[Lavasept as an alternative to PVP-iodine as a preoperative antiseptic in ophthalmic surgery. Randomized, controlled, prospective double-blind trial]. / Lavasept als Alternative für PVP-Iod zur präoperativen Antiseptik in der Ophthalmochirurgie Eine randomisierte, kontrollierte, prospektive Doppelblindstudie.

BACKGROUND: To reduce the risk of endophthalmitis PVP-iodine is typically used preoperatively. Since iodine is contraindicated in patients with a specific allergic history or severe thyroid disorder we studied the effect of Lavasept, which contains Polyhexanid as an antiseptic alternative. PATIENTS AND METHODS: In a randomized controlled double-blind trial 3 drops of 0.2% Lavasept, 1.25% PVP-iodine or Ringer's solution were applied preoperatively to 67 patients, which have had a minimum of 5 colony forming units (cfu's) in the conjunctival swap. The effectiveness and tolerability were measured. RESULTS: After application of Lavasept or PVP-iodine, the number of cfu was statistically significantly reduced. Lavasept reduced the number of bacterial colonies significantly better than PVP-iodine (p=0.05). All test solutions were equally well tolerated. CONCLUSION: The use af Lavasept is safe, well tolerated and reduces the microbiological contamination of the conjunctival fornix effectively. lt provides a more effective reduction of the cfu's than PVP-iodine 1.25% and this effect tends to be prolonged. Lavasept is a good alternative option in ophthalmology for preoperative antisepsis.

[Polyhexamethylbiguanid (PHMB) as preoperative antiseptic for cataract surgery]. / Polyhexamethylbiguanid (PHMB) zur präoperativen Antisepsis bei Kataraktoperation.

BACKGROUND: We examined the efficacy and tolerability of Lavasept (polyhexamethylenbiguanid or PHMB)-an iodine-free antiseptic-in comparison to polyvinylpyrolidon iodine and Ringer's solution, as an alternative preoperative antiseptic. PATIENTS AND METHODS: In a randomized controlled double-blind trial 3 drops of Lavasept, 1.25%, PVP-iodine or Ringer's solution were applied preoperatively in 29 patients. The number of colony forming units (cfu) grown from conjunctival smears and conjunctival hyperaemia, corneal epitheliopathy and ocular surface pain were assessed preoperatively, intraoperatively and 1 day postoperatively. RESULTS: Despite intraoperative application of PVP-iodine, 40% of patients receiving Ringers solution still presented with more than 5 colony forming units (cfu) at the end of the procedure, while all patients that had additional preoperative Lavasept or PVP-iodine achieved relative sterility with less than 5 cfu (p < 0.05). While the effect of Lavasept lasted until the next day, conjunctival microbial colonisation recurred in eyes treated with PVP-iodine. As expected conjunctival hyperaemia and corneal epitheliopathy increased significantly postoperatively but no differences were observed between the 3 solutions tested. CONCLUSION: The preoperative application of Lavasept reduces the conjunctival flora safely and effectively. The microbicidal efficacy is equal to PVP-iodine, but potentially longer lasting. No signs of local or systemic intolerability were observed. Lavasept may be used as a potential alternative preoperative antiseptic and is suitable for iodine-intolerant patients.

[The influence of a new surface treatment of silicone intracoular lenses with fluoralkylsitan on the adherence of endophthalmitic bacteria in vitro]]. / Effekt einer neuen Oberflächenbehandlung von Intraokularlinsen aus Silikon durch ein Fluoralkylsilan auf das Adhärenzverhalten Endophthalmitis-relevanter Bakterien in vitro.

INTRODUCTION: Dynasilan is a fluoroalkylsilan which is able to bind to surface active molecules of intraocular lenses (IOLs), thereby offering a new option for surface modification of silicone lenses. The purpose of this in vitro study was to investigate the influence of this new surface treatment on the adherence of two typical endophthalmitis-inducing bacteria ( Staphylococcus epidermidis, Propionibacterium acnes). MATERIALS AND METHODS: A total of 14 Dynasilan-treated and 14 untreated silicone lenses were incubated at 37 degrees C for 24 h in brain heart infusion broth (10(8) CFU/ml) either with Staphylococcus epidermidis or with Propionibacterium acnes for 1 h. Subsequently, the adherent bacteria were resuspended using ultrasonification at 35 kHz for 3 x 45 s. After a dilution series and incubation at 37 degrees C for 24 h or 3 days the colonies were counted. RESULTS: On untreated IOLs incubated with Staphylococcus epidermidis the average number of bacteria was 3.6 x 10(7)/ml, and on treated IOLs the number of counted colonies was reduced to 1.09 x 10(7)/ml. Incubated with Propionibacterium acnes the average number of adherent bacteria on untreated IOLs was 4.75 x 10(4)/ml and on modified IOLs the number was reduced to 2.94 x 10(4)/ml. CONCLUSION: Dynasilan surface treatment may reduce the adherence of Staphylococcus epidermidis and Propionibacterium acnes on silicone intraocular lenses. Further studies regarding the stability of this treatment, its biocompatibility and influence on lens epithelial cell adhesion are in progress.

