ability to survive normally lethal concentrations of the agent, regardless of the duration of exposure. Disinfectants and antibiotics are fundamentally different Disinfectants are usually used at concentrations well above the minimum inhibitory concentration (MIC) of bacteria, whereas antibiotics are dosed as high as necessary (efficacy) and as low as possible (patient comfort) [2]. In addition, disinfectants only work for seconds to hours. As a result, bacteria in contact with disinfectants have little time to arm themselves by adapting. In addition, disinfectants usually have a non-specific effect, e.g. destroying the bacterial membrane. In contrast, antibiotics often target individual metabolic pathways [4]. Antibiotic therapy also usually uses only one active ingredient, while disinfectants often consist of combinations of active ingredients [5]. Low risk of bacterial adaptation to disinfectants The differences show that research on antibiotics cannot simply be transferred to disinfectants. Even if genuine resistance to disinfectants cannot be ruled out, the risk is low if disinfectants are used correctly [1]. What do these terms mean in relation to disinfectants? Resistance or tolerance? The term ’resistance‘ is well known in the context of antibiotics. But what about resistance to disinfectants? To understand that this is not usually true resistance, the terms need to be clarified. A review article from the HARTMANN SCIENCE CENTER addresses this issue [1]. In it, the team distinguishes between definitions from antibiotic and disinfectant research and provides an assessment of the risk of ’true’ disinfectant resistance. KNOWLEDGE References Krewing M et al. (2024) J Hosp Infect 150: 51-60. https://doi.org/10.1016/j.jhin.2024.05.006 Abel Zur Wiesch P et al.(2017) PLoS Comput Biol 13: e1005321. https://doi.org/10.1371/journal.pcbi.1005321 Huet AA et al. (2008) Microbiology 154: 3144-3153. https://doi.org/10.1099/mic.0.2008/021188-0 Noel DJ et al.(2021) mBio 12: e0228121. https://doi.org/10.1128/mBio.02281-21 Exposure time Mode of action Composition Concentration Antibiotics and disinfectants differ in... 5
FORUM That was our centenary year JUNE APRIL MARCH JANUARY Celebrating Anniversaries: Anniversary event at the University Hospital Hamburg-Eppendorf On 16 January, the BODE Chemie GmbH celebrated its 100th anniversary. To mark the occasion, HARTMANN invited partners, companions and former and current employees to an anniversary event. The guest of honour was Prof Dr Peter Kalmár, who in 1964 came up with the idea for Sterillium® and played a major role in its development. Publication Placement of disinfectant dispensers A study of the HARTMANN SCIENCE CENTER investigated the site-specific use of wall-mounted and point-of-care dispensers using the electronic HH monitoring system NosoEx® on 17 wards in nine German hospitals. Green wipes: Bacillol® 30 Sensitive Green Tissues The wipe material is sourced from sustainable forestry and is completely plastic-free: Bacillol® 30 Sensitive Green Tissues were launched in April. Thinking new things HSC Symposium 2024 on Infection Prevention This year’s HARTMANN SCIENCE CENTERs symposium on 10 and 11 June proved to be spot on. Historical milestones that have shaped infection prevention, particularly over the last 100 years, as well as AI and sustainability were a recurring theme throughout the two-day programme. Celebration: 100 years of BODE birthday celebration The company‘s anniversary was celebrated with a party for all employees. Achieve more: Bacillol® Zero Tissues XL Since June, the innovative Bacillol® Zero Tissues have also been available in an XL format. 6
SEPTEMBER 2024 AUGUST OCTOBER DECEMBER Publication: Resistance or tolerance? Highlighting the need for precise terminology in the field of disinfection Have you ever wondered what the difference between adaptation, tolerance and resistance in the field of disinfection is? The new publication of the HARTMANN SCIENCE CENTER gives clarification of definitions in the context of disinfectants. Publication: Sterillium® med and Sterillium® pure fulfil the requirements of EN 1500 in 15 seconds A study has shown that an ethanol-based hand disinfectant and a propanol-based hand disinfectant meet the requirements for bactericidal efficacy of hygienic hand disinfection (EN 1500) at a contact time of 15 seconds. Professional disinfection: Sterillium® surface