GMS Hygiene and Infection Control最新文献

This review explore the rise of multidrug-resistant (MDR) Gram-negative bacteria, highlighting β-lactamase inhibitor combinations as crucial therapeutic options. It examines β-lactam resistance mechanisms, established combinations (e.g., ticarcillin/clavulanic acid, piperacillin/tazobactam), and the clinical efficacy of newer therapies like ceftazidime/avibactam (CAZ-AVI) for carbapenem-resistant Klebsiella pneumoniae (CRKP) and ceftolozane/tazobactam (TOL-TAZ) for MDR Pseudomonas aeruginosa. Additionally, novel combinations (e.g., cefepime-enmetazobactam, cefepime-taniborbactam) are discussed for tackling extensively drug-resistant (XDR) bacteria. Through comparative analyses, this review provides key insights into efficacy, resistance, pharmacokinetics, and safety, guiding researchers in optimizing antimicrobial strategies and clinicians in managing MDR infections, while supporting antibiotic management and future research.

Introduction: Reference tests are crucial for ensuring the comparability and quality assurance of test results in the field of chemical disinfectant testing. For testing virucidal activity, EN 14476:2019 specifies formaldehyde as reference substance. However, due to toxicological and technical concerns, formaldehyde needs to be replaced with new and more suitable reference substances.In order to find the replacement, in 2023-24 an international ring trial was conducted by the European Standardization Committee TC 216 WG 1 (chemical disinfectants and antiseptics, working group human medicine) with 17 participating laboratories. The goal was to evaluate the suitability of these substances for optimization of existing standards.

Materials and methods: The study assessed the stability of the test viruses used in the disinfection test - specifically, Modified vaccinia virus Ankara, Adenovirus type 5, Murine Norovirus S99, Minute Virus of Mice, Poliovirus type 1 strain LSc-2ab and Bovine Enterovirus type 1 - to two newly selected reference substances: glutaraldehyde and peracetic acid. The study tested reproducibility and repeatability based on a predefined test protocol.

Results: The results of the two tested reference substances - glutaraldehyde and peracetic acid - provide new reference substance ranges for relevant test viruses. The findings are incorporated into the revision of the European standards, ensuring the quality assurance of efficacy testing in virucidal testing.

Objective: To describe persistent symptoms after a work-related COVID-19 infection in health and welfare workers and the identification of predictors of these symptoms.

Methods: This short report summarises updated results on a bidirectional cohort study of employees in the health and welfare services who had reported a work-related SARS-CoV-2 infection in 2020. Participants were interviewed for the fourth time (T4) in April 2023 using a paper-and-pencil questionnaire. In this extended follow-up study (total prospective follow-up time: 26 months, maximum observation time 32 months), questions were asked about the type and severity of persistent symptoms. Kaplan-Meier curves were used to visualize cumulative survival rates, and Cox regression was used to identify predictors.

Results: Of the 2,053 participants in the baseline study (response rate: 47%), 1,075 people took part in the 4^th survey (follow-up rate: 52%); the analysis sample for the longitudinal study comprised 1,809 participants. The most frequently reported persistent symptoms at T4 were fatigue (61%), concentration or memory problems (55%) and shortness of breath (49%). After 12 weeks, the cumulative survival rate was 76.3%, after 12 months 69.3%, and after 32 months 60.0%. Female gender was a statistically significant risk factor for a longer recovery time (Hazard Ratio [HR]: 0.8, 95% CI: 0.63-0.93, p=0.007) as was older age (HR ≥50 years 0.6, 95% CI: 0.51-0.76, p<0.001). Participants with one pre-existing condition had a 20% statistically significant increased risk (HR: 0.8, 95% CI: 0.66-0.95, p= 0.010), subjects with two pre-existing conditions a HR of 0.6 (95% CI: 0.46-0.75, p<0.001) and those with ≥3 pre-existing conditions had a HR of 0.3 (95%-CI: 0.23-0.48, p<0.001). Risk increases were also observed for the number of severe acute symptoms: the more symptoms, the greater the increase in risk. Individuals with medical activity (physicians) were 50% less likely to have a longer time to recovery compared to all other occupational groups (HR: 1.5, 95%-CI: 1.21-1.89, p<0.001).

