Prevention of Nosocomial Infections with KLEANIK Self ... · Prevention of adherence of microorganisms and particles on the inner wall of the drain trap ( biofilm formation ) by vibration

Prevention of Nosocomial Prevention of Nosocomial

Infections with KLEANIKInfections with KLEANIK™™

Self Self -- Disinfecting Drain Disinfecting Drain

TrapTrap

22

TheThe Drain Trap Drain Trap asas a a SourceSource

of Transmission of of Transmission of

PathogensPathogens�� Content of living microContent of living micro--organisms in sealing liquid of organisms in sealing liquid of

common drain traps : 10common drain traps : 1066 -- 10101010 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

101088 -- 10101212 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 pathogensresistant pathogens outside the outside the human human bodybody. .

33

TheThe drain trap drain trap asas a a SourceSource of of

Transmission of Transmission of PathogensPathogens

�� In patient rooms sink In patient rooms sink drains are the drains are the major major reservoirs of living reservoirs of living microorganisms microorganisms outside the human outside the human bodybody 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 open ““reservoirsreservoirs..

44

�� 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 substratessubstrates

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

Drain trapsDrain traps offer excellentoffer excellent conditionsconditions forforgrowth of microgrowth of micro--organismsorganisms

1.00E+00

1.00E+02

1.00E+04

1.00E+06

1.00E+08

0 1 2 3 4 5 6 7 8 9 10 11 12

Investigation period (w eeks)Li

ve B

acte

rial C

ount

( C

FU

/ m

l )

55

Biofilm Biofilm –– The Ally of BacteriaThe Ally of Bacteria

�� BiofilmBiofilm 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 biofilmbiofilm 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 biofilmbiofilm acts as protective barrier acts as protective barrier against antiagainst 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 antibioticsantibiotics..

66

TheThe KnownKnown ProblemProblem::Transmisson of Bacteria Transmisson of Bacteria fromfrom drain trap to drain trap to

PatientPatient�� Drain traps are permanent Drain traps are permanent ““openopen”” 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 >> 101055

CFU/mlCFU/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 aeruginosaaeruginosa) 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( DÖÖRING et al. 1989 ).RING et al. 1989 ).

77

TheThe ApproachApproach

�� 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 ( biofilmbiofilmformation ) by formation ) by vibrationvibration

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

88

TheThe Technical Technical SolutionSolution

�� Vibration Vibration UltrasoundUltrasound

�� Heat Heat --DisinfectionDisinfection

T > 70T > 70°°CC

99

LabLab-- ResultsResults::Kinetics of Heat Killing of Bacteria ( Kinetics of Heat Killing of Bacteria ( Ps.aerugPs.aerug.) .)

in the Selfin the Self--disinfecting drain trapdisinfecting drain trap

Bactericidal Pseudomonas aeruginosa

1.00E+00

1.00E+02

1.00E+04

1.00E+06

1.00E+08

0 0.5 1 1.5 2 2.5 3 4 5 6 7 8

Treatment time (h)

Live

Bac

teria

l Cou

nt(

CF

U /

ml )

1010

LabLab-- ResultsResults::KineticsKinetics ofof Heat KillingHeat Killing ofof BacteriaBacteria ( Ps.( Ps.aerugaerug.) in .) in

the Selfthe Self--disinfectingdisinfecting drain trapdrain trapExplanation of figure 2Explanation of figure 2 ::

�� Using the selfUsing the self--regulating heatingregulating heating--system the temperature system the temperature of sealing liquid increases within 20 minutes from 18of sealing liquid increases within 20 minutes from 18°°C C up to 75up to 75°°C.C.

�� After about 2 hours the survival rate of Pseudomonas After about 2 hours the survival rate of Pseudomonas aeruginosaaeruginosa 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.

1111

FunctionalFunctional 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 TTüübingenbingen) ) was to corroborate the was to corroborate the action of vibration, and action of vibration, and

heating under actual operating conditionsheating 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. CinarCinar, , TTüübingenbingen, 2000., 2000.

