DISINFACTS ISSUE 02/2025 Comprehensive hygiene solutions for outpatient care
EDITORIAL 03 FORUM Congress report: ‘ICPIC 2025‘ 04 Three awards for commitment to sustainability 12 HARTMANN at the Freiburg Congress on Infections 2025 21 The role of pharmacies in patient safety 24 KNOWLEDGE The 5 moments of surface hygiene: Do visualizations improve compliance? 06 New overview of relevant pathogens in healthcare and the associated hygiene measures 13 European standards in the field of disinfectants 14 Improving hand hygiene in Spanish nursing homes PRINCESS programme 17 Odour nuisance in the workplace 18 C. difficile – A persistent challenge in clinical practice 20 Hygiene measures in dialysis 22 PRACTICE Pathogens that require enhanced hygiene measures 19 Hand and surface hygiene in the dental sector 23 Hand hygiene in everyday life 25 Athlete‘s foot – an underestimated fungal infection in everyday life and sport 26 Insights from the latest Eurosurveillance & new WHO resolution 27 Conscious use of medical disposable gloves 28 is possible STUDIEN New findings on the Hawthorne effect in hand hygiene 7 INTERVIEW Experience with the software module „Observe“ 8 DISINFACTS MAGAZINE AND NEWSLETTER 30 Content 2
Editorial DISINFACTS 2|2025 Dr. Heide Niesalla The coronavirus pandemic has clearly demonstrated the crucial role of consistent hygiene and infection prevention measures in all areas of society, including hospitals and care facilities. This issue focuses specifically on outpatient care. We explore the solutions that HARTMANN offers to dental practices, examine how dialysis facilities can best support patients with chronic kidney failure and weakened immune systems, and consider the important role that pharmacies play. As the first point of contact for many health issues, pharmacies make a vital contribution to patient safety. A special highlight of this edition is our new pathogen poster. For the first time, it provides a comprehensive overview of the most important pathogens in healthcare, relevant for both inpatient and outpatient settings. It provides infection prevention specialists as well as medical and nursing staff, with a practical tool to support them in their daily work and provide guidance. In addition, we address issues that go beyond everyday clinical and practical matters yet remain crucial for health and patient safety. A prime example of this is the responsible use of resources. The HARTMANN GROUP and its subsidiaries have already received several awards for this, including the EcoVadis certification. We hope that this issue will support you in your daily work and encourage you to consider issues beyond your own area. After all, infection prevention remains a common task for us all. Your Dr. Heide Niesalla, Head of HARTMANN SCIENCE CENTER 3
FORUM One thing is clear to us: safe care is based on healthy hands! This is why we presented sustainable disinfection and skin care solutions, as well as innovative infection prevention approaches, at our booth in Geneva. At the Conference Centre in Geneva, HARTMANN also organized a symposium that critically examined ‘60 years of alcohol-based hand disinfectants - New perspectives on efficacy and skin health’. Particular focus was given to new scientific findings regarding their effectiveness and impact on skin health. HARTMANN Symposium We were delighted to welcome infection prevention and control expert and former medical coordinator of the national Clean Hands Campaign in Germany PD Dr Tobias Kramer (LADR GmbH Medical Care Centre, Dr Kramer & Colleagues, Geesthacht, Germany) and specialist in dermatology and venerology, environmental medicine, and occupational dermatology Prof Dr Swen Malte John (University of Osnabrück), who provided scientific insights during the symposium. In his presentation, ’Reassessing alcoholbased hand rubs – balancing speed, compliance and efficacy‘, Tobias Kramer discussed the re-evaluation of alcoholbased hand disinfectants in terms of speed, compliance and effectiveness: ‘In order to address our colleagues in hospital settings and further improve adherence to the 5 Moment Model, we need new impulses. To achieve this, we need do take the user experience into account. Why is a 15-second hand rub more effective than a 30-second one? How does it potentially improve compliance? There can only be a psychological explanation for that‘. Prof Dr Swen Malte John (Chair Taskforce Occupational Skin Diseases of EADV and Research Coordinator of the Institute for Interdisciplinary Dermatology Prevention and Rehabilitation at the University of Osnabrück (iDerm) Osnabrück, Germany) presentation, titled: ’Safe hands, safe care – The role of skin health in hand hygiene‘, among others addressed the new resolution of the World Health Assembly (WHA), highlighting the importance of skin health in hand hygiene. His message was that skin diseases must be treated as a priority. ‘Healthy and protected hands mean safe care‘, he said. ‘What we need is education. This is even more important when you consider what usually happens. If the use of alcohol-based hand rubs starts stinging, many healthcare workers will start washing their hands even more frequently. This will actually cause them to develop hand eczema.‘ Preventing healthcare-associated infections and tackling antibiotic resistance are ongoing global challenges. This was made clear once again in mid-September at the eighth International Conference on Prevention & Infection Control (ICPIC), held in Geneva - the city of the WHO headquarters. We at HARTMANN seized the opportunity to discuss the successes achieved to date and the future challenges of alcohol-based hand disinfection with experts from around the world. Congress report: ‘ICPIC 2025‘ Looking back to the future: The future of alcohol-based hand disinfection ICPIC 2025 4
