DISINFACTS ISSUE 01/2025 Sterillium®: 60 years in safe hands
EDITORIAL 03 FORUM Sterillium® has been writing (success) stories for 60 years 04 Raise your hand for World Hand Hygiene Day: hand hygiene affects us all! 17 KNOWLEDGE 175 years of development 06 Key facts and figures on the ’blue classic‘ 08 It‘s all about the fibres 10 Influenza season hard on US and Europe 12 How long can bacteria & co. multiply on surfaces? 13 New pathogens on the rise? 14 Prevention of biofilms in surgery 15 PRACTISE Healthy hands according to plan 16 STUDIES New index to assess the quality of hand hygiene 14 INTERVIEW Therapy in your sleep! 18 DATES & EVENTS 20 POSTER INSERTS Wearing medical protective gloves When and when not? Annual Virus Calendar 2025 Prevention by vaccination Content INSAFEHANDS 60YEARS 2
Editorial DISINFACTS 1|2025 Dr Heide Niesalla Sometimes one anniversary follows the next: after celebrating 100 years of BODE last year, we are once again celebrating a special occasion, which we honour in this issue of DISINFACTS Sterillium® turns 60! Since its launch in 1965, our ’classic blue‘ has become one of the world‘s most successful hand disinfectants. Sterillium® has significantly increased the acceptance of hand hygiene and helped to prevent countless infections. This year‘s HARTMANN SCIENCE CENTER Symposium also looks to the future. The hybrid event has two main themes: infection prevention in outpatient care and dialysis, with a special focus on hand hygiene. The focus will be on how to maintain and improve the high standards already in place. It will also look at the future of inpatient care and discuss the challenges and opportunities that lie ahead. World Hand Hygiene Day is also of particular importance to us this year. This time, the WHO is calling attention to disposable medical gloves - a topic we cover in this issue. You will also find a poster illustrating when it is appropriate to wear gloves and when it is not. Speaking of infection control, new pathogens are on the rise! On the following pages we present some particularly interesting examples. Working together to protect patients and staff - with knowledge, innovation and experience. Enjoy reading! Yours Dr Heide Niesalla, Head of HARTMANN SCIENCE CENTER 3
FORUM It all started with a bowl of germs: Sterillium® has been writing (success) stories for 60 years The decisive idea came to him during a visit by a senior physician at the University Hospital Hamburg-Eppendorf: ’The rooms were small, only the most important doctors went in, and I was standing in front of the door with the others. In front of the door was a sink with a diluted disinfectant solution in which all the doctors dipped their hands. The liquid looked suspicious to me,‘ Professor Dr Peter Kalmár recalled in an interview years ago. After the visit, he sent a sample to the laboratory. ’The solution was full of germs. Suddenly I had the idea of a skin-friendly disinfectant that could be rubbed on without washing.‘ Production started on 4 June 1965 The rest is hygiene history. The young surgeon‘s idea fell on fertile ground at Dr. Bode & Co. just a few miles away: on 4 June 1965, the first bottle of Sterillium® was filled at Dr. Bode & Co. in Hamburg-Stellingen. Sterillium® was the world‘s first marketable alcohol-based hand disinfectant. It combined reliable elimination of microorganisms with easy and time-saving application. It was also gentle on the skin thanks to its lipid-replenishing components. The way surgical hands were disinfected in the past is hard to imagine today: ’We used to scrub our hands and forearms with soap and a brush under running water before surgery. We then applied 96% alcohol to the skin and dried it with sterile cloths,‘ recalls Peter Kalmár. This had consequences: ’For many surgeons, the heavily degreased skin became brittle and cracked in places as a result of washing.‘ ’Brand of the century‘ and name of a product family The name Sterillium® has become synonymous with hand disinfection. In 2025, Sterillium® was named Brand of the Century for the fourth time. Today, the name also stands for a family of products whose members show their Sterillium® DNA - innovation, proximity to practice and research. Three examples: in 1995, Sterillium® Virugard was the first alcoholic hand disinfectant to be listed as effective against viruses. Since 2019, Sterillium® pure has only been available in a propanol-based formulation, making it suitable for people with allergies and atopic skin. Sterillium® foam extra care is the latest addition to the Sterillium® range. A doctor‘s wash basin turned out to be a germ trap - and was the starting point for the development of a revolutionary hand disinfectant. In one fell swoop, it made the fight against pathogens more efficient, safer and faster. 4
FORUM The low-drip foam is not only effective against bacteria, viruses and yeasts, but also contains an innovative skin care complex that nourishes the hands during disinfection. Loyal to its location: Sterillium® from Stellingen The site has not changed since 1964: ’Sterillium® is still manufactured by BODE in Hamburg-Stellingen. And it will stay that way: As recently as 2022, BODE invested around 12 million euros in a new production line there. This makes our production site for disinfectants one of the most modern in the world,‘ says Arne Roettger, Managing Director, BODE Chemie GmbH, a company of the HARTMANN GROUP. Being able to supply customers from Germany proved to be an advantage during the COVID-19 pandemic. At that time, production was running around the clock and the normal volume was tripled overnight. Trucks delivered Sterillium® in large 1,000-litre intermediate bulk containers (IBCs) to customers, who refilled their empty Sterillium® bottles themselves. Conclusion: a fundamental change The fundamental change that the development of Sterillium® has brought about in the fight against nosocomial infections is illustrated by Professor Kalmár‘s recollection: ’At over 10%, the infection rate was relatively high in the mid-1960s; today it is much lower. Since 1965, there have been dispensers in the patient rooms, the corridors and in washrooms, and of course they have to be used.‘ EN 17430: Practical testing of virucidal efficacy for hygienic hand disinfection Hygienic hand disinfection is the most important measure for the prevention of healthcare-associated infections, and therefore the proven reduction of microorganisms on hands is essential for clinical practice. To demonstrate efficacy, disinfectants should ideally be tested under conditions as close to real-life use as possible and against a range of relevant pathogens. Until recently, there was only a step 1 test for virucidal efficacy: Step 1 (EN 14476): Quantitative suspension test for virucidal efficacy of a disinfectant. Here, a disinfectant is added to a virus suspension and, after a defined period of time, it is determined whether the disinfectant has sufficiently reduced the number of infectious viruses. In May 2024, with EN 17430 a step 2 test for virucidal hygienic hand disinfection was published, which is designed to demonstrate the efficacy of a disinfectant under conditions similar to those in clinical practice. With the publication of the new test standard, manufacturers now have 18 months to test products that are effective against viruses in accordance with EN 17430. For our Sterillium® products, we are working on incorporating the expert opinions according to EN 17430 into the national approvals. Find more detailed information here: https://www.hartmann-sciencecenter.com/en/hygiene-knowledge/ hand-hygiene/hand-disinfection/ en-17430 5
