Rückblick auf 10 Jahre Infektionsschutzgesetz

In 2001, the German Protection against Infection Act came into force, implementing a variety of new regulations. For the first time, obligatory infection control visits of the public health departments in surgical ambulatory practices were implemented, as well as optional infection control visits in all medical, dental and paramedical practices using invasive methods. Based on the data of the public health department of the city of Frankfurt am Main, Germany, an evaluation of this new regulation is given in this paper. First, prioritization of these new tasks was mandatory. First priority was given to the obligatory visits in surgical practices, second priority to the hygiene visits in practices performing endoscopy in gastroenterology as well as in urology and in practices of traditional healers, and third priority was given to all other doctors’ practices. After receiving preliminary information and further training of the doctors etc., the control visits were performed by members of the public health department, using a checklist based on the guidelines of the German Commission on Hospital Infection Prevention (“Kommission für Krankenhaushygiene und Infektionsprävention”). Since 2001, more than 1100 infection control visits in medical practices in Frankfurt am Main were documented. Not only in surgical, but also in gastroenterological and urological practices great improvement could be achieved, regarding not only hand hygiene and reprocessing surface areas, but especially in reprocessing medical devices. In practices for internal medicine and those of general practitioners, errors in hand hygiene, skin antiseptic and surface disinfection also decreased. According to our results, especially regarding the improved quality of structure as well as quality of process and with regard to the public discussion on this hygiene topic, our evaluation is absolutely positive. The new regulation proved worthwhile.     

Multidrug-resistant bacteria in geriatric clinics,nursing homes,and ambulant care – Prevalence and risk factors

Colonization/infection with multidrug-resistant bacteria (MDRB) such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae, is an increasing problem not only in hospitals but also in long-term care facilities. The aim of this study was to determine the prevalence as well as the risk factors of colonization/infection with MRSA, VRE, and ESBL producing Enterobacteriaceae in geriatric clinics, nursing homes, and ambulant care in Frankfurt am Main, Germany. 288 patients from 2 geriatric clinics (n = 46), 8 nursing homes (n = 178), and 2 ambulant care facilities (n = 64) as well as 64 staff members were screened for MDRB in the time period from October 2006 to May 2007. 58 patients (20.1%) and 4 staff members (6.2%) were colonized with MDRB. Among patients, 27 (9.4%) were colonized with MRSA, 11 (3.8%) were screened positive for VRE, and 25 (8.7%) were found to be colonized with ESBL producing Enterobacteriaceae. Prevalence of MDRB in geriatric clinics, nursing homes, and ambulant care facilities were 32.6%, 18.5%, and 15.6%, respectively. Significant risk factors for MDRB were immobility (OR: 2.7, 95% CI: 1.5–4.9; p = 0.002), urinary catheter (OR: 3.1, 95% CI: 1.7–5.9; p < 0.001), former hospitalization (OR: 2.1, 95% CI: 1.1–4.0; p = 0.033), and wounds/decubiti (OR: 2.3, 95% CI: 1.5–4.9; p = 0.03). Finally, the high level of MDRB in geriatric clinics, nursing homes, and ambulant care points to the importance of these institutions as a reservoir for dissemination.     

Public health in homes for the aged and nursing homes--experiences from monitoring by the public health office in Frankfurt am Main from 1989 to 1998

Hygiene conditions in residential homes for the aged must be surveyed by the Public Health services according to German legislation (Bundesseuchengesetz, Law for Protection against Infectious Diseases). We report here on the data of the routine controls of the public health department in Frankfurt am Main in all of the 31 residential homes for the aged of the city. RESULTS: In 1989, a special plan for cleaning and disinfection was available in one home only, whereas a hygiene plan was not available in any of the homes. Up to 1998, plans for cleaning and disinfection were established in 29 of the homes, and more than 50% of them had fulfilled their hygiene plan. The supply and maintenance of dispersers for disinfectants, the usage of disinfectants and the knowledge regarding proper disinfection and sterilisation procedures could be improved. The same was true of the kitchens: there, up to 1998 testing of samples set aside for later reassessment was properly done in most of the homes. CONCLUSION: Hygiene in the homes and the knowledge of the staff members were markedly improved during the last years. Some of the most relevant hygienic problems are today: wearing private clothing instead of special working clothes, or deficits in the knowledge of the management of MRSA-colonised residents.     

