Transcript Allgemeine Sicherheitsunterweisung

Hygiene in the non-clinical environment
Dirk Bockmühl
Hygiene at home?
Gerd had rather spent
more money in toilet
cleaning agents…
Home hygiene: the consumer’s view
Hygiene threats are
mostly found outside
my home
According to a GfK survey for the „Apotheken-Umschau“ 2006
Notifiable infections in Germany (2008)
Source: RKI
Household-associated infections
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Krause et al.: Emerg Inf Dis 13(10) (2007)
outside
at home
The key message
• The domestic environment is one
of the most important sources for
infectious diseases
• These infections are
predominately food-borne
The risk of infection at home
Risk
Source: IFH
7
The risk of infection at home
Risk
Source: IFH
Decontamination of food contact surfaces
The dishwasher: a risk?
Dishwashers host black yeasts
Dishwashers host black yeasts
Zalar et al. (2011)
But is there a risk of infection?
Estimation of infection risk
1. Pathogenic microbes?
2. Routes of infection?
3. Exposition?
4. Risk factors?
Groups of higher risk: YOPIs
Young
Old
Pregnant
Immunocompromised
Antibacterial effect of hand dishwashing
Time needed to reduce 99,9% of Salmonella
Soaking time [min]
60
50
40
Water
30
Water +
Detergent
20
10
0
47
50
53
Temperature [°C]
Mattick et al.: Int J Food Microbiol 85 (2003) 213– 226
57
60
The „killer“ sponge
102 – 107
microbial cells
per gramm
SEM-photograph: A. Hinnemann, Rhine-Waal University of Applied Sciences
Enriquez et al. Dairy Food Environ. Sanitation. 17:20-24.
How to sanitize a kitchen sponge
Sharma et al. Food Control 20 (2009) 310–313
The dishwasher kills…
The dishwasher kills…
…bacteria!
Thus it is an important
means to ensure
decontamination of foodcontact surfaces
The risk of infection at home
Risk
Source: IFH
The washing machine as source of germs
Will we all die now?
Infections and laundering
Fungal infections
(Athlete‘s foot, Candida)
Viral infections
(Noroviruses)
Inactivation of Norovirus via laundering
Detection of viral RNA on fecally contaminated textiles
Lemm et al. Tenside, Surfactants, Detergents (submitted)
Challenge: low temperatures
70
100
90
60
Medium washing temperature
70
60
40
50
30
40
30
20
Textiles washed at ≥60°C
20
10
10
0
0
1972
1987
1996
2001
Survey on german households
Source: IKW Sustainability Report 2010
2005
2008
2009
2010
%
T [°C]
50
80
Hygiene in the wash- and use-cycle
Wearing
Storage
Washing
Drying
Input of
microorganisms
Hygiene in the wash- and use-cycle
Wearing
Reduction of
microorganisms
Storage
Washing
Drying
Input of
microorganisms
Hygiene in the wash- and use-cycle
skin flora
excretions
biofilms
fungal
spores
Wearing
dust
Storage
Reduction of
microorganisms
cross
contamination
dehydration
Washing
Drying
dehydration
temperature
chemistry
mechanics
temp.
Challenges
Challenges
Wich microbes?
Quantity?
Challenges
Machine impact?
Challenges
Impact of drying
and ironing?
What happens when you wash your towels?
100000
cfu/cm2
10000
1000
100
10
After use
Blümke et al., EDC conference 2011
After
laundering
After
drying
What happens when you wash your towels?
100000
cfu/cm2
10000
1000
100
10
After use
Blümke et al., EDC conference 2011
After
laundering
After
drying
What happens when you wash your towels?