Dr Viktoria Kolbe (scientist at the HARTMANN SCIENCE CENTRE) concluded the series of presentations with her presentation ‚Requirements for modern alcohol-based hand rubs‘ by explaining the requirements that alcohol-based hand disinfectants must meet for hygienic hand disinfection today. Posters and stand: current research In addition to the symposium, the HARTMANN SCIENCE CENTRE contributed a total of four posters to the ICPIC scientific programme. Topics included factors influencing the quality of hand hygiene in different clinical units, such as operating theatres and surgical outpatient clinics (P1087: ‚Factors influencing hand hygiene quality in functional units‘) Another HARTMANN study, presented as a poster, compared the physical properties of cellulose fibre wipes with those of conventional PET-based wipes. The results provide valuable practical information, particularly with regard to patient safety and user-friendliness (P1165: Analysis of the material of readyto-use disinfection wipes for surface disinfection and their impact on patient safety). FORUM You weren‘t in Geneva? No problem! All posters are available to view and download online on the ICPIC 2025 conference website. You will also find video recordings of the symposium presentations there. Find out more here: https://www.hartmann-science-center.com/en/top-issues/events/icpic-2025 The other two posters addressed questions about alcoholbased hand disinfectants that are of great interest to many practitioners in everyday clinical care. Do alcohol-based hand disinfectants (one ethanol-based and one propanol-based) fulfil the strict efficacy requirements of the EN 1500 standard in just 15 seconds? (P1238: ‘Alcohol-based hand rubs fulfil EN 1500 in 15 seconds‘). And is the recommended amount of 3 milliliters really necessary to achieve the required hand coverage? (P1239: Influence of hand rub volume on hand coverage, spillage and user preference). 5
The 5 moments of surface hygiene Do visualizations improve compliance? Differences between the concepts The 5 moments of hand hygiene are divided into near-patient and far-patient and are process-oriented. All moments build on each other along a stringent path. In comparison, the 5 moments of surface hygiene are more complex. They are not a sequence of steps, but independent moments. The proposed visualization [3] deliberately changes the perspective compared to the standard presentation of the 5 moments of hand hygiene in order to differentiate the illustrations from one another. To keep the text short, moment 1, for example, summarizes the disinfection of near-patient and high-touch surfaces as routine disinfection. Successful visual representations facilitate the transfer of knowledge - this also applies in the healthcare sector. This is clearly illustrated by the concept of the 5 moments of hand hygiene [1], whose success is not least due to the strong visual language. Five moments have also been proposed for surface hygiene [2], but the concept has not yet become established. A recent article [3] now proposes a visualization of the 5 moments of surface hygiene in analogy to hand hygiene. This should help to promote the acceptance of surface hygiene as an important pillar of infection prevention. From theory to practice Employee habits can only be changed gradually. Acceptance of surface hygiene is also hindered by the fact that cleaning work and cleaning staff have so far been little noticed. In practice, the hygiene plan and risk analysis of the clinics determine which work steps fall under the 5 moments of surface hygiene. The frequency of cleaning and disinfection also differs between areas with different levels of risk. The visualization of the 5 moments of surface hygiene can help to transfer the complex requirements of surface hygiene into practice. Visualizations should also be used as a supplementary tool as part of a comprehensive training and intervention program. References 1. WHO (2009). WHO Guidelines on Hand Hygiene in Health Care. https://www.who.int/publications/i/item/9789241597906 (accessed on 18.02.2025) 2. Dancer SJ, Kramer A (2019) J Hosp Infect 103: e1–8. https://doi.org/10.1016/j.jhin.2018.12.015 3. Krewing M et al. (2025) Hyg Med. 50(6):D46-D51. 4. Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (2022) Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 65: 1074-1115. https://doi.org/10.1007/s00103-022-03576-1 Visualization of the 5 moments of surface hygiene according to [2,4], published in [3]. 1 3 2 4 5 Download the poster here: KNOWLEDGE routine disinfection after contaminations before aseptic procedures terminal disinfection in case of outbreaks 6
STUDIES No observation without influence! New findings on the Hawthorne effect in hand hygiene 24/7 data from the EMS, supplemented by direct observations During the study, data was collected from an intensive care unit, an intermediate care unit, and a standard ward. Patient rooms, waste disposal/cleaning rooms, and other areas (e.g. kitchens and corridors) were examined. While the EMS provided continuous data via sensor-equipped disinfectant dispensers, hygiene specialists carried out direct observations of HHC in accordance with the ‘5 Moments‘ approach [2]. The results were statistically modelled for evaluation [1]. The Hawthorne effect (HE) refers to the phenomenon whereby people behave differently when they know they are being observed. As the HE can distort the results of a study, every effort is made to avoid it in research. However, despite awareness of the HE, direct observation is still considered the gold standard for monitoring hand hygiene compliance (HHC). A new study at a German hospital has now quantified the HE using an electronic monitoring system (EMS), finding differences between wards and room types [1]. Positive Hawthorne effect strongest in patient rooms Overall, a positive HE (i.e. improved HHC under direct observation) was most evident in patient rooms in the normal and intensive care wards. In contrast, there was no significant difference in the intermediate care ward. Negative HE (i.e. poorer HHC despite observation) was primarily found in waste disposal rooms. However, fewer observations were made in these rooms, and the observed staff may have exhibited reactive behaviour [1]. References 1. Otchwemah R et al. (2025) Am J Infect Control: S0196-6553(25)00451-1. https://doi.org/10.1016/j.ajic.2025.06.020 2. WHO (2009). WHO Guidelines on Hand Hygiene in Health Care. https://www.who.int/publications/i/item/9789241597906 (accessed on 31.07.2025) Conclusion Although further studies are needed to corroborate the results, one thing is clear: HE is particularly relevant in direct patient contact. It can also vary significantly between different hospital wards. To monitor HHC as accurately as possible, hospitals can use a combination of electronic and staff-based methods, as was done in this case. The full article is available to download here: Observing is influencing: How hand disinfection compliance observations affect hand disinfection rates; specifics derived from an electronic monitoring system - American Journal of Infection Control Figure based on [1]. Significance levels: * ≤ 0.05, ** ≤ 0.01, *** ≤ 0.001. Other Utility/Waste Patient w/o observation observation 25 20 15 10 5 0 ** + 31.4% ** + 57.7% *** + 70.5% Rate (HD/patient day) normal ward Other Utility/Waste Patient 50 40 30 20 10 0 + 3.5% *** -99.4% + 5.3% IMC Other Utility/Waste Patient 75 60 45 30 15 0 *** + 27.4% * + 32.9% ** + 32.0% ICU 7
