Patientensicherheit durch indikationsgerechte desinfizierende Flächenreinigung bzw. Flächendesinfektion

Axel Kramer

doi:10.1055/a-2512-0319

OP-Management up2date, Table of Contents

OP-Management up2date 2025; 05(01): 69-90
DOI: 10.1055/a-2512-0319

Hygienemanagement

Patientensicherheit durch indikationsgerechte desinfizierende Flächenreinigung bzw. Flächendesinfektion

Axel Kramer

Abstract

All articles of this category

Durch desinfizierende Flächenreinigung sollen die Übertragungswege von kontaminierten Flächen zu Patient*innen unterbrochen werden. Insbesondere im Fall der gezielten Desinfektion nach sichtbarer Kontamination trägt die desinfizierende Flächenreinigung auch zum Gesundheitsschutz der Mitarbeitenden bei. Bei aseptischen Arbeitsprozessen wird durch Flächendesinfektion im Arbeitsumfeld ein erregerarmes Umfeld gewährleistet.

Schlüsselwörter

Krankenhaushygiene - Flächendesinfektion - Infektionsprophylaxe - Desinfektion - Reinigungsplan

Full Text

References

Literatur
1 Gastmeier P. From 'one size fits all' to personalized infection prevention. J Hosp Infect 2020; 104: 256-260
2 Händehygiene in Einrichtungen des Gesundheitswesens. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI). Bundesgesundheitsblatt 2016; 59: 1189-1220
3 Kramer A, Wendt C, Jacobshagen A. et al. Reinigung, desinfizierende Flächenreinigung und Flächendesinfektion. In: Kramer A, Assadian O, Exner M. , Hrsg. Krankenhaus- und Praxishygiene. 4. Aufl. München: Elsevier; 2022: 39-50
4 Kramer A, Lexow F, Bludau A. et al. How long do bacteria, fungi, protozoa, and viruses retain their replication capacity on inanimate surfaces? A systematic review examining environmental resilience versus healthcare-associated infection risk by “fomite-borne risk assessment”. Clin Microbiol Rev 2024; 0: e00186-e00123
5 Robert Koch-Institut. Anforderungen an die Hygiene bei der Reinigung und Desinfektion von Flächen. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsblatt 2022; 65: 1074–115. Accessed December 07, 2024 at: https://link.springer.com/content/pdf/10.1007/s00103–022–03576–1.pdf
6 Robert Koch-Institut. Infektionsprävention im Rahmen der Pflege und Behandlung von Patienten mit übertragbaren Krankheiten. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsblatt 2015; 58: 1151-1170
7 Assadian O, Harbarth S, Vos M. et al. Practical recommendations for routine cleaning and disinfection procedures in healthcare institutions: a narrative review. J Hosp Infect 2021; 113: 104e114
8 Rutala WA, Weber DJ, and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008; update: June 2024. Centers for Disease Control and Prevention (CDC) Atlanta, Georgia. https://www.cdc.gov/infection-control/hcp/disinfection-and-sterilization/index.html
9 Suleyman G, Alangaden G, Bardossy AC. The role of environmental contamination in the transmission of nosocomial pathogens and healthcare-associated infections. Curr Infect Dis Rep 2018; 20: 12
10 World Health Organisation (WHO). Environmental cleaning and infection prevention and control in health care facilities in low- and middle-income countries: modules and resources. 2022. Accessed November 04, 2024 at: https://iris.who.int/bitstream/handle/10665/366380/9789240051065-eng.pdf
11 Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006; 6: 130
12 Martínez JA, Ruthazer R, Hansjosten K. et al. Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patients treated in a medical intensive care unit. Arch Intern Med 2003; 163: 1905-1912
13 Cassone M, Zhu Z, Mantey J. et al. Interplay between patient colonization and environmental contamination with vancomycin-resistant enterococci and their association with patient health outcomes in postacute care. Open Forum Infect Dis 2020; 7: ofz519
14 Wu YL, Yang XY, Ding XX. et al. Exposure to infected/colonized roommates and prior room occupants increases the risks of healthcare-associated infections with the same organism. J Hosp Infect 2019; 101: 231-239
15 Kreidl P, Mayr A, Hinterberger G. et al. Outbreak report: a nosocomial outbreak of vancomycin resistant enterococci in a solid organ transplant unit. Antimicrob Resist Infect Contro 2018; 7: 86
16 Kaatz GW, Gitlin SD, Schaberg DR. et al. Acquisition of Clostridium difficile from the hospital environment. Am J Epidemiol 1988; 127: 1289-1294
