Prevention of Nosocomial Prevention of Nosocomial Infections with - - PowerPoint PPT Presentation

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Prevention of Nosocomial Prevention of Nosocomial Infections with KLEANIK Infections with KLEANIK Self - - Disinfecting Drain Disinfecting Drain Self Trap Trap The Drain Trap Drain Trap as as a a Source Source The of

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SLIDE 1

Prevention of Nosocomial Prevention of Nosocomial Infections with KLEANIK Infections with KLEANIK™ ™ Self Self -

  • Disinfecting Drain

Disinfecting Drain Trap Trap

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SLIDE 2

2 2

The The Drain Trap Drain Trap as as a a Source Source

  • f Transmission of
  • f Transmission of

Pathogens Pathogens

  • Content of living micro

Content of living micro-

  • organisms in sealing liquid of
  • rganisms in sealing liquid of

common drain traps : 10 common drain traps : 106

6 -

  • 10

1010

10 colony forming units per

colony forming units per ml. ml.

  • drain traps contain about 200 ml of sealing liquid.

drain traps contain about 200 ml of sealing liquid.

  • Total amount of living bacteria per drain trap

Total amount of living bacteria per drain trap 10 108

8 -

  • 10

1012

12 colony forming units.

colony forming units.

  • Due to the excellent growth conditions, drain traps can

Due to the excellent growth conditions, drain traps can be an important source for the cultivation of antibiotic be an important source for the cultivation of antibiotic resistant pathogens resistant pathogens outside the

  • utside the human

human body body. .

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SLIDE 3

3 3

The The drain trap drain trap as as a a Source Source of

  • f

Transmission of Transmission of Pathogens Pathogens

  • In patient rooms sink

In patient rooms sink drains are the drains are the major major reservoirs of living reservoirs of living microorganisms microorganisms

  • utside the human
  • utside the human

body body and in the direct and in the direct environment of the environment of the patient. patient.

  • Common drain traps

Common drain traps are always are always „ „ open

  • pen “

“ reservoirs reservoirs. .

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SLIDE 4

4 4

  • High nutrient content and

High nutrient content and sufficient nutrient flow. sufficient nutrient flow.

  • Moderate room

Moderate room temperatures are sufficient temperatures are sufficient for fast multiplication. for fast multiplication.

  • Oxygen containing

Oxygen containing substrates substrates

  • Figure 1

Figure 1: Multiplication of : Multiplication of bacteria in a drain trap bacteria in a drain trap

Drain traps Drain traps offer excellent

  • ffer excellent conditions

conditions for for growth of micro growth of micro-

  • organisms
  • rganisms

1.00E+00 1.00E+02 1.00E+04 1.00E+06 1.00E+08 1 2 3 4 5 6 7 8 9 10 11 12 Investigation period (weeks) L iv e B a c te r ia l C o u n t ( C F U / m l )

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SLIDE 5

5 5

Biofilm Biofilm – – The Ally of Bacteria The Ally of Bacteria

  • Biofilm

Biofilm is the main tool for microorganisms to is the main tool for microorganisms to survive and multiply in waste water survive and multiply in waste water environments ( e.g. drain traps ) environments ( e.g. drain traps )

  • Within this

Within this biofilm biofilm a lot of excellent conditions a lot of excellent conditions necessary for growth of microbes in waste water necessary for growth of microbes in waste water tubes can be found. tubes can be found.

  • Because the

Because the biofilm biofilm acts as protective barrier acts as protective barrier against anti against anti-

  • microbial substances it can be a

microbial substances it can be a possibility for expression of resistance against possibility for expression of resistance against antibiotics antibiotics. .

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SLIDE 6

6 6

The The Known Known Problem Problem: :

Transmisson of Bacteria Transmisson of Bacteria from from drain trap to drain trap to Patient Patient

  • Drain traps are permanent

Drain traps are permanent “ “open

  • pen”

” reservoirs of pathogenic and reservoirs of pathogenic and non non -

  • pathogenic microorganisms, bacteria, yeast and fungi,

pathogenic microorganisms, bacteria, yeast and fungi, respectively. respectively.