INTERVIEW Experience with the software module ‘Observe‘ ‘One major advantage is that direct feedback can now be provided.‘ Dear Ms Hombeuel, since when have you been using Observe to record hand hygiene compliance at Memmingen Hospital? How has using it changed things for you? Alexandra Hombeuel: We have been using Observe since 2020. Since then, assessing compliance has been much easier. In fact, it is easier to do this with a click than manually. It is also convenient: I have a device where I can store everything important to me. This means I always have everything at my fingertips, including for evaluation purposes. It‘s great that you can generate statistics and visual representations of the results immediately, without lots of words. Depending on what you want to know or illustrate, you can also generate a wide variety of statistics. That‘s really useful. And you, Mr Hohl: since when have you been measuring hand hygiene compliance at Aarau Cantonal Hospital? In what ways has Observe influenced your hospital‘s work? Stefan Hohl: Hand hygiene compliance has been effectively recorded at this hospital since 2006. We have been using the Observe system since 2017. Initially, the data was recorded manually. Digitalisation was not yet so advanced at that time. The data was recorded on paper and then transferred to an Excel spreadsheet. This process was very time-consuming and tedious, and also prone to errors. I wasn‘t here at the time, but I am familiar with this type of recording method from another clinic. We used to work that way there, too. That‘s why I know how exhausting it was, as you had to concentrate hard to ensure that you entered the correct numbers in the right places. Today, everything is much easier: errors are minimised, and we save time because we don‘t have to re-enter the data afterwards. Another big advantage is that we can now give direct feedback to the observers. Whenever possible, we conduct a feedback discussion outside the patient‘s room after the observation. It helps when the evaluation is presented visually in the app with these bar charts. Has the introduction of the Observe module also improved adherence with hand hygiene? Stefan Hohl: The number of recordings naturally increased with the introduction of Observe. This is because the process became easier, but it may also be because more people joined the team and participated. Since then, we have averaged around 500 additional recordings per year. In total, we have consistently exceeded 2,000 recordings per year. Before that, we were well below that figure. Adherence with hand hygiene has changed over the years. It is difficult to say whether this was due to Observe. We also observed a ‘COVID-19 effect‘: during the pandemic, which began in early 2020, compliance rose sharply due to an increased presence on the wards and greater awareness of hygiene. How was it in Memmingen, Ms Hombeuel? Has Observe also improved hand hygiene adherence at your facility? Alexandra Hombeuel: Yes, but it is only sustainable in a few areas of our clinic. There are several factors that play a role in the practical implementation of hygiene rules. Above all, however, it is long-term awareness that needs to change. Our data shows that there are still significant fluctuations among occupational groups. That is the reality. There is still a widespread belief that simple measures such as hand disinfection after the five moments cannot have a significant impact on infection prevention. Unfortunately, there is a lack of understanding that everyone can contribute and that each individual is responsible for doing so. Since 2015, the ‘Observe‘ software module of the HARTMANN Hygiene Platform has helped hospitals in eight countries record and analyse hand hygiene compliance in accordance with the WHO‘s ‘Five Moments for Hand Hygiene‘. In an interview with DISINFACTS, Alexandra Hombeuel, Hygiene specialist at the hospital Memmingen (Bavaria, Germany) and Stefan Hohl, Infection Prevention Specialist at the Cantonal Hospital Aarau (Switzerland), share their experiences of using the digital assistant to improve hand hygiene compliance monitoring.* *The interviews were conducted separately and the interviewees were not aware of the statements made by others. 8
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INTERVIEW Experience with the software module ‘Observe‘ Has the improvement in hand hygiene compliance also resulted in a decrease in the number of infections in areas where it has been implemented? Alexandra Hombeuel: We can‘t say for certain. There has been nothing negative noted in our infection records. Ultimately, though, hand hygiene is just one part of overall hygiene. Mr Hohl, do you think there is a connection between improved hand hygiene compliance and a decrease in infections? Stefan Hohl: No, that‘s actually very difficult to say. Whether infections are rising or falling depends on various factors, such as the staff, staff turnover and the number of temporary staff. More generally, it depends on hygiene in the operating theatre, which, although less so than in other departments, is also related to hand hygiene. It is difficult to separate these factors from one another — ultimately, everything plays a role. How do you use the collected data? Have you developed any interventions for your institution based on it? Stefan Hohl: At the beginning of the year, we extract data from the system and then evaluate the previous year. We use this information to create an annual report. The results are then shared with the wards, their respective managers and the medical management. Any nursing wards with an adherence rate of less than 75% then receive specific training on hand hygiene. Training courses are also held for doctors. For example, our 2023 findings showed that hand hygiene compliance could have been better. That‘s why we held lecture hall events the following year. These compulsory events were attended by all nursing staff and doctors. We also conducted