KNOWLEDGE The history of hand disinfection 175 years of development 1847: Semmelweis invents chlorinated lime for hand disinfection In the mid-19th century, due to poor hygienic conditions, around half of all patients died after surgery from so-called wound fever (sepsis) [3]. Semmelweis found that mothers died after childbirth particularly often if they were delivered by doctors who had previously performed autopsies. He drew the right conclusions and introduced hand washing with chlorinated lime in 1847. This rapidly reduced maternal mortality from up to 12% (1842) to around 1% (1848) [1]. However, it took several years for his findings to be implemented [1,3]. 1867: Lister introduces surgical antisepsis In the second half of the 19th century, the discoveries of several doctors built on each other to advance hygiene. While Robert Koch in Germany identified the causative agent of tuberculosis [4], Louis Pasteur in France discovered that heating kills micro-organisms and can make food last longer [4,5]. Meanwhile, in Scotland, Sir Joseph Lister concluded from Pasteur‘s findings that bacteria could also be responsible for poor wound healing after surgery [5]. He developed a phenol-based antiseptic that was used to clean fingers and instruments and soak wound dressings, drastically reducing mortality [4-6]. Hygiene in healthcare facilities was neglected until the first half of the 19th century, resulting in many preventable deaths. The Hungarian doctor Ignaz Semmelweis was the first to establish a link between doctors‘ hands and puerperal fever, which killed many women in labour. Semmelweis is now regarded as the founder of hygienic hand disinfection [1]. It was not until the end of the 20th century that hand disinfection with alcoholic hand rubs was recognised as the most effective way of preventing healthcareassociated infections [2]. 1965: Sterillium® conquers the world Until the 1960s, hand disinfectants used all kinds of substances that were harmful to the skin and did not last long. To improve efficacy and tolerability, researchers at BODE Chemie, a company of the HARTMANN GROUP, worked with doctors to develop Sterillium® in 1965, the first marketable alcoholic hand disinfectant. Today, Sterillium® is synonymous with hand disinfectants and is established in more than 50 countries worldwide [7]. 6
2016: Sterillium® named ’Brand of the Century‘ for the first time As only healthy skin can be effectively disinfected, the caring properties of Sterillium® products have been at the forefront from the very beginning. Due to its great international success, the ZEIT publishing group awarded Sterillium® the title of ’Brand of the Century‘ for the first time in 2016, which stands for an entire product category [8]. Since then, Sterillium® has received the award regularly. 2024: Hand disinfection in 15 seconds instead of 30? The EN 1500:2013 test standard [9] specifies the bactericidal properties of hand disinfectants. Currently, EN 1500 does not provide for testing in less than 30 seconds. However, in recent years there have been increasing calls for a shorter exposure time to better reflect the needs of clinical practice. For this reason, an independent, accredited testing laboratory, including the HARTMANN SCIENCE CENTER, investigated whether two hand disinfectants from our product range could meet the bactericidal efficacy requirements for hygienic hand disinfection according to EN 1500 with an exposure time of 15 seconds [10]. The result: Both the ethanolic and propanolic products performed as well as the reference and met the efficacy requirements of EN 1500 after just 15 seconds [10]. References 1. Stang A et al. (2022) A twenty-first century perspective on concepts of modern epidemiology in Ignaz Philipp Semmelweis‘ work on puerperal sepsis. Eur J Epidemiol 37: 437-445. https://doi.org/10.1007/s10654-022-00871-8 2. WHO (2009). WHO Guidelines on Hand Hygiene in Health Care. https://www.who.int/publications/i/item/9789241597906 (accessed on 25.02.2025) 3. Goddemeier C (2011) Dtsch Arztebl Int [Internet] Feb 4;22. https://www.aerzteblatt.de/archiv/ignaz-philipp-semmelweis-retter-der-muetter-edb1846a-ea5c4764-8dd0-08723fe0f215 (accessed on 25.02.2025) 4. Poczai P et al. (2022) Front Public Health 10: 979464. https://doi.org/10.3389/fpubh.2022.979464 5. Roy A et al. (2020) Int J Community Med Public Health 7: 2845. https://doi.org/10.18203/2394-6040.ijcmph20203025 6. Katz JD (2004) Anesthesiol Clin North Am 22: 457-471. https://doi.org/10.1016/j.atc.2004.04.002 7. https://www.sterillium.info/de-at/%C3%BCber-sterillium (accessed on 25.02.2025) 8. https://www.hartmann.info/de-de/wissen/d/f/sterillium-eine-marke-des-jahrhunderts (accessed on 26.02.2025) 9. DIN EN 1500-2013: Chemical disinfectants and antiseptics - Hygienic handrub - Test method and requirements (phase 2/step 2). 2013. 10. Mönch E et al. (2024) GMS Hyg Infect Control 19: 1–6. https://doi.org/10.3205/dgkh000496 KNOWLEDGE 7
KNOWLEDGE The essence of Sterillium®: Key facts and figures on the ’blue In 60 years of development, optimisation, use and testing, Sterillium® has been measured, weighed and approved in numerous laboratory and field tests. A lot of data has been collected. How well do you know them? 0.3 or 0.03 or 0.003: How many millilitres of Sterillium® are required for hygienic hand disinfection? 0.003 litres, or 3 millilitres (ml), is enough to prevent one infection. That‘s more than you think: a teaspoon contains about 5 ml. 15 or 30 or 45: How long - in seconds - should Sterillium® be rubbed into the hands? 30 seconds is sufficient. During this time, hands should be moistened, particularly fingertips, nail folds and thumbs. Over 50 or 79 or 123: In how many countries in the world is Sterillium® used? Sterillium® is available in more than 50 countriesworldwide. 89.99 or 98.99 or 99.99: What percentage of bacteria on our hands do not survive hygienic hand disinfection with Sterillium®? 99.99% of the bacteria on our hands are reduced by hygienic hand disinfection with Sterillium®. 8