  • This means there is a uncovered surface between the upper

This means there is a uncovered surface between the upper surface of the contaminated sealing liquid and the room air. surface of the contaminated sealing liquid and the room air. When the sink is used this surface is moved, an aerosol is When the sink is used this surface is moved, an aerosol is formed and so an exchange of microorganisms between liquid formed and so an exchange of microorganisms between liquid and air occurs. and air occurs.

  • If the concentration of living bacteria in sealing liquid is

If the concentration of living bacteria in sealing liquid is > > 10 105

5

CFU/ml CFU/ml, , transmission of bacteria from sealing fluid to hands of transmission of bacteria from sealing fluid to hands of hospital personnel takes place. hospital personnel takes place.

  • Bacteria (e.g. Pseudomonas

Bacteria (e.g. Pseudomonas aeruginosa aeruginosa) can survive up to 70 ) can survive up to 70 minutes on hands of hospital personnel and therefore minutes on hands of hospital personnel and therefore transmission to the patient is possible. transmission to the patient is possible. ( D ( DÖ ÖRING et al. 1989 ). RING et al. 1989 ).

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SLIDE 7

7 7

The The Approach Approach

  • Prevention of adherence of

Prevention of adherence of microorganisms and particles on the microorganisms and particles on the inner wall of the drain trap ( inner wall of the drain trap ( biofilm biofilm formation ) by formation ) by vibration vibration

  • Prevention of bacterial growth and

Prevention of bacterial growth and multiplication by multiplication by heat disinfection heat disinfection

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SLIDE 8

8 8

The The Technical Technical Solution Solution

  • Vibration

Vibration Ultrasound Ultrasound

  • Heat

Heat -

  • Disinfection

Disinfection T > 70 T > 70° ° C C

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SLIDE 9

9 9

Lab Lab-

  • Results

Results: :

Kinetics of Heat Killing of Bacteria ( Kinetics of Heat Killing of Bacteria ( Ps.aerug Ps.aerug.) .) in the Self in the Self-

  • disinfecting drain trap

disinfecting drain trap

Bactericidal Pseudomonas aeruginosa

1.00E+00 1.00E+02 1.00E+04 1.00E+06 1.00E+08

0.5 1 1.5 2 2.5 3 4 5 6 7 8 Treatment time (h) Live Bacterial Count ( CFU / ml )

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SLIDE 10

10 10

Lab Lab-

  • Results

Results: :

Kinetics Kinetics of

  • f Heat Killing

Heat Killing of

  • f Bacteria

Bacteria ( Ps. ( Ps.aerug aerug.) in .) in the Self the Self-

  • disinfecting

disinfecting drain trap drain trap Explanation of figure 2 Explanation of figure 2 : :

  • Using the self

Using the self-

  • regulating heating

regulating heating-

  • system the temperature

system the temperature

  • f sealing liquid increases within 20 minutes from 18
  • f sealing liquid increases within 20 minutes from 18°

° C C up to 75 up to 75° ° C. C.

  • After about 2 hours the survival rate of Pseudomonas

After about 2 hours the survival rate of Pseudomonas aeruginosa aeruginosa is less than 0,001%. is less than 0,001%.

  • After about 60 minutes the concentration of survived

After about 60 minutes the concentration of survived bacteria is less than the critical transmission level. bacteria is less than the critical transmission level.

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11 11

Functional Functional Test in Hospital ( ICU ) Test in Hospital ( ICU )

  • The aim of functional test in hospital (Intensive

The aim of functional test in hospital (Intensive Care Unit Hospital of University of Care Unit Hospital of University of T Tü übingen bingen) ) was to corroborate the was to corroborate the action of vibration, and action of vibration, and heating under actual operating conditions heating under actual operating conditions

  • Results of this phase of testing are documented

Results of this phase of testing are documented in doctoral theses E. in doctoral theses E. Cinar Cinar, , T Tü übingen bingen, 2000. , 2000.

