What are disinfectants used in hospitals

German Society for Hospital Hygiene e.V.

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Leading US hygienists call for routine surface disinfection to prevent and control antibiotic-resistant pathogens in hospitals and other medical settings

Prof. Dr. med. habil. A. Kramer (I. Chairman)
Dr. jur. A. Schneider (2nd chairman)

In the Journal of Hospital Infection (2001; 48, Supplement a: 64 68), the leading US American hygienists WA Rutala Lind DJ Weber, who advise the Center for Disease Control and Prevention (CDC) on issues of disinfection and sterilization, call on the basis a risk analysis and assessment of the state of knowledge, the cleaning and disinfection of patient-near surfaces routinely and after the discharge of patients and also consider the disinfection of floors in the patient area as a measure to control hospital infections.

They justify their prevention recommendations briefly as follows:

  • In previous risk analyzes, the importance of surfaces as an indirect source of infection (e.g. via contamination of the hands of patients and medical staff) was underestimated.
  • According to current knowledge, surfaces can be important in the transmission of epidemologically important pathogens such as methicillin-resistant Staphylococcus aurereus strains (MRSA), vancomycin-resistant enterococci, (VRE) or viruses (rotaviruses, rhinoviruses). A number of important pathogens causing nosocomial infections contaminate the vicinity of the patient, including the floor, and can persist on dry surfaces for weeks to months.
  • Classic and modern epidemiological as well as genotypic identification methods prove the effectiveness of chemical disinfection methods in controlling outbreaks caused by antibiotic-resistant microorganisms
  • Disinfection processes are far more effective than cleaning processes (detergents) for killing or inactivating pathogens on surfaces
  • Cleaning agents are often quickly contaminated with nosocomial infectious agents and then lead to their spread into the immediate patient environment. This concerns, among other things. Pseudomonas aeruginosa and Campylobacter and Enterobacteriaceae.
  • According to the US Isolation Guideline, medical devices that are contaminated with blood, body fluids, secretions or excreta must be cleaned and disinfected. The same guideline recommends cleaning and disinfecting surfaces near the patient such as bed frames, bedside tables, tables, cupboards and door handles to control nosocomial infectious agents such as enterococci in particular, which can survive for a long time in the inanimate environment of the patient.
  • Newer disinfectants have persistent antimicrobial effects. By transferring antimicrobial components (silver), lasting antimicrobial effects can be achieved on surfaces over a period of up to 13 days.
  • By using a single preparation (disinfectant), the safety of quality-assured use can be increased for the cleaning staff, which is usually insufficiently trained.
  • There is no justification for the exclusive mention of disinfectants, excluding cleaning agents, as a possible stress factor for the cleaning stages of sewage treatment plants, as cleaning agents can result in an analogous or higher pollution of sewage treatment plants depending on the active substance.
    (The aldehydic disinfectants and disinfection processes based on oxygen-releasing compounds, which are mainly used in Germany, are considered to be environmentally friendly).
  • The additional costs of using surface disinfectants are minimal compared to the total costs of a hospital. According to information from Rutala and Weher, they are $ 2,000 p.p. for a 930 bed hospital. a. (in US $ 1987). According to this, a single infection acquired in hospital is more expensive than the annual costs when using a surface disinfectant.
  • There is no evidence for the hypothesis of a selection of antibiotic-resistant microorganisms through the use of surface disinfectants.

From the above For this reason, the authors believe that so-called non-critical surfaces are also routinely disinfected in most US hospitals. In the opinion of the authors, supplementary studies should be carried out to verify the clinical consequences of surface disinfection.

Comment of the board of the DGKH

In accordance with the official justification for the Infection Protection Act, at least 525,000 hospital infections per year are acquired in German hospitals with an annual health-economic burden of 2.53 billion DM without taking social follow-up costs into account. At least 30% of these infections can be prevented with hospital hygiene measures.

In this context, reference is made to the risk assessment of surface contamination and the position of surface disinfection as an indispensable component of the multi-barrier strategy for the prophylaxis of nosocomial infections within the concept of primary prevention, as represented in agreement with the American authors by the DGKH, the disinfectant commission of the DGHM and the AWMF becomes.

This contradicts the opinion of the National Reference Center for Hospital Hygiene (NRZ), which considers routine surface disinfection to be dispensable because of the epidemiological evidence that has not yet been confirmed. This risk assessment by the NRZ is rejected, not least because of the clear statement of the US experts on surface disinfection, mainly for the following reasons:

  • The minimal effectiveness of cleaning processes in reducing, in particular, antibiotic-resistant but also other pathogens, including viruses, represents a considerable risk potential.
  • Due to the minimal or no antimicrobial effect of cleaning agents, there is a risk of contamination of the cleaning agent e.g. B. antibiotic-resistant bacteria and their subsequent spread via contaminated cleaning agents or utensils into the patient environment.

The currently (since 1987) valid annex of the guideline for hospital hygiene and infection prevention for "house cleaning and surface disinfection" is in agreement with the assessment of Rutala and Weber. On the basis of new findings on the importance of the areas in the epidemiology of nosocomial infections, this system is being carried out on behalf of the Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute z. Currently revised and updated.

It can be assumed that the assessment of US hygienists will be of great importance for the clarification of outbreaks of nosocomial infections and related legal proceedings. In such legal proceedings, the so-called reversal of the burden of proof is to be expected, i. H. a hospital has to prove that infections that have occurred are not related to the exclusive use of cleaning processes instead of disinfection processes. Since the national reference center for hospital hygiene has so far not provided any scientific proof that it is safe to dispense with the routine use of surface disinfection measures, hospitals run a legal risk if they follow this recommendation.

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