KNOWLEDGE e classic‘ 4,700 or 47,000 or 470,000 How many kilograms of Sterillium® leave the BODE production facility in HamburgStellingen in Germay per day? 47,000 kilograms Sterillium®, i.e. 47 tonnes, leave our plant every day. This is roughly equivalent to the weight of 10 adult elephants. 350 or 400 or 800: How many products for disinfection, cleaning, skin care and skin antisepsis does HARTMANN produce in addition to Sterillium®? In addition to Sterillium®, HARTMANN produces more than 400 products for disinfection, cleaning, skin care and skin antisepsis across the entire product range and in all country versions. 40,000,000 or 4,000,000,000 or 44,000,000,000: How many hand disinfections are performed each year worldwide with Sterillium®? 4,000,000,000 - Sterillium® provides around 4 billion hand disinfections per year worldwide. This means that 780 million litres of Sterillium® have been used in the last 65 years. To put this in perspective, an Olympic swimming pool holds about 2.5 million litres. So 780 million litres could fill 312 Olympic swimming pools. Tricky: Can you explain the equation: 2016 + 2019 + 2022 + 2025 = 4? Sterillium® has been named ’Brand of the Century‘ four times by the ZEIT publishing group. The first time was in 2016. The last time was at the beginning of this year. The award goes to German brands that are exemplary for an entire product category and have become an integral part of German life. 4 9
KNOWLEDGE New white paper on surface disinfection and sustainable wipe fibres It‘s all about the fibres Fibre residues and lint can cause serious problems in the healthcare sector: this has been known for many years and is why, for example, textiles used in operating theatres are particularly low-linting. This greatly reduces the risk to patients. As sustainability becomes more and more important in the healthcare sector, and new, more environmentally friendly materials are increasingly used, the ’health problem of fibre residues‘, which is actually quite well solved, is becoming more and more topical. Possible problems: contamination, wound healing, measurement errors, etc. Lint can be contaminated with pathogens and expose patients to pathogens. This may be the case with disinfectant wipes once the alcohol has evaporated. Fibre residue can also impede the healing process and/or lead to granulomas (usually benign, granular new tissue formations) and tissue adhesions if it gets into a wound. Inside technical equipment, lint can cause malfunction. For example, if they accumulate in the equipment and affect measurements. Last but not least, lint producing disinfectant wipes can have a negative impact on compliance: for example, if users find it inefficient to disinfect surfaces with such a wipe because they have to wipe again and again to remove fibre residues. Possible solution: cellulose wipes without an intermediate pulp layer When nonwoven wipes for surface disinfection come from sustainable sources, they are beneficial for the environment. But how much fibre residue do these new materials leave behind? Experiments with soaked and then pressed and dried flowpack stacks of wipes show that cellulose-based wipes with a pulp layer leave behind five times more fibre residue than wipes without a pulp layer. The cellulose-based Bacillol® product family (Bacillol® 30 Sensitive Green Tissues and Bacillol® Zero Tissues), both of which have no pulp interlayer, did not differ significantly from the long-established Bacillol® 30 Sensitive Tissues with a PET plastic fibre interlayer. They are much more than ’just‘ the carrier material for the disinfectant: the fibres of pre-saturated disinfectant wipes influence, among other things, the efficacy, sustainability and efficiency of surface disinfection. A new white paper from the HARTMANN SCIENCE CENTRE (HSC) highlights all the aspects that need to be considered when using disinfectant wipes made from renewable cellulose-based fibres instead of PET fibres. Here is a brief summary of the key points: Fibre residue after disinfection with a high linting disinfectant wipe on a patient bed with a structured surface pulp 10
KNOWLEDGE Tear resistance offers many benefits in everyday clinical practice Tear resistance or tensile strength of disinfectant wipes is another important consideration. This is because it has a subtle influence on the efficiency of wipe application and the efficient use of wipes in everyday clinical practice.Tear-resistant wipes offer the following advantages in clinical practice: a strong and tear-resistant wipe can be applied to a surface with more pressure. This means stubborn and dried-on dirt or contamination can be removed more effectively. A stronger wipe can also be used on textured or rough surfaces - such as Sustainable growth: The cellulose-based disinfectant wipes Bacillol® Zero Tissues and Bacillol® 30 Sensitive Green Tissues have been available in BIG PACKS since December. The big advantage for customers is that the 20 x 18 cm wipes now allow surfaces to be disinfected 160 times per pack in a cost-effective and more sustainable way. Bacillol® Zero Tissues, available from September 2023, represent a new generation of professional disinfectant wipes and set standards in several areas: the nonwoven wipe material is made from raw materials sourced from sustainable forestry and is 100% plastic-free. The Bacillol® Zero Tissues packaging foil is made from pure polypropylene and thus,fully recyclable. The disinfecting action of the wipes is based on a new patented complex of naturally occurring organic fruit acids: the Organic Acid Complex. Bacillol® 30 Sensitive Green Wipes have also been available in BIG PACKs since December. The disinfectant wipes, available from April 2020, are the ’green‘ version of Bacillol® 30 Sensitive Tissues: they are just as effective and gentle on materials and skin as the tissues but save around 30% CO2 per pack and up to 65% per wipe compared to Bacillol® 30 Sensitive Tissues. now also available in BIG PACKS patient beds - without tearing. Once you have gained confidence in the strength of tear-resistant wipes, you will also stop pulling out multiple wipes as a ’precaution‘: this saves money in the long run and is more sustainable. Bacillol® Zero Tissues & Bacillol® 30 Sensitive Green Tissues 11