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12 12

Functional Functional Test in Hospital ( ICU ) Test in Hospital ( ICU )

(T (Tü übingen 1999, Prof. D bingen 1999, Prof. Dö öring , Diss. E. ring , Diss. E.Cinar Cinar, 2000 ) , 2000 )

After complete replacement of all common After complete replacement of all common drain traps by our self drain traps by our self – – disinfecting drain disinfecting drain traps at an intensive care unit the number traps at an intensive care unit the number

  • f living cells within the sealing liquid was
  • f living cells within the sealing liquid was

near zero. This means: Using the self near zero. This means: Using the self-

  • disinfecting drain trap there is

disinfecting drain trap there is no risk of no risk of transmission of living bacteria from the transmission of living bacteria from the drain traps to patients drain traps to patients. .

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SLIDE 13

13 13

Functional Functional Test in Hospital (ICU) Test in Hospital (ICU)

(T (Tü übingen 1999, Prof. D bingen 1999, Prof. Dö öring , Diss. E. ring , Diss. E.Cinar Cinar, 2000 ) , 2000 )

1 2 3 4 5 6 7 8 9 10 1.00E+00 1.00E+02 1.00E+04 1.00E+06 1.00E+08

Live Bacterial Count ( CFU / ml )

Investigation Period (Weeks) Total Number of Microorganisms Pseud.aerug. Critical Level

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SLIDE 14

14 14

Functional Functional Test in Hospital (ICU ) Test in Hospital (ICU )

(T (Tü übingen 1999, Prof. D bingen 1999, Prof. Dö öring , Diss. E. ring , Diss. E.Cinar Cinar, 2000 ) , 2000 )

After two weeks of regular functioning one After two weeks of regular functioning one

  • f the drain traps has been switched out. It
  • f the drain traps has been switched out. It

is shown that the growth of bacteria starts is shown that the growth of bacteria starts immediately after vibration and heating immediately after vibration and heating was out of function. was out of function. The critical level for transmission ( CLT ) The critical level for transmission ( CLT ) ( conc. of living bacteria higher than 10 ( conc. of living bacteria higher than 105

5

CFU/ml ) was reached again after two CFU/ml ) was reached again after two weeks. weeks.

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SLIDE 15

15 15

Functional Functional test in Hospital ( ICU ) test in Hospital ( ICU )

( T ( Tü übingen 1999, Prof. D bingen 1999, Prof. Dö öring, Diss.E. ring, Diss.E.Cinar Cinar, 2000 ) , 2000 )

1 2 3 4 5 6 7 8 9 10

1.00E+00 1.00E+02 1.00E+04 1.00E+06 1.00E+08 1.00E+10 Live Bacterial Count ( CFU / ml ) Period of Investigation (Weeks )

ITS Tübingen, Zi. 313, 1999

Total Number of Microorganisms Pseud.aerug. Critical Level Installed Disabled

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SLIDE 16

16 16

Results Results of

  • f the Functional

the Functional Test in Test in Hospital ( ICU ) Hospital ( ICU )

  • The concentration of living bacteria in the self

The concentration of living bacteria in the self disinfecting drain trap does not depend on any disinfecting drain trap does not depend on any circumstances outside. circumstances outside.

  • The concentration of living micro

The concentration of living micro-

  • organisms is
  • rganisms is

always always 10 101

1 to 10

to 103

3 CFU / ml

CFU / ml

  • This

is 0,01 to 1%

  • f

the critical This is 0,01 to 1%

  • f

the critical concentration

  • f

living bacteria for concentration

  • f

living bacteria for transmission ( CLT = 10 transmission ( CLT = 105

5 CFU / ml )

CFU / ml )

  • Within 2 years

Within 2 years no formation of no formation of biofilm biofilm has has been observed. been observed.

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SLIDE 17

17 17

Results Results of

  • f the functional

the functional test in a test in a hospital hospital

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18 18

Colonization Colonization and and Infection Infection

  • Colonization is the basis of infection.

Colonization is the basis of infection.

  • There is no infection without any

There is no infection without any coloni coloni-

  • zation

zation. .

  • Therefore

Therefore: The incidence rate

  • f

: The incidence rate

  • f

colonization ( IRC ) is a very sensitive and colonization ( IRC ) is a very sensitive and useful indicator for the expected incidence useful indicator for the expected incidence rate of rate of nosocomial nosocomial infections ( IRNI ). infections ( IRNI ).

