DISINFACTS - Issue 2/2019 - bode-science-center.com · National hand hygiene campaigns: Significant...

Issue 2/2019

DISINFACTSSafely into the future.

Achieving more – together.Infection protection affects us all. From physicians and nursing staff to hygiene professionals and patients: the exchange of knowledge and mutual support help to master hygiene challenges.

EDITORIAL 03

EXPERTISEOrdinance on biocidal products 04

5 May 2019: World Hand Hygiene Day 09

FOCUSMy Hygiene SOP: Digital monitoringof working processes 05 DAILY ROUTINE

Increased EN requirements for gloves 14

Storage of disinfectants during summer 18

KNOWLEDGENational hand hygiene campaigns:Role model Australia 07

Home care: Contact with multi-resistant pathogens is part of daily nursing routine 15

FORUM13th Ulm Symposium onNosocomial Infection 11

Psychology in hand hygiene 13

DISINFACTS 2/19 page 2

Editorial

Dear Reader,

DISINFACTS is geared towards diversity: it regularly presents the widest possible range of current and relevant content on all aspects of hygiene and infection prevention. That’s important to us. And in order to achieve this, we combine a variety of topics with varied editorial formats.

In this DISINFACTS issue you will for example read a review of this year‘s 13th Ulm Symposium on Nosocomial Infection. You will also read about an Australian long-term study on hand hygiene, about how to store disinfectants during summer and about how to correctly deal with problematic germs in home care.

One important topic in this edition of DISINFACTS: World Hand Hygiene Day under the banner “Clean care for all – it’s in your hands”. Find out about the eight core elements WHO identified for safe hygienic care and how these requirements can be put into practice. HARTMANN‘s Hand Hygiene Evolution Concept offers helpful support in this respect.

I wish you an insightful and inspiring reading,

Dr. Henning MallwitzDirector Research & Development


EXPERTISE

The 2012 Biocidal Products Regulation (BPR) stipulates that biocidal products and their active ingredients must meet a number of new requirements in order to be authorised [1]. This also applies to disinfectants declared as biocidal products.

Ordinance on biocidal products:

What do the requirements mean in practice?

Sources:

1. Regulation (EU) No 528/2012 of the European Parliament and of the Council of 22 May 2012 concerning the making available on the market and use of biocidal products.

2. Bundesministerium für Umwelt, Naturschutz und nukleare Sicherheit https://www.bmu.de/themen/gesundheit-chemikalien/chemikaliensicherheit/biozide/ (accessed on 16 May 2019).

The consequences that the BPR, which came into force in September 2013, has on users of disinfection products are becoming increasingly apparent now: the manufacturers‘ product portfolios are changing, certain products are removed from the ranges, new are added. And many users are wondering what exactly is behind these changes.

Detailed rules for authorisationThe key here is that since 2013 the requirements placed on biocides have significantly increased. The BPR comprises for example a detailed definition of the requirements for authorisation, ranging from the application for approval of the active substance to the authorisation, from the packaging to the advertising of the biocidal product [2]. The regulation thus aims to harmonise the provision and use of biocidal products within the European market while ensuring the protection of humans, animals and the environment.

Accordingly, biocidal products shall not be made available on the market or used unless authorised in accordance with the regulation. The corresponding evaluation procedure takes place in two stages. The first step is to decide whether an active substance should be included in the Union list of approved active substances. Once the active substance has been approved, the second step is to review the authorisation of the biocidal products containing this active substance. All biocidal products must pass through this EU-wide, harmonised authorisation procedure, which is binding on all market participants.

Future-proof product rangeHARTMANN was quick to deal with the raised requirements of the BPR and put its product range to the test. On this basis, HARTMANN then developed a portfolio with future-proof active ingredients: equivalent or even better products are now available for the preparations that have been taken out of the range. So, users can rely on the fact that also in the future effective disinfection products will be available for every need.


From nursing activities and cleaning to surface disinfection and instrument reprocessing – HARTMANN’s My Hygiene SOP supports the safe execution of a wide variety of work processes in hospitals. A thorough update to the digital eHealth application will be available in the 3rd quarter of 2019. My Hygiene SOP ensures maximum flexibility – from creating individual SOPs to statistical evaluation.

