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.

Efficacy of two iso-propanol-based skin antiseptics applied to human skin with many sebaceous glands for 2 and 10 minutes.

Background: Recent research suggests that specific ethanol-based skin antiseptics exhibit their efficacy on the resident skin flora of the forehead in only 2.5 minutes. We have now looked at the efficacy of two skin antiseptics based on 63% (w/w) propan-2-ol (iso-propanol) and applied for 10 and 2 minutes on skin with a high density of sebaceous glands.

Accuracy of robotic patient positioners used in ion beam therapy.

Background: In this study we investigate the accuracy of industrial six axes robots employed for patient positioning at the Heidelberg Ion Beam Therapy Center.

Methods: In total 1018 patient setups were monitored with a laser tracker and subsequently analyzed. The measurements were performed in the two rooms with a fixed horizontal beam line.

Banana leaves as an alternative wound dressing.

Background: There is a need for cheap and efficacious wound dressings in developing countries. Banana leaves have been described as an excellent, inexpensive, easily available dressing material in tropical countries. As a natural product, banana leaves are heavily contaminated with various pathogens that must be removed before they can be used as wound dressings, but effective sterilization methods that do not affect the beneficial wound-dressing properties of banana leaves have not been described.

The new requirements of endoscopy.

The following on new requirements of endoscopy contains commentaries on the risk of infection in endoscopy, the need to eliminate contamination, and the use of a disposable system in transnasal endoscopy.

[Methicillin-resistant Staphylococcus aureus (MRSA) infections. Epidemiology, diagnostics, therapy, and prevention].

The increasing number of complicated soft-tissue or invasive infections caused by methicillin-resistant Staphylococcus aureus (MRSA) is a frequent reason for elaborate treatment regimens. Unidentified MRSA carriers may be the origin of endemic spread to other patients and medical staff. Recently, community-associated cMRSA with particular virulence factors were isolated from persons without the typical history of hospital contacts.

Methods of labeling skin surgical specimens.

Background: Accurate pre-operative or intra-operative labeling of the skin is often necessary to mark exactly the surgical excision lines. Pre-operative "unsterile" permanent skin labeling systems are needed for example for vein and sentinel lymph node surgery; here the dyes must resist two surgical skin disinfection procedures. In contrast, excision borders are labeled during surgery using a "sterile" skin marking system.

Acquisition of antibiotic-resistant Enterococcus faecium strains during long-term hospitalization and fast adaptation of enterococcal flora to antibiotic treatment: a case report.

Recently, it has been suspected that long durations of hospitalization might be a possible risk factor to get colonized by multiple VRE strains. Here we present the case of a patient who underwent stem cell transplantation and subsequently stayed at the hospital for about 4 months until death. At least four different Enterococcus faecium strains were identified from routinely taken microbiological specimens as demonstrated by pulsed-field gel-electrophoresis.

Vancomycin-resistant enterococci outbreak, Germany, and calculation of outbreak start.

On the basis of a large outbreak of vancomycin-resistant Enterococcus faecium in a German university hospital, we estimated costs ( approximately 1 million Euros) that could have been avoided by early detection of the imminent outbreak. For this purpose, we demonstrate an easy-to-use statistical method.

Severe diarrhoea caused by Aeromonas veronii biovar sobria in a patient with metastasised GIST.

This report describes the isolation of Aeromonas veronii biovar sobria as the causative enteropathogen of diarrhoea in an oncological patient after failure of detection of other infectious agents. The case points out the severe and long course of the infection, the diagnostic dilemma, and the prompt recovery after antibiotic treatment.

Efficacy of two ethanol-based skin antiseptics on the forehead at shorter application times.

Background: Recent research suggests that alcohol-based skin antiseptics exhibit their efficacy on the resident skin flora of the forehead in less than 10 minutes. That is why we have looked at the efficacy of two ethanol-based skin antiseptics applied for 10, 2.5 and 2 minutes on skin with a high density of sebaceous glands.

Monoclonal outbreak of catheter-related bacteraemia by Ralstonia mannitolilytica on two haemato-oncology wards.

Background: Ralstonia mannitolilytica is a non-fermentative, gram-negative bacterium isolated infrequently from clinical samples. However, within a period of 11 weeks five inpatients of the tertiary care hospital of the University of Tübingen developed clinical signs of infection and R. mannitolilytica was cultivated from blood samples of all patients suggesting an outbreak.

Evaluation of two methods of determining the efficacies of two alcohol-based hand rubs for surgical hand antisepsis.

The antimicrobial efficacies of preparations for surgical hand antisepsis can be determined according to a European standard (prEN 12791 [EN]) and a U.S. standard (tentative final monograph for health care antiseptic drug products [TFM]).

Linezolid-resistant E. faecium isolated from an open joint fracture: a report of the first isolate from Italy?

This report describes the isolation of a linezolid-resistant Enterococcus faecium and a carbapenem-resistant Acinetobacter baumannii from an infected open patella fracture after a car accident in southern Italy.

Two episodes of vancomycin-resistant Enterococcus faecium outbreaks caused by two genetically different clones in a newborn intensive care unit.

In 2001 two outbreak episodes (January-March and June-July) caused by vancomycin-resistant E. faecium (VRE) of the VanA-type were observed at a neonatal intensive care unit (NICU) of a university hospital in south-west Germany. To identify the initial source and the route of transmission environmental samples were examined as well as stool samples from patients and the staff.

Surveillance of Pseudomonas aeruginosa-isolates in a neonatal intensive care unit over a one year-period.

Outbreaks of gram-negative bacteria such as Pseudomonas aeruginosa in neonatal intensive care units (NICU) can be life-threatening to pre-term infants, which are highly susceptible to serious infections with bacteria. Forty-two ventilated neonates in the NICU of the University Children's Hospital of Tuebingen were found to be colonized (n = 40) or infected (n = 2) with P. aeruginosa within a sampling period of one year.

Infectivity of prion protein bound to stainless steel wires: a model for testing decontamination procedures for transmissible spongiform encephalopathies.

Objectives: To establish an animal model to study transmissible spongiform encephalopathy using hamsters and steel wires contaminated with infectious brain materials as transfer vehicles, and, based on this model, to test decontamination procedures against the infectious prion proteins on the steel wires as a near real situation bioassay.

Design: Infectious brain materials were given to healthy hamsters intracerebrally either as a suspension or as dried materials on the surface of steel wires. The animals were observed for 18 months.

[Conception of heavy ion beam therapy at Heidelberg University (HICAT)].

The ion beam therapy facility HICAT presently under construction at the Heidelberg University Clinic will be the first clinical irradiation facility for heavy ions in Europe. Its capacity should enable the treatment of 1000 patients per year. The use of different ion species ranging from protons to oxygen under identical conditions should clarify the question of which particle species is best suited in terms of indication.

[Clinical dosimetry for heavy ion therapy].

Since December 1997, patients are treated with carbon ions at GSI (Gesellschaft für Schwerionenforschung). Dose delivery is performed with the intensity-controlled raster-scanning technique, which allows a highly conformal treatment of the tumor. To meet the special requirements of dosimetry with heavy ion beams, new dosimetric measurement techniques were developed and introduced into clinical application by the DKFZ (Deutsches Krebsforschungszentrum).