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19 19

Colonization as an Indicator Colonization as an Indicator for Infection for Infection

  • 3,3 %

3,3 %

  • f patients
  • f patients without colonization

without colonization

  • f
  • f

trachea bronchial system came down with trachea bronchial system came down with pneumonia. pneumonia.

  • 48 %

48 %

  • f patients
  • f patients with colonization

with colonization of the

  • f the

trachea bronchial system came down with trachea bronchial system came down with pneumonia. pneumonia.

  • 30 %

30 % of all people are colonized by facultative

  • f all people are colonized by facultative

pathogens pathogens.

.

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SLIDE 20

20 20

Colonization as an Indicator Colonization as an Indicator for Infection for Infection

  • The impact of an infection control device

The impact of an infection control device can be determined by its influence on the can be determined by its influence on the incidence rate of incidence rate of nosocomial nosocomial infections infections as well as on the as well as on the incidence rate of incidence rate of colonization ( IRC ). colonization ( IRC ).

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Bacteriological Bacteriological and and Epidemiological Epidemiological Tests Tests in Hospital ( ICU ) in Hospital ( ICU )

( Bautzen ( Bautzen-

  • Bischofswerda 2002/2003, B.

Bischofswerda 2002/2003, B. Sissoko Sissoko ) )

Detection of Pathogens: Overall Bacterial Counts 20 40 60 80

Jan Feb M är Apr M ai Jun Jul Aug Sep Okt Nov Dez Jan Feb M är

Period of Investigation 2002 - 2003

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22 22

Bacteriological Bacteriological and and Epidemiological Epidemiological Tests Tests in Hospital ( ICU ) in Hospital ( ICU )

( Bautzen ( Bautzen-

  • Bischofswerda 2002/2003, B.

Bischofswerda 2002/2003, B. Sissoko Sissoko ) )

Antibody Detection: Germs Typical Water

5 10 15 20

Jan Feb Mär Apr Mai Jun Jul Aug Sep Okt Nov Dez Jan Feb Mär

Period of Investigation 2002 - 2003

Overall Bacterial Counts Pseudomonas Spec. Klebsiella Pneumonia Acinetobacter Spec.

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SLIDE 23

23 23

Bacteriological Bacteriological and and Epidemiological Epidemiological Tests Tests in Hospital ( ICU ) in Hospital ( ICU )

( Bautzen ( Bautzen-

  • Bischofswerda 2002/2003, B.

Bischofswerda 2002/2003, B. Sissoko Sissoko ) )

Antibody Detection: Overall Bacterial Counts - Water Germs 20 40 60 80

Jan Feb M är Apr M ai Jun Jul Aug Sep Okt Nov Dez Jan Feb M är

Period of Investigation 2002 - 2003

Overall Bacterial Counts Water Germs

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24 24

Bacteriological Bacteriological and and Epidemiological Epidemiological Tests Tests in Hospital ( ICU ) in Hospital ( ICU )

( Bautzen ( Bautzen-

  • Bischofswerda 2002/2003, B.

Bischofswerda 2002/2003, B. Sissoko Sissoko ) )

Antibody Detection: Pseudomonas Spec 5 10 15

Jan Feb M är Apr M ai Jun Jul Aug Sep Okt Nov Dez Jan Feb M är

Period of Investigation 2002 - 2003 Antibody Detection ( N )

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25 25

Bacteriological Bacteriological and and Epidemiological Epidemiological Tests Tests in Hospital ( ICU ) in Hospital ( ICU )

( Bautzen ( Bautzen-

  • Bischofswerda 2002/2003, B.

Bischofswerda 2002/2003, B. Sissoko Sissoko ) )

Antibody detection: Klebsiella Pneumonia 2 4 6 8

Jan Feb M är Apr M ai Jun Jul Aug Sep Okt Nov Dez Jan Feb M är

Period of Investigation 2002 - 2003

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SLIDE 26

26 26

Bacteriological Bacteriological and and Epidemiological Epidemiological Tests Tests in Hospital ( ICU ) in Hospital ( ICU )

( Bautzen ( Bautzen-

  • Bischofswerda 2002/2003, B.

Bischofswerda 2002/2003, B. Sissoko Sissoko ) )

Antibody Detection: of Acinetobacter Spec.