1212

FunctionalFunctional Test in Hospital ( ICU )Test in Hospital ( ICU )(T(Tüübingen 1999, Prof. Dbingen 1999, Prof. Dööring , Diss. E.ring , Diss. E.CinarCinar, 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 of living cells within the sealing liquid was of living cells within the sealing liquid was near zero. This means: Using the selfnear 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 patientsdrain traps to patients..

1313

FunctionalFunctional Test in Hospital (ICU)Test in Hospital (ICU)(T(Tüübingen 1999, Prof. Dbingen 1999, Prof. Dööring , Diss. E.ring , Diss. E.CinarCinar, 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

Bac

teria

l Cou

nt (

CF

U /

ml )

Investigation Period (Weeks)

Total Number ofMicroorganisms

Pseud.aerug.

Critical Level

1414

FunctionalFunctional Test in Hospital (ICU )Test in Hospital (ICU )(T(Tüübingen 1999, Prof. Dbingen 1999, Prof. Dööring , Diss. E.ring , Diss. E.CinarCinar, 2000 ), 2000 )

After two weeks of regular functioning one After two weeks of regular functioning one of the drain traps has been switched out. It of 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 1055

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

1515

Functional Functional test in Hospital ( ICU )test in Hospital ( ICU )( T( Tüübingen 1999, Prof. Dbingen 1999, Prof. Dööring, Diss.E.ring, Diss.E.CinarCinar, 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

Bac

teria

l Cou

nt

( C

FU

/ m

l )

Period of Investigation(Weeks )

ITS Tübingen, Zi. 313, 1999

Total Number ofMicroorganismsPseud.aerug.

Critical Level

Installed

Disabled

1616

ResultsResults of of the Functionalthe 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 microThe concentration of living micro--organisms is organisms is always always 101011 to 10to 1033 CFU / ml CFU / ml

�� This is 0,01 to 1% of the critical This is 0,01 to 1% of the critical concentration of living bacteria for concentration of living bacteria for transmission ( CLT = 10transmission ( CLT = 1055 CFU / ml )CFU / ml )

�� Within 2 years Within 2 years no formation of no formation of biofilmbiofilm has has been observed.been observed.

1717

ResultsResults of of the functionalthe functional test in a test in a hospitalhospital

1818

ColonizationColonization andand InfectionInfection

�� Colonization is the basis of infection.Colonization is the basis of infection.

�� There is no infection without any There is no infection without any colonicoloni--zationzation..

�� ThereforeTherefore: The incidence rate of : The incidence rate of 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 nosocomialnosocomial infections ( IRNI ).infections ( IRNI ).

1919

Colonization as an Indicator Colonization as an Indicator

for Infectionfor Infection�� 3,3 %3,3 % of patients of patients without colonizationwithout colonization of of

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

�� 48 %48 % of patients of patients with colonizationwith colonization of the of the trachea bronchial system came down with trachea bronchial system came down with pneumonia.pneumonia.

�� 30 %30 % of all people are colonized by facultative of all people are colonized by facultative pathogenspathogens..

2020

Colonization as an Indicator Colonization as an Indicator

for Infectionfor 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 nosocomialnosocomial infectionsinfections

as well as on the as well as on the incidence rate of incidence rate of

colonization ( IRC ).colonization ( IRC ).

2121

BacteriologicalBacteriological andand EpidemiologicalEpidemiological Tests Tests in Hospital ( ICU )in Hospital ( ICU )

( Bautzen( Bautzen--Bischofswerda 2002/2003, B. Bischofswerda 2002/2003, B. SissokoSissoko ))

Detection of Pathogens: Overall Bacterial Counts

0

2040

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

2222



Antibody Detection: Germs Typical Water

0

5

10

15

20

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


Overall Bacterial Counts

Pseudomonas Spec.

Klebsiella Pneumonia

Acinetobacter Spec.

