key: cord-0034523-ilj642q6
authors: Sattar, S.A
title: The prevention and control of nosocomial infections: it is time for renewed emphasis and efforts: Proceedings of the 7th international BODE hygiene days, 15–17 May 2003, Tarragona (Barcelona), Spain
date: 2004-04-09
journal: J Hosp Infect
DOI: 10.1016/j.jhin.2003.12.032
sha: feb71f628015e65509eaf04b2cd90ec29af96786
doc_id: 34523
cord_uid: ilj642q6

nan

This supplement is devoted to 21 presentations from nine different countries at the 7th International BODE Hygiene Days held in Tarragona (Barcelona), Spain (May 2003). The 180 or so delegates came from countries that covered nearly the entire globe. The papers, and the discussions following them, clearly reemphasized that, in spite of much progress in the past few decades, nosocomial infections remain a serious threat to human health worldwide. Indeed, many on-going changes in our societies, wide-spread drug resistance and immunosuppression, greater international trade in livestock and comestibles, faster and more frequent air travel as well as general reductions in health care funding have considerably enhanced the risk from nosocomial infections in our times. The information presented covered the highly relevant and topical issues of environmental surface disinfection, 1 hand hygiene, 2 -5 reprocessing of medical devices, 6-10 surveillance of nosocomial infections 11 and the role of viruses as nosocomial pathogens. 12 -14 French gave a balanced perspective on the dangers of newly discovered pathogens and our ability to successfully deal with them, as evidenced in the recent past; also, while complete elimination of hospital-acquired infections may never be attainable, we must continually apply our improving knowledge in medicine, biology and epidemiology to making hospitals safer.

The controversy on the need and benefits of disinfecting floors in hospitals rages on. 15 Exner expressed the view that the potential of environmental surfaces as reservoirs and sources of nosocomial pathogens is underestimated, and the equivocal findings thus far could be due to a lack of methods to assess detergents and disinfectants properly in the field. 1 Kramer showed that routine movement of staff could rapidly spread localized experimental contamination of hospital floors with the spores of Bacillus stearothermophilus, used primarily as surrogates for Clostridium difficile and Bacillus anthracis; sporicidal disinfectants were the only effective means of preventing such spread. While this study makes a case for the use of sporicidal chemicals in the disinfection of hospital floors, we need further studies to determine the benefit: hazard ratio of the wide-spread use of sporicides, many of which can be unsafe. The contact time for sporicidal activity under ambient conditions would also require a substantial reduction to make routine application of sporicides on hospital floors practicable.

A substantial portion of the symposium was devoted to the topic of hand hygiene with contributions from world-renowned experts and with particular emphasis on the European norms and the newly released guideline from the U.S. Centers for Disease Control and Prevention (CDC). 16 Kampf discussed several key factors to improve compliance with hand hygiene and emphasized that preventing even a small number of nosocomial infections through proper hand antisepsis could easily justify the added expense of making handrubs available; this view was corroborated by Pittet. Boyce and Pittet, the two coauthors of the CDC guideline, gave the scientific basis and global implications of its recommendations. This document has already had a substantial impact on the practices of hand hygiene in the U.S., particularly by catalyzing the acceptance of alcohol-based hand rubs in healthcare settings.

Rotter provided an update on the accepted or candidate European methods to assess hand antiseptics against a variety of nosocomial pathogens. 3 These developments are leading the world in the introduction and refinement of standardized methods for testing the microbicidal activity of skin antiseptics in general.

Widmer outlined several crucial factors in the testing and selection of alcohol-based hand rubs to ensure their effectiveness, acceptance and safe use and King 4 described a hospital-based pilot study on the introduction and use of an alcohol-based hand antiseptic; the antiseptic pump dispensers were installed on each patient's bed and the staff were encouraged to use them through posters and information sessions.

Reprocessing of endoscopes was the second most extensively covered topic at this symposium. The emphasis here was on cleaning of such medical devices prior to their disinfection and several perspectives from Europe 6 -9 and the U.S. 10 were presented, thus facilitating the exchange of ideas between several nations.

Steinmann 13 summarized the European approach to testing chemical disinfectants against nosocomial viral pathogens and the use of surrogate viruses in such testing, and also described the European experience in assessing the virucidal activity of hand antiseptics employing ASTM International's (formerly American Society for Testing and Materials) fingerpad method. 17 The U.S. still does not allow the use of surrogate viruses to evaluate products, while it is an accepted practice in Europe and Canada. Payan's 12 was a rare study where a cell culture system (HepG2) was used to assay the infectivity of human hepatitis B virus before and after its exposure to several types of disinfectants. Sattar 14 presented an overview on viruses and their mounting significance as nosocomial pathogens, with the SARS virus (Severe Acute Respiratory Syndrome) and noroviruses as examples; it was also noted that there are major gaps in our knowledge on the exact mechanisms of spread of many types of viruses in hospital settings and prevention and control strategies to be applied. Rosselló-Urgell 11 described how recently introduced surveillance programs are generating useful information on the incidence of nosocomial infections in Spain. The design and application of these programs has been possible due to unprecedented collaboration between government agencies, scientific societies and the pharmaceutical industry. The Spanish expertise and experience are now ready to be applied in other European countries.

The right blending of science and culture in the conference program, the generally high quality of the speakers, and the charm, elegance and historical significance of the setting itself made the event highly conducive to the exchange of knowledge and ideas inside as well as outside the conference venue. The relatively small number of the participants and the focused nature of the subject matters also greatly facilitated the interactions. The organizational acumen and the hospitality of the sponsors of the event were of the highest order.

Household cleaning and surface disinfection: new insights and strategies

The six golden rules to improve compliance in hand hygiene

European norms in hand hygiene

Provision of alcohol hand rub at the hospital bedside: a case study

Efficacy of alcohol-based gels compared with simple hand wash and hygienic hand disinfection

The importance of cleaning for the overall results of reprocessing endoscopes

Reprocessing endoscopes: national recommendations with a special emphasis on cleaning-the German perspective

Importance of cleaning for reprocessing endoscopes and thermolatice sterile medical devices: French use and regulations

Test models to determine efficacy with different types of bioburden and its clinical correlation

Reprocessing endoscopes: United States perspective

Nosocomial infection surveillance and control activities in Spain under HELICS and NosoMed programs frame

Assessment of new chemical disinfectants for HBV virucidal activity in a cell culture model

Surrogate viruses for testing virucidal efficacy of chemical disinfectants

Microbisicides and the environmental control of nosocomial viral infections

Should we routinely disinfect floors?

Guidelines for hand hygiene in healthcare setting

Standard test method for determining the virus-eliminating effectiveness of liquid hygienic handwash and handrub agents using the fingerpads of adult volunteers. Document #E1838-02