2 4

Jan Feb M är Apr M ai Jun Jul Aug Sep Okt Nov Dez Jan Feb M är

Period of Investigation ( 2002 - 2003 )

Antibody detection ( N )

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SLIDE 27

27 27

Bacteriological Bacteriological and and Epidemiological Epidemiological Tests Tests in Hospital ( ICU ) in Hospital ( ICU )

( Bautzen ( Bautzen-

  • Bischofswerda 2002/2003, B.

Bischofswerda 2002/2003, B. Sissoko Sissoko ) )

NI ( ges. ) - NI ( Ps.,K. )

2 3 1 2 3 8 2 2 1 1 6 2 1

2 4 6 8 10 12

Jan Feb M rz Apr M ai Jun Jul Aug Sep Okt Nov Dez Jan Feb M rz

Period of Investigation ( Jan 2002 bis März 2003 ) Number ( N )

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SLIDE 28

28 28

Bacteriological Bacteriological and and Epidemiological Epidemiological Tests Tests in Hospital ( ICU ) in Hospital ( ICU )

( Bautzen ( Bautzen-

  • Bischofswerda 2002/2003, B.

Bischofswerda 2002/2003, B. Sissoko Sissoko ) )

  • The results show that the

The results show that the self self-

  • disinfecting drain trap

disinfecting drain trap significantly reduces the significantly reduces the rate of colonization of rate of colonization of patients patients. .

  • Therefore it is to be

Therefore it is to be expected that a expected that a significant significant decrease of incidence rate decrease of incidence rate

  • f
  • f nosocomial

nosocomial infections infections will be found if the number will be found if the number

  • f patients investigated is
  • f patients investigated is

high enough high enough. .

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SLIDE 29

29 29

Kinetics Kinetics of

  • f Nosocomial

Nosocomial Infections Infections – – I I

Kinetics of Nosocomial Infections Caused by Water Borne Pathogens

2 4 6 8 10 12 14 16 18 Jan Feb Mrz Apr Mai Jun Jul Aug Time Rate of Incidence (%)

Standard drain trap KLEANIK™

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SLIDE 30

30 30

Kinetics Kinetics of

  • f Nosocomial

Nosocomial Infections Infections – – II II

Kinetics of Nosocomial Infections Caused by Non-Water Borne Pathogens 2 4 6 8 10 12 Jan Feb Mrz Apr Mai Jun Jul Aug Time Rate of Incidence ( % )

Standard drain trap KLEANIK™

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SLIDE 31

31 31

Rates of Rates of Incidence Incidence ( abs.) ( abs.)

Nosocomial Infections

1 2 3 4 5 6 7 8

w bp nw bp both Incidence Rate ( % ) (abs.)

St andard KLEANIK™

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SLIDE 32

32 32

Rates of Rates of Incidence Incidence ( rel.) ( rel.)

Nosocomial Infections

20 40 60 80 100 120

w bp nw bp both Relative Rate of Incidence ( % )

St andard KLEANIK™

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33 33

Conclusions Conclusions

  • These

These results indicate results indicate a a significant reduction significant reduction

  • f
  • f nosocomial infections

nosocomial infections in the ICU in the ICU

  • Infections caused by

Infections caused by water water-

  • borne

borne pathogens pathogens : : reduction of reduction of 75 % or 75 % or more more

  • Infections caused by

Infections caused by non non – – water water-

  • borne

borne pathogens pathogens : : reduction of 50 % reduction of 50 %

  • All

All nosocomial infections caused by nosocomial infections caused by water water-

  • borne

borne and non and non-

  • water

water-

  • borne

borne pathogens pathogens: : reduction of 60 % reduction of 60 %

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34 34

Kleanik Kleanik™ ™ – – The Convenient & The Convenient & Preventive Solution Preventive Solution

  • Continuous Disinfection

Continuous Disinfection

  • Fully Automatic

Fully Automatic

  • Self

Self-

  • Regulating

Regulating

  • Compact Unit

Compact Unit – – Easy Installation Easy Installation

  • Built

Built-

  • in Safety Features

in Safety Features

  • Proven Technology

Proven Technology

  • Enhanced Patient Safety

Enhanced Patient Safety

  • Reduced Hospital Costs

Reduced Hospital Costs