2323



Antibody Detection: Overall Bacterial Counts - Water Germs

0

20

40

60

80



Overall Bacterial Counts

Water Germs

2424



Antibody Detection: Pseudomonas Spec

0

5

10

15



Ant

ibod

y D

etec

tion

( N

)

2525



Antibody detection: Klebsiella Pneumonia

02

46

8



2626



Antibody Detection: of Acinetobacter Spec.

0

2

4


Period of Investigation ( 2002 - 2003 )

Ant

ibod

y de

tect

ion

( N

)

2727



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

2

0 0

3

0

10

2

3

8

0

2 2

0 0

1

0 0 0

1

0

6

0 0

2

0 0 0 0 0

1

0

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 )

Num

ber

( N

)

2828


( Bautzen( Bautzen--Bischofswerda 2002/2003, B. Bischofswerda 2002/2003, B. SissokoSissoko ))�� The results show that the The results show that the

selfself--disinfecting drain trap disinfecting drain trap significantly reduces the significantly reduces the

rate of colonization of rate of colonization of

patientspatients..

�� 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

of of nosocomialnosocomial infections infections

will be found if the number will be found if the number

of patients investigated is of patients investigated is

high enoughhigh enough..

2929

Kinetics Kinetics of of Nosocomial Nosocomial

InfectionsInfections –– I I

Kinetics of Nosocomial Infections Caused by Water Borne Pathogens

0

2

4

6

8

10

12

14

16

18

Jan Feb Mrz Apr Mai Jun Jul AugTime

Rat

e of

Inci

denc

e (%

)

Standard drain trap

KLEANIK™

3030

KineticsKinetics ofof Nosocomial Nosocomial

InfectionsInfections –– II II

Kinetics of Nosocomial Infections Caused by Non-Water Borne Pathogens

0

2

4

6

8

10

12

Jan Feb Mrz Apr Mai Jun Jul Aug

Time

Rat

e of

Inci

denc

e (

% )

Standard drain trap

KLEANIK™

3131

Rates of Rates of IncidenceIncidence ( abs.)( abs.)

Nosocomial Infections

0

1

2

3

4

5

6

7

8

w bp nw bp both

Inci

denc

e R

ate

( %

)

(abs

.)

St andard

KLEANIK™

3232

Rates ofRates of IncidenceIncidence ( rel.)( rel.)

Nosocomial Infections

0

20

40

60

80

100

120

w bp nw bp both

Rel

ativ

e R

ate

of

Inci

denc

e (

% )

St andard

KLEANIK™

3333

Conclusions Conclusions �� These These results indicate results indicate a a significant reductionsignificant reduction

of of nosocomial infectionsnosocomial infections in the ICUin the ICU

�� Infections caused by Infections caused by waterwater--borneborne pathogens pathogens : : reduction ofreduction of 75 % or 75 % or more more

�� Infections caused by Infections caused by non non –– waterwater--bornebornepathogens pathogens :: reduction of 50 %reduction of 50 %

�� All All nosocomial infections caused by nosocomial infections caused by waterwater--borneborneand nonand non--waterwater--borneborne pathogenspathogens: :

reduction of 60 %reduction of 60 %

3434

KleanikKleanik™™ –– The Convenient & The Convenient & Preventive SolutionPreventive Solution

�� Continuous DisinfectionContinuous Disinfection�� Fully AutomaticFully Automatic�� SelfSelf--RegulatingRegulating�� Compact Unit Compact Unit –– Easy Installation Easy Installation �� BuiltBuilt--in Safety Featuresin Safety Features�� Proven TechnologyProven Technology�� Enhanced Patient SafetyEnhanced Patient Safety�� Reduced Hospital CostsReduced Hospital Costs

Documents

Prevention of Nosocomial Infections with KLEANIK Self ... · Prevention of adherence of microorganisms and particles on the inner wall of the drain trap ( biofilm formation ) by vibration