100000
cfu/cm2
10000
1000
100
10
After use
Blümke et al., EDC conference 2011
After
laundering
After
drying
The washing machine as a reservoir for germs
• Microbial colonisation of the rinsing chamber is independent of
the chosen temperature
• Contamination after the main wash cycle
Another real-life study…
Analysis of
Laundry in
Nursery Homes
cfu / 100 cm2
Analysis of Laundry in Nursery Homes
Before
laundering
After
laundering
Survey on 16 nursery homes in the district of Kleve
Bertelmann et al., DGHM conference 2012
After
drying
Log reduction (before/after laundering)
Individual reduction factors
Bertelmann et al., DGHM conference 2012
Nursery home #
Impact factors on laundry hygiene
Nursery school #
1
2
3
4
5
7
8
9
12
13
16
17
18
21
23
28
Reduction factor
before/after washing
0,3
9,7
1,1
12,8
6,5
11,0
5,2
0,1
1,6
3,3
9,0
23,0
1,2
28,5
7,5
1,2
Machine age (y)
15
2
15
7
5
4
5
6
1
10
6
15
10
7
4
16
Use of Hygiene
rinser
-
-
-
-
-
+
-
+
-
-
+
-
+
-
-
-
Use of bleach
-
-
-
-
-
+
+
+
+
+
+
+
+
-
+
+
Washing
temperature (°C)
40
60
60
90
60
60
60
60
40
60
60
60
60
60
60
60
Machine cleaning
+
+
-
-
+
+
+
-
+
+
-
+
+
+
-
+
Bertelmann et al., DGHM conference 2012
Impact factors on laundry hygiene
Nursery school #
1
2
3
4
5
7
8
9
12
13
16
17
18
21
23
28
Reduction factor
before/after washing
0,3
9,7
1,1
12,8
6,5
11,0
5,2
0,1
1,6
3,3
9,0
23,0
1,2
28,5
7,5
1,2
Machine age (y)
15
2
15
7
5
4
5
6
1
10
6
15
10
7
4
16
Use of Hygiene
rinser
-
-
-
-
-
+
-
+
-
-
+
-
+
-
-
-
Use of bleach
-
-
-
-
-
+
+
+
+
+
+
+
+
-
+
+
Washing
temperature (°C)
40
60
60
90
60
60
60
60
40
60
60
60
60
60
60
60
Machine cleaning
+
+
-
-
+
+
+
-
+
+
-
+
+
+
-
+
Bertelmann et al., DGHM conference 2012
Impact factors on laundry hygiene
Nursery school #
1
2
3
4
5
7
8
9
12
13
16
17
18
21
23
28
Reduction factor
before/after washing
0,3
9,7
1,1
12,8
6,5
11,0
5,2
0,1
1,6
3,3
9,0
23,0
1,2
28,5
7,5
1,2
Machine age (y)
15
2
15
7
5
4
5
6
1
10
6
15
10
7
4
16
Use of Hygiene
rinser
-
-
-
-
-
+
-
+
-
-
+
-
+
-
-
-
Use of bleach
-
-
-
-
-
+
+
+
+
+
+
+
+
-
+
+
Washing
temperature (°C)
40
60
60
90
60
60
60
60
40
60
60
60
60
60
60
60
Machine cleaning
+
+
-
-
+
+
+
-
+
+
-
+
+
+
-
+
Bertelmann et al., DGHM conference 2012
Impact factors on laundry hygiene
Nursery school #
1
2
3
4
5
7
8
9
12
13
16
17
18
21
23
28
Reduction factor
before/after washing
0,3
9,7
1,1
12,8
6,5
11,0
5,2
0,1
1,6
3,3
9,0
23,0
1,2
28,5
7,5
1,2
Machine age (y)
15
2
15
7
5
4
5
6
1
10
6
15
10
7
4
16
Use of Hygiene
rinser
-
-
-
-
-
+
-
+
-
-
+
-
+
-
-
-
Use of bleach
-
-
-
-
-
+
+
+
+
+
+
+
+
-
+
+
Washing
temperature (°C)
40
60
60
90
60
60
60
60
40
60
60
60
60
60
60
60
Machine cleaning
+
+
-
-
+
+
+
-
+
+
-
+
+
+
-
+
Bertelmann et al., DGHM conference 2012
Impact factors on laundry hygiene
Nursery school #
1
2
3
4
5
7
8
9
12
13
16
17
18
21
23
28
Reduction factor
before/after washing
0,3
9,7
1,1
12,8
6,5
11,0
5,2
0,1
1,6
3,3
9,0
23,0
1,2
28,5
7,5
1,2
Machine age (y)
15
2
15
7
5
4
5
6
1
10
6
15
10
7
4
16
Use of Hygiene
rinser
-
-
-
-
-
+
-
+
-
-
+
-
+
-
-
-
Use of bleach
-
-
-
-
-
+
+
+
+
+
+
+
+
-
+
+
Washing
temperature (°C)
40
60
60
90
60
60
60
60
40
60
60
60
60
60
60
60
Machine cleaning
+
+
-
-
+
+
+
-
+
+
-
+
+
+
-
+
Bertelmann et al., DGHM conference 2012
cfu / 100 cm2
Analysis of Laundry in Nursery Homes
Very low counts
after tumble drying
Before
laundering
After
laundering
Bertelmann et al., DGHM conference 2012
After
drying
Do hygiene rinsers help?