KNOWLEDGE 2025 flu season has proven to be one of the most intense in the last 15 years Influenza season hard on US and Europe Severe influenza wave challenges public health systems The 2025 influenza season has proven to be exceptionally severe in both the United States and Europe, with activity levels not observed for over a decade. The current influenza wave thus poses significant challenges to the public health [1-3]. Up to 650,000 deaths by influenza this season Every year during the winter season, seasonal influenza circulates in all parts of the world, causing epidemics of varying sizes. According to the World Health Organization (WHO) there are around a billion cases of seasonal influenza annually worldwide, including 3–5 million cases of severe illness and up to 650,000 deaths [4]. The 2024-2025 flu season has been of particular severity in the United States and in Europe. Most flu hospitalisations in the US in over a decade In the United States this season’s flu wave has had a magnitude not seen since the 2009 swine flu pandemic [5]. The Centers for Disease Control and Prevention (CDC) estimates that there have been at least 43 million illnesses, 560,000 hospitalizations and 24,000 deaths so far in the US [6]. The peak of the season was reached in late February, with over 6 flu-related hospitalisations per 100,000 inhabitants. The greatest impact in secondary care has been seen in adults 65 years old and above [5]. Outpatient respiratory illness currently decreased but as of end of March 2025 remains above the national baseline for the sixteenth consecutive week [6]. Amid the worst flu season in 15 years, health officials raised concerns about rare but serious neurological complications in children following influenza infections as in approximately 13% of pediatric flu death an influenza-associated encephalopathy or encephalitis has been reported. These cases are to be further investigated [7]. As the flu is still widespread getting vaccinated is strongly recommended [2]. Significant burden on European public health systems Also, in Europe the 2024-2025 flu season was particularly intense. The European Centre for Disease Prevention and Control (ECDC) reports a significant burden on public health systems due to the combination of a severe flu season and circulating infections with respiratory syncytial virus (RSV) [8, 9]. While hospital admissions due to influenza have been observed in all age groups to date, individuals aged 65 years and older tend to have the highest risk of hospitalisation and severe outcomes [8, 9]. Hand hygiene crucial to prevent infections With high flu activity taking preventive measures remains critical in reducing the spread and severity of illness. The WHO recommends getting vaccinated, frequent hand hygiene and staying home when sick as actions to reduce your and other’s risk of getting ill and developing severe disease. This underscores once more the role of hand hygiene as a simple but highly effective means in preventing infections such as influenza [2]. Reference 1. https://www.paho.org/en/documents/epidemiological-alert-increased-activity-seasonal-influenza-virus-and-other-respiratory (accessed on 25/03/2025) 2. https://www.who.int/europe/news/item/22-01-2025-influenza-season-well-underway-across-the-who-european-region--protect-yourself--protect-those-around-you (accessed on 25/03/2025) 3. https://www.scientificamerican.com/article/why-this-years-flu-season-is-the-worst-in-more-than-a-decade/ (accessed on 25/03/2025) 4. https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal) (accessed on 25/03/2025) 5. https://www.cdc.gov/flu/php/surveillance/in-season-severity.html (accessed on 25/03/2025) 6. https://www.cdc.gov/fluview/surveillance/2025-week-11.html (accessed on 25/03/2025) 7. https://www.cdc.gov/mmwr/volumes/74/wr/mm7406a3.htm (accessed on 25/03/2025) 8. https://www.ecdc.europa.eu/en/publications-data/communicable-disease-threats-report-15-21-march-2025-week-12 (accessed on 25/03/2025) 9. https://www.ecdc.europa.eu/en/news-events/acute-respiratory-infections-eueea-epidemiological-update-and-current-public-health-0 (accessed on 25/03/2025) 12
Surface material The RC not only differs significantly between different pathogens, but is also influenced by numerous external factors. For example, it is known that copper surfaces significantly shorten the RC of pathogens compared to textiles, plastic or steel. The nature of the surface also plays a role, with viruses in particular benefiting from greater porosity [1]. Humidity and temperature Thanks to their cell walls, Gram-positive bacteria tolerate dry conditions better than Gram-negative bacteria. Viruses are also influenced by their envelope:Enveloped viruses, especially respiratory pathogens, maintain their RC longer at low humidity, while non-enveloped viruses require more humid air. In addition, lower temperatures appear to be more favorable for the RC of airborne bacteria and certain viruses. SARS-CoV-2, for example, remains infectious longest at low temperatures and extremely high humidity. Enteric viruses, on the other hand, which spread mainly faecal-orally, multiply particularly well from 20 °C [1]. Biofilms Biofilms not only ensure the survival of pathogens in their natural habitat, but also in healthcare facilities. For example, they protect them from environmental factors such as dryness. Klebsiella pneumoniae, for example, can remain viable in a dry biofilm for up to 4 weeks. Biofilms therefore require particularly thorough cleaning methods [1]. Systematic review of the environmental resilience of nosocomial pathogens How long can bacteria & co. multiply on surfaces? Contaminated surfaces play an important role in the spread of nosocomial infections (NI). The risk of NI depends on various factors such as exposure, the degree of contamination and the infectious dose. The decisive factor, however, is whether the pathogens on surfaces are still viable and even able to multiply. A current systematic review [1] now provides a comprehensive overview of numerous relevant bacteria, viruses, fungi and protozoa and their capacity to replicate (RC) on surfaces. Following further scientific discussion, recommendations for the cleaning and disinfection of surfaces should be derived from this in the future. KNOWLEDGE Reference 1. Kramer A et al. (2024) Clin Microbiol Rev 37: e0018623. https://doi.org/10.1128/cmr.00186-23 Timeline of replication capacity of pathogens on surface xy at room temperatute (schematic illustration) Timeline of replication capacity of pathogen xy on different surfaces at room temperatute (schematic illustration) 1 minute 1 hour 1 week 1 month 1 year 1 minute 1 hour 1 week 1 month 1 year 13
