A European approach to infection prevention and control goals.

The current pandemic caused by COVID-19 has underlined the importance of a joint effort and approach to ensure patient and health care worker safety in medical care throughout Europe. In addition, the recent flood disasters in Germany and other countries called for immediate joint action, in this case with regard to the prevention of water-borne infections. Environmental disasters will increase with consequences for hospitals and nursing homes.

Chemical disinfection in healthcare settings: critical aspects for the development of global strategies.

Chemical disinfection is an indispensable means of preventing infection. This holds true for healthcare settings, but also for all other settings where transmission of pathogens poses a potential health risk to humans and/or animals. Research on how to ensure effectiveness of disinfectants and the process of disinfection, as well as on when, how and where to implement disinfection precautions is an ongoing challenge requiring an interdisciplinary team effort.

Antibiotic resistance: What is so special about multidrug-resistant Gram-negative bacteria?

In the past years infections caused by multidrug-resistant Gram-negative bacteria have dramatically increased in all parts of the world. This consensus paper is based on presentations, subsequent discussions and an appraisal of current literature by a panel of international experts invited by the Rudolf Schülke Stiftung, Hamburg. It deals with the epidemiology and the inherent properties of Gram-negative bacteria, elucidating the patterns of the spread of antibiotic resistance, highlighting reservoirs as well as transmission pathways and risk factors for infection, mortality, treatment and prevention options as well as the consequences of their prevalence in livestock.

Lesser-known or hidden reservoirs of infection and implications for adequate prevention strategies: Where to look and what to look for.

In developing hygiene strategies, in recent years, the major focus has been on the hands as the key route of infection transmission. However, there is a multitude of lesser-known and underestimated reservoirs for microorganisms which are the triggering sources and vehicles for outbreaks or sporadic cases of infection. Among those are water reservoirs such as sink drains, fixtures, decorative water fountains and waste-water treatment plants, frequently touched textile surfaces such as private curtains in hospitals and laundry, but also transvaginal ultrasound probes, parenteral drug products, and disinfectant wipe dispensers.

The role of surface disinfection in infection prevention.

Background: The Rudolf Schuelke Foundation addresses topics related to hygiene, infection prevention and public health. In this context a panel of scientists from various European countries discussed "The Role of Surface Disinfection in Infection Prevention". The most important findings and conclusions of this meeting are summarised in the present consensus paper.

Pharmacokinetics of linezolid in septic patients with and without extended dialysis.

Purpose: Linezolid is an option for the treatment of infections caused by multiresistant Gram-positive bacteria. The survival of critically ill patients with acute renal failure (ARF) can be improved by increasing the dose of renal replacement therapy. Extended (daily) dialysis (ED) is a new and important approach to renal replacement therapy in intensive care units.

Implementation of practice guidelines for antifungal therapy in a surgical intensive care unit and its impact on use and costs.

Background: Considering the complexity of diagnosis, high costs of therapy and high morbidity and mortality of systemic fungal infections, antifungal therapy of intensive care patients should follow clearly defined guidelines. We outline the impact of a standardised practice of antifungal treatment in an interdisciplinary surgical intensive care unit of a university hospital.

Methods: Therapy was intended to be optimised by implementation of standardised practice guidelines supported by the clinical pharmacist.

Tissue penetration of moxifloxacin into human gallbladder wall in patients with biliary tract infections.

Objectives: Moxifloxacin, the newest fourth-generation fluoroquinolone, has a broad spectrum of antibacterial activity covering both Gram-positive and Gram-negative aerobic and anaerobic bacteria and is therefore very well suited for the treatment of biliary tract infections. The present study aimed to determine the penetration of moxifloxacin into gallbladder tissue to evaluate its antibiotic potential in this indication.

Patients And Methods: Hospitalized patients with acute cholecystitis received a single, 1 h infusion of 400 mg of moxifloxacin before cholecystectomy.

Survey of attitudes towards curriculum reforms among medical teachers in different socio-economic and cultural environments.

Background: Curriculum reforms in medical schools require cultural and conceptual changes from the faculty.

Aims And Methods: We assessed attitudes towards curriculum reforms in different academic, economic, and social environments among 776 teachers from 2 Western European medical schools (Belgium and Denmark) and 7 medical schools in 3 countries in post-communist transition (Croatia, Slovenia, Bosnia and Herzegovina). The survey included a 5-point Likert-type scale on attitudes towards reforms in general and towards reforms of medical curriculum (10 items each).

Prevention is in! Surveillance is out!

There has been a major change in the basic approach taken to hospital hygiene practices, and indeed to infection control within the hospital on the whole. Whereas as recently as the 1990s lectures on the topic of hand disinfection at international congresses were confined to "the periphery of the congress", today several keynote speakers address this issue with the full attention of the audience. This trend is also reflected in publications, and going beyond the domain of hand disinfection, has highlighted the important role of surface disinfection as well as of instrument disinfection in the prevention of nosocomial infections.

A comprehensive assessment of medical schools in Bosnia and Herzegovina.

Objectives: To perform internal and external evaluations of all 5 medical schools in Bosnia and Herzegovina against international standards.

