[Occurrence of enteritis-causing agents in private households--a pilot study]. / Untersuchungen über das Vorkommen von Enteritis-Erregern im Haushalt--eine Pilotstudie.

The increasing occurrence of infectious enteritis caused us to perform a prospective, epidemiological pilotstudy in households, in order to receive informations about the practicability of such a project and the bacteriology of food prepared at home as well. 10 families were asked to gather samples of all foodstuffs consumed during the day in separate containers and to keep them frozen at - 20 degrees C until collected by us once a week. Thus we received 4.683 samples within a 6-months-period. In the laboratory those samples were mixed following Table 2 and examined concerning the occurrence of enteropathogenic bacteria. Additionally we carried out an investigation of kitchensurfaces and -utensils by means of "Rodac"-plates. The evaluation of the food-samples showed no growth of salmonella, shigella, yersinia or campylobacter; however, in 267 samples were found staphylococci, in 191 enterococci, in 388 enterobacteria, in 28 aerobic sporeformers and in 144 fungi. Mainly sausage- and meatproducts appeared to be contaminated by staphylococci, also enterococci and enterobacteria (Fig. 1); other groceries were colonized by these microorganisms only to a minor degree. Fungi and aerobic sporeformers were isolated primarily in salads, bakery- and milkproducts (Fig. 2). Though some of the foodstuffs contained up to 10(5) pathogenes/g (Fig. 5), no cases of gastroenteritis were observed within our families. In case of mishandling (e.g. storage of food in refrigerators with temperatures above 4 degrees C) the development of foodborne enteritis has to be taken into account. The kitchens' examination showed a relatively high degree of contamination with pathogenic resp. potentially pathogenic organisms, represented in Fig. 7 by data obtained from different objects of investigation (surfaces, sinks and cloths).

[Travellers' diarrhoea. I. Field study on frequency and causes in German tourists (author's transl)]. / Reisediarrhoe. I. Feldstudie über die Häufigkeit und Ursachen bei deutschen Touristen.

Even after successful localization of dangerous epidemics, infectious diseases represent a troublesome accompaniment of growing tourism to warm countries. Classical pathogens of diarrhoea are subjected to a worldwide control network to prevent this disease at least from being spread. Close surveillance has shown that, additionally, less clearly defined pathogens exist which affect a high percentage of tourists and cause a usually harmless but nevertheless often very annoying diarrhoea. In a tropic insular state a field study was carried out with voluntary assistance of German flight passengers in order to investigate the qualitative and quanitative importance of travellers' diarrhoea and to supplement American observations mainly gained in Mexico. In a first study we found that pathogens were detected only in six out of 173 stool samples: the pathogens were Salmonellae which had caused clinical symptoms in two cases only. With respect to diarrhoea with different origin which affected some 20 per cent of our examinees we will inquire into the importance of E. coli as pathogen, which is generally classified harmless but liable to interfere considerably with holidays and recreation.

[Hygienic and bacteriological comparative studies in 50 hospitals. V. Bacterial contamination of hospital surfaces (author's transl)]. / Hygienisch-bakteriologische Vergleichsuntersuchungen an 50 Krankenhäusern. V. Keimzahlen auf Flächen in Krankenhäusern.

Environmental examination were carried out in 50 hospitals using "rodac-plates" (size: 21 cm2) for 7971 samples, to acquire a semiquantitative assessment of microbial contamination of surfaces. Up to 20 percent of the impression cultures showed uncountable numbers of colonies (more than 300/21 cm2). Therefore statements on the microbial content were not to be based on mean values alone. The actual state of surface contamination was assessed by the mean value of all plates with colony counts below 300 and by the median value. Additionally numbers of samples with colony counts below 10 and more than 300 were recorded. The mean value of all samples with less than 300 colonies/21 cm2 was 58. 21% had less than 10, 23% more than 300 colonies. In operating suites, delivery rooms, and premature wards the mean value was 30 colonies/21 cm2. Surfaces with less than 10 colonies amounted to 30 percent, with more than 300 to 5 percent. Samples from intensive-care units, from new-born-, and childrens wards had mean values of 50 colonies/21 cm2. Percentages of plates below 10 and above 300 colonies differed too much to be grouped. Surgical, internal, and gynaecological wards showed mean values of more than 60 colonies/21 cm2. 15 percent of plates had less than 10 colonies, 10 percent more than 300. Differentiations as to specifications of rooms and surfaces in regard to bacterial contamination have been made.