FORUM FORUM KNOWLEDGE STUDIES New pathogens on the rise? References 1. https://www.aerzteblatt.de/nachrichten/156741/WHO-kann-Berichte-zu-Ausbruch-mit-humanem-Metapneumovirus-in-China-nicht-bestaetigen (accessed on 10.02.2025) 2. https://www.who.int/news-room/questions-and-answers/item/human-metapneumovirus-(hmpv)-infection (accessed on 10.02.2025) 3. https://www.openpr.de/news/1276284/FSME-Co-Forscherinnen-entdecken-in-den-Alpen-neues-Zeckenvirus-idw.html (accessed on10.02.2025) 4. Nowotny N et al. (2025) Viruses 17: 122. https://doi.org/10.3390/v17010122 5. https://www.who.int/news-room/fact-sheets/detail/chikungunya (accessed on 10.02.2025) 6. https://www.ecdc.europa.eu/en/chikungunya-monthly (accessed on10.02.2025) New index to assess the quality of hand hygiene Glove Use and Hand Disinfection The indications for the use of disposable medical gloves in healthcare facilities are often unclear. In Germany, the Commission for Infection Prevention in Medical Facilities and in Care and Integration Assistance Facilities and Companies (KRINKO) therefore published a statement in 2024 [1]. Researchers at the German Consulting Center for Infection prevention and Control in Freiburg, Germany took this as an opportunity to develop an index of glove hand hygiene (GU) and hand disinfection (HD) - the so-called GUHDI [2]. This can be used as an additional measure to assess the quality of hand hygiene. How is the GUHDI calculated? The GUHDI assumes that two gloves count as one glove use. It is calculated as follows GHD per patient day divided by HD per patient day. While a GHDI of 1 indicates that one HD occurs per GHD, a GHDI of 0.5 indicates two HDs per GHD - and so on. The researchers piloted the GUHDI in three hospitals with a total of 1100 beds and concluded that the index can be collected with little to moderate additional effort. Optimal GUHDI to be determined Since in practice there are more indications for HD than for GU, the GUHDI should be less than 0.5. However, studies have yet to determine an optimal range. When the GUHDI is incorporated into a comprehensive surveillance programme, it can provide meaningful data for the improvement of hand hygiene practices. References 1. Hoch B, Schulz-Stübner S (2024) J Infect Prev: 17571774241297671. https://doi. org/10.1177/17571774241297671 2. Robert Koch-Institut (2024) Epidemiol Bull 10: 3–15. https://www.rki.de/ DE/Aktuelles/Publikationen/Epidemiologisches-Bulletin/2024/10_24.pdf?__ blob=publicationFile&v=2 (accessed on 10.02.2025) Human metapneumovirus (hMPV)1,2 • Occurs seasonally worldwide, especially in children. Currently more common in China (outbreak not confirmed by WHO). • Cold symptoms such as cough, fever, runny nose. Risk groups (young children, elderly, immunocompromised, chronically ill) may become seriously ill. Rarely fatal. • Droplet and aerosol transmission. Alpine chamois encephalitis virus (ACEV)3,4 • So far detected in three chamois in Austria and Italy (2017 and 2023) • Neurological disease leading to death. • Transmitted by ticks. It is unclear whether it is transmitted to other species or to humans. Currently no evidence of zoonotic risk. Chikungunya virus5,6 • Occurs mainly in South America (current focus Brazil with > 400,000 cases in 2024) and parts of Asia. • Sudden onset of fever, severe joint pain, possibly other general symptoms Rarely fatal. • Transmitted by tiger mosquito. Extremely low risk within Europe. : GUHDI GHD per patient day divided by HD per patient day 14
KNOWLISESDEGNE PREVENTIA® Surgical Irrigation Prevention of biofilms in surgery Dissolving a biofilm requires a combination of the mechanical power of irrigation fluid itself and ingredients that support it [4]. Current studies confirm the efficacy of PREVENTIA® Surgical Irrigation against biofilms and planktonic cells as well as its tolerability for human cells and tissue [4-6]. This irrigation solution consists of the active ingredient polyhexanide (PHMB) and the surfactant poloxamer. While PHMB has long been known for its antimicrobial activity, the novel combination allows it to reach the site of action more efficiently [7]. PREVENTIA® can be used, for example, for orthopaedic procedures and in the wound closure phase in general. PREVENTIA® Surgical Irrigation is effective in higher dilutions than PVP iodine The in vitro study by Dudek et al. [4] investigated the efficacy of various antiseptic and rinsing solutions against several hospital germs. For example, PREVENTIA® effectively killed all pathogens even when tested in higher dilutions than PVP iodine. In addition, cytotoxicity was investigated in an alternative in vivo model using caterpillars. Interestingly, only PVP iodine caused noticeable damage to the animals tested. [4]. Biofilms pose a major challenge in surgery. The shielded environment that a biofilm offers microorganisms protects them from external influences and can favour the development of antibiotic-resistant germs [1]. Surgical site infections account for around 16% of all nosocomial infections in Europe [2] and 80% are attributable to biofilms [3]. Complete inactivation within one minute Watson et al. [5] confirmed the efficacy of PREVENTIA® in the timekill assay: among others, PREVENTIA® completely inactivated all cultures within one minute. The therapeutic index (ratio between required active concentration and toxicity on mammalian cells) was also most favorable for PREVENTIA® compared to PVP iodine and others [5]. Finally, the efficacy of PREVENTIA® was demonstrated in a third in vitro study in which all but one of the solutions met the requirements for bactericidal activity, while toxicity was not part of the study [6]. Conclusion Efficacy and tolerability must always be carefully weighed up against each other. PREVENTIA® Surgical Irrigation proved to be effective overall against biofilms and planktonic cells – while at the same time being very well tolerated. With PREVENTIA®, HARTMANN is making a further contribution to the Mission: Infection Prevention (M: IP®) Figure based on data from [4]. MBEC = minimal biofilm eradication concentration. Concentration of PHMB in combination with macrogol lower than in PREVENTIA® (0.04% vs. 0.1%). * = none of the tested dilutions was sufficient to inactivate the biofilm. Figure modified after [5]. Time-kill assay, here exemplified for P. aeruginosa. CFU = colony forming units. Concentration of PHMB in combination with macrogol lower than in PREVENTIA® (0.04% vs. 0.1%). References 1. Sahoo K, Meshram S (2024) Cureus 16: e70629. https://doi.org/10.7759/cureus.70629 2. European Center for Disease Prevention and Control. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. Stockholm: ECDC; 2024. https://www.ecdc.europa.eu/sites/default/files/documents/healthcare-associated-point-prevalence-survey-acute-carehospitals-2022-2023.pdf (accessed on 27.02.2025) 3. Hrynyshyn A et al. (2022) Antibiotics (Basel) 11: 69. https://doi.org/10.3390/antibiotics11010069 4. Dudek B et al. (2024) Int J Mol Sci 25: 12720. https://doi.org/10.3390/ijms252312720 5. Watson F et al. (2014) GMS Hyg Infect Control 19: Doc73. https://doi.org/10.3205/dgkh000528 6. Honegger AL et al. (2025) Antibiotics (Basel) 14: 25. https://doi.org/10.3390/antibiotics14010025 7. https://www.hartmann.info/de-de/themen/surgical-site-infection/preventia (accessed on 27.02.2025) 15