17 Rampling A, Wiseman S, Davis L. et al. Evidence that hospital hygiene is important in the control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2001; 49: 109-116
18 Tankovic J, Legrand P, De Gatines G. et al. Characterization of a hospital outbreak of imipenem-resistant Acinetobacter baumannii by phenotypic and genotypic typing methods. J Clin Microbiol 1994; 32: 2677-2681
19 Doidge M, Allworth AM, Woods M. et al. Control of an outbreak of carbapenem-resistant Acinetobacter baumannii in Australia after introduction of environmental cleaning with a commercial oxidizing disinfectant. Infect Control Hosp Epidemiol 2010; 31: 418-420
20 Neely AN, Maley MP, Warden GD. Computer keyboards as reservoirs for Acinetobacter baumannii in a burn hospital. Clin Infect Dis 1999; 29: 1358-1359
21 Chmielarczyk A, Higgins PG, Wojkowska-Mach J. et al. Control of an outbreak of Acinetobacter baumannii infections using vaporized hydrogen peroxide. J Hosp Infect 2012; 81: 239-245
22 Hobson RP, MacKenzie FM, Gould IM. An outbreak of multiply-resistant Klebsiella pneumoniae in the Grampian region of Scotland. J Hosp Infect 1996; 33: 249-262
23 Carter Y, Barry D. Tackling C difficile with environmental cleaning. Nurs Times 2011; 107: 22-25
24 Orenstein R, Aronhalt KC, McManus JE. et al. A targeted strategy to wipe out Clostridium dificile. Infect Control Hosp Epidemiol 2011; 32: 1137-1139
25 Hacek DM, Ogle AM, Fisher A. et al. Signifcant impact of terminal room cleaning with bleach on reducing nosocomial Clostridium difcile. Am J Infect Contr 2010; 38: 350-353
26 Mayfeld JL, Leet T, Miller J. et al. Environmental control to reduce transmission of Clostridium difcile. Clin Infect Dis 2000; 31: 995-1000
27 Wilcox MH, Fawley WN, Wigglesworth N. et al. Comparison of the effect of detergent versus hypochlorite cleaning on environmental contamination and incidence of Clostridium difficile infection. J Hosp Infect 2003; 54: 109-114
28 Ray AJ, Deshpande A, Fertelli D. et al. A multicenter randomized trial to determine the efect of an environmental disinfection intervention on the incidence of healthcare-associated Clostridium difficile infection. Infect Control Hosp Epidemiol 2017; 38: 777-783
29 Anderson DJ, Chen LF, Weber DJ. et al. Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefts of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study. Lancet 2017; 389: 805-814
30 Engelhart S, Saborowski F, Krakau M. et al. Severe Serratia liquefaciens sepsis following vitamin C infusion treatment by a naturopathic practitioner. J Clin Microbiol 2003; 41: 3986-3988
31 Below H, Ryll S, Empen K. et al. Impact of surface disinfection and sterile draping of furniture on room air quality in a cardiac procedure room with a ventilation and air-conditioning system (extrusion airflow, cleanroom class 1b (DIN 1946–4)). GMS Krankenhaushyg Interdiszip 2010; 5: Doc10
32 Dancer SJ, Kramer A. Four steps to clean hospitals: LOOK, PLAN, CLEAN and DRY. J Hosp Infect 2019; 103: e1-e8
33 CDC. Infection control guidance: Candida auris . Accessed November 04, 2024 at: https://www.cdc.gov/candida-auris/hcp/infection-control/index.html
34 Boyce JM. Quaternary ammonium disinfectants and antiseptics: tolerance, resistance and potential impact on antibiotic resistance. Antimicrob Resist Infect Contr 2023; 12: 32
35 Kramer A, Assadian O. Wallhäußers Praxis der Sterilisation, Antiseptik und Konservierung. Stuttgart: Thieme; 2008
36 Robert Koch-Institut. Hygienemaßnahmen bei Clostridioides difficile-Infektion (CDI). Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsblatt Gesundheitsforsch Gesundheitssch 2019; 62: 906-923
37 Kramer A, Assadian O, Ryll S. et al. Immediate infection control measures and preventive monitoring after excessive water damage in an aseptic working area of a blood donation service centre. Indoor Built Environm 2013; 24: 153-161
38 Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO). Stellungnahme der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) zu Anforderungen an Desinfektionsmittel für den Einsatz in infektionshygienisch sensiblen Bereichen. Epid Bull 2023; 23: 22-26