[Hygienic and bacteriological comparative studies in 50 hospitals. VI. The efficacy of a hospital-hygienic instruction regarding 6 hospitals]. / Hygienisch-bakteriologische Vergleichsuntersuchungen an 50 Krankenhäusern. VI. Zur Effektivität krankenhaushygienischer Beratung am Beispiel von 6 Krankenhäusern.

The efficacy of hospital hygienic measures was checked in six hospitals. The programme was started by determining the effective state. Subsequently a two-day extension course for the training and instruction of the responsible personnel in charge (physicians, nurses and administrative staff) in the essential problems of hospital hygiene was held. The next measure consisted in giving advice in the preparation of hygiene plans which had to make allowance for the prevailing personal and constructional situation as well as for the hospital equipment. The hygiene plans represented the written concept of the measures to be implemented. Then enquiries, local inspections as well as hygienic-bacteriological ambient analyses were carried out to determine the hygienic situation in the hospital after adoption of the measures and the findings were compared with the situation preceding the initiation of the hygienic programme. The results show that the proposed improvements were mostly realised as far as such administrative measures as the procurement of disinfectant dispensers, throwaway towels and suitable disinfectants were concerned. The instructions given for the implementation of suitable methods of application were complied with to a lesser extent. Moreover, considerable improvements were achieved with regard to the operation and efficiency of the sterilizers. On the whole, the present study demonstrates that suitable measures largely reduce the extensive gaps in information on the part of the staff on hospital hygiene and that the resulting intensification of efforts can greatly contribute towards an improvement of the overall hygiene in hospitals.

[Hygienic and bacteriological comparative studies in 50 hospitals. II. The role of staff in the distribution of pathogenic organisms in surgical wards (author's transl)]. / Hygienisch-bakteriologische Vergleichsuntersuchungen an 50 Krankenhäusern. II. Zur Bedeutung des Personals für die Ausbreitung von Krankheitserregern auf chirurgischen Stationen

Before hygienic measures are recommended to a hospital it is absolutely necessary for the source of infection and the paths of infection - both possible and to be expected - to be clearly established. In order to be able to evaluate the paths of spread, one of the basic prerequisites would be to carry out examinations with a view to determining the number of persons who are carriers of pathogenic germs. To this effect, bacteriological samples of the right hand, the skin at the forehead/hairline, the coat in the area of the navel and the throat were taken from the nursing staff in surgical wards in 50 different hospitals. At the same time details of hand disinfection and hand drying were collected by questioning and local inspection. In at least one of the 4 swabs from 72 persons (= 38%) and in two or more swabs from 26 persons (= 14%). Staph. aureus was detected. The hair was the most contaminated area, followed by the coat and hands, while the throat was the least contaminated zone. To prevent pathogenic germs being spread by hand, alcohol-containing preparations were prevalently used (in 79% of the wards inspected). The hygienic hand disinfection was inadequate in 53% of the surgical wards. In four wards the hands were washed with soap exclusively. 35% of the surgical wards used common towels and disposable towels were used almost as frequently. In the remaining cases common and disposable towels were employed simultaneously. Storage of the used and unused disposable towels was in the main unsatisfactory. In view of the conditions met with in the various hospitals, proper hand disinfection must be insisted on, i.e. the hands must first be disinfected with a tested preparation and then washed, as may be required. If time plays a major role, alcohol-containing preparations should be used. Towels for common use must no longer be available in hospitals because they are important carriers of pathogenic germs.

