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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  GMS Hygiene and Infection Control; VOL: 12; DOC20 /20171130/
    Publication Date: 2017-11-30
    Description: Background: In accordance with the German Infection Protection Act, the treatment and handling of laundry was checked by the Public Health Department in 2016 in all Frankfurt nursing homes with special focus on the staff's clothing.Methods: On-site visits and surveys were conducted in all 44 nursing homes in Frankfurt/Main, Germany, and random microbiological examinations of 58 reprocessed and 58 already worn protective gowns were performed to determine the numbers of the colony forming units (cfu) and microbiological differentiation of the pathogen species.Results: 41 (93%) of the 44 homes tested had contracted a certified laundry service. 23 (52%) of the homes also ran a laundry of their own; in 21 of these, laundry was reprocessed and disinfected in an industrial washing machine. Regular technical or microbiological tests were carried out in 16 or 12 of the home-owned laundries, respectively. Only 31 homes (70%) provided uniforms for their employees. The staff's clothing was processed in 25 homes by the external laundry, in 9 homes by the internal laundry, and in 12 homes, the nursing staff had to do this privately at their own home.Used coats exhibited significantly higher contamination than freshly prepared ones (median: 80 vs. 2 cfu/25 cm2; P 95 percentile: 256 cfu vs. 81 cfu/25 cm2). Clothing prepared in private homes showed significantly higher contamination rates than those washed in the certified external laundry or in the nursing homes themselves (Median: 16 cfu/25 cm2 vs. 0.5-1 cfu/25 cm2).Conclusion: Considering various publications on pathogen transfers and outbreaks due to contaminated laundry in medical facilities, the treatment of laundry, in particular the uniforms, must be given more attention, also in nursing homes for the elderly. The private reprocessing of occupational clothing by the employees at home must be rejected on hygienic principles, and is furthermore prohibited by law in Germany.
    Description: Hintergrund: Im Rahmen der im deutschen Infektionsschutzgesetz verankerten infektionshygienischen Überwachung wurden im Jahr 2016 in allen Frankfurter Alten- und Pflegeheimen die Aufbereitung und der Umgang mit der Wäsche mit besonderem Fokus auf der Dienstkleidung der Mitarbeiter überprüft.Methoden: Mittels Vor-Ort-Begehung, Befragung in allen 44 Altenpflegeheimen und stichprobenartiger mikrobiologisch-krankenhaushygienischer Untersuchung von 58 frisch aufbereiteten und 58 getragenen Schutzkitteln mittels Kontaktkulturen, Nachweis der Koloniezahl und mikrobiologischer Erregerdifferenzierung wurde der Hygienestatus bewertet.Ergebnisse: 41 (93%) der überprüften 44 Heime hatten eine zertifizierte Fremdwäscherei unter Vertrag. 23 (52%) der Heime verfügten auch über eine eigene Wäscherei, 21 davon bereiteten die Wäsche desinfizierend in einer Industriemaschine auf. Regelmäßige technische Prüfungen wurden in 16, regelmäßige bakteriologische Untersuchungen in 12 der heiminternen Wäschereien vorgenommen. Nur in 31 Häusern (70%) wurde die Dienstkleidung für das Pflegepersonal vom Haus gestellt. Die Dienstkleidung der Pflegemitarbeiter wurde in 25 Häusern in der externen und in 9 Häusern in der internen Wäscherei aufbereitet, 12 Häuser ließen die Dienstkleidung des Pflegepersonals von diesem privat zu Hause waschen. Gebrauchte Kittel wiesen eine deutlich höhere Kontamination auf als frisch aufbereitete (Median: 80 vs. 2 KBE/25 cm2; P 95 percentile: 256 vs. 81 KBE/25 cm2). Die privat zu Hause aufbereitete Dienstkleidung wies deutliche höhere Kontaminationsraten auf als die in der Wäscherei aufbereitete (Median: 16 KBE/25 cm2 vs. 0,5-1 KBE/25 cm2).Schlussfolgerung: Angesichts verschiedener Publikationen zu Erregerübertragungen und Ausbrüchen durch kontaminierte Wäsche in medizinischen Einrichtungen muss der Aufbereitung der Wäsche, insbesondere der Dienstkleidung, mehr Beachtung geschenkt werden, auch in Altenpflegeheimen. Die Aufbereitung von Dienstkleidung durch die Mitarbeiter privat zu Hause ist fachlich abzulehnen und juristisch untersagt.