39 Verbund für Angewandte Hygiene (VAH) e.V.. Desinfektionsmittel-Liste des VAH.. Accessed November 04, 2024 at: https://vah-online.de/de/
40 Robert Koch-Institut. Liste der vom Robert Koch-Institut geprüften und anerkannten Desinfektionsmittel und -verfahren. Stand: 31. Oktober 2017 (17. Ausgabe). Bundesgesundheitsblatt 2017; 60: 1274-1297
41 Kramer A, Assadian O, Gebel J. et al. Nutzen-Risiko-Bewertung. In: Kramer A, Assadian O, Exner M. , Hrsg. Krankenhaus-und Praxishygiene. Hygienemanagement und Infektionsprävention in medizinischen und sozialen Einrichtungen.. 4. Aufl. München: Elsevier; 2022: 19-32
42 Paul Hartmann AG. Bacillol Zero Tissues. . Accessed November 04, 2024 at: https://www.hartmann.info/de-de/loesungen/l/de/kamp/bacillol-zero-tissues
43 Kramer A. Nutzen-Risiko-Bewertung von Quartären Ammoniumverbindungen. Manag Krankenh 2020; 6: 20
44 Hrubec TC, Seguin RP, Xu L. et al. Altered toxicological endpoints in humans with quaternary ammonium compound exposure. Toxicol Rep 2021; 8: 646-656
45 Zheng G, Webster TF, Salamova A. Quaternary ammonium compounds: bioaccumulation potentials in humans and levels in blood before and during the Covid-19 pandemic. Environ Sci Technol 2021; 55: 14689-14698
46 Melin VE, Potineni H, Hunt P. et al. Exposure to common quaternary ammonium disinfectants decreases fertility in mice. Reprod Toxicol 2014; 50: 163-170
47 Herron JM, Hines KM, Tomita H. et al. Multi-omics investigation reveals benzalkonium chloride disinfectants alter sterol and lipid homeostasis in the mouse neonatal brain. Toxicol Sci 2019; 171: 32-45
48 Kramer A, Below H, Assadian O. Health risks of surface disinfection in households with special consideration on quaternary ammonium compounds (QACs). In: Johanning E, Morey PR, Auger P. , Hrsg. Bioaerosols – 6th Int Sci Conf on Bioaerosols, Fungi, Bacteria, Mycotoxins in Indoor and Outdoor Environments and Human Health.. Albany, New York: Fungal Research Group Foundation; 2012: 174-184
49 Dumas O, Wiley AS, Quinot C. et al. Occupational exposure to disinfectants and asthma control in US nurses. Eur Respir J 2017; 50: 1700237
50 Romero Starke K, Friedrich S, Schubert M. et al. Healthcare workers at an increased risk for obstructive respiratory diseases due to cleaning and disinfection agents? A systematic review and meta-analysis. Int J Environ Res Public Health 2021; 18: 5159
51 DIN EN ISO 374–1. 2018–10. Schutzhandschuhe gegen gefährliche Chemikalien und Mikroorganismen – Teil 1: Terminologie und Leistungsanforderungen für chemische Risiken. Beuth; Berlin: 2018
52 Oztoprak N, Kizilates F, Percin D. Comparison of steam technology and a two-step cleaning (water/detergent) and disinfecting (1,000 resp. 5,000 ppm hypochlorite) method using microfiber cloth for environmental control of multidrug-resistant organisms in an intensive care unit. GMS Hyg Infect Contr 2019; 14: Doc15
53 La Fauci V, Costa G, Anastasi F. et al. An innovative approach to hospital sanitization using probiotics: in vitro and feld trials. J Microb Biochem Technol 2015; 7: 305
54 Vandini A, Temmerman R, Frabetti A. et al. Hard surface biocontrol in hospitals using microbial-based cleaning products. Plos One 2014; 9: e108598
55 Caselli E, Arnoldo L, Rognoni C. et al. Impact of a probiotic-based hospital sanitation on antimicrobial resistance and HAI-associated antimicrobial consumption and costs: a multicenter study. Infect Drug Resist 2019; 12: 501-10
56 Caselli E, D’Accolti M, Vandini A. et al. Impact of a probiotic-based cleaning interventionon the microbiota ecosystem of the hospital surfaces: focus on the resistome remodulation. PLoS ONE 2016; 11: e148857
57 Leistner R, Kohlmorgen B, Brodzinski A. et al. Environmental cleaning to prevent hospital-acquired infections on non-intensive care units: a pragmatic, single-centre, cluster randomized controlled, crossover trial comparing soap-based, disinfection and probiotic cleaning. E Clinical Med 2023; 59: 10195
58 Caselli E, Brusaferro S, Coccagna M. et al. Reducing healthcare-associated infections incidence by a probiotic-based sanitation system: a multicentre, prospective, intervention study. PLoS ONE 2018; 13: e199616
59 Tarricone R, Rognoni C, Arnoldo L. et al. A probiotic-based sanitation.system for the reduction of healthcare associated infections and antimicrobial resistances: a budget impact analysis. Pathogens 2020; 9: 502