Source: Forum Waschen
Do hygiene rinsers help?
Claim: Kill 99,9(99)% of germs
Substantiated via suspension tests
Source: Forum Waschen
Efficacy in the washing machine?
• Additional detergency effect
• Textile effect
• Different germs
• etc.
Powder detergent with hygiene rinser
100.0
100.0
99.0
100.0
98.8
100.0
30°C+PD+HR
40°C+PD
40°C+PD+HR
60°C+PD
60°C+PD+HR
% reduction
80.0
60.0
40.0
20.0
18.8
0.0
30°C+PD
Lucassen et al., Tenside, Surfactants, Detergents (2013)
Cross resistance between antibiotics and
biocides
Akimitsu et al.: Antimicrob Agents Chemother 1999;43:3042-3
Cross-resistance
Lambert: Journal of Applied Microbiology 2004, 97, 699–711
# Isolates
Anzahl
Resistance profile vs. origin
Clinical Isolates
Klinische
Isolate
TSI: Total Susceptibility Index
Lambert et al.: Journal of Applied Microbiology 2001, 91, 972±984
Does biocide use enhance antibiotic
resistance?
 Clinical isolates are more
resistance in general
 Antibiotic resistance is
predominately found in clinical
isolates
 Clinical environment fosters
resistance
Lambert et al.: Journal of Applied Microbiology 2001, 91: 972-984
Biocides at home?
Biocides at home?
Hygiene rinsers:
only for special cases
Biocides at home?
http://londoncleaning-services.co.uk
Hygiene rinsers:
only for special cases
Detergents with activated oxygen
bleach ensure sufficient hygiene
Are we too clean? The hygiene hypothesis
Strachan (1989):
20th century rise in
allergic diseases is
related to lower
incidence of infection
in early childhood
Hygiene hypothesis: the consumer‘s view
„We need some bacteria to
train our immune system“
„Too clean is harmful“
Hygiene hypothesis: the consumer‘s view
Hygiene hypothesis: the scientific view
Taken from: Smith et al.: The Hygiene Hypothesis and its implications for home hygiene, lifestyle and
public health, IFH review 2012; based on: Rook G Clin Exper Immunol 2010; 160:70-79.
Old friends hypothesis (Graham Rook)
Microorganisms that were
once abundant
(but aren‘t any more)
trained our immune system to
be more tolerant:
- Lactobacilli
- Saprophytic Mycobacteria
- Parasitic worms
Are we too clean?
Cleaning does most probably not increase the
risk for allergy and asthma
Are we too clean?
Cleaning does most probably not increase the
risk for allergy and asthma
The targeted use of cleaning and antimicrobial
products may help to reduce the risk for
household-associated infections
Targeted Hygiene
Risk
Source: IFH
Thanks
Britta Brands, Angelina Eckert, Marlitt Honisch, Davina Lemm,
Ralf Lucassen, Nadine Merettig, Ramona Steiner
Thank you