Conclusion: Minimal further recovery was observed in this cohort of insured persons after a 26-month prospective follow-up. Identified risk factors for persistent symptoms, i.e. female gender, older age, severe acute symptoms, and pre-existing illnesses, define a high-risk group of individuals, who should receive sufficient attention in the early phase of their COVID-19 disease and receive appropriate therapy to minimize the risk of post-COVID-19 syndrome.

Background: Prevention of nosocomial infections continues to be crucial to ensure patient safety and improve healthcare outcomes. In this regard, surface contamination plays an important role in the undetected transmission of nosocomial pathogens as a continuous, sporadic event or in the context of outbreaks. However, the impact of reducing bacterial contamination through copper-coated surfaces remains controversial.

Methods: A pilot study was set up in a blinded, randomized controlled design to elucidate the antimicrobial activity of door handles coated with a copper-nickel alloy. Twelve doors in a specialized department of tumor and revision surgery of a German orthopedic hospital were randomly selected to install visually indistinguishable stainless-steel door handles, either without coating (control group, n=6) or with an alloy coating consisting of 30% copper and 70% nickel (study group, n=6). Patients, all involved personnel and investigators were blinded with regard to the assignment of door handles. Door handles were sampled for viable microorganisms at 24 h after disinfection by (i) consecutive use of wet and dry swabs and (ii) contact agar slides. Bacterial growth was detected and bacteria were identified using MALDI-TOF mass spectrometry. In addition, contamination kinetics of door handles were determined by ATP measurement at time points 0 h, 1 h, 2 h, 4 h, 8 h, 12 h and 24 h after disinfection. Each technique was used on three subsequent days.

Results: Using swab method, the mean total number of colony forming units (cfu) of control and copper-nickel alloy surfaces was 2.14 cfu/cm² and 0.67 cfu/cm², respectively, yielding a difference of 68.7% (p=0.27). Bacterial counts from contact agar slide samples resulted in 0.86 cfu/cm² on control and 0.6 cfu/cm² on coated door handles which equals a difference of 30.2% (p=0.31). ATP bioluminescence measured over three subsequent days from coated door handles showed a decreased bioburden by 70.8%, 23.1%, 55.5%, 79.7%, 45.9%, 56.0%, and 68.3% of relative light units compared to control door handles at time points 0 h (before disinfection), 0 h (after disinfection), 1 h, 2 h, 4 h, 8 h, and 12 h, respectively. Statistically significant differences (p<0.05) were obtained for time points 4 h and 12 h.

Conclusion: Our data indicate a trend of reduced bacterial and overall bioburden on copper-nickel-coated door handles. Further, larger randomized controlled trials are warranted to investigate the influence of copper-coated surfaces on the prevention of hospital-acquired infections.

Curcumin, which is a polyphenol from the rhizomes of Curcuma longa, has been found to possess anti-inflammatory, antioxidant, and antimicrobial activities. This systematic review examines the effectiveness of curcumin in treating oral inflammation, e.g., periodontal diseases, gingivitis, oral lichen planus (OLP), and radiation-induced oral mucositis (ROM). The studies in this review assess different curcumin formulations, including gels, hydrogels, nano-curcumin, and mouthwashes, as adjunctive agents in oral inflammatory diseases. The studies indicate that curcumin significantly decreases clinical markers of inflammation, improves healing, and reduces patient discomfort, warranting its use as an adjunctive therapeutic agent.

An ecological community of commensals, symbiotic and pathogenic organisms share our body space. Alterations in the ecologically balanced population of microflora result in dysbiosis and are critical determinants of systemic health and diseases, especially in the context of immunosuppression. The oral microbiome and chronic inflammation may have a role in carcinogenesis.