NEW: My Hygiene SOP

Digital monitoring of working processes now customizable

Studies show that it is easier for nursing and medical staff to implement hygiene recommendations when standard operating procedures (SOPs) are in place [1, 2, 3]. Based on recommendations from KRINKO (German Commission for Hospital Hygiene and Infection Prevention) and CDC (Centers for Disease Control and Prevention), HARTMANN and its BODE SCIENCE CENTER therefore have developed SOPs for frequent activities associated with nosocomial infection. The eHealth application comprises evidence-based step-by-step instructions as well as checklists and allows efficient monitoring of the compliance with hygiene protocols during patient care.

Optimal workflow for infection protectionThe digital standard work processes such as “Placing a peripheral venous catheter”, “Inserting an indwelling transurethral urinary catheter” or “Dressing change” go far beyond the mere application of a technique and, in addition to the important hand hygiene, also consider other measures relevant for patient protection.

Sources:1. Kampf et al. Improving patient safety during insertion of peripheral venous catheters: an observational intervention study. GMS Hygiene and Infection Control. (2013) 8(2).2. Scheithauer et al. Improving hand hygiene compliance rates in the haemodialysis setting: more than just more hand rubs. Nephrol Dial Transplant (2012) 27: 766–770.3. Son et al. Practically speaking: Rethinking hand hygiene improvement programs in health care settings. American Journal of Infection Control. (2011) 39(9):716-24.4. Prävention von Infektionen, die von Gefäßkathetern ausgehen Teil 2 – Periphervenöse Verweilkanülen und arterielle Katheter. Empfehlung der Kommission für Krankenhaushygiene

und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsbl 2017.

FOCUS


FOCUS

Essential: the idea of an optimal workflow, i. e. employees rather learn the respective activity in the process and no longer have to remember for every single step whether it requires a hand disinfection or any other hygiene measure.

As part of a technical update, the eHealth application has now been made even more user friendly: “My Hygiene SOP” allows maximum possible adaptation to the conditions and needs on site.

Also the German Robert Koch-Institute (RKI) recommends defining written standards and corresponding training of all employees [4]. HARTMANN’s new “My Hygiene SOP” helps to better adhere to the defined standards in the facilities – a step forward for patient safety.

My Hygiene SOP – the new top functions

• SOP editor to create institution-specific, individual SOPs

• Customizable statistical evaluations and overviews

• Direct feedback and versatile comment functions – predefined or individual

• Modern design and intuitive user navigation

• Compatibility with all commercially available smartphones and operating systems

NEW: My Hygiene SOP

Digital monitoring of working processes now customizable


Role model AustraliaNational hand hygiene campaigns:

Significant increase in hand hygiene

A longitudinal study investigated the effect of the Australian national hand hygiene campaign [1]. Over eight years, significant successes were achieved in both hand hygiene compliance and the reduction of bacteraemia due to S. aureus. One of the key factors for success according to the authors: the central coordination by a government commission. And: only those hospitals were accredited and budgeted that participated in the campaign and met its standards.

From 1 January 2009 to 30 June 2017, M. Lindsay Grayson et al. examined the effect of the Australian National Hand Hygiene Initiative (NHHI) on the number of participating clinics, on the hand hygiene compliance and on the incidence of bacteraemia caused by Staphylococcus aureus [1]. Additionally, the researchers examined the initiative’s impact on employee participation in training and identified the cost of the initiative.

The campaign is based on WHO‘s multimodal hand hygiene-promoting strategy and its 5 Moments. The NHHI focuses on the shift towards a comprehensive safety culture, on training employees and on hand hygiene monitoring and feedback.

Participating Hand hygienehealth facilities compliance

2009 105 63.6 %

2010/11 Incidence rate* 1.27

2017 937 84.3 % Incidence rate* 0.87

**per 10,000 patient days

Healthcare-associated S. aureus bacteraemia (HA-SAB)

KNOWLEDGE


1 1232

3

The three most important key factors

Central coordination / government requirements• Integrated campaign with evidence-based standards

for training• Central campaign coordination by a government

commission• Campaign participation as a prerequisite for

accreditation (budget authorisation) of all clinics throughout the country

• Publication of compliance rates and benchmarks on the publicly accessible MyHospital website

Comprehensive commitment to training • Access to extensive training material incl. e-learning programmes• For a clinic to become accredited all healthcare

workers must participate in basic training package• Completion of the hygiene training module for

surgeons as a prerequisite for participating in the exams

Validated monitoring and feedback• Establishment of reliable and reproducible

monitoring and feedback instruments, including a monitoring app, which halved the effort required