60 Denkel LA, Voss A, Caselli E. et al. Can probiotics trigger a paradigm shift for cleaning healthcare environments? A narrative review. Antimicrob Resist Infect Contr 2024; 13: 119
61 Desinfektionsmittel-Kommission im VAH und „4+4-Arbeitsgruppe“. Zur Verwendung von Tuchspendersystemen in Bereichen mit besonderem Infektionsrisiko. Hyg Med 2014; 39: 358-359
62 Carling PC, Parry MF, von Beheren SM. Healthcare Environmental Hygiene Study Group. Identifying opportunities to enhance environmental cleaning in 23 acute care hospitals. Infect Control Hosp Epidemiol 2008; 29: 1-7
63 Weber DJ, Rutala WA, Anderson DJ. et al. Effectiveness of ultraviolet devices and hydrogen peroxide systems for terminal room decontamination: focus on clinical trials. Am J Infect Contr 2016; 44: 77-84
64 Cobrado L, Ramalho P, Ricardo E. et al. Efficacy assessment of different time cycles of nebulized hydrogen peroxide against bacterial and yeast biofilms. J Hosp Infect 2022; 127: 7-14
65 Amodio E, Kuster SP, Garzoni C. et al. Disinfecting noncritical medical equipment – Effectiveness of hydrogen peroxide dry mist as an adjunctive method. Am J Infect Contr 2020; 48: 897-902
66 Koburger T, Below H, Dornquast T. et al. Decontamination of room air and adjoining wall surfaces by nebulizing hydrogen peroxide. GMS Krankenhaushyg Interdiszip 2011; 6: Doc09
67 Estienney M, Daval-Frerot P, Aho-Glélé LS. et al. Use of a hydrogen peroxide nebulizer for viral disinfection of emergency ambulance and hospital waiting room. Food Environ Virol 2022; 14: 217-221
68 Agrawal A, Agrawal P, Gautam A. et al. Prospective randomized double-blind placebo-controlled study to assess the effects of nano-ozonized hydrogen peroxide nebulization on results of rtpcr for novel coronavirus thus infectivity and clinical course among moderately sick COVID-19 patients. J South Asian Fed Obstetri Gynaecol 2022; 14: 35-40
69 Mitchell BG, White N, Farrington A. et al. Changes in knowledge and attitudes of hospital environmental services staff: the researching effective approaches to cleaning in hospitals (REACH) study. Am J Infect Contr 2018; 46: 980e
70 White LF, Dancer SJ, Robertson C. et al. Are hygiene standards useful in assessing infection risk?. Am J Infect Contr 2008; 36: 381-384
71 Sexton T, Clarke P, O’Neill E. et al. Environmental reservoirs of methicillin resistant Staphylococcus aureus in isolation rooms: correlation with patient isolates and implications for hospital hygiene. J Hosp Infect 2006; 62: 187-194
72 Carling PC, Parry MM, Rupp ME. et al. Improving cleaning of the environment surrounding patients in 36 acute care hospitals. Infect Control Hosp Epidemiol 2008; 29: 1035-1041
73 Carling PC, Parry MF, Bruno-Murtha LA. et al. Improving environmental hygiene in 27 intensive care units to decrease multidrug resistant bacterial transmission. Crit Care Med 2010; 38: 1054-1059
74 Manian FA, Griesnauer S, Senkel D. Impact of terminal cleaning and disinfection on isolation of Acinetobacter baumannii complex from inanimate surfaces of hospital rooms by quantitative and qualitative methods. Am J Infect Contr 2013; 41: 384-385
75 Rutala WA, Kanamori H, Gergen MF. et al. Enhanced disinfection leads to reduction of microbial contamination and a decrease in patient colonization and infection. Infect Control Hosp Epidemiol 2018; 39: 1118-1121
76 Carling PC, Briggs JL, Perkins J. et al. Improved cleaning of patient rooms using a new targeting method. Clin Infect Dis 2006; 42: 385-388
77 Smith PW, Beam E, Sayles H. et al. Impact of adenosine triphosphate detection and feedback on hospital room cleaning. Infect Control Hosp Epidemiol 2014; 35: 564-569
78 Mitchell BG, Hall L, White N. et al. An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomised trial. Lancet Infect Dis 2019; 19: 410-418
79 Dancer SJ, White LF, Lamb J. et al. Measuring the effect of enhanced cleaning in a UK hospital: a prospective crossover study. BMC Med 2009; 7: 28
80 Healthcare-Associated Infections (HAIs). Considerations for reducing risk: surfaces in healthcare facilities. Accessed November 04, 2024 at: https://www.cdc.gov/healthcare-associated-infections/hcp/infection-control/index.html