Background: The risk of transmission of hepatitis B virus (HBV) to healthcare workers (HCW) is well known. However, evidence for supporting guidelines with respect to exclusion of infected HCW from exposure prone procedures (EPP) remains poorly characterized.

Method: A systematic review of studies published providing serological data for transmission of HBV infected HCW to patients was performed. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) we searched MEDLINE, Scopus and Cochrane databases to identify publications prior to September 2024.

Results: The literature search yielded 311 studies and 39 from nine countries met the inclusion criteria. A total 53 of HCW were considered as source cases of transmission and 25,000 individuals tested for at least one HBV marker. 66 transmissions by HCW to patients were confirmed through DNA analysis; in 100 patients HBV transmissions were considered probable and in 480 patients at least possible. Of the 36 studies in which HBeAg in HCW was determined, the antigen was positive in 29 studies (80.6%), and negative only in seven studies (19.4%), comprising a total of only 31 and 17 HCW, respectively. The HBV viral load of the transmitting HCW was conducted in only 8 studies including 18 HCW, of those four were HBeAg-positive and 14 HBeAg-negative. Although the viral load in HBeAg-negative sources generally was 10 times lower than in HBeAg-positives, considerable variability was seen in HBeAg-negatives with overlapping values up to 1.5×10⁹ copies/mL. A HBV DNA value of 4×10⁴ copies/mL represents the lower threshold for transmissibility for 18 source cases in all studies, however, for the other 35 no measurements were available. Due to the low evidence on defining an HBV DNA viral load below which HBV transmission from HCW to patients appears unlikely, the safety thresholds for excluding infected HCW from performing EPP in most recent national guidelines (UK, Germany, the Netherlands and the US) still differ by factors of as much as 5 (200 IU/mL to 1,000 IU/mL).

Conclusions: The published literature on HBV transmission from HCW to patients is sparse and offers only limited guidance on national prevention guidelines.

Background: The COVID-19 pandemic has highlighted the risk of airborne transmission of viruses, especially in public indoor spaces or healthcare settings. Effective indoor air purification systems are necessary to limit the spread of these pathogens, and the deployment of portable air cleaners (PACs) has increased rapidly since then. Germicidal ultraviolet (UV) radiation technologies have recently supplemented conventional air filtration technologies. Thus, the purpose of this study was to evaluate the air decontamination efficacy of a PAC using a 275-nm UVC-LED unit and fibrous-media air filters.

Method: Two different filters were used in the study: a High-Efficiency Particulate Air (HEPA) filter and an Efficient Particulate Air (EPA) filter. The PAC was operated in an experimental aerosol chamber with an airflow rate of 200 m³/hour for 10 or 20 minutes. Subsequently, the concentration of infectious viruses and particles in the air was measured. Decontamination efficacy was compared between UVC-LED radiation, filtration, and a combination thereof against Feline Coronavirus (FCoV) and influenza A virus (H3N2) aerosols.

Results: Infectious virus reductions were comparable between the UVC and filter measurements. A decrease of 94% in FCoV concentration was observed after 10 minutes of device runtime, increasing to 99.8% after 20 minutes compared to control measurements. H3N2 showed greater susceptibility, with a reduction of 99.7% achieved after 10 minutes. Interestingly, a synergistic effect was observed with significantly lower virus concentrations when both technologies were combined.

Conclusion: These findings highlight the potential of PACs equipped with emerging UVC-LED technologies as effective tools for indoor air decontamination. The deployment of PACs equipped with UVC radiation and filtration could be a promising alternative or supplement to ventilation systems, especially in healthcare settings and other public spaces.