• Representative review of compliance successes with validated processes• Nationwide two-day auditor training courses with

final exam• Training of monitoring and feedback in all clinics

throughout the country according to the Train the Trainer model

The three greatest successes

Each 10 % increase in hand hygiene compliance resulted in a decrease in S. aureus-bacteraemia by 15 %

94.1 % of hospitals reached the national benchmark: a hand hygiene compliance rate of 80 %

Hand hygiene compliance among medical staff rose from 50.5 % to 71.7 %, but was still between 10 % and 15 % below that of nursing staff

Source:

1. Grayson ML et al. Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study. The Lancet Infectious Diseases 2018; 18 (11):1269-1277.

KNOWLEDGE


Reaching the goal with the right measuresWorld Hand Hygiene Day:

“Clean care for all – it’s in your hands”. That was the motto of the World Health Organization (WHO) for this year‘s World Hand Hygiene Day on 5 May 2019. More than 20,000 healthcare institutions meanwhile participate in national campaigns to protect against treatment-associated infection. According to WHO, improved hand hygiene saves between five and eight million lives every year.

WHO identified the eight most important elements that are necessary to prevent nosocomial infection and contain multidrug-resistant pathogens: from evidence-based guidelines and continuing education to training and hand hygiene monitoring and feedback.

In order for these core elements of infection control to be better implemented in practice, programmes are needed that are based on local conditions. HARTMANN‘s Hand Hygiene Evolution Concept offers a comprehensive solution here – with eHealth applications, eLearning programmes, flexibly adaptable standard operating procedures and continuous on-site support.

EVO meets WHO: how HARTMANN‘s Hand Hygiene Evolution Concept supports the implementation of important WHO modules for infection protection (next page):

EXPERTISE

INFECTIONPREVENTION&CONTROLLEADERS

Monitor infectionprevention andcontrol standards

Take action and improve practices

Be part of the WHO SAVE LIVES:Clean YOUR Hands campaign

#InfectionPrevention

#HandHygiene #HealthForAll

Based on the poster “Infection prevention and control leaders” URL: http://www.who.int/infection-prevention/campaigns/clean-hands/en/ © World Health Organization 2019.

PATIENTADVOCACYGROUPSAsk for clean care

It’s your right

#InfectionPrevention

#HandHygiene #HealthForAll

Be part of the WHO SAVE LIVES:Clean YOUR Hands campaignBased on the poster “Patient advocacy groups” URL: http://www.who.int/infection-prevention/campaigns/clean-hands/en/© World Health Organization 2019.

#HandHygiene #InfectionPrevention #HealthForAll

Based on the Main Poster URL: http://www.who.int/infection-prevention/campaigns/clean-hands/en/ © World Health Organization 2019.

Posters of the WHO for this year‘s World Hand Hygiene Day on 5 May 2019


https://www.bode-science-center.com/center/hand-hygiene/hand-hygiene-day/detail-hand-hygiene-day/article/world-hand-hygiene-day-2019-the-core-elements-of-infection-prevention.html

That’s what the Evo Concept offers:

• eHealth applications with optimised checklists for important activities structure work processes and integrate steps relevant

to infection protection

Multimodal strategy

Institution-specific infection control programme

Implementation of guidelines

Environment and equipment considering infection control

Staffing and bed occupancy

Education and training

Surveillance of nosocomial infection

Monitoring and feedback


• Modern eHealth apps for compliance

monitoring and feedback

• High-quality presentations of results


• A multimodal overall concept

based on the modular principle

• With modern digital applications


• All components are based on

scientific principles

• Constant adaptation to new standards


• Demanding eLearning programmes

• eHealth application for compliance monitoring

• Appealing slides for classroom training

WHO’s infection control elements and the appropriate instruments of the Evo Concept

Source:WHO Guidelines on Hand Hygiene in Health Care. World Health Organization 2009.


• Sterillium classic pure – the leading hand disinfectant

in German clinics*

• Dispenser systems for every room situation

• Evidence-based dispenser checklists

*GfK 2018 Disinfection market clinics, last update: 02/2018

EXPERTISEEVO meets WHO: how HARTMANN‘s Hand Hygiene Evolution Concept supports the implementation of important WHO modules for infection protection:


FORUM

Everything on autopilot13th Ulm Symposium on Nosocomial Infection

The Ulm Symposium on Nosocomial Infection has firmly established itself in the calendar of many infection control practitioners. This year again, the top-class congress impressed by a broad and inspiring spectrum of topics. At its Lunchtime Symposium “Psychology in Hand Hygiene”, HARTMANN also focused on a current topic.