training sessions in 2022. At that time, however, they were held directly in the nursing wards. This was because we had observed poor implementation of hand hygiene the previous year, particularly before patient contact and before invasive procedures. We use the available data to influence the wards or doctors when necessary. Alexandra Hombeuel: We hold debriefings and then agree on further measures. Unfortunately, however, these often come to nothing. Those of us in the hygiene department simply do not have the authority to issue instructions. This means that even if we agree on something, we cannot enforce it. Although it is now easier to identify problems with hand hygiene compliance and present the results quickly in an appealing graphical format, you are still struggling to bring about lasting change. How would you rate the practical use of the Observe module? Are you satisfied with it? Alexandra Hombeuel: I think the application is basically great as it is. It has everything you need for compliance monitoring. The main advantage is that digital recording increases the credibility of the data collected. And that‘s not all. The SOPs are included too. That‘s useful. However, creating your own SOPs can be difficult at times. It‘s quite a tough job. In this respect, the application could be more user-friendly. Stefan Hohl: We are very satisfied with Observe. And also with HARTMANN‘s entire hygiene platform, which we have been using for two years. With the hygiene platform, the system works even better and is even more stable. Previously, the system would sometimes crash during data entry, or data would not be recorded correctly. It is now also more visually appealing and data entry is relatively self-explanatory. This enables us to explain the system quickly and effectively to new users who are using it for the first time. It‘s great that you can generate statistics and visual representations of the results immediately, without lots of words. Alexandra Hombeuel 10
INTERVIEW The hygiene platform makes the system work even better and provides greater stability. Stefan Hohl 11
FORUM Bronze, silver, and platinum Three awards for commitment to sustainability EcoVadis is one of the world‘s leading providers of sustainability ratings, supporting companies in achieving their sustainability goals. It assesses companies based on 21 criteria across four areas: environment, labour and human rights, ethics, and sustainable procurement. Only companies with a strong sustainability management system and above-average performance compared to other assessed companies are awarded medals. Bronze for the HARTMANN GROUP The current EcoVadis assessment confirms that the HARTMANN GROUP has successfully implemented many effective sustainability measures and is therefore well on track: According to the assessment, HARTMANN ranks in the top 35% of all companies audited by EcoVadis in the last twelve months. The group ranks among the top 18% in the overall assessment and among the top 4% in the environmental category. The HARTMANN GROUP also clearly exceeds the industry average in the labour and human rights and sustainable procurement categories, ranking among the top 15% and top 12%, respectively. Silver for the Herbrechtingen site In the latest reassessment, the HARTMANN site in Herbrechtingen was awarded a silver rating by EcoVadis. This places the site among the top 3% of companies in the medical and dental equipment and materials industry that have recently been assessed. It performed particularly well in the areas of ethics (top 2%), labour and human rights (top 3%), and the environment (top 4%). It also achieved excellent results in sustainable procurement (top 5%). Triple confirmation: platinum again for Kneipp Kneipp, a subsidiary of the HARTMANN Group, has an impressive sustainability success story: It has achieved the EcoVadis Platinum rating for the third time, placing it among the top 1% of all audited companies worldwide. This recognises the company‘s commitment to finding environmentally friendly, socially responsible and economically viable solutions. The EcoVadis rating also recognises the continuous improvement of internal processes. The bar for top ratings is raised every year. Nevertheless, in 2025, Kneipp improved its result: for the first time, the company was awarded the highest rating of ‘excellent‘ in all categories. The commitment has paid off: This year, the HARTMANN GROUP, as well as its individual sites and subsidiaries, were awarded medals by EcoVadis in recognition of their commitment to sustainability. Overall rating Environment Labour and human rights Sustainable procurement Top 18% Top 4% Top 15% Top 12% Overall rating Environment Labour and human rights Sustainable procurement Top 2% Top 3% Top 4% Top 5% 12
ersonal Protective Equipment (PPE) Basic hygiene (hands and surface) ( ) Use PPE in a targeted and situational manner. Depending on the risk of contamination, gloves, protective gowns, face masks or safety goggles may be required, regardless of the pathogen. Examples: Contact with blood, secretions/excretions, extensive wound care Contact protection measures/ contact isolation ( ) Use disposable med. gloves and protective gowns. Depending on the pathogen and clinical picture, protective goggles and a face mask may also be required. Examples: MRSA, Droplet isolation (short-range transmission) ( ) Use disposable med. gloves, protective gowns and face mask. Depending on the pathogen and clinical picture, protective goggles may also be required. Example: Whooping cough Aerogenic isolation (long-range transmission) ( ) Use disposable med. gloves, protective gown, respirator (e. g. FFP-2). Depending on the pathogen and clinical picture, protective goggles may be required. Examples: Overt tuberculosis of the respiratory tract, measles Special isolation station Generally use of blower protection suits. Examples: Ebola, Marburg virus Pathogen Category Spectrum of activity Main route of infection Hygiene measures Typical symptoms/clinical picture 3-MRGN Acinetobacter baumannii bactericidal 1 Catheter-associated urinary tract infections and pneumonia, wound and soft-tissue infections, sepsis 4-MRGN Acinetobacter baumannii bactericidal 2 Catheter-associated urinary tract infections and pneumonia, wound and soft-tissue infections, sepsis Adenovirus limited spectrum virucidal activity a (Kerato-)Conjunctivitis, gastroenteritis, pharyngitis, respiratory tract