PRACTICE HARTMANN hand hygiene system Healthy hands according to plan Integrating skin care and protection into everyday Hand hygiene guidelines not only provide recommendations for cleaning and disinfecting hands, but also deal with skin protection and care [4,5]. For example, all medical and nursing staff are recommended to apply hand cream regularly - using skin protection and skin care products that are suitable for the skin type and have been dermatologically proven to be effective [4]. Ideally, this should be done in the ’3 moments of skin care‘: before work, during work (e.g. after washing hands) and after work [6]. If this approach is followed consistently, most skin problems can be prevented from the outset. From one source - for all hands HARTMANN is one of the few suppliers to offer a complete hand hygiene system. This includes not only high-quality hand cleaning and disinfection products, but also disposable medical gloves, dispensers, digital solutions for monitoring hand hygiene and the skin care system from the Baktolan® range. The hands of healthcare staff are exposed to great strain day after day. Around 85% of nursing staff suffer from skin irritation at some point [1]. The causes are varied and range from excessive hand washing to inadequate skin care [2,3]. Occupational skin diseases are largely preventable - if the right strategy is used! References 1. Robert Koch-Institut (2019) Epidemiol Bull 19: 157-161. https://www.rki.de/DE/Aktuelles/Publikationen/Epidemiologisches-Bulletin/2019/19_19.pdf?__ blob=publicationFile&v=1 (accessed on 18.02.2025) 2. Hamnerius N et al. (2018) Br J Dermatol 178: 452-461. https://doi.org/10.1111/bjd.15813 3. Soltanipoor M et al. (2019) Contact Dermatitis 80: 26-34. https://doi.org/10.1111/cod.13148 4. Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (2016) Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 59: 59:1189-1220. https://doi.org/10.1007/s00103-016-2416-6 5. WHO (2009). WHO Guidelines on Hand Hygiene in Health Care. https://www.who.int/publications/i/item/9789241597906 (accessed on 18.02.2025) 6. Hines J et al. (2017) J Eur Acad Dermatol Venereol 31: 53-64. https://doi.org/10.1111/jdv.13851 How to implement skin care and –protection into your daily workday: … with the right products to do everything right. Wash hands Wash hands if visible dirty Skin protection after longer work breaks Protect skin Skin care Disinfect hands and wear gloves when indicated Disinfect hands and wear gloves when indicated Before work: After work: During work: 16
FORUM World Hand Hygiene Day, 5 May Raise your hands for World Hand Hygiene Day: hand hygiene affects us all! Good hand hygiene in healthcare - when applied at the right time - prevents healthcare-associated infections and saves millions of lives every year [1]. Therefore, hand hygiene is important for all healthcare workers. Hand disinfection is undoubtedly one of the most important infection prevention measures. But hand washing, skin care and protection, and examination gloves also play a major role. It is important to note that the use of medical examination gloves does not replace hand disinfection [2] and that there are many activities where gloves do not need to be worn. However, preventing healthcare-associated infections is not just the responsibility of healthcare workers. Patients and visitors can also help prevent the transmission of pathogens. As our hands come into contact with a wide range of pathogens every day, good hand hygiene is important to prevent the spread of germs. Show your support for World Hand Hygiene Day! As every year, HARTMANN supports the WHO initiative. Under the motto ’Hands up for World Hand Hygiene Day‘, we would like to encourage everyone to raise their hands in a symbolic gesture of support for better hand hygiene: whether in healthcare facilities, at home or in public – everyone can help prevent the spread of germs and protect their fellow human beings. The HARTMANN SCIENCE CENTER has created various materials on the correct way to use gloves, which are available to download from our campaign website: https://www.hartmann-science-center.com/en/ top-issues/campaign-days/world-hand-hygieneday-2025 Hand hygiene adherence saves lives This year we are particularly motivated by an anniversary: 2025 marks the 60th anniversary of Sterillium®. Since its introduction in 1965, Sterillium®‘s skin-friendliness has helped to promote hand hygiene around the world, saving many people from lifethreatening infections. To celebrate its 60th anniversary, Sterillium® is not only getting a fresh new look. We also used the anniversary as an opportunity to enrich the topic of hand hygiene with exciting lectures at the HARTMANN SCIENCE CENTER Symposium 2025: https://www.hartmann-science-center.com/ en/top-issues/events/hsc-symposium-2025 5 May is World Hand Hygiene Day again. This year, the World Health Organization (WHO) is highlighting the importance of hand hygiene under the theme ’It might be gloves. It‘s always hand hygiene.‘ References: 1. WHO-Kampagnen-Webseite zum ’World Hand Hygiene Day 2025‘: https://www.who.int/campaigns/world-hand-hygiene-day/2025 2. Robert Koch-Institut (RKI). Epidemiologisches Bulletin 19/2024. https://www.rki.de/DE/Aktuelles/Publikationen/Epidemiologisches-Bulletin/2024/19_24.pdf?__ blob=publicationFile&v=5 (accessed on 04.03.2025) 17