This year‘s Ulm Symposium on Nosocomial Infection was an outstanding success. A total of around 1,300 participants attended the event, which took place from 27 to 29 March at the Maritim Congress Centrum Ulm, Germany. The conference focused on psychology of decision-making, information transfer and acceptance. Experts for example examined the following questions: Why is medical staff reluctant to accept vaccination offers? How can knowledge be effectively conveyed in hospital hygiene training? Apart from the official programme, many participants took the opportunity to exchange knowledge and experiences on hygiene and infection control.

Socio-psychological factors influencing hand hygieneWith its Lunchtime Symposium “Psychology in Hand Hygiene”, HARTMANN also demonstrated its keen instinct for trend-setting topics. In her presentation “Psychology in Hand Hygiene” held on 28 March, Dr. Svenja Diefenbacher, Lecturer

and Researcher at the Department of Social Psychology, University of Ulm presented the role of socio-psychological aspects such as feedback, goal setting and habits in hand hygiene. The participants’ interest reflected just how relevant this topic is for many infection control practitioners: with its more than 200 participants the Lunchtime Symposium was one of the best-attended lunchtime events during the congress.

One focus of the lecture was a study by Diefenbacher et al. where the researchers—with the participation of the BODE SCIENCE CENTER—for the first time brought together the aspects of feedback and goal setting in hand hygiene [1]. The four-arm intervention study was conducted in different wards of the Clinic Heidenheim, Germany, investigating the effect of feedback and the goal setting, or a combination of both, on the frequency of hand disinfection. The study included an additional control group.

Baseline

Intervention

Post-Intervention

HH

Esda

y &

roo

m

25

20

15

10

5

0Only

targetOnly

feedbackGoal setting &

feedbackControl

******

HHE = hand hygiene event*** = significant increase† = marginally significant increase

Best intervention: combination of feedback and definition of targets


Innovative determination of feedbackIn order to determine the feedback, the authors chose an innovative approach: a combination of electronically measured dispenser activities in the patient rooms and random direct compliance monitoring. Together with the findings of the observations, the dispenser activations recorded around the clock allowed to estimate the compliance. Depending on the study arm, this compliance rate was then permanently shown on a monitor in the ward as feedback. For goal setting, the compliance rates to be achieved were determined in team meetings and then displayed in the ward room.

The result was clear: the combination of feedback and goal setting proved to be the best intervention to increase the frequency of hand disinfection. The number of hand infections per room rose significantly from 7.9 to 17.0. And even four weeks after the intervention had ended, the number of hand disinfections remained significantly higher (see figure on page 12).

Everything on autopilotDr. Svenja Diefenbacher also talked about another socio-psychological phenomenon that is decisive for hand hygiene: the habit. She distinguished between habit as it is understood in everyday life and habit in the scientific sense. The latter describes a mental connection between a certain element of the situation, a so-called context-dependent cue, and a certain behavioural option.With a strongly pronounced mental connection, actually encountering the context-dependent cue in a situation then automatically initiates the behaviour. With regard to the behavioural option of hand hygiene, the indications,

e. g. before patient contact, can serve as context-dependent cues. If it is possible to link the indication with the behaviour option of hand hygiene on a long-term basis, a habit has been established for this indication. Hand hygiene is then carried out habitually – as in autopilot.

Live voting of the participantsBoth the concept of goal setting and the idea of the autopilot were well received by the participants, as shown by the evaluation of questions that the audience voted on during the lunchtime symposium using tablets. Accordingly, more than half of the participants stated that they considered moderated team meetings for goal setting and posters to be good (52.87 %) or even very good (5.1 %) to implement. And 52.56 % of the participants rated the idea of “Autopilot for hand hygiene” as a new interesting perspective. This feedback as well as the subsequent discussion with many questions prove: infection control practitioners see additional potential for better hand hygiene in socio-psychological factors such as defining goal setting, feedback and habits.