Introduction: The chemical composition and microbial contaminants of commercially bottled water are managed according to public health regulations, but there are gaps in these criteria for fungal agents. For this reason, commercial bottled water brands filled in 19-L polycarbonate bottles from various water sources in western Anatolia and sold in Izmir and neighboring provinces were randomly selected and analyzed.

Materials and methods: Fungal screening was carried out in water samples using the membrane filtration technique. The number of fungi was counted in colony-forming units (cfu)/100 ml. All fungi isolated from packaged water samples were initially phenotypically analyzed for initial preliminary identification. Amplification of the well-conserved internal transcribed spacer (ITS) region was performed by polymerase chain reaction (PCR) using internal transcribed spacer (ITS)1/ITS4 primers for genotypic identification of the isolates. Using the basic local alignment search tool (BLAST), sequencing results were compared with the National Center for Biotechnology Information (NCBI) database, and species assignments were made for 31 samples. 25 moulds and 6 yeasts were identified, and molecular identification was supported by the actin gene region. The mycotoxin formation potential of the isolated Penicillium, Aspergillus, Alternaria and Cladosporium spp. was also screened using the ammonium vapor test, LC-MS and HPLC. The amount of citrinin, the metabolite produced by the Penicillium citrinum B4 strain, was determined by liquid chromatography-mass spectrometry.

Results: The most dominant strains detected in the analysis of water samples were Cladosporium, Penicillium and Alternaria. With 411.586 µg/l, the amount of citrinin was well above the upper limit for beverages.

Conclusion: The values obtained here emphasize that fungal contaminants and mycotoxins in bottled water should be included in the water analysis criteria. To the best of our knowledge, this is the first detailed research in this field in Turkey.

Introduction: A blinded survey in 81 dental practices, 84 medical practices, and 35 hospitals revealed that for conducting disinfecting surface cleaning and surface disinfection, instead of reusable clothes moistened on-site with disinfectant solution, either wipe dispenser systems for self-preparation or ready-to-use (RTU) wipes are being used. Therefore, the aim of this study was to examine, i.e., the impact of incorrect loading of the wipe roll with disinfectant solution (DS) when using wipe dispenser systems, and the consistency of the DS delivery amount when using RTU wipes.

Method: In two different wipe dispenser systems, the saturation of the wipe roll after loading with DS was visually inspected and photographically documented by adding 0.1% fluorescein sodium to the disinfectant solution. The coverage of the wipes used on a melamine resin surface (75x133 cm) was visually checked after a defined wiping mode following analogous staining.For two RTU products, a flow pack and a stand-up bag pwith the opening at the top, the saturation of the wipes and the delivery amount of the DS during use were gravimetrically determined.

Results: In the wipe dispenser system with alcohol-based DS, the amount of disinfectant solution released decreased when the solution was loaded horizontally or vertically, instead of circularly as recommended by the manufacturer. After circular loading with the manufacturer-recommended wetting time of 30 minutes, the wipe rolls were evenly saturated, and the delivery amount onto the surface during wiping disinfection was sufficiently constant. In the wipe dispenser system with an oxygen-releasing DS, after horizontal instead of circular loading the residual volume in the dispenser after removal of the last cloth was 320 ml instead 350 ml. The delivery amount onto the surface during wiping disinfection was therefore also lower (4.2+0.574 g instead of 5.0+0.606 g, p<0.0001). For the flow pack, uniform saturation was achieved when the package was stored upside down with the sealed opening facing downward the night before the first use. In the vertical pack, the delivery amount of the first wipe was significantly lower than that of the subsequent wipes.

Conclusion: For the tested flow pack, it should be noted in the user manual that the flow pack should be stored upside down, i.e., with the opening facing downward, for more than 12 hours before the first use, to achieve uniform wetting of all wipes.For the stand-up bag, it is important to follow the manufacturer's instruction that the first wipe be discarded.Since the DS delivery amount differed between the flow pack and vertical pack, it would be beneficial if, as in both cases, the manufacturer generally specified the reach for wiping disinfection for each RTU product.