INTERVIEW Occupational Safety and Hand Hygiene Therapy while you sleep! Professor John, according to your publications, skin diseases - dermatoses - are among the most common occupational diseases. About a third of all work-related illnesses in the EU and the US affect the skin alone. Why is that? Many of those affected work in the healthcare sector. They should know how to protect their skin, shouldn‘t they? There are occupations where the typical activities put people at significantly increased risk of skin diseases. These include jobs in the healthcare sector. Nurses are particularly at risk. Studies of nurses and geriatric nurses have shown a point prevalence of around 20%. This means that one in five has an occupational skin disease. For example, the number of times hands are washed with soap each day is a significant risk factor for occupational dermatoses. Another important risk factor is the length of time disposable gloves are worn. Both are common in the healthcare sector. The longer disposable gloves Professor Dr Swen Malte John is Head of the Department of Dermatology, Environmental Medicine and Health Sciences at the University of Osnabrück, Chairman of the Task Force Occupational Skin Diseases of the European Academy of Dermatology and Venereology and Scientific Director of the Institute for Interdisciplinary Dermatology Prevention and Rehabilitation (iDerm) in Osnabrück, Germany. are worn during work, the greater the likelihood of developing skin disease. The same goes for washing your hands with soap: the more often you wash your hands, the more likely you are to develop eczema, an inflammatory skin condition. However, it is also important to note that many health care professionals perceive their occupational eczema as an inevitable consequence of their professional duties, a perception that is often accompanied by the belief that they are performing their duties in the correct manner. This is a mistake. Damaged hands are not part of the job! Nor are they a sign of commitment. Who is generally at increased risk and should pay attention to skin care and protection? Around 30 to 40% of the population possess sensitive skin, a condition that is attributable to their genetic make-up. Only untreated skin diseases are incurable! 18
INTERVIEW Nonetheless, everyone should pay attention to skin care and protection. This includes proper hand disinfection with a lipid-replenishing alcoholic hand rub. However, women are twice as likely as men to develop contact dermatitis, an inflammatory skin condition caused by contact with a harmful substance, at some point in their lifetime. This is because women are more likely than men to do wet work at work and at home: they clean, wash dishes and do laundry more often than men. And water is not good for the skin in the long run! The protective horny layer of the epidermis is only 0.02 millimeters thick. In a healthy state, the cells are closely packed, forming a protective wall. If the skin is exposed to moisture for a long period of time, the bricks will swell up and the whole bandage will come apart at the seams and become permeable. This is also an easy route for the spread of disease. The longer disposable gloves are worn during work, the greater the likelihood of developing skin disease And then what? How can you help them? What is important in treatment? Depending on the severity of the disease, treatment consists of the local application of anti-inflammatory agents, which also includes the short-term application of glucocorticoids, i.e. cortisone, and systemic therapies that work throughout the body. Regular use of skin care products is also very important. For example, patients apply cream to their hands every evening and wear thin cotton gloves overnight to avoid soiling their bedding and to ensure that the product is well absorbed. We call this ’therapy during sleep‘. It is used to stabilize the damaged epidermal barrier. And that‘s the good news: Skin damage usually resolves with the right treatment. Only untreated skin diseases are incurable! How to wear gloves correctly Disinfect Hands: Before putting on gloves, disinfect your hands and let them dry. Proper Glove Application: Put on gloves correctly to avoid contamination. Change Gloves Regularly: Change gloves every 10 to 15 minutes to prevent crosscontamination and hand perspiration [1]. Correct Glove Removal: Remove gloves properly to avoid contaminating your hands. werden. Disinfect Hands Again: After removing gloves, use an alcohol-based hand rub to disinfect your hands. Use skin care and skin protection products: Apply skin care and skin protection products to protect your skin. 2 Min. 10-15 min References 1. Hübner NO et al (2013) BMC infectious diseases 13:1-7. https://doi.org/10.1186/1471-2334-13-226 19
DATES & EVENTS ICPIC 2025 8th International Conference on Prevention & Infection Control (ICPIC) When? September 16, 2025 Where? Geneva, Switzerland www? https://conference.icpic.com/ In addition to the ICPIC 2025 Congress programme, we would like to invite you to this year‘s HARTMANN Symposium on the topic of ’60 years of Alcoholic Hand Disinfection: New Perspectives on Efficacy and Skin Health‘. Our event is scheduled for Tuesday, September 16 (15:00-16:00). You can look forward to the following presentations: PD Dr Tobias Kramer LADR Laboratory Group Dr. Kramer & Colleagues, Geesthacht, Germany Presentation 1: ’Reassessing Hand Disinfection - Balancing Speed, Compliance, and Efficacy‘ Prof Dr Swen Malte John Head of the Department of Dermatology, Environmental Medicine and Health Sciences at the University of Osnabrück Scientific Director of the Institute for Interdisciplinary Dermatology Prevention and Rehabilitation at the University of Osnabrück (iDerm) Osnabrück, Germany HARTMANN will have an exhibition stand at ICPIC Use disinfectants safely. Always read the label and product information before use. SGSH Annual Meeting 2025 When? September 24-26, 2025 Where? Interlaken, Switzerland www? https://sginf2025.congress-imk.ch/frontend/index.php?folder_ id=3998&page_id= Presentation 2: ’Safe Hands, Safe Care - The Role of Skin Health in Hand Hygiene‘ Invitation to share with an extra dose of expertise Hazardous Classification Sterillium® foam extra care: Attention H226: Flammable liquid and vapour. H319: Causes serious eye irritation. 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 Picture credits: Title IStockphoto; P. 2/3: BODE Chemie; P. 4/5: Beling Grafikdesign, IStockphoto; P. 6/7: BODE Chemie, Marco Grundt, P .8/9: BODE Chemie, Stockphoto; P. 10/11: BODE Chemie, Marco Grundt; P.12/13: Patrick Schwalb Fotografie, www.christineschube.de; P.14: Stockphoto; P. 16: Marco Grundt; P. 18: iDerm, Marco Grundt; P.19: Synthese Hazardous Classification Sterillium® pure: Attention H226: Flammable liquid and vapour. H319: Causes serious eye irritation. H336: May cause drowsiness or dizziness. H412: Harmful to aquatic life with long lasting effects. Hazardous Classification Sterillium® med: Attention H226: Flammable liquid and vapour. H319: Causes serious eye irritation. H412: Harmful to aquatic life with long lasting effects. Hazardous Classification Sterillium® Virugard: Attention H226: Flammable liquid and vapour. H319: Causes serious eye irritation. H412: Harmful to aquatic life with long lasting effects.