[Not Available]. / Zytotoxizität der Extrakte von Schimmelpilzen aus feuchtebelasteten Gebäuden.

Two toxicity tests (pollen tube growth test and methylen blue-assay) were examined regarding their sensitivity towards certain chosen mycotoxins. The IC50 values of the PTGT were in a concentration range between 0,01 µg/ml and 11,18 µg/ml, of the MB-assay in a concentration range between 0,003 µg/ml and 17,91 µg/ml. Both tests can be used to record toxigenic fungal wild strains in mould-infested apartments. Independently from the well-known immunochemical methods or HPLC/GC-MS analysis must be used for an exact determination of the kind and the content of the mycotoxins.

Content of mycotoxins in conidiospores from mould in buildings.

Extraction and disintegration processes that allow processing of conidiospores apart from the rest of the culture have been tested. The mechanical disintegration with a ball mill and glass granule addition (φ 2-3 mm) was the most efficient. From the conidiospores of six pure cultures of wild strains from mould infested indoor areas, out of which four were toxin positive strains, patulin, gliotoxin, aflatoxin B1 and G1, ochratoxin A and satratoxin H were quantified in a concentration range of 0,004 µg till 10,3 µg/10(7) respectively 10(8) conidiospores.

[Incidence of nosocomial infections as an element of cost-conscious quality management of inpatient care]. / Erhebung nosokomialer Infektionen als Element eines kostenbewussten Qualitätsmanagements im stationären Bereich.

The prevention of nosocomial infections is a result of many variables in a wide range of architectural, personal and organisational decisions taken into account in modern hospital plannings. The frequency of nosocomial infections in a given period can be used as one possible indicator of outcome quality of our hospitals. Contrary to the frequently uttered claims of many experts, who demand for a continuous hygienic monitoring in hospitals [1;2;3;4], routine procedures have not been unanimously established until now. Assessment and evaluation of nosocomial infections seem to be anything but trivial. Purpose of the described pilot study at the University of Lubeck was the development and test of a set of practicable routines to early discover and assess nosocomial infections. Methods of epidemiologic evaluation have been implemented to grant a perpetuos hygienic monitoring even on a limited base of personal, structural and financial resources. In a next step, further adaptations and improvements are planned, thus making assessment and evaluation independent of central institutions.

[Indoor air studies of mould fungus contamination of homes of selected patients with bronchial asthma (with special regard to evaluation problems)]. / Raumluftuntersuchungen schimmelpilzbelasteter Wohn- und Aufenthaltsräume bei ausgewählten Patienten mit Asthma bronchiale (unter besonderer Berücksichtigung der Bewertungsproblematik).

Investigations of indoor air of the homes of seven patients with asthma bronchiale who showed up with positive reactions following intracutaneous application of fungal allergens revealed that their places of residence were contaminated by fungal and bacterial spores. The number of colony forming units of mesophilic fungal spores of the indoor air ranged from 100 to 1000 CFU/m3 and this was much higher than the mould flora of the outdoor air determined simultaneously. The major fungi species found by the indoor investigation were: Penicillium sp. > Aspergillus sp. > Cladosporium sp., Mucor sp., Chrysonilia sp., Verticillium sp. > Geotrichum sp., Trichoderma sp. In two cases Thermoactinomyces species could be detected in the indoor air. The main cause of fungal contamination were moist building materials on room walls, insufficient air ventilation, bad maintenance of the circulating air-machines and insufficient room hygiene (e.g. biological garbage in the kitchen).

[Comparison of in vitro action of cetylpyridinium chloride containing preparations]. / Vergleichende In-vitro-Wirksamkeit von verschiedenen Cetylpyridiniumchlorid-haltigen Zubereitungen.

