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Hygiene in the non-clinical environment Dirk Bockmühl.

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Presentation on theme: "Hygiene in the non-clinical environment Dirk Bockmühl."— Presentation transcript:

1 Hygiene in the non-clinical environment Dirk Bockmühl

2 Hygiene at home? Gerd had rather spent more money in toilet cleaning agents…

3 Home hygiene: the consumer’s view Hygiene threats are mostly found outside my home According to a GfK survey for the „Apotheken-Umschau“ 2006

4 Notifiable infections in Germany (2008) Source: RKI

5 Household-associated infections Krause et al.: Emerg Inf Dis 13(10) (2007)

6 The key message The domestic environment is one of the most important sources for infectious diseases These infections are predominately food-borne

7 The risk of infection at home