wipes Since September, professional germ protection from the clinic is now available for private use. Secure closure: BODE X-Wipes Safety Pack New design saves plastic: Since September, the BODE X-Wipes Safety Packs consist of a stand-up pouch with a quick-release fastener. This has reduced the amount of plastic in each Safety Pack by 25%. Systemic care: Baktolin® & Baktolan® with colour code Turquoise, violet, red: the tried and tested skin care products in the Baktolin®/Baktolan® range have been available in a new, user-friendly design since September. Colour codes and symbols now make selection easier. The HARTMANN SCIENCE CENTER joined forces with Hypros GmbH to examine which dispensers can be found in German healthcare facilities, how much disinfectant they dispense and how well they work. Pack more: Bacillol® surface disinfection tissues as BIG PACKS More is more (and more economical): from December, the sustainable disinfectant tissues Bacillol® Zero Tissues and Bacillol® 30 Sensitive Green Tissues will also be available as BIG PACKs. 15 Sek. 15 sec. 3 / 5 mL Publication: Hand disinfectant dispensers in German healthcare facilities 7
PRACTICE Bacillol® Zero Tissues: The future of sustainable surface disinfection Bacillol® Zero Tissues represent a new ’green‘ generation of professional disinfectant wipes and are available in the BIG PACK from December on. Available from September 2023, the wipes set new standards in several areas of sustainability: their disinfecting effect is based on a novel, patented active ingredient complex of organic fruit acids that also occur in nature: the organic acid complex. Alcohols, QACs, and peroxides are not used. Bacillol® Zero Tissues are therefore classified as non-hazardous and do not require hazardous substance labelling. This means they can be used without gloves.* Another plus: Bacillol® Zero Tissues are free of fragrances and dyes. The nonwoven is made from raw materials sourced from sustainably managed forests and is 100% plastic-free. The flexible packaging film used for Bacillol® Zero Tissues is made of pure polypropylene and is fully recyclable. Bacillol® Zero Tissues are virucidal in 2 minutes (also: bactericidal, yeasticidal, tuberculocidal, mycobactericidal). * If infection control and occupational safety protocols permit it The ’green‘ cleaning and disinfecting wipes Bacillol® Zero Tissues and Bacillol® 30 Sensitive Green Tissues are now available in BIG PACKs. We are expanding our range of ready-to-use disinfectant wipes. The big advantage for you: with 160 wipes per pack, each measuring 20 x 18 centimetres, you can now disinfect surfaces cost-effectively and sustainably. Green growth: Bacillol® Zero Tissues & Bacillol® 30 Sensitive Tissues in the BIG PACK As of December 2024 8
PRACTICE Design update for BODE X-Wipes Safety Pack – less plastic You may have noticed that the packaging design of the BODE X-Wipes Safety Packs has changed. The BODE X-Wipes Safety Packs come now in a stand-up pouch with quick-release fastener. The advantage of the new design is that the plastic content of each Safety Pack has been reduced by a further 25%. BODE X-Wipes Safety Pack offers high compliance even in high-risk areas due to its convenience and ease of use. The system can be used with all liquid surface disinfectants and selected HARTMANN instrument reprocessing products. Bacillol® 30 Sensitive Tissues: Our bestseller – now sustainable Bacillol® 30 Sensitive Green Tissues are also available in a BIG PACK of 160 wipes as of December. These disinfectant wipes, which have been on the market since April, are the green version of our classic Bacillol® 30 Sensitive Tissues. The new Bacillol® 30 Sensitive Green Tissues are just as effective, material and skin compatible as our classic. We are now also saving 30% of CO2 per pack and 65% per tissue.** The disinfectant wipes are free of aldehydes, dyes, and fragrances. The testing, inspection and certification company SGS Institut Fresenius certifies excellent skin compatibility. Bacillol® 30 Sensitive Green Tissues are bactericidal, yeasticidal, tuberculocidal and mycobactericidal. They are ‘virucidal against enveloped viruses’ (incl. HBV, HIV, HCV) and exhibit a ‘limited spectrum of virucidal activity’. ** Compared to Bacillol® 30 Sensitive Tissues 9