The fungicidal efficacy on Candida albicans of cetylpyridinium chloride (CAS 123-03-5) solution (CPC I solution, Dobendan) in various dilutions was tested with help of the quantitative suspension test and compared with CPC containing self-made preparations with or without addition of alcohol. The dilution of all test preparations caused an impairment of antimicrobial efficacy; the activity was reduced distinctly: due to a 50% dilution a decrease of 2-3 ten's powers was observed. The reduction of efficacy of the self-made preparation was less pronounced. The addition of 1% albumin as well impaired the fungicidal activity of all test preparations. CPC + alcohol revealed the most pronounced fungicidal efficacy; no differences were seen between CPC (without alcohol) and CPC I solution.

[Health problems in air-conditioned treatment rooms in a pediatric intensive care unit]. / Befindlichkeitsstörungen in klimatisierten Behandlungsräumen einer Kinderintensivstation.

Personnel of a pediatric intensive care unit claimed health problems due to air draughts. Mucous membrane symptoms such as burning eyes, an increased number of colds as well as headaches and stiff necks were the most frequent complaints. According to our indoor climate analysis high turbulence intensities were the main cause for thermal discomfort (Tumax = 88%, Tumin = 50%, median = 58% at measuring position Nr. 7). The percentage of people dissatisfied due to draught (PD value) were for example PDmax = 31%, PDmin = 6.7%, median = 16% at measuring position Nr. 7. In addition the humidification device of the HVAC system was not run continuously resulting in relative humidities below existing standards (51% r.h. in summer and 28% r.h. during the heating period).

[The behavior of Penicillium spores in air filters for automobile interiors. Testing of germination and propagation under static and dynamic test conditions using microscopic and microbiologic methods]. / Das Verhalten von Penicillium-Sporen in Luftfiltern für den Kraftfahrzeug-Innenraum. Prüfung auf Auskeimung und Vermehrung unter statischen und dynamischen Versuchsbedingungen mittels mikroskopischer und mikrobiologischer Methoden.

Microbiological tests show, that 3-layer car-air filters (Polycarbonate-microfiber type AF 901) are not a substrate for fungi frequently present in outdoor air. Microscopical investigations of the filter samples, which were exposed to Penicillium spores under static and dynamic conditions show no growth and no germination. The particles of dust which are trapped in the car-air filter, have no components with fungicidal effect, but include substances for inhibition of spore germination. In static model experiments (without air stream) already driven car-air filters were tested and fungal growth was obtained by very high concentrations of substrate and spores. On the other hand, however, in dynamic tests (with air stream) fungal growth cannot be detected, because the liquid humidity is absent.

[Characteristics of a new bioindicator and its testing in practice assays of thermal disinfection methods]. / Charakterisierung eines neuen Bioindikators und seine Erprobung bei der Praxisprüfung thermischer Desinfektionsverfahren.

Thermolysin (EC 3.4.24.4) is a thermostable metalloproteinase isolated from Bacillus thermoproteolyticus. It has been tested for its suitability as a macromolecular bioindicator for the screening of thermal disinfection methods. Using the time- und temperature-dependent inactivation rate of the immobilized enzyme we get a measure if given parameters of disinfection have been maintained. In order to determine standard conditions of practical use, physico-chemical properties of the enzyme (pH- and temperature-optimum, Km, Vmax) were ascertained first. Then, thermal inactivation of thermolysin was analyzed for temperatures between 75 degrees and 93 degrees C and exposition time 3-20 min. This new method of testing thermal disinfection is compared with conventional physical and microbiological testing methods; in addition values of reference for selected disinfection programs were analyzed. The bioindicator proved to be stable for up to 12 weeks of storage (room temperature).

[Ionogenic liberation of mercury from dental amalgam in waste water and sludge]. / Zur ionogenen Freisetzung von Quecksilber aus Dentalamalgam im Abwasser und Klärschlamm.

Reduction of mercury content in communal waste water and sludge is mandatory. The release rate of Hg from dental amalgam (gamma 2 Lux Alloy) in waste water was determined. The Hg-ionic rate was found to be as low as 0.004% of total mercury content in waste water. In addition, the concentration of Hg (4.39-8.20 mg/kg), Ag (73.35-84.03 mg/kg and Sn (22.51-61.30 mg/kg) in sludge was estimated under anaerobic conditions. Compared with legal limits for drinking water (1 microgram Hg/l) in the F.R.G. mercury loads of dental surgeries are far below threshold levels where toxicological effects are to be expected.