Methods: We carried out a 2-stage survey study using the same 5-point Likert scale for internal and external evaluations of 5 medical schools in Bosnia and Herzegovina (Banja Luka, Foca/East Sarajevo, Mostar, Sarajevo and Tuzla). Participants consisted of managerial staff, teaching staff and students of medical schools, and external expert assessors.

Reproducibility and workability of the European test standard EN 12791 regarding the effectiveness of surgical hand antiseptics: a randomized, multicenter trial.

Objectives: To evaluate the reproducibility and workability of the in vivo test model of the European test standard EN 12791 regarding the effectiveness of surgical hand antiseptics and, as a secondary objective, to evaluate the power of the model to discriminate between the effectiveness of various formulations of surgical hand antiseptics.

Design: Prospective, randomized, multicenter study with a Latin square design.

Setting: Five laboratories at 2 universities, 2 disinfectant manufacturers, and 1 private testing institution.

Can soda fountains be recommended in hospitals?

Mineral water (soda water) is very popular in Germany. Therefore, soda fountains were developed as alternatives to the traditional deposit bottle system. Nowadays, different systems of these devices are commercially available.

Bacterial contamination of preserved and non-preserved metal working fluids.

Metal working fluids (MWFs) are important facilities for certain industrial processes. Besides their advantage concerning the effective technical applicability it is disadvantageous that they are excellent culture media for bacterial and fungal growth and may therefore act as an infectious source for employees getting in contact with them. As a matter of prevention most of MWFs are nowadays treated with preservatives to eliminate the contamination of possible human pathogenic bacteria and fungi.

Temptation of academic medicine: second alma mater and "shared employment' concepts as possible way out?

Apparently, in developing and in well-developed societies we are confronted with a crisis of academic medicine in all aspects: health care, teaching, and research. Health care providers in teaching hospitals are under pressure to generate revenues, academic research is pressed to keep pace with institutions devoted solely to research, and teaching is often understood not as privilege and honor but as burden and nuisance. The key problem and the principal cause of the crisis are low interest of the best young graduates to follow an academic career in a world where the benefits and values of the private sector are prevailing.

Reform of medical education in Bosnia-Herzegovina: luxury or necessity?

We present the current status of medical education in Bosnia-Herzegovina to set the stage for the curriculum reform. Two principal questions are asked: is the reform necessary, and is it possible? In spite of the differences in size and tradition of medical schools in Bosnia and Herzegovina (BH), they have more features in common than not: all of them are under internal and external pressures for change and reform, which will eventually be inevitable. The history and strategy of reform in Heidelberg, Germany, and Vienna, Austria, are described and recommendations are made on the basis of their experience.

Description of new mutations in the rpoB gene in rifampicin-resistant Neisseria meningitidis selected in vitro in a stepwise manner.

Fourteen meningococcal strains were selected towards rifampicin resistance in a stepwise manner in vitro; final MICs were between 8 and >256 microg ml(-1). Sequence analysis of a 295 bp subgenic fragment of the RNA polymerase beta-subunit (rpoB) gene from the original and the fully resistant strains revealed that, with one exception, the strain pairs differed by just one position in the deduced amino acid sequence. Transformation of a PCR-amplified subgenic rpoB fragment harbouring the mutated site into a susceptible strain demonstrated the resistance-conferring mechanism.

Disinfection of surfaces by photocatalytic oxidation with titanium dioxide and UVA light.

Particularly in microbiological laboratories and areas in intensive medical use, regular and thorough disinfection of surfaces is required in order to reduce the numbers of bacteria and to prevent bacterial transmission. The conventional methods of disinfection with wiping are not effective in the longer term, cannot be standardized, are time- and staff-intensive and use aggressive chemicals. Disinfection with hard ultraviolet C (UVC) light is usually not satisfactory, as the depth of penetration is inadequate and there are occupational medicine risks.

Immunogenicity of recombinant L7/L12 ribosomal protein of Neisseria meningitidis--high prevalence of specific antibodies in humans but limited immunogenicity for T cells.

The rplL gene, coding for ribosomal protein L7/L12 of Neisseria meningitidis was cloned and expressed as a fusion protein. The recombinant protein was used in Western blots and lymphocyte proliferation assays to study the prevalence of specific antibodies in human sera and the immunogenicity for the cellular immune system. Most of the serum samples studied were found to be positive for L7/L12-specific antibodies.

A new test for the detection of pyrogens in pharmaceutical products. Examinations for the validation of the human whole blood assay.

The human whole blood assay utilises the natural fever response to detect pyrogens by determination of the release of IL-1beta. In order to replace the official method, the rabbit pyrogen test, a validation of the whole blood assay is necessary. A comparison of the results obtained from many blood samples has revealed the following: 1) Blood not stimulated by LPS does not produce IL-1beta.

Evaluation and further development of a pyrogenicity assay based on human whole blood.

When cells of the immune system, i.e. primarily blood monocytes and macrophages, come into contact with pyrogens (fever inducing contaminations) they release mediators transmitting the fever reaction within the organism.