For us, the consistent use of green electricity is an important milestone on the road to climate neutrality. By switching to green electricity alone, BODE has already reduced its emissions of the greenhouse gas carbon dioxide (CO2) in two important areas by a total of two thirds (66%): This includes all indirect CO2 emissions that were previously caused by the energy we purchased, such as electricity and district heating. Zero emissions by 2050 By consistently saying ’yes‘ to green electricity, BODE is making a significant contribution to the ambitious environmental goals of its parent company, HARTMANN. PAUL HARTMANN AG has set itself the goal of reducing greenhouse gas emissions resulting from direct or indirect energy consumption at all company locations by at least 50% by 2030. By 2050, HARTMANN aims to be completely climate neutral. This also includes all emissions generated by the company in upstream and downstream processes along the entire value chain. In other words, also by suppliers, service providers and end users. ESG: Sustainability at HARTMANN The goal of reducing the company‘s carbon footprint is just one milestone in a comprehensive sustainability strategy: for HARTMANN, caring for people‘s health also means protecting the natural environment. And if you‘re serious about it, this goes beyond climate protection. That is why HARTMANN takes a holistic approach to sustainability and is active in three areas. We call this our ’ESG approach’ (E = Environment, S = Social, G = Governance). In concrete terms, this means E: We protect the environment by reducing our environmental footprint. We do this by investing in the development and use of alternative energy sources, measures to reduce packaging and waste, and strategies to conserve resources. S: People are our top priority. We ensure that human rights are respected, health and safety at work is protected, and the social and cultural needs of our employees, customers and communities are met. G: We contribute to sustainable economic development through innovative products and solutions, fair competition and reliable supply chains. Sustainable disinfection – what does that mean? We want our products to produce less of the greenhouse gas CO2, less (plastic) waste and fewer environmental toxins. At the same time, we do not want to compromise on the quality and effectiveness of our disinfection products. This means that we develop all products using the Product Lifecycle Management (PLM) approach in project teams that include representatives from all relevant departments. Wherever possible, we increase Green electricity and more: BODE acts sustainably You probably haven‘t noticed, but all of our disinfectant products and solutions have changed significantly since the beginning of 2024: Sterillium®, Bacillol® & Co. have a lower carbon footprint since the beginning of the year. That‘s because BODE only uses electricity that is produced sustainably and without greenhouse gas emissions in its administration and throughout the entire production chain. PRACTICE 10
Monofoil the use of recycled, biogenic and/or certified raw materials. And we design our products to reduce greenhouse gas emissions throughout the value chain. We aim to continuously increase the recyclability of our product packaging. We want to minimise the toxic effects of our products on people, the environment and nature. This means more natural ingredients, less ’hard‘ chemistry and fewer environmental toxins. This applies to us as well as our suppliers: That is why we carry out regular audits of our suppliers. Good examples: Bacillol® and Sterillium® The new Bacillol® Zero Tissues represent a new, sustainable generation of professional disinfectant wipes: their disinfectant action is based on organic fruit acids. The plastic-free non-woven material is sourced from sustainable forestry. The packaging film is made of unmixed polypropylene and can be recycled. As a result, Bacillol® Zero wipes have a 75% lower carbon footprint than other low-alcohol disinfectant wipes - the ’market standard‘. ’Less is more’ also applies to our classic blue packaging: Sterillium® plastic bottles are now lighter. This alone saves 83 tonnes of raw material for the production of PE bottles each year. Optimising the bottle labels has also reduced production steps and improved the recycling process. And the ethanol used to produce it comes from renewable resources. We would like you to join us on our journey towards healthier and greener business practices. Support us by choosing our more sustainable disinfection solutions more often in the future! * only applies to the non-woven fibre without soaking solution Reduction of greenhouse gas emissions by at least 50% by the year 2030 100% carbon neutral by 2050 A new white paper shows how sustainability can be achieved. Read more on page 23! PRACTICE 11