    Keywords: ddc: 610
    Language: English
    Type: article
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  • 2
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  GMS Infectious Diseases; VOL: 6; DOC01 /20180201/
    Publication Date: 2018-02-01
    Description: Objectives: Tuberculosis (TB) and multidrug- and extensively drug-resistant TB in particular are remaining a major global health challenge and efficient new drugs against TB are needed. This study evaluated the anti-tubercular activity of a natural stilbene and its synthetic derivatives against M. tuberculosis .Methods: Isopropylstilbene and its synthetic derivatives were analyzed for their anti-tubercular activity against M. tuberculosis ATCC 27294 as well as multidrug- and extensively drug-resistant M. tuberculosis clinical isolates by using MGIT 960 instrumentation and EpiCenter software equipped with TB eXiST module. Cytotoxic effects of drug candidates were determined by a MTT dye reduction assay using A549 adenocarcinomic human alveolar basal epithelial cells.Results: Growth of M. tuberculosis ATCC 27294 was suppressed by the natural isopropylstilbene HB64 as well as synthetic derivatives DB56 and DB55 at 25 µg/ml. Growth of clinical isolates MDR and XDR M. tuberculosis was suppressed by HB64 at 100 µg/ml as well as by synthetic derivatives DB56 and DB55 at 50 µg/ml and 25 µg/ml, respectively. No anti-tubercular activity was demonstrated for synthetic derivatives DB53, EB251, and RB57 at 100 µg/ml. Toxicity in terms of IC50 values of HB64, DB55 and DB56 were 7.92 µg/ml, 12.15 µg/ml and 16.01 µg/ml, respectively.Conclusions: Synthetical derivatives of stilbene might be effective candidates as anti-tubercular drugs. However, toxicity of these substances as determined by IC50 values might limit therapeutic success in vivo . Further investigations should address lowering the toxicity for parenteral administration by remodeling stilbene derivatives.
    Keywords: tuberculosis ; drug resistance ; new substances ; epoxide hydrolases ; stilbene ; ddc: 610
    Language: English
    Type: article
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  • 3
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  GMS Infectious Diseases; VOL: 5; DOC07 /20171122/
    Publication Date: 2017-11-22
    Description: Healthcare professionals (HCP) might be at increased risk of acquisition of multidrug-resistant bacteria (MDRB), i.e., methillicin-resistant Staphyl oc occus aureus (MRSA), vancomycin-resistant enterococci (VRE), and multidrug-resistant gram-negative bacteria (MDRGN) and could be an unidentified source of MDRB transmission.The aim of this study was to determine the prevalence as well as risk factors of MDRB colonization among HCP.HCP (n=107) taking part in an antibiotic stewardship program, were voluntarily recruited to perform a rectal swab and to fill in a questionnaire to identify risk factors of MDRB carriage, i.e. being physician, gender, travel abroad within the previous 12 months, vegetarianism, regular consumption of raw meat, contact to domestic animals, household members with contact to livestock, work or fellowship abroad, as well as medical treatment abroad and antibiotic therapy within the previous 12 months. Selective solid media were used to determine the colonization rate with MRSA, VRE and MDRGN. MDRGN were further characterized by molecular analysis of underlying beta-lactamases. None of the participants had an intestinal colonization with MRSA or VRE. 3.7% of the participants were colonized with extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae , predominantly bla CTX-M type. Neither additional flouroquinolone resistance nor carbapenem resistance was detected in any of these isolates. No risk factors were identified to have a significant impact of MDRB carriage among HCP.A colonization rate of 3.7% with ESBL-producing Enterobacteriaceae is of interest, but comparing it to previously published data with similar colonization rates in the healthy population in the same geographic area, it is probably less an occupational risk.