infections/pneumoniaa, pharyngoconjunctival fever, follicular conjunctivitis Aspergillus spp. fungicidal Aspergillosis, sinusitis, pneumonia Bacillus anthracis sporicidal a Anthrax Bordetella pertussis bactericidal Whooping cough Borrelia spp. bactericidal Borreliose (Lyme disease, lice relapsing fever, tick relapsing fever) Brucella spp. bactericidal Brucellosis Burkholderia mallei bactericidal Glanders, malleus Burkholderia pseudomallei bactericidal Melioidosis Burkholderia cepacia bactericidal Respiratory tract infections, catheter-associated urinary tract infections (CAVE: exclude contaminated care products) Campylobacter jejuni/coli bactericidal 3 Gastroenteritis Candida albicans yeasticidal Mucosal or skin candidiasis, organ candidiasis, candidaemia Candidozyma auris (formerly: Candida) yeasticidal 4 Candidiasis, Candidaemia Chikungunya virus (CHIKV) virucidal activity against enveloped viruses Chikungunya fever Chlamydia psittaci bactericidal Ornithosis/Psittacosis Chlamydia trachomatis bactericidal Trachoma, urogenital tract infections 3-MRGN Citrobacter spp. bactericidal 1 Urinary tract infections, wound infections, sepsis 4-MRGN Citrobacter spp. bactericidal 2 Urinary tract infections, wound infections, sepsis sporicidal ( ) 5 -associated diarrhea (CDI) Clostridium tetani sporicidal Tetanus Coronavirus (not SARS-CoV-2) virucidal activity against enveloped viruses Respiratory tract infections, sniffle, bronchitis Corynebacterium diphtheriae bactericidal a b Cutaneous diphteriaa, pharyngeal diphtheriab Coxiella burnetii bactericidal Q-fever pneumonia Coxsackie virus virucidal activity Hand-mouth-foot disease, respiratory tract infections, myocarditis, meningitis Crimean Congo haemorrhagic fever virus(CCHFV) virucidal activity against enveloped viruses Viral hemorrhagic fever, hepatitis, encephalitis From A for Acinetobacter to Z for Zika virus New overview of relevant pathogens in healthcare and the associated hygiene measures What spectrum of activity do I need when dealing with hepatitis A viruses? And what isolation measures must be observed for a patient with a 4-MRGN pathogen? These and other questions are answered in a new overview poster from the HARTMANN SCIENCE CENTER. In addition to spectra of activity and transmission routes, the information poster focuses primarily on the necessary hygiene measures, including the required personal protective equipment. KNOWLEDGE You can download the full poster here: https://hartmannsciencecenter.com/g0MtPR Hygienic measures P 13
Complex Content with Practical Relevance European Standards in the Field of Disinfectants Standards are not exactly easy for most people to understand, being technical, comprehensive, and detailed. Nevertheless, many professional groups in the healthcare sector need to familiarise themselves with the basics of various standards. European standards are essential for ensuring consistent disinfectant standards across Europe. They provide a binding framework for manufacturers, testing laboratories, and users. Without uniform specifications, different national requirements would apply, making it difficult to compare products and hindering trade. European standards therefore ensure transparency and create a consistent level of quality, guaranteeing health protection and safety. Efficacy testing under realistic conditions The efficacy of a disinfectant can only be ensured when it is tested according to clearly defined procedures, under realistic conditions, against a wide range of relevant pathogens. Disinfectants should therefore be tested against a wide range of relevant pathogens under conditions that are as close to real life as possible. For this purpose, a two-stage test procedure is usually used. Step 1 tests are quantitative suspension tests, which determine the effectiveness against various microorganisms under protein load. Step 2 tests are based on real-life conditions and are therefore carried out on the relevant surface. Since this involves hands in the case of hand disinfectants, only non-pathogenic organisms are used here so as not to endanger the health of test subjects. Two new Level 2 standards were published in 2024: EN 17430 for prehygienic hand disinfection, and EN 17846 for sporicidal surface disinfection. EN 17430: Virucidal hygienic hand disinfection For several years, a two-stage procedure in accordance with EN 13727 (step 1) and EN 1500 (step 2) has been used to verify bactericidal hygienic hand disinfection. In contrast, there were only step 1 tests for virucidal hygienic hand disinfection until recently. It was not until May 2024 that a step 2 test for virucidal activity was published in EN 17430 [2]. This test uses murine norovirus (MNV), which is harmless to humans. As MNV is an non-enveloped virus, EN 17430 can be used to verify a limited spectrum virucidal activity and a virucidal activity. For efficacy claims against enveloped viruses (virucidal activity against enveloped viruses), testing in accordance with EN 14476 (step 1) is sufficient. The EN 17430 test is carried out with 18–22 subjects, who wash their hands beforehand. The test is then performed as illustrated in Figure 1. First, the hands are artificially contaminated with KNOWLEDGE Hands are artificially contaminated with the surrogate murine norovirus. 1 After drying, the finger tips are sampled (pre-value). 2 Finger tips are sampled again (post-value). 4 The efficacy in virus inactivation is compared between reference and test product. 5 Hand disinfection is performed for 2x 30 s with 2x 3 mL 70% ethanol. 3 2x 2x 3 mL 30 s Hand disinfection is performed with the test product for 30-60 s. 3 X mL ≥30 s Reference Tested rub Fig 1: Procedure for testing virucidal hygienic hand disinfection in accordance with EN 17430. 14