Spread of tropical infectious pathogens Occurrence Africa, South and Southeast Asia, India, Arabian Peninsula, islands in the Indian Ocean, Caribbean islands, South, Central and North America, isolated outbreaks in Southern Europe (e.g. Italy) Reservoir Warm-blooded animals (rodents, primates and other apes) Infection pathway Mosquitoes especially Aedes spec., Culex, Anopheles Incubation period 3-12 days Human-to-human transmission No Chikungunya virus Dengue virus Occurrence Endemic to over 100 tropical and subtropical regions in Asia, Central and South America, Africa, the Middle East and the Pacific Islands. There is also a tendency to spread, for example to southern Europe Reservoir Human Infection pathway Mosquitoes, especially Aedes aegypti, occasionally also Aedes albopictus Incubation period 3-14 days, usual 4-7 days Human-to-human transmission No Infection pathway: Various mosquitoes Prophylaxis: Protection against mosquito bites, vector control, elimination of potential mosquito breeding sites Required spectrum of activity: Limited virucidal Chikungunya virus Dengue virus Yellow fever virus West Nile virus Zika virus Occurrence: 12
Find out more here, including the clinical symptoms of the respective pathogens Products with activity against enveloped viruses West Nile virus Zika virus Occurrence All continents. Especially Africa, Israel, the Middle East, India, parts of South East Asia, North and parts of Central America and Europe (southern France, northern Italy, western Turkey, Greece and large parts of the Balkans, parts of the Czech Republic, Hungary, Slovakia and Austria as well as Germany) Reservoir Wild birds Infection pathway • Bites of infected mosquitoes, especially Culex, but also Aedes and Mansonia species Incubation period 2-14 days Human-to-human transmission No, For exceptions, see infection pathway • Organ transplantation • Blood transfusion • During pregnancy to unborn child Occurrence In warmer regions of the world, Zika viruses circulate in the tropical and near-tropical subtropical regions of all continents Reservoir Unknown Infection pathway • Bite of infected mosquitoes of the genus Aedes, main vector is the yellow fever mosquito (Aedes aegypti) • Sexual transmission from person to person possible • Transmission through transfusions possible Incubation period 3-12 days (usual 3-7 days) Human-to-human transmission Yes (sexual) Yellow fever virus Occurrence Central and West Africa, South America and individual islands in the Caribbean Reservoir Primates Infection pathway Mosquitoes, especially Aedes spec., Haemagogus spec. Incubation period 3-6 days Human-to-human transmission No (Exception: blood donation) 13
Baktolin® and Baktolan® in modern packaging Systematic skin care: Proven quality in modern packaging The Baktolin®/Baktolan® range of products is well known among healthcare professionals for its gentle cleaning and high quality care. The relaunch does not change the proven quality. Instead, user-friendly changes have been made to the design. Colour codes and symbols now make selection easier. The Baktolan®/Baktolin® range offers the right product for every skin type. Baktolin® sensitive, Baktolan® lotion and Baktolan® balm are formulated for normal skin. Baktolin® pure, Baktolan® lotion pure and Baktolan® balm pure are suitable for sensitive skin. Wash Turquoise stands for the washing lotions Baktolin® pure and Baktolin® sensitive Care Purple is the colour code for the care products Baktolan® balm, Baktolan® balm pure, Baktolan® lotion, Baktolan® lotion pure und Baktolan® vital Protect Red adorns the labels of the skin protection products Baktolan® protect and Baktolan® protect + pure PRACTICE 14