January: Orthopoxvirus simiae February: Clostridium tetani March: Rickettsia prowazekii April: Bordetella pertussis May: Measles virus June: Vibrio cholerae July: Rabies virus August: Corynebacterium diphtheriae September: Plasmodium falciparum October: Respiratory syncytial virus (RSV) November: Dengue virus December: Mycobacterium tuberculosis Prevention by vaccination MO TU WE TH FR SA SU 49 1 2 3 4 5 6 7 50 8 9 10 11 12 13 14 51 15 16 17 18 19 20 21 52 22 23 24 25 26 27 28 1 29 30 31 1 2 3 4 DECEMBER MO TU WE TH FR SA SU 44 27 28 29 30 31 1 2 45 3 4 5 6 7 8 9 46 10 11 12 13 14 15 16 47 17 18 19 20 21 22 23 48 24 25 26 27 28 29 30 NOVEMBER MO TU WE TH FR SA SU 40 29 30 1 2 3 4 5 41 6 7 8 9 10 11 12 42 13 14 15 16 17 18 19 43 20 21 22 23 24 25 26 44 27 28 29 30 31 1 2 OCTOBER MO TU WE TH FR SA SU 36 1 2 3 4 5 6 7 37 8 9 10 11 12 13 14 38 15 16 17 18 19 20 21 39 22 23 24 25 26 27 28 40 29 30 1 2 3 4 5 SEPTEMBER MO TU WE TH FR SA SU 31 28 29 30 31 1 2 3 32 4 5 6 7 8 9 10 33 11 12 13 14 15 16 17 34 18 19 20 21 22 23 24 35 25 26 27 28 29 30 31 AUGUST MO TU WE TH FR SA SU 27 30 1 2 3 4 5 6 28 7 8 9 10 11 12 13 29 14 15 16 17 18 19 20 30 21 22 23 24 25 26 27 31 28 29 30 31 1 2 3 JULY MO TU WE TH FR SA SU 22 26 27 28 29 30 31 1 23 2 3 4 5 6 7 8 24 9 10 11 12 13 14 15 25 16 17 18 19 20 21 22 26 23 24 25 26 27 28 29 JUNE MO TU WE TH FR SA SU 18 28 29 30 1 2 3 4 19 5 6 7 8 9 10 11 20 12 13 14 15 16 17 18 21 19 20 21 22 23 24 25 22 26 27 28 29 30 31 1 MAY MO TU WE TH FR SA SU 14 31 1 2 3 4 5 6 15 7 8 9 10 11 12 13 16 14 15 16 17 18 19 20 17 21 22 23 24 25 26 27 18 28 29 30 1 2 3 4 APRIL MO TU WE TH FR SA SU 09 24 25 26 27 28 1 2 10 3 4 5 6 7 8 9 11 10 11 12 13 14 15 16 12 17 18 19 20 21 22 23 13 24 25 26 27 28 29 30 MARCH MO TU WE TH FR SA SU 05 27 28 29 30 31 1 2 06 3 4 5 6 7 8 9 07 10 11 12 13 14 15 16 08 17 18 19 20 21 22 23 09 24 25 26 27 28 1 2 FEBRUARY MO TU WE TH FR SA SU 01 30 31 1 2 3 4 5 02 6 7 8 9 10 11 12 03 13 14 15 16 17 18 19 04 20 21 22 23 24 25 26 05 27 28 29 30 31 1 2 JANUARY 2025
Rabies virus Disease: Spectrum of efficacy: rabies virucidal activity against enveloped viruses Europe is officially rabies-free, but the virus remains a threat worldwide. It is transmitted through animal bites and can cause severe damage to the nervous system. Vibrio cholerae Disease: Spectrum of efficacy: cholera bactericidal It can cause severe diarrhoea and dehydration when transmitted through contaminated water or food. Clean water and hygiene are the key to prevention! Measles virus Disease: Spectrum of efficacy: measles virucidal activity against enveloped viruses Highly contagious and widespread worldwide. They can cause severe symptoms such as fever and skin rashes. Clostridium tetani Disease: Spectrum of efficacy: tetanus sporicidal The bacterium that causes tetanus can enter the body through small wounds and trigger dangerous spasms. Orthopoxvirus simiae Disease: Spectrum of efficacy: mpox virucidal activity against enveloped viruses The viruses can be transmitted from person to person and cause skin rashes, fever, and other symptoms. Rickettsia prowazekii Disease: Spectrum of efficacy: epidemic typhus bactericidal Transmitted by lice, this bacterium can cause high fever, headaches, and skin rashes. Historically feared, but rare today. Bordetella pertussis Disease: Spectrum of efficacy: whooping cough bactericidal This bacterium causes a long-lasting, spasmodic cough that can be particularly dangerous for babies and toddlers. Corynebacterium diphtheriae Disease: Spectrum of efficacy: diphtheria bactericidal Diphtheria is a severe respiratory infection that can become life-threatening if left untreated. It is rare in Europe, but there are isolated outbreaks of imported diphtheria. An infection remains a relevant health risk, especially globally. Plasmodium falciparum Disease: Spectrum of efficacy: malaria effective against parasites Transmitted by mosquito bites, the parasite causes fever and chills and can be lifethreatening if left untreated. Prevention and protection against mosquito bites are essential. Respiratory syncytial virus Disease: Spectrum of efficacy: respiratory virucidal activity against infections enveloped viruses Babies, toddlers, and the elderly are particularly affected. The virus can cause severe bronchiolitis and pneumonia. Mycobacterium tuberculosis Disease: Spectrum of efficacy: tuberculosis tuberculocidal This bacterium mainly affects the lungs and is transmitted through the air. Symptoms such as coughing and weakness should be taken seriously. Dengue virus Disease: Spectrum of efficacy: dengue fever virucidal activity against enveloped viruses Transmitted by mosquitoes, it can cause fever, severe headaches, and skin rashes. In severe cases, there is a risk of complications. Protection is particularly important in risk areas.
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