MNV (step 1). Then, after drying, the hands are kneaded in a petri dish with growth medium to determine the prevalue (i.e. the number of pathogens before disinfection) (step 2). Step 3 involves disinfecting the hands with 2 x 3 ml of 70% (v/v) ethanol as a reference for 2 x 30 seconds using a standardised rubbing method. After disinfection, the hands are kneaded again in growth medium. This allows the number of pathogens remaining on the hands after disinfection to be determined (step 4; post-value). The logarithmic reduction is then calculated from the difference between the pre-value and the post-value (step 5). To test the test product, the process starts again from the beginning. However, in step 3, the hands are disinfected with the test product instead of the reference product. A quantity of disinfectant specified by the manufacturer is then rubbed in for 30–60 seconds using the standardised rubbing method. In order to pass EN 17430, the test product must be at least as effective as the reference product. EN 17846: Sporicidal efficacy of surface disinfectants against C. difficile EN 17846 [3] also describes phase 2/step 2 test procedure. However, this standard relates to the verification of the effectiveness of surface disinfectants against the spore-forming bacterium C. difficile, which frequently causes nosocomial diarrhoea and whose spores can survive on surfaces for up to five months [4]. Figure 2 shows the test procedure: four consecutive test areas, each measuring 5 x 5 cm, are marked on a test surface. The first test area is contaminated with the test pathogen and organic load (protein and, if applicable, blood) (step 1). The four test areas are then disinfected with the test product and weighed down with a standard weight, starting with test area 1 (step 2). After the exposure time, which ranges from 1–30 minutes for patient-near surfaces and 1–60 minutes for patient-far surfaces, the individual test areas are sampled using moist cotton swabs to recover any remaining pathogens (step 3). Finally, the number of pathogens on each test area is counted and compared with the initial count (step 4). To be considered effective against C. difficile, a disinfectant must reduce the pathogen count on the first test area by four logarithmic steps, while the pathogen count on test areas 2 to 4 must not exceed 50 colony-forming units. Fig 2: Procedure for testing the sporicidal efficacy of surface disinfectants in accordance with EN 17846. Continued #1 #2 #3 #1 #2 #3 #4 #1 #2 #3 #4 EN 16615 | Carrier test (4-field-test) Phase 2 / Stufe 2: Sporicidal, with mechanic Special test pathogens are applied to the first field together with an organic load. A cloth soaked in disinfectant is attached to the underside of a standard weight. The weight is then wiped over the test fields The colonies are counted. An effective disinfectant should have inactivated a certain number of cells. KNOWLEDGE 15
At a glance: Key European standards for disinfectants in the field of human medicine References 1. Bolten A et al. (2022) GMS Hyg Infect Control 17: Doc14. https://doi.org/10.3205/dgkh000417. 2. DIN EN 17430:2024-05. Chemische Desinfektionsmittel und Antiseptika - Viruzide hygienische Händedesinfektion - Prüfverfahren und Anforderungen (Phase 2/Stufe 2); Deutsche Fassung EN 17430:2024. 3. DIN EN 17846:2024-01. Chemische Desinfektionsmittel und Antiseptika - Quantitatives Prüfverfahren zur Bestimmung der sporiziden Wirkung gegen Clostridioides difficile auf nicht-porösen Oberflächen mit mechanischer Einwirkung mit Hilfe von Tüchern im humanmedizinischen Bereich (4-Felder-Test) - Prüfverfahren und Anforderungen (Phase 2/Stufe 2); Deutsche Fassung EN 17846:2023. 4. https://www.hartmann-science-center.com/-/media/country/hsc/top-issues/factsheet-clostridioides-difficile_de.pdf?rev=4ebad2529c1a43649dd611795a4108de&sc_ lang=de-de (accessed on 28.08.2025) Test Spectrum of efficacy Hands Surface (with mechanics) Instruments Hygienic hand disinfection Surgical hand disinfection Phase 2 Step 1 Quantitative suspension test Bactericidal EN 13727 EN 13727 EN 13727 EN 13727 Yeasticidal EN 13624 EN 13624 EN 13624 EN 13624 Fungicidal x x EN 13624 EN 13624 Mycobactericidal/ Tuberculocidal EN 14348 x EN 14348 EN 14348 Virucidal EN 14476 x EN 14476 x Sporicidal x x EN 17126 EN 17126 Phase 2 Step 2 Quantitative carrier test Bactericidal EN 1500 EN 12791 EN 16615 EN 14561 Yeasticidal x x EN 16615 EN 14562 Fungicidal x x x EN 14562 Mycobactericidal/ Tuberculocidal x x x EN 14563 Virucidal EN 17430 x x EN 17111 Sporicidal x x EN 17846 x KNOWLEDGE 16
PRINCESS programme Improving hand hygiene in Spanish nursing homes What is PRINCESS? PRINCESS (the ‘Programa para la Prevención de Infecciones en Centros Residenciales Dirigidos a Personas Mayores de Servicios Sociales’) is a programme initiated by the Spanish Ministry of Health for infection prevention in nursing homes [1]. The recently published recommendations were contributed to by renowned hygienists. Nursing homes must now adapt their hygiene procedures and implement routine hand disinfection at four defined moments, adapted from the ‘Five Moments’ of the World Health Organization (WHO) [2]. Healthcare-associated infections (HAI) cause more than 7,000 deaths and incur direct costs of around €2 billion each year in Spain. Three-quarters of Spanish seniors in care facilities are over 80 years old and therefore particularly at risk. As many of them take medication long-term, the risk of antibiotic interactions increases, and multi-resistant infections are also commonplace. Given that hand disinfection is not yet routinely practiced across the board in Spanish nursing homes, there is also an urgent need for action. The PRINCESS programme aims to address this issue and increase the safety of those in need of care, as well as reducing infections. Five pillars for success The programme is based on five pillars. To meet the ‘infrastructure and resources’ requirement, facilities must provide permanently installed and mobile dispensers filled with proven, effective alcohol-based hand disinfectants. Particular attention should be paid to locations where there is contact with body fluids or where large numbers of people gather. Additionally, common rooms and bathrooms must have sinks with running water, soap, and paper towels [1]. The guideline also provides clear recommendations on the topics of ‘education and training‘ (e.g. content and evidence), ‘evaluation‘, ‘strategic reminders on hand hygiene‘ (e.g. visual cues) and ‘promoting a good safety culture‘. The illustrated appendix containing posters on hand hygiene and glove use facilitates the practical implementation of the programme by institutions. References 1. PROGRAMA PRINCESS (2025). https://seguridaddelpaciente.sanidad.gob.es/informacion/publicaciones/2024/docs/PROGRAMA_PARA_LA_MEJORA_DE_HIGIENE_DE_ MANOS_EN_CENTROS_RESIDENCIALES_DIRIGIDOSA_PERSONAS_MAYORES.pdf (accessed on 01.08.2025) 2. WHO (2009). WHO Guidelines on Hand Hygiene in Health Care. https://www.who.int/publications/i/item/9789241597906 (accessed on 01.08.2025) KNOWLEDGE dos a ores encial d en del Before contact to resident After contact to resident _____ ______ P egenzentrum 4 1 Before aseptic task 2 After body fluid exposure risk 3 17