[Hygienic and bacteriological comparative studies in 50 hospitals. III. The efficacy of sterilization (author's transl)]. / Hygienisch-bakteriologische Vergleichsuntersuchungen an 50 Krankenhäusern. III. Die Effektivität der Sterilisation

As part of an investigation carried out in 50 hospitals we particularly checked the sterilisers available for proper functioning and correct operation. The work group examined 461 sterilisation programmes in 338 sterilisation units (176 autoclaves, 153 hot-air apparatus and 9 ethylene oxide units) during the daily routine operation. The group carried out biological and physical inspections and carefully recorded the faults and deficiencies detected during the sterilisation procedure. It was found that only in 22% of the hospitals was a proper functioning and correct operation of all the sterilising units in use ensured. Technical faults and errors in operating the equipment and especially in the loading in 23% of the programmes prevented sterility. Almost 50% of the hot-air sterilisers and about a quarter of the autoclaves fail to produce a consistent satisfactory effect. The incidence of errors which occurred with ethylene oxide sterilisation cannot be generalised, since only a limited number of units were checked. A breakdown by functional areas and wards indicates that serious errors occur not only in the centralised large units but also in little-used small autoclaves in peripheral areas. A comparison with the literature shows that our results do not differ to any appreciable extent from those obtained by other workers, over the last twenty years. Here systematic inspections by external control authorities could improve the situation within a few years. Regular inspections to be carried out by the hospitals themselves using modern test methods are necessary, and need internal record-keeping. In spite of this, we cannot at present do without external inspections. We pin our hopes mainly in regular and thorough expert training of the staff and on much closer cooperation between hospital and hygienist.

[Hygienic and bacteriological comparative studies in 50 hospitals. I. Methods and aim of microbiological monitoring (author's transl)]. / Hygienisch-bakteriologische Vergleichsuntersuchungen an 50 Krankenhäusern. I. Methoden und Ziele der Kontrolluntersuchungen

Within a period of a year, environmental examinations were carried out in 50 hospitals selected at random in Rheinland-Pfalz with a view to determining the effective conditions, mainly in such risky areas as operating theatres, delivery rooms, intensive-care units and neonatal wards. In this first report the method is described. Such investigations are based on a detailed interrogation of the staff, and local inspection. As is evident from the extract from the questionnaire, the investigation was mainly concerned with details of the functional procedure and the implementation of measures of hospital hygiene. During the subsequent inspection of the rooms, we had the various procedures demonstrated to us. The testing of the sterilisation effect of all 461 programmes of the sterilisers was carried out with spore earth in accordance with DIN 58947. Staph. aureus and Bac. mesentericus spore preparations in accordance with DIN 58949 were used to check the thermal bed-disinfection apparatus. For the determination of the qualitative and quantitative contamination of persons, we employed 2321 sponge-type impression preparations and 8790 "Rodac plates" for the surfaces of floors and furniture. Throat swabs were taken from each of the 831 persons examined, and checked for the presence of pathogens. 2848 blood agar plates were exposed for one hour to ascertain the sedimenting air germs. Although this method is not suitable for determining the germ content per cubic metre of air, it nevertheless furnishes a good idea of the prevailing conditions without involving much work. As part of such environmental examinations, it is very important to determine the contamination of liquids from buckets, disinfecting solutions, bottles from oxygenators, air humidifiers etc. When the samples contained growth-inhibiting additives, we immediately mixed them with an inactivation medium. In the laboratory, blood and endo-agar plates were inoculated with the concentrate and dilutions. In addition we enriched the sediment in 2% sugar bouillon. All culture media were incubated for 48 hours at 37 degrees C. Subsequently we counted the colonies and differentiated in accordance with the usual biochemical or, if required, serological methods. Further reports will discuss the results of this investigation.

