The risk of nosocomial infections caused by resistant organisms continues to increase. A common reservoir for these germs is presented by water installations in hospitals. This has been indicated by an extensive review of the literature (Gorden et al., CID 2017:64) which evaluated more than 3,000 publications, 32 of which in greater depth. Numerous outbreaks and infections can be attributed to carbapenem-resistant organisms (CROs) that are spread through faucets, shower heads, and siphons.
As gene analysis methods show, patients and staff who come into contact with water-bearing installations contribute significantly to the spread of CROs. Once resistant germs have settled on faucets and shower heads, they form a biofilm and colonize siphons and drains from there. In addition to Pseudomonas aeruginosa (41% of all cases), Klebsiella, Acetinobacter, and Enterobacteriaceae can be detected to a large extent when it comes to resistances in the siphons. The gene transfer (plasmid transfer) of the microorganisms plays a decisive role in the spread of these resistances.
The possible measures available in order to stop outbreaks include daily chemical disinfection of siphons and heating or replacing fixtures. However, lasting barriers are required in order to stop the dangerous spread of CROs in both the medium and the long term.
Above all, this includes the use of terminal sterile filters that are able to demonstrate effective retrograde protection over the entire application period. Their particular benefit consists in the fact that they are effective in both directions: On the one hand they control germs from the water installation. On the other hand they also counteract the contaminants that reach the washing area from the outside. This is the only way to provide genuine protection of water-bearing installations against CROs.
Water filters with a long service life and minimal costs that control germs in only one direction do not suffice in order to achieve the required protection in hospitals.
In its recommendation, "Requirements for infection prevention in medical care for immunocompromised patients", the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at Robert Koch Institute also advocates the use of terminal sterile filters. In this context, it must be ensured "that no external contamination of the filters results in transmission of pathogens whose nosocomial transmission is to be prevented by the filter (Cat. II)."
The antibacterial property of the plastic surfaces of the sterile filter is crucial. According to the standard ISO 22196, this property can be determined by measuring the germ reduction on the filter surface and should be clearly verified over the entire clinical service life. Against this background, it is regrettable that several filter manufacturers nevertheless advertise freely selectable service lives of one to four months – thus contributing to customer uncertainty.
Conclusion: In view of the immense challenges posed by the spread of resistant germs, a reassessment of the use of terminal sterile filters is required: as a lasting barrier, they not only serve to control germs from the water supply, but must also prevent the spread of bacteria applied to the water intake by patients or staff. This is the only way to provide patients with effective protection.
Published in Management & Krankenhaus
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