KNOWLEDGE Just unpleasant or also hazardous to health? Odour nuisance in the workplace Whether you like a smell or find it unpleasant is usually a matter of personal preference, particularly when it comes to light and natural smells. Opinions tend to be more consistent when it comes to strong or chemical smells. This may be because inhaling chemicals can harm health, a fact that most people are aware of or assume to be true [1]. In fact, certain odour parameters can be measured objectively; for example, ‚vapour pressure‘ can be measured [2]. A high vapour pressure value, as exhibited by peracetic acid (PES), means that a substance quickly transitions to the gas phase at low temperatures and can therefore be easily inhaled. If such substances are also toxic, they can quickly pose a health risk. Beyond vapour pressure: Why DNEL values matter just as much The DNEL (Derived No-Effect Level, or the exposure level below which human health is not affected) is considered the toxicological limit value for assessing the risk posed by a substance [3]. The DNEL is one of many limit value measures and can be used alongside the No Observed Effect Level (NOEL) or the No Observed Adverse Effect Level (NOAEL). Plotting the vapour pressure against the DNEL (see figure) makes it immediately apparent that isopropanol and ethanol are harmless, while formaldehyde, chlorine and PES should not be inhaled deeply and protective measures should be taken when handling them. DNEL values also form the basis for determining protective measures in the workplace. These measures protect the health of employees in chemical laboratories, for example, as well as cleaning staff, who are often exposed to volatile, odorous substances when cleaning surfaces. Good to know: The new Bacillol® Oxy Tissues products for surface disinfection only contain hydrogen peroxide and glycolic acid, both of which are relatively odourless, and do not contain PES. Even ‚harmless‘ smells can cause discomfort Unlike vapour pressure and DNEL, objective, established measurement methods for odour perception and recognition thresholds do not currently exist. It is also not possible to predict whether a person will experience symptoms such as nausea or loss of appetite in response to a ‚harmless‘ odour, such as horse manure [1,4]. Of course, a fundamental distinction must be made between pure nuisance and danger. Nevertheless, even a ‚harmless‘ odour nuisance that cannot be avoided can damage health through causing permanent stress [1]. With regard to occupational safety and the associated occupational exposure limits, information in Section 8 of a Safety Data Sheet is also relevant. References 1. Brüning T, Sucker K (2022) Arbeitsmed Sozialmed Umweltmed 57: 448 –455. https://doi.org/10.17147/asu-1-204767 2. https://www.bgbau.de/themen/sicherheit-und-gesundheit/gefahrstoffe/sicherheitsdatenblatt/dampfdruck (accessed on 19.08.2025) 3. https://www.weka.de/arbeitsschutz-gefahrstoffe/dnel/ (accessed on 19.08.2025) 4. Van Thriel C et al. (2023) Geruchsintensive Stoffe: Grundlagen, Bewertung und Markierung. The MAK Collection for Occupational Health and Safety 8: Doc010. https:// doi.org/10.34865/mb0geruchdgt8_1or 5. Technische Regel für Gefahrstoffe. Ausgabe: Januar 2006. BArBl. Heft 1/2006 S. 41-55. Zuletzt geändert und ergänzt: GMBl 2025, S. 155 [Nr. 8] (vom 20.03.2025). Berichtigt: GMBL 2025 S. 234 [Nr. 10-11] (vom 06.05.2025). https://www.baua.de/DE/Angebote/Regelwerk/TRGS/pdf/TRGS-900.pdf?__blob=publicationFile&v=11 (accessed on 24.09.2025) Chlorine Toxicity (based in DNEL-values) Vapour pressure Water Isopropanol Peracetic acid Formaldehyde Essigsäure H2O2 Chlorine bleach Chloroform Ethanol Methanol R-Limonene (orange flavour) Diagram in double logarithmic scale based on data from the European Chemicals Agency (ECHA) chemicals database 18
PRACTICE When standard precaution measures are not enough Pathogens that require enhanced hygiene measures Resistant pathogens: routine disinfection ineffective in about 10% of healthcare-associated infections Based on data from European point prevalence surveys conducted at regular intervals by the European Centre for Disease Prevention and Control (ECDC), the majority of healthcare-associated infections (approximately 90%) are caused by vegetative bacteria, such as S. aureus (including MRSA), E. coli and K. pneumoniae [2, 3]. These pathogens can easily be inactivated using lowalcohol surface disinfectants as part of standard precaution procedures. However, an estimated 10% of healthcare-associated In surface hygiene, there is a distinction between routine disinfection, which forms part of standard precaution measures, and targeted disinfection. Routine disinfection involves wiping down near-patient surfaces daily with a bactericidal and yeasticidal disinfectant which is also active against enveloped viruses (standard precaution measures), while targeted disinfection measures include terminal disinfection, disinfection in the event of contamination, and situations in which a special spectrum of activity is required (e.g. in isolation rooms) [1]. References 1. Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI) (2022). Bundesgesundheitsbl 65:1074-1115. https://doi. org/10.1007/s00103-022-03576-1 2. European Centre for Disease Prevention and Control (ECDC) (2023). Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals, 2016-2017. Stockholm. 3. European Centre for Disease Prevention and Control (ECDC) (2024) Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals, 2022-2023. Stockholm.* 4. Liu C et al. (2023) Antibiotics (Basel) 12: 1141. https://doi.org/10.3390/antibiotics12071141 10% of healthcare-associated infections require a spectrum of activity that goes beyond standard precautions. 90% of healthcare-associated infections can be prevented by using products with bactericidal, yeasticidal and efficacy against enveloped viruses. infections are caused by more difficult-to-combat pathogens [2,3]. Clostridioides difficile is of particular relevance to healthcare facilities as it forms spores that are difficult to inactivate and can cause severe diarrhoeal diseases that are highly contagious to vulnerable individuals. Due to the emergence of hypervirulent strains, C. difficile can quickly put entire hospitals in a state of emergency [4]. Consistent hand hygiene is particularly important for both staff and patients. In addition, surfaces and wet rooms in close proximity to patients should be cleaned daily using a sporicidal disinfectant, such as one based on hydrogen peroxide. Vegetative bacteria: 85% Yeasts (e.g. Candida sp.) 5% Enveloped viruses: > 1% Basic hygiene 90% Bacterial spores 8% Fungi: 1% Non-enveloped viruses: < 1% Enhanced 10% spectrum of efficacy These estimates are based on data from the last two European point prevalence surveys [2, 3]. The relative frequencies of C. difficile may have been overestimated as a positive microbiological result is required by definition. This analysis does not take into account healthcare-associated infections with SARS-CoV-2. 19