    Keywords: healthcare professional ; ESBL ; MRSA ; VRE ; colonization ; ddc: 610
    Language: English
    Type: article
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  • 4
    Publication Date: 2019-06-29
    Description: Background: Refugees have a significant risk of carrying multidrug-resistant organisms (MDRO), including multidrug-resistant gram-negative organisms (MDRGN) and methicillin-resistant Staphylococcus aureus (MRSA). Since the duration of MDRGN colonization has been shown to last for several months, we hypothesize that the prevalence of MDRO in refugees gradually declines during their stay in Germany to the level of MDRO prevalence in non-refugee patients. Knowledge about the dynamics of refugees' MDRO prevalence might provide the basis for appropriate infection control measures for refugees in hospitals as well as refugees' MDRO epidemiology in general.Material and methods: MDRO prevalence in 109 refugees admitted to the University Hospital Frankfurt, Germany, were compared to 819 adult controls and 224 pediatric patients admitted to the intensive care unit between June 2016 and May 2017.Results: 41.3% (95% confidence interval=31.9-51.1) of the refugees, 5.7% (4.2-7.6) of the adult controls and 8.9% (5.5-13.5) of the pediatric controls were positive for at least one MDRGN. The highest MDRGN prevalence was found in refugees who recently arrived (〈=3 months) in Germany (72.4%; 52.8-87.3). Refugees' MDRGN prevalence declined continuously over time, reaching the adult and pediatric controls' MDRGN prevalence 18 months at the earliest after their arrival in Germany, i.e., 14.9% (1.8-42.8). Conclusion: This study demonstrates that refugees' MDRGN prevalence is declining over time since their arrival in Germany. 18 months after their arrival, refugees' and locals' MDRGN prevalence no longer differs significantly, although the refugees' MDRGN prevalence is still higher. A decline of MRSA prevalence was found 18 months after refugees' arrival. However, MRSA prevalence was still 14%, and thus 8 times higher than that of controls, indicating that precautionary measures continue to be necessary to prevent MRSA transmission.
    Description: Hintergrund: Für Flüchtlinge ist ein erhöhtes Risiko bekannt, Träger multiresistenter Organismen, v.a. multiresistenter Gram-negativer Organismen (MRGN) oder Methicillin-resistenter Staphylococcus aureus (MRSA), zu sein. Vor dem Hintergrund, dass für MRGN eine Nachweisdauer von mehreren Monaten beschrieben ist, haben wir vermutet, dass sich die MRGN-Prävalenz bei Flüchtlingen in Abhängigkeit von deren Aufenthaltsdauer in Deutschland allmählich der der einheimischen Bevölkerung angleicht. Kenntnisse um die Dynamik der MRGN-Prävalenz bei Flüchtlingen können dazu beitragen, krankenhaushygienische Maßnahmen situationsgerecht anzupassen.Material und Methode Retrospektive Evaluierung der MDRO-Prävalenz bei 109 Patienten mit Flüchtlingsanamnese im Vergleich zu 819 erwachsenen sowie 224 pädiatrischen Intensivpatienten, die zwischen Juni 2016 und Mai 2017 am Universitätsklinikum Frankfurt behandelt wurden. Ergebnisse: Bei 41,3% (95%-Konfidenzintervall: 31,9-51,1) der Flüchtlinge, 5,7% (4,2-7,6) der erwachsenen und 8,9% (5,5-13,5) der pädiatrischen Intensivpatienten lässt sich mindestens eine MRGN-Spezies nachweisen. Die höchste MRGN-Prävalenz findet sich bei kürzlich (〈=3 Monate) in Deutschland eingereisten Flüchtlingen (72,4%; 52,8-87,3). Die MRGN-Prävalenz bei Flüchtlingen mit einer Aufenthaltsdauer 〉18 Monate unterscheidet sich nicht mehr signifikant von der der Kontrollgruppen (14,9%; 1,8-42,8).Schlussfolgerung: Diese Studie untersucht den Zusammenhang zwischen der Aufenthaltsdauer der Flüchtlinge in Deutschland und deren MRGN-Prävalenz. Es zeigt sich, dass die MRGN-Prävalenz bei Flüchtlingen umso niedriger ist, je länger sie sich in Deutschland aufhielten. Bei Flüchtlingen mit einer Aufenthaltsdauer von mindestens 18 Monaten findet sich im Vergleich zu den hier untersuchten Kontrollgruppen kein statistisch signifikanter Unterschied mehr, wenngleich auch nach dieser Zeitspanne die MRGN-Prävalenz bei Flüchtlingen noch über der Prävalenz der einheimischen kritisch-kranken Kontrollkohorte liegt. Hinsichtlich MRSA zeigt sich bei der Gruppe der Flüchtlinge ebenfalls eine Abnahme der Prävalenz über Zeit. Da allerdings die MRSA-Prävalenz in dieser Patientengruppe auch 18 Monate nach Einreise in Deutschland die der einheimischen Bevölkerung nahezu achtfach übersteigt, sollten risikoadaptierte Hygienemaßnahmen zur Vermeidung einer MRSA-Übertragung auch nach dieser Zeit strikt eingehalten werden.
    Keywords: refugee ; multidrug-resistant organisms ; infection control ; Flüchtlinge ; Multiresistente Organismen ; Infektionsprävention ; ddc: 610
    Language: English
    Type: article
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