52.56 %of theparticipants

Source:1. Diefenbacher, et al., A quasi-randomized controlled before-

after study using performance feedback and goal setting as elements of hand hygiene promotion. Journal of Hospital Infections 2019; 101(4):399-407.

FORUM


FORUM

Participant: Who defines the targets and determines the hand hygiene compliance rate to be achieved?Diefenbacher: In my opinion, it is important that the compliance goal is set jointly by the employees. If targets are set from top to bottom, there is a high risk that the target will not be accepted. The same also applies if the offer of participation to the employees is not meant seriously. Hand hygiene is a group performance: all employees must participate so that the positive effect of hand hygiene on infection control can be achieved. Against this background, I find it particularly reasonable to relate the targets to the group level.

Participant: Is it realistic for a single person to implement the target alone?Diefenbacher: In principle, there are also very good findings for defining targets for individuals. But as I said before, in the context of hand hygiene in the hospital setting, it is important to make it a group performance. Therefore, from my point of view, it also makes more sense to approach the target at group level. A very interesting subsequent research question would be how strongly individual persons have been involved in the achievement of the group target. If you notice a higher compliance in a ward, this may be due to the fact that many employees have got a little better or

that some of them have greatly improved. Such information is highly valuable for the effect of an intervention to be better

understood and for it to be successfully transferred from one clinic to the other.

Participant: How long does it take for a habit, an autopilot, to develop in hand hygiene?Diefenbacher: Unfortunately, there are still no concrete figures available specifically for the context of hand hygiene. This is an aspect that we are continuing to research, because it is of course highly relevant in practice. In general, it can be said that interventions in other behavioural contexts have relatively different time approaches. Sometimes it‘s four weeks, sometimes it‘s six or eight weeks. What can already be said now is that in any case it takes several weeks until a habit has become established. And it‘s also clear that the development of a habit depends on the individual person.

Participant: Can a habit also be “forgotten” again?Diefenbacher: There is a very clear answer to that: yes, a habit can also be forgotten again. In the case of bad habits this is of course good news, but in the case of helpful habits, such as hand hygiene, this is unfortunate. If adverse external influences occur, they can also negatively influence a desirable habitual behaviour and the habit can regress – the autopilot does not protect against everything.

Speaking of adverse influences: it is crucial for the success of socio-psychological approaches that the basic conditions in an institution are good. This especially applies to staffing and infrastructure. If there are too few employees, these approaches of defining targets and developing habits will hardly help. The framework conditions are important so that good work is possible at all.

Psychology in hand hygieneQuestions and answers:

Dr. Svenja Diefenbacher‘s lecture “Psychology in Hand Hygiene” at HARTMANN’s Lunch Symposium in Ulm, Germany encouraged lively discussions among the audience. Using the tablets provided, the participants used the opportunity to ask many questions about the definition of targets, feedback and habits. In the following you will read a selection of these questions and the corresponding answers of Dr. Svenja Diefenbacher.

Dr. Svenja Diefenbacher,Lecturer and Researcher at the Department of Social Psychology, University of Ulm, Germany

Source:“Psychology in Hand Hygiene” by Dr. Svenja Diefenbacher, University of Ulm, Lunch Symposium of PAUL HARTMANN AG, 13th Ulm Symposium on Nosocomial Infection, 28 March 2019.


The amended EN ISO 374 now includes considerably increased requirements for protective and examination gloves when handling chemicals and microorganisms. DISINFACTS presents how HARTMANN’s Peha-soft® nitrile gloves meet these increased requirements.

Increased EN requirements for gloves

A safe grip for any taskFrom hospitals and primary health care to nursing homes and emergency services: every single day, HARTMANN’s examination and protective gloves provide protection against microorganisms and chemicals in a wide variety of tasks. Its synthetic nitrile gloves also meet the increased requirements of the current EN 374 and are certified accordingly.

Peha-soft® nitrile gloves …… correspond to the new Type B classification,i. e. they have a permeation resistance of at least 30 minutes with at least three test chemicals.

… protect against chemicals according to the new EN ISO 374-4,i. e. they are tested for degradation caused by chemicals. Degradation refers to changes in the glove material, such as embrittlement, shrinkage or swelling.

… protect against microorganisms in accordance with the new EN ISO 374-5,i. e. they meet the requirements with regard to risks from bacteria and fungi. In addition, the gloves meet the requirements for virus protection, which must be proven in an additional test.