Washing your hands: Mild cleansing is crucial Washing your hands too often can lead to skin irritation. This is especially true for people who wash their hands 15 or more times a day [1]. In fact, there are very few situations in healthcare that require hand washing [2]. To keep the skin healthy, hand washing should be reduced and mild cleansers should be used, while alcohol-based hand sanitizers do not damage the skin, contrary to popular belief [3]. Baktolin® wash lotions are alkali-free, soap-free and dye-free and owe their good skin compatibility to modern, mild ingredients. Skin care thrives on regular application Regular hand care is particularly important to prevent skin irritation [4]. A survey of surgeons found that three quarters did not use any skin care/protection, despite half suffering from skin irritation [5]. Inadequate skin care not only affects the surgeon‘s own skin health, but also patient safety, as only healthy skin can be safely disinfected. The Baktolan® range of skincare products is tailored to different needs and contains mild, high-quality ingredients that increase skin hydration and strengthen the skin‘s natural barrier. Use skin protection BEFORE problems occur During the COVID-19 pandemic, healthcare workers increased their hand hygiene practices. At the same time, hand eczema increased significantly [6]. However, preventing skin irritation is much easier than treating it. Therefore, skin protection products should be used as a preventative measure. Baktolan® skin protection creams provide reliable and longlasting protection for skin in contact with water or aqueous liquids. Mild, natural ingredients help to regenerate stressed and chapped skin. Skin irritations and eczema: avoidable with good strategies The importance of general skin health was also emphasised by Prof. Dr. Swen Malte John, Head of Dermatology at the University of Osnabrück, at the HARTMANN Symposium in October as part of ’Freiburger Infektiologie- and Hygienekongress‘ in Freiburg, Germany. He described the increase in hand eczema among healthcare workers as an ’epidemic during the pandemic’ and drew attention to the fact that healthcare workers with occupational skin diseases are three times more likely to be colonised with methicillin-resistant S. aureus (MRSA) [7]. His preventive approach: the ’3 moments of skin care‘ - BEFORE starting work, AFTER washing hands, AFTER work [8]. Find out more on the following pages. References 1. Technische Regeln für Gefahrstoffe 401 (TRGS 401) (2022). GMBl 40: 895–926. https://www.baua.de/DE/Angebote/Regelwerk/TRGS/TRGS-401 (abgerufen am 09.09.2024) 2. Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (2016) Bundesgesundheitsbl 59: 1189-1220. https://doi. org./10.1007/s00103-016-2416-6 3. Robert Koch-Institut (RKI) (2019) Epidemiol Bull 19: 157-161. https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2019/Ausgaben/19_19.pdf?__ blob=publicationFile(abgerufen am 09.09.2024) 4. Kampf G, Ennen J (2006) BMC Dermatol 6: 1. https://doi.org/10.1186/1471-5945-6-1 5. Harnoss JC et al. (2014) BMC Infect Dis 14: 315. https://doi.org/10.1186/1471-2334-14-315 6. Reinholz M et al. (2021) Eur J Dermatol 31: 392-395. https://doi.org/10.1684/ejd.2021.4046 7. Brans R et al. (2016) Occup Environ Med 2016 73: 670-675. https://doi.org/10.1136/oemed-2016-103632 8. Hines J et al. (2017) J Eur Acad Dermatol Venereol 31: 53-64. https://doi.org/10.1111/jdv.13851 PRACTICE 15
No compromises in hand hygie HARTMANN at the Freiburg Congress on Infectious Diseases and Hygiene in October 2024 As every year, the Freiburg Congress on Infectious Diseases and Hygiene in October - organised by the Advisory Centre for Hygiene (BZH) - featured numerous current topics. HARTMANN and the HARTMANN SCIENCE CENTER (HSC) were also represented with an exhibition stand and a lunch symposium. The HARTMANN stand featured live demonstrations of hand hygiene and surface disinfection – for example of the material compatibility of Bacillol® 30 Sensitive Green Tissues with acrylic glas. The HARTMANN SCIENCE CENTER symposium entitled ’No compromises in hand hygiene’ was devoted entirely to hand hygiene, and Prof Dr Swen Malte John (Dermatology, Environmental Medicine and Health Sciences and Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück; Lower Saxony Institute for Occupational Dermatology) and Dr Marco Krewing (HSC) provided interesting insights. FORUM 16