[Hygienic and bacteriological comparative studies in 50 hospitals. IV. The bacterial contamination of fluids of intensiv care units, wards for premature children and new-born wards (author's transl)]. / Hygienisch-bakteriologische Vergleichsuntersuchungen an 50 Krankenhäusern. IV. Die bakterielle Kontamination von Flüssigkeiten aus Intensiv- pflege-, Frühgeborenen- und Neugeborenenstationen

In intensive-care units and wards for prematures frequent use is made of medical apparatuses (such as oxygenators, nebulizers, respirators and incubators). These units are provided with a water reservoir which is utilized for the humidifications of the inspiratory air. They have become indispensable tools, especially in the treatment of seriously-ill patients. However, the water reservoirs of these devices have also frequently been found to harbour sometimes high concentrations of pathogens. With a view to clarifying the question as to the extent that liquids of different origin in the hospital area are contaminated with bacteria, 323 liquid samples were collected from intensive-care units, wards for premature and for newborn babies, and submitted for analysis. The senior nurse was questioned to obtain information about the measures of disinfection adopted in the respective wards. It was possible to cultivate pathogens from 22 per cent of the samples. P. aeruginosa accounted for 46 per cent, Enterobacter for 17.6% and E. coli for 12 per cent. A breakdown of the liquids by origin gives the following picture: 30 per cent of the liquids used for humidification of the inspiratory air (from respirators, inhalers etc.) were contaminated with pathogens. The analysis yielded a similar result in about 47 per cent of the cleaning water samples, in 10 per cent of the solutions in which clinical thermometers are kept and in 0 per cent of liquids from containers in which dressing forceps are kept. It emerged from inquiries that the lack of knowledge about the proper implementation of disinfection measures on the part of the nursing staff is still considerable. As a result, disinfectants of the quarternary ammonium compounds were used for the disinfection of medical apparatus in 37 per cent of all applications although their bactericidal action on gram-negative bacteria is limited. As regards the antimicrobial treatment of such parts as nebulizer chambers, connecting tubes, reservoirs of ultrasonic nebulizers, oxygen bottles and respiratory, parts with which the patient does not come into direct contact - the possibility of sterilizing them by autoclaving should be examined first. Not until this procedure has been ruled out on account of the thermolability of the materials used should another procedure such as keeping the materials in a disinfecting solution be adopted.

[Elder people in institutions - Problems concerning health and hygiene (author's transl)]. / Der alte Mensch im Heim - Gesundheitliche und hygienische Probleme

On the basis of our earlier studies on the hygienic, health and social situation of old people living in their own flats, we investigated the conditions in all 12 larger old people's homes of a big city in the Rhine-Main area, as well as 100 selected subjects of a defined socio-economic group within these homes. We checked the existence of pathogenic germs and the total number of germs on a total of 247 air culture plates in as many rooms and 669 impression preparations; additionally, we evaluated 35 examinations of members of the staff. We classified our findings according to the following typical areas: flats, recreation rooms, corridors, bathrooms, toilets, tea kitchens and main kitchens as well as washing and ironing rooms. - In all the homes we found with a single exception up to eight samples with Staphyl. aureus and, occasionally, E. coli, Proteus mirabilis and other pathogens. A typical localisation for these groups was not found. In contrast, a clear "graduation" was found to exist with respect to the average figures of the colony size, with the kitchens and laundries revealing the best figures, the living and social rooms - these usually less frequently used - intermediate, and bathrooms, toilets and corridors, and especially the tea kitchens, the most unfavourable figures. In view of the disinfection measures which are often of a merely symbolic nature, carried out in old people's homes, our figures emphasize the necessity for intensive education and counselling. As regards personal hygiene and cleanliness, formerly acquired habits and patterns of behaviour were influenced by the home only insofar as help and surveillance eliminate all gross forms of deficient care. The establishment of clinical findings and the detailed questioning on anamnestic and social problems confirmed the significance of the multimorbidity and the degree of seriousness of the diseases to which the occupants of old people's homes are exposed despite good medical and nursing care.