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 Transmission of of Transmission of Pathogens Pathogens � Content of living micro Content of living micro- -organisms in sealing liquid of organisms in sealing liquid of � 6 - 10 colony forming units per common drain traps : 10 6 - 10 10 10 colony forming units per common drain traps : 10 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 � 8 - 12 colony forming units. 10 8 - 10 10 12 colony forming units. 10 � 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 outside the resistant pathogens outside the human human body body. . 2 2
The drain trap drain trap as as a a Source Source of of The Transmission of Pathogens Pathogens Transmission of � In patient rooms sink In patient rooms sink � drains are the major drains are the major reservoirs of living reservoirs of living microorganisms microorganisms outside the human outside the human body and in the direct and in the direct body environment of the environment of the patient. patient. � Common drain traps Common drain traps � are always „ „ open are always open “ “ reservoirs . . reservoirs 3 3
Drain traps offer excellent offer excellent conditions conditions for for Drain traps growth of micro- -organisms organisms growth of micro � High nutrient content and High nutrient content and � sufficient nutrient flow. sufficient nutrient flow. � Moderate room Moderate room 1.00E+08 � L iv e B a c te r ia l C o u n t temperatures are sufficient temperatures are sufficient ( C F U / m l ) 1.00E+06 for fast multiplication. for fast multiplication. 1.00E+04 � Oxygen containing Oxygen containing � 1.00E+02 substrates substrates 1.00E+00 0 1 2 3 4 5 6 7 8 9 10 11 12 � Figure 1 Figure 1: Multiplication of : Multiplication of � Investigation period (weeks) bacteria in a drain trap bacteria in a drain trap 4 4
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 � Biofilm � 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- -microbial substances it can be a microbial substances it can be a against anti possibility for expression of resistance against possibility for expression of resistance against antibiotics. . antibiotics 5 5
: Problem : The Known Known Problem The Transmisson of Bacteria from from drain trap to drain trap to Transmisson of Bacteria Patient Patient � Drain traps are permanent Drain traps are permanent “ “open open” ” reservoirs of pathogenic and reservoirs of pathogenic and � non - - pathogenic microorganisms, bacteria, yeast and fungi, pathogenic microorganisms, bacteria, yeast and fungi, non 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 10 5 5 � , transmission of bacteria from sealing fluid to hands of transmission of bacteria from sealing fluid to hands of CFU/ml , CFU/ml 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. ( DÖ ÖRING et al. 1989 ). RING et al. 1989 ). ( D 6 6
The Approach Approach The � Prevention of adherence of Prevention of adherence of � microorganisms and particles on the microorganisms and particles on the inner wall of the drain trap ( biofilm biofilm inner wall of the drain trap ( formation ) by vibration formation ) by vibration � Prevention of bacterial growth and Prevention of bacterial growth and � multiplication by heat disinfection multiplication by heat disinfection 7 7
The Technical Technical Solution Solution The � Vibration Vibration � Ultrasound Ultrasound � Heat Heat - -Disinfection Disinfection � T > 70° ° C T > 70 C 8 8
Lab- - Results Results: : Lab Kinetics of Heat Killing of Bacteria ( Ps.aerug Ps.aerug.) .) Kinetics of Heat Killing of Bacteria ( in the Self- -disinfecting drain trap disinfecting drain trap in the Self Bactericidal Pseudomonas aeruginosa Live Bacterial Count 1.00E+08 ( CFU / ml ) 1.00E+06 1.00E+04 1.00E+02 1.00E+00 0 0.5 1 1.5 2 2.5 3 4 5 6 7 8 Treatment time (h) 9 9
Lab- - Results Results: : Lab Kinetics of of Heat Killing Heat Killing of of Bacteria Bacteria ( Ps. ( Ps.aerug aerug.) in .) in Kinetics the Self- -disinfecting disinfecting drain trap drain trap the Self Explanation of figure 2 : : Explanation of figure 2 � Using the self Using the self- -regulating heating regulating heating- -system the temperature system the temperature � of sealing liquid increases within 20 minutes from 18° ° C of sealing liquid increases within 20 minutes from 18 C up to 75° ° C. up to 75 C. � After about 2 hours the survival rate of Pseudomonas After about 2 hours the survival rate of Pseudomonas � aeruginosa is less than 0,001%. is less than 0,001%. aeruginosa � 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. 10 10
Functional Test in Hospital ( ICU ) Test in Hospital ( ICU ) Functional � The aim of functional test in hospital (Intensive The aim of functional test in hospital (Intensive � Care Unit Hospital of University of T Tü übingen bingen) ) Care Unit Hospital of University of was to corroborate the action of vibration, and was to corroborate the 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. Cinar Cinar, , T Tü übingen bingen, 2000. , 2000. in doctoral theses E. 11 11
Functional Test in Hospital ( ICU ) Test in Hospital ( ICU ) Functional (Tü übingen 1999, Prof. D bingen 1999, Prof. Dö öring , Diss. E. ring , Diss. E.Cinar Cinar, 2000 ) , 2000 ) (T After complete replacement of all common After complete replacement of all common drain traps by our self – – disinfecting drain disinfecting drain drain traps by our self traps at an intensive care unit the number traps at an intensive care unit the number of living cells within the sealing liquid was of 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 no risk of disinfecting drain trap there is no risk of transmission of living bacteria from the transmission of living bacteria from the . drain traps to patients . drain traps to patients 12 12
Functional Test in Hospital (ICU) Test in Hospital (ICU) Functional (Tü übingen 1999, Prof. D bingen 1999, Prof. Dö öring , Diss. E. ring , Diss. E.Cinar Cinar, 2000 ) , 2000 ) (T 1.00E+08 Live Bacterial Count 1.00E+06 ( CFU / ml ) Total Number of 1.00E+04 Microorganisms Pseud.aerug. 1.00E+02 Critical Level 1.00E+00 1 2 3 4 5 6 7 8 9 10 Investigation Period (Weeks) 13 13
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