ene and surface disinfection FORUM Healthy skin is no coincidence In the first lecture of the symposium, Prof John emphasised the personal responsibility of healthcare professionals in maintaining skin health. He dispelled many myths, including that of ’unavoidable‘ skin changes. He used vivid images of severely damaged skin to raise awareness of the seriousness of occupational contact dermatitis (OCD), which accounts for up to 35% of all occupational diseases in Europe [1] and costs billions of euros each year [2]. In Germany, about one in five nurses is affected [3]. OCD also increases the risk of methicillinresistant Staphylococcus aureus (MRSA) colonisation [4]. Primary prevention: The ’3 moments of skin care‘ Data shows that alcohol-based hand disinfection is less irritating to the skin than soap [5], despite the fact that around 70% of carers believe the opposite [6]. According to Prof John, this misconception leads to a vicious cycle that exacerbates the problem: frequent hand washing dries out the skin, which then burns when the hand is disinfected. Disinfection is then avoided and instead hands are washed more often. This promotes mild hand eczema, which will get worse if the wrong strategy is maintained. Prof John therefore emphasised the importance of good education on how to avoid eczema in the first place - with a tailored prevention approach using the Live demonstration 1 – hand hygiene: Visitors were able to measure the skin moisture of their hands before and after using our hand hygiene products. The result: the skin had already received additional moisture from the proven Sterillium® skin care complex with Sterillium® med and Sterillium® classic pure. With the right skin care and protection, the value could be increased even further. Live demonstration 2 – quality in surface disinfection: On a well-lit black Plexiglas panel, the wetting of the surface by the pre-saturated sustainable wipes was clearly visualised. The result: Our high quality sustainable nonwoven used in Bacillol® 30 Sensitive Green Tissues and Bacillol Zero Tissues wets the surface as well as PET wipes. In addition to wetting, this station also tested the feel and tear strength of various sustainable wipes. Again, the wiping quality of Bacillol® 30 Sensitive Green Tissues and Bacillol Zero Tissues was convincing. Live demonstration 3 – material compatibility: Three Plexiglas rods in a display case were clamped in a holder and moistened with Bacillol® 30 Sensitive Green Wipes, low alcohol wipes, 40-50% alcohol wipes and high alcohol wipes (>70%). When the alcoholic wipes with an alcohol content of > 40% were used, stress cracks occurred and the rods broke after a short time. This experiment was repeated at the request of visitors. 17
FORUM Andreas F. Widmer was awarded the Robert Koch Award for Hospital Hygiene and Infection Prevention in 2024. The award ceremony, which is endowed with 50,000 euros, took place this year on 8 November in Berlin. Prof Dr Andreas F. Widmer is being honoured for his outstanding and long-standing work in the field of infection control and prevention. As President of the National Centre for Infection Prevention, Swissnoso, which he co-founded in 1994 with Patrick Francioli and Didier Pittet, he worked for more than ten years as an expert at the Robert Koch Institute and for more than 15 years for the World Health Organization (WHO) on topics such as hand hygiene and wound infections. NEWS References 1. Bauer A et al. (2023) Contact Dermatitis 88: 263-274. https://doi.org/10.1111/cod.14280 2. Augustin M et al. (2022) J Eur Acad Dermatol Venereol 36 Suppl 7: 3-16. https://doi.org/10.1111/jdv.18168 3. Skudlik C et al. (2009) Contact Dermatitis 60: 136-143. https://doi.org/10.1111/j.1600-0536.2008.01496.x 4. Brans R et al. (2016) Occup Environ Med 2016 73: 670-675. https://doi.org/10.1136/oemed-2016-103632 5. Pedersen LK et al. (2005) Less skin irritation from alcohol-based disinfectant than from detergent used for hand disinfection. Br J Dermatol 153: 1142-1146. https:// doi.org/10.1111/j.1365-2133.2005.06875.x 6. Stutz N et al. (2009) Br J Dermatol 160: 565-572. https://doi.org/10.1111/j.1365-2133.2008.08951.x 7. Hines J et al. (2017) J Eur Acad Dermatol Venereol 31: 53-64. https://doi.org/10.1111/jdv.13851 8. Brans R et al. (2016) Contact Dermatitis 75: 205-212. https://doi.org/10.1111/cod.12614 9. Valim MD et al. (2024) Antimicrob Resist Infect Control 13: 7. https://doi.org/10.1186/s13756-023-01356-3 ’3 moments of skin protection‘ as the primary strategy. The moments are based on the use of protective skin care products: 1. BEFORE work, 2. AFTER hand washing and 3. AFTER work [7]. The success of the prevention programme was demonstrated in a multi-centre cohort study: of 1,410 workers with OCD, 87% were still able to work three years