International Infection Prevention Week C. difficile – A persistent challenge in clinical practice C. difficile is considered a particularly stubborn pathogen as its spores are resistant to many conventional disinfectants and cleaning methods [3-4]. It is transmitted through direct or indirect contact with contaminated persons or surfaces, causing a faecal-oral smear infection. In industrialised countries, C. difficile is the most common cause of antibiotic-associated diarrhoea following previous antibiotic therapy. This allows C. difficile to multiply unhindered in disturbed intestinal flora [3]. CDI Cases on the Rise – A Growing Concern Since 2003, there has been a continuous increase in CDI cases worldwide, with more than 150,000 cases per year in Europe [5] and up to 500,000 cases per year in the USA [6, 7]. The prevention and containment of CDI in healthcare facilities therefore plays a key role. Precautionary measures, strict hand hygiene and consistent surface disinfection are essential, as the tenacity of the spores can quickly lead to recontamination and the initiation of new chains of transmission [4, 8]. Consistently Implementing Preventive Measure Preventing and containing CDI requires consistent coordination of various hygiene measures. Controlled use of antibiotics is essential to reduce the risk of infection. Patients with CDI should be accommodated in single rooms with wet rooms. In the event of an outbreak, cohort isolation should be implemented. Protective gowns and disposable gloves should be worn when entering the patient‘s room. Particular attention should be paid to hand hygiene: gloves should be worn when entering the room and changed when activities change. Hands should be disinfected and then washed when leaving the room. Patients should also be encouraged to practise thorough hand hygiene. For surface disinfection, all areas close to the patient and wet rooms should be treated daily with a sporicidal surface disinfectant [3]. Infection Prevention as a shared goal These measures can also prevent the spread of stubborn pathogens such as C. difficile. International Infection Prevention Week (IIPW) serves as a reminder of the importance of infection prevention for everyone. From 19 to 25 October 2025, the International Infection Prevention Week (IIPW) – first held in 1986 – once again drew global attention to the central importance of infection prevention. This year, the focus was on educating people about hygiene measures for Clostridioides difficile. These spore-forming bacteria present a significant challenge in infection prevention efforts [1, 2]. References 1. Robert Koch Institut. Clostridioides (früher Clostridium) difficile. RKI-Ratgeber. Stand: 22.01.2025. https://www.rki.de/DE/Aktuelles/Publikationen/RKI-Ratgeber/ Ratgeber/Ratgeber_Clostridium.html?nn=16777040#doc16790860bodyText2 (accessed on 25.08.2025) 2. Yakout A et al. (2024) J Prim Care Community Health 15:21501319241249645 3. Hygienemaßnahmen bei Clostridioides difficile-Infektion (CDI). Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (2019). Bundesgesundheitsbl 62: 906–923 4. Vance J, Turner N (2025) Infect Dis Clin North Am S0891-5520(25)00067-4. doi: 10.1016/j.idc.2025.07.004 5. European Centre for Disease Prevention and Control (ECDC). Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals 2022–2023. https://www.ecdc.europa.eu/sites/default/files/documents/healthcare-associated-point-prevalence-survey-acute-care-hospitals-2022-2023.pdf 6. Guh A et al. (2020) N Engl J Med 382: 1320–30. DOI: 10.1056/NEJMoa1910215 7. Lessa F et al. (2015) N Engl J Med 372: 825–34. DOI: 10.1056/NEJMoa1408913 8. Krishna A, Chopra T (2021). Infect Dis Clin North Am 35(4): 995–1011 KNOWLEDGE 2003 2025 20
HARTMANN at the Freiburg Congress on Infections 2025 Hygiene Under Pressure – Compliance and Innovation in Focus HARTMANN enriched the most important professional event for hygiene experts in the German-speaking world — which attracted over 1,500 participants — by holding a lunch symposium focusing on the care of patients with Clostridioides difficile infections. The key message served alongside the meal was: ’C. difficile can be controlled when theory and practice go hand in hand.‘ The recipe for success involves using personal protective equipment (PPE) and practising good hand hygiene in accordance with guidelines, selecting suitable disinfectants and procedures, and ensuring that practical processes in the isolation room run smoothly. Renowned experts presented the arguments for this assessment in two specialist lectures. Prof. Dr. Markus Dettenkofer, Head of Hygiene and Infection Prevention at SANA Kliniken AG, focused on clinical practice. ’C. difficile in isolation rooms: Safely Implementing Current Recommendations‘, in which he applied new infectious disease medicine findings to everyday ward life. A key takeaway is that C. difficile is primarily transmitted via the hands. Therefore, hand washing and hand disinfection is mandatory for everyone before leaving the room: staff, patients and visitors alike! Afterwards, Dr. Marco Krewing, HARTMANN SCIENCE CENTER, provided information on ’High-level surface disinfection‘, covering topics ranging from occupational safety to cytotoxicity. At the beginning of October, the Advisory Centre for Hygiene (BZH) organised the Freiburg Congress on Infections. This year, the urgent importance of the topics were discussed at the Freiburg Concert Hall. As well as addressing practical questions about endoscopic examinations and the correct diagnosis of infections, the congress also tackled issues such as how to deal with multiresistant pathogens in hospitals. FORUM 21
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