… have been extensively tested in accordance with EN requirements,i. e. they have been subjected to leak tests (air and water) as well as to hydrostatic pressure tests. Additionally, they have been tested for puncture resistance.

… provide users with more safety,i. e. they can prove that they have been subjected to a uniform certification.

Packaging with new pictogramsA striking innovation are the pictograms on the glove packaging. According to the modified EN 374, these must be shown on the packaging from April 2019.

EXPERTISE


Around one third of the 1.9 million people currently in need of care in Germany are cared for by outpatient nursing services—often in cooperation with relatives. More than half of the nursing staff come into contact with multidrug-resistant (MDR) germs during their work [1]. Consistent basic hygiene and enhanced communication can prevent the spread of problematic germs in outpatient care.

Contact with multi-resistant pathogens is part of nursing routine

Multidrug-resistant pathogens are a growing challenge in outpatient care: in a quantitative survey conducted by the Centre for Quality in Nursing (ZQP), 57 % of employees stated that they have had contact with problematic germs in the past twelve months [1]. Another study by the MDR network in the Rhine-Main region showed that 3.7 % of patients had MRSA and 14.4 % had ESBL/MRGN [2].

Organisational tips for the prevention of MDR germsIn addition to basic hygiene, the following results of the ZQP survey provide helpful impulses for hygiene management:

• Complete profile during first contact Four out of seven risk factors for MRSA colonisation

are insufficiently recorded and should be included: dialysis dependency, antibiotic therapy in the past six months, a previous stay in a nursing home and the use of catheters in the past

• Training on MDR One third of respondents see the most urgent need for

training on problematic germs and hand hygiene

• Communication According to the survey, the internal exchange on

hygiene issues, the transfer of information to relatives and the exchange with general practitioners should be intensified

Home care

KNOWLEDGE


57 % of outpatient nursing services have had contact with problem germs over the past 12 months.

Please note: By definition, 3MRGN/4MRGN can also include ESBL formers, but usually go beyond their resistance spectrum.

Source: Eggert S., Sumann D., Teubner C. (2016). Erfahrung mit Hygiene in ambulanten Pflegediensten.

Thereof

95 % of them had contact with MRSA

25 % of them had contact with ESBL formers

18 % of them had contact with Clostridium difficile

16 % of them had contact with 3MRGN

7 % of them had contact with 4MRGN

4 % of them had contact with VRE

The overwhelming majority of problematic germs identified in the ZQP survey include methicillin-resistant Staphylococcus aureus (MRSA). However, Gram-negative bacteria such as 4MRGN are also playing an increasing role in outpatient care. As recently as in 2014, a study on the prevalence of MDR was unable to identify multidrug-resistant Gram-negative germs.

MDR risk in outpatient care

57 %

KNOWLEDGE

Pseudomonas aeruginosa

Klebsiella spp.

Clostridium difficile

Staphylococcus aureus

Acinetobacter baumannii

Escherichia coli

Enterobacter spp.


KNOWLEDGE

Paying more attention to basic hygieneBasic hygiene, especially hand hygiene, is the most important measure when having contact with MDR organisms. It includes hand hygiene, surface disinfection and cleaning, reprocessing of medical devices, and the use of protective clothing. Consistent compliance with these measures ensures reliable protection against pathogen transmission – and this

Basic hygiene in case of MDR germs in home care settings

Pathogen examples

Surgical face mask

Dishes Dishwasher < 60 °C

applies to both antibiotic-resistant and sensitive microorganisms. Usually, the MDR status of a patient in need of care is not known in outpatient care, since no screening is carried out, even not for risk factors.

Measures

Clostridium difficileESBLMRSA

not applicableWhen suctioning the mouth / throat area or tracheostoma

• When repositioning the patient

• In case of strongly scaling skin• Sputum/cough in case of

nasal colonisation• When doing tracheostoma

suctioning• In case contaminated body

fluids are spilled

According to recommendations and references of the Robert Koch-Institute:Hygienemaßnahmen bei Patienten mit Durchfällen aufgrund von toxinbildendem Clostridium difficile, Robert Koch-Institut 2008. Merkblätter der regionalen Netzwerke zum Umgang mit multiresistenten Erregern in der ambulanten Pflege. https://www.rki.de/DE/Content/Infekt/Krankenhaushygiene/Pflege/Lit_Heime_ambul.html (accessed on 20 March 2019)

Sources:1. Eggert S., Sumann D., Teubner C. ZQP-ANALYSE. Erfahrung mit Hygiene in ambulanten Pflegediensten. Studiendesign Quantitative Befragung in der ambulanten Pflege.