PCP in the blood plasma: current exposure of the population in Germany, based on data obtained in 1998

The fungicidal substance pentachlorophenol (PCP) had been used commonly for wood protection and leather impregnation in Germany until 1989, when this substance was prohibited by law. Hence, the body burden in the general population in Germany has been steadily declining. The reference values (95th percentiles) in blood plasma decreased from 20 micrograms PCP/l in 1991 to 12 micrograms/l in 1996. In 1998 the current exposure in a large residential population was investigated. 623 persons with an average age of 34.6 years (0-62 years) were investigated. For all of them there was neither evidence of occupational contact with PCP nor of the presence of PCP in the residential indoor environment. The mean PCP concentration in the plasma samples was 2.4 +/- 3.9 micrograms/l, the median 1.7 micrograms/l, and the 95th percentile 6.1 micrograms/l, the maximum value was 59.3 micrograms/l. In children and adolescents higher median and 95th percentiles were obtained than in adults (median 2.5 vs. 1.5 micrograms/l and 95th percentile 7.7 vs. 5.9 micrograms/l). All values above 20 micrograms/l were checked again individually: relationships with the level of PCP in household dust could not be detected. In one family leather clothing containing PCP, however, was found to be the cause of unusually high PCP values in the blood. Our investigations confirm a trend observed in recent years: exposure to PCP in the population in Germany decreases steadily and leads to an actualized reference value of 6.1 micrograms PCP/l plasma. In individual cases, however, greatly increased PCP levels in blood can still occur today, for example due to leather clothing treated with PCP.     

Wie steht es um die Hygiene beim Endoskopieren?

Flexible endoscopy is essential for the practice of modern medicine. However, with inadequate reprocessing of endoscopes and additional instruments, infections can be transmitted. Therefore, guidelines for reprocessing flexible endoscopes have been published in many countries. The goal of the present survey was to examine the current compliance with German Guidelines in a German urban region, covering all hospitals (15 hospitals) and private practices (23 practices) of this area, without any exception. All endoscopic units in Frankfort on the Main were visited by members of the Public Health Service, using a checklist based on the recommendations of the German Guidelines. In 2004, a reevaluation of 14 hospitals and 20 private practices took place, either by analysing the written reports of the institutions or by revisiting the institutions. In 2003, compliance with the guidelines in hospitals was satisfactory. In practices, however, many problems were identified in 2003. Between 2003 and 2004, great improvements could be seen (data of 2003 in parentheses). At the end of 2004, in 90% of the practices adequate storage of the endoscope without risk of recontamination (2003:52%), correct reprocessing the bottle and the tube for air/water channel flushing including filling with sterilized water was observed (2003:74% and 52%). In 100% of the practices, ultrasonic cleaning (2003:26%) and sterilizing of endoscopic accessories was guaranteed (2003:57%) and routine tests of endoscopes after reprocessing (2003:56%) were performed. In conclusion the relevance and the effect of the advising and control of public health have been so efficient that between 2003 and 2004 most faults have been corrected. Therefore control visits of the Public Health Services should not only cover hygiene in reprocessing the endoscopes but also hygiene in reprocessing endoscopic accessories as well.     

Polyzyklische aromatische Kohlenwasserstoffe (PAH) im Innenraum

In recent years, the use of tar-containing parquet glue led to intensive discussion because of the health effects associated with indoor pollution caused by polycyclic aromatic hydrocarbons (PAH) contained in these materials. In addition to environmental tobacco smoke, fossil and organic fuels in stoves, cookers, firesides and other combustion processes contribute to the build up of PAH in the indoor environment. However, food remains to be the greatest source of PAH exposure to man; >90% of the daily PAH intake is food related. In the present review, an attempt will be made to throw light on the question of whether PAH exposure from indoor air sources may cause health effects.     

Targeting of antisense PNA oligomers to human galanin receptor type 1 mRNA

In this work, we have targeted positions 18-38 of the human galanin receptor type 1 (GalR1) mRNA coding sequence with different peptide nucleic acid (PNA) oligomers. This region has previously been shown to be a good antisense region and therefore we aimed to identify the subregions and/or thermodynamic parameters determining the antisense efficacy. Nine different PNA oligomers were conjugated to a cell-penetrating peptide, transportan, to enhance their cellular uptake. Concentration-dependent down-regulation of GalR1 protein expression in human melanoma cell line Bowes was measured by radioligand binding assay. No reduction of GalR1 mRNA level was observed upon PNA treatment, thus, the effect was concluded to be translational arrest. Judging from the EC50 values, antisense PNA oligomers targeting regions 24-38 (EC50=70 nM) or 27-38 (EC50=80 nM) were the most potent suppressors of protein expression. No parameter predicted by M-fold algorithm was found to correlate with the measured antisense activities. Presence of some subregions was found not to increase antisense efficiency of PNA. Presence of a short unpaired triplet between nucleotides 33 and 35 in the target region was, on the other hand, found to be the most critical for efficient GalR1 down-regulation. Thus, the results are of high impact in designing antisense oligomers. Specific results of this study demonstrate 20-fold more efficient antisense down-regulation of GalR1 as achieved before.