after participating in the programme, and 75% were even able to continue in their original occupation [8]. Prof John also explained in detail how people with BKD can get help from company doctors, dermatologists and the German Statutory Accident Insurance (DGUV). Protecting yourself and others: the choice of hand disinfectants Dr Marco Krewing (HSC) then presented further evidence on hand hygiene. When choosing a hand disinfectant, self-protection and protection of others cannot be separated, because self-protection includes maintaining skin health, which in turn affects efficacy (only healthy skin can be effectively disinfected) and thus protection of others. In this regard, Dr Krewing showed that hand disinfection can have a positive effect on skin hydration [9]. He also explained the advantages of high-alcohol hand rubs over low-alcohol ones, as well as the possibilities and limitations of shorter exposure times. Andreas F. Widmer was awarded the Robert Koch Award for Hospital Hygiene and Infection Prevention in 2024 18
STUDIES PRACTICE A new study involving the HARTMANN SCIENCE CENTER - conducted by an independent accredited test laboratory - shows that two disinfectants from the Sterillium® range meet the bactericidal efficacy requirements for hygienic hand disinfection according to the EN 1500 test standard with an exposure time of 15 seconds [1]. EN 1500 [2] does not currently allow for testing of less than 30 seconds. Therefore, the minimum contact time stated by the manufacturer is 30 seconds, but this is not always adhered to in everyday clinical practice. The two Sterillium® products - one ethanolic, one propanolic - were compared with the unmodified reference at a 15 second rubin time using two different rub-in techniques and volumes. The result: Both products were not inferior to the reference in either technique and therefore met the efficacy requirements of EN 1500 after just 15 seconds [1]. References 1. Mönch E et al. (2024) GMS Hyg Infect Control 19: 1–6. https://doi.org/10.3205/dgkh000496 2. DIN EN 1500-2013: Chemical disinfectants and antiseptics - Hygienic handrub - Test method and requirements (phase 2/step 2). 2013.blob=publicationFile (aufgerufen am 25.03.2024) EN 1500 in 15 seconds? Selected hand disinfectants fulfil the requirements Now that HARTMANN has been successfully marketing the NosoEx® hand hygiene monitoring system in Germany for two years, the first pilot projects in other EU countries began this year. One of the two pilot projects in Hungary is taking place in the neonatal intensive care unit at Semmelweis University in Budapest. To reduce the number of nosocomial infections in his department, Dr Csaba Nádor, head physician, wanted to use a new, innovative approach to better understand the current level of hand hygiene and to provide impetus for improvement. As part of the 6-month project, NosoEx® sensors were attached to all hand disinfection dispensers to record and automatically analyse all hand disinfections. In addition, transponders were given to ward staff and parents to monitor the hand hygiene behaviour of each group and remind them to disinfect their hands regularly. To analyse habits, knowledge, motivations and fears regarding hand disinfection and electronic monitoring, questionnaires were given to the staff in advance and will be repeated towards the end of the project to see what effect the pilot has had. The first successes are already evident in the fact that more hand disinfections are being carried out than before. The next step is to establish the habit of using a sufficient amount of hand disinfectant. The results of the intervention will then be published. The NosoEx® system is also in use at the Emergency Centre of the Medical University of Pécs. A structured intervention program will be developed for this site in the near future. Electronic hand hygiene monitoring in Hungary Status of the NosoEx® installations in Budapest and Pécs Day-to-day life in the neonatal intensive care unit 15 Sek. 15 Sek. 3 / 5 mL Want to know more? Read the website article at https://www.hartmann-science-center. com/en/hygiene-knowledge/hand-hygiene/ hand-disinfection/publication-en1500-in-15seconds Head physician Dr Csaba Nádor (left), Sales Manager HARTMANN Hungary Aliz Benkó (right), team of the neonatal intensive care unit (background) in the lecture hall 19
www.hartmann-science-center.comRkJQdWJsaXNoZXIy NDU5MjM=