[Effect of parting surfaces on the transmission of airborne organisms at junctions between areas of different hygienic standards]. / Der Einfluss von Trennflächen auf die Luftkeimübertragung an Verkehrsverbindungen zwischen Bereichen unterschiedlichen hygienischen Standards.

Parting surfaces between areas having different standards of hygienic requirements, represent naturally the weak points in the hygienic conception of operating theatres. These boundary areas between the operation room on the one hand and the adjoining entrance lock for the staff on the other are of specific interest in this connection. While opening the connecting doors, dust particles may be whirled up due to turbulence, thermic, constructional and other effects, which are difficult to be identified and may then settle down directly on the operating area after reaching there from the entrance lock through the airways. Since bacteria are in most cases attached to particles, it may be assumed that each air flow loaded with dust particles is also a potential carrier of air-borne germs (contact germs----contaminated dust particles----air borne germs----settling germs). Therefore, the present paper is to be understood as a contribution towards the application of methods for identifying air-borne routes of infection in the operating area and finding ways and means for their elimination. In comparison with the investigations done by Esdorn and Kanz during simulated and operating activities respectively, the experiments described in this paper have been carried out while the operating theatre was not running. It is to be assumed that even under these tranquil conditions, parting surfaces appear to act as permanent disturbing factors. Transmission of germs from the entrance lock for the staff to the operating room is only then possible, if the doors suffer functional disturbance and the entrance lock is found hygienically in objectionable condition. Functional measures regarding construction aim, therefore, at the principle of clear-cut separation of the clean side from the unclean in the design and running of operating theatres, as specified in the guidelines of the Bundesgesundheitsamt. The constructional conception of entrance lock can contribute to achieving almost automatically the necessary hygienic provisions. One of the principle purposes of air-handling systems in operating theatres is to keep a protecting pressure in areas with very high hygienic requirements in relation to those with lower standards of air cleanliness. Air-flow must always follow the direction from the clean to the less clean areas (2, 4, 9, 22, 24, 26, 30). A British-Scandinavian multi-centre study of ultra-clean air and sepsis following total hip replacement (19) showed that the risk of nosocomial infection increases directly with the air contamination.(ABSTRACT TRUNCATED AT 400 WORDS)

[Staphylococcus aureus in the hemodialysis unit]. / Staphylococcus aureus in der Dialysestation.

In haemodialysis patients Staphylococcus aureus is the most frequent pathogen in infections of vascular access. At the same time, a very high share of these patients (up to 55%) are Staphylococcus aureus carriers. Hygienic measures during puncture of the shunt are highly important for prevention of shunt infection which is most likely endogenous.

[Prevention of infection in sonography]. / Infektionsprophylaxe bei der Sonographie.

The instruments and surroundings of five ultrasound diagnostic departments were tested for bacteria, antimicrobic characteristics, and prevalence of Hbs Ag in commercial contact medium (cellulose) and were also analysed after contamination in vitro. Facultative pathogenic bacteria as well as normal skin bacteria were found on the ultrasound equipment. It was established that cellulose and oils taken from wide- mouthed containers and applied manually or with a brush, were often contaminated. However, no contamination was evident in contact medium that was still in its original packing or stored in small containers and subsequently refilled daily. No antimicrobic activity on the part of preservative agents in the cellulose could be demonstrated after artificially contaminating some contact medium with Staph. aureus and E. coli. Elimination of artificially added Hbs Ag in the contaminated contact medium could not be proven. It is postulated that transfer of bacteria or Hepatitis B infection during an ultrasound diagnosis is possible. It is therefore recommended that appropriate prophylactic hygienic measures be taken, especially with patients susceptible to infection.

[UV irradiation of the peritoneal dialysis solution for the prevention of peritonitis]. / UV-Bestrahlung der Peritonealdialyselösung zur Peritonitisprophylaxe.

Micro-organisms causing peritonitis during peritoneal dialysis or CAPD can reach the peritoneal cavity either along the Tenckhoff-catheter or via contaminated dialysis fluid. Laboratory experiments with UV irradiation of artificially contaminated CAPD fluid were made to demonstrate whether decontamination could be achieved during the flow through a UV-penetrable (lambda 2537 A) section of the CAPD catheter. Five CAPD bags were contaminated with a fluid culture of the following micro-organisms which frequently cause peritonitis (S. epidermidis, S. aureus, P. aeruginosa, E. coli, and Candida albicans). After UV irradiation positive cultures could not be demonstrated. UV irradiation of the peritoneal dialysis fluid before entering the peritoneal cavity is proposed as an additional preventive measure.