Befragung von 400 Leitern sowie Qualitäts- und Hygienebeauftragten von ambulanten Pflegediensten in Deutschland, published in June 2016.2. Neumann N et al. Multidrug-resistant organisms (MDRO) in patients in outpatient care in the Rhine-Main region, Germany, in 2014: Prevalence and risk factors.

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016 Feb;59(2):292-300.

• BEFORE touching a person in need of care• BEFORE aseptic procedures• AFTER body fluid exposure risk• AFTER touching a person in need of care• AFTER touching patient surroundings• AFTER glove removalAdditional in case of C. difficile: For the AFTER indications: first disinfect hands to inactivate the vegetative C. difficile bacteria. Then, wash your hands to mechanically remove the spores.

Hand disinfection

Organisational issues Follow hygiene planCare preferably at the end of the tour

Gloves

Protective gown (disposable gown)

Protection in case of close patient contact and contact with infectious material. Dispose of protective clothing in a plastic bag.

Basic and treatment careas well as in case of possible contact with contaminated material/secretionAdditional in case of C. difficile:Always when dealing with diarrhoeal patients.

Instruments

Surface disinfection Wipe disinfection of surfaces close to treatment, of nursing utensils and equipmentAdditional in case of C. difficile: pay attention to sporicidal activity

• Use one per person• Prefer disposable instruments• Alternative: manual or mechanical reprocessing and sterilisationAdditional in case of C. difficile: pay attention to sporicidal activity


DAILY ROUTINE

Storage of disinfectants in summerReally stable:

The heat wave in 2018 has raised questions with many users concerning the safe storage of disinfectants. Here, you will learn what basic rules need to be followed.

At summer temperatures, storage and transport of disinfectants must above all ensure one aspect: the stability of the disinfectants.

Important: constant storage conditionsIn terms of storage, all disinfectants manufactured by BODE Chemie are strictly tested in accordance with the ICH Directive (International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use).This includes storage temperatures between 10 °C and 30 °C. If the temperature falls below or exceeds this range for short periods during summer or winter this does not

have a negative effect on the stability of the preparations, as our own tests in product development have shown. After delivery, the disinfection products can be easily transported and stored at temperatures down to 0 °C or up to 40 °C for up to three days. The only exception: our Dismozon products. These preparations should not be heated above 25 °C and by no means above 30 °C.

Storage according to TRGS 510Generally, it is important to note that disinfectants are usually classified as hazardous substances. Therefore, the requirements to be considered when storing disinfectants are essentially regulated in the Technical Rule for Hazardous Substances (TRGS) 510 “Storage of Hazardous Substances in Transportable Containers”. However, they do not include any special specifications regarding the storage at summer temperatures.

Source:1. TRGS 510 Lagerung von Gefahrstoffen in ortsbeweglichen Behältern,

Fassung 30.11.2015,http://www.baua.de/de/Themen-von-A-Z/Gefahrstoffe/TRGS/TRGS-510.html

Storage of BODE Chemie disinfectants:

• Further information can be found in the safety datasheet under 7 “Handling and storage”.

Wir forschen für den Infektionsschutz. www.bode-science-center.deBSB1

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1DE_03

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CreditsConcept / editorial office: SCI COM GmbH, scientific communication Schmilinskystraße 32, 20099 Hamburg,Tel.: +49 40 / 25 32 86-05, Fax: -08E-mail: [email protected] Niknam (responsible), Anja Garcia ZiemsenISSN 1618-8292

Design: Beling Grafikdesign, Hamburg

DISINFACTS is published by order of BODE Chemie GmbH, Hamburg – A company of the HARTMANN GROUP, Hamburg

Photo credits:Title: iStockphoto; page 2/3: iStockphoto; page 4: iStock-photo, page 5/6: BODE Chemie GmbH, Beling Grafikdesign; page 7/8: iStockphoto, Beling Grafikdesign; page 13: Scicom GmbH; page 13/14: Patrick Schwalb Fotografie, Beling Gra-fikdesign; page 15: HARTMANN; page 16: BODE Chemie GmbH, page 18: BODE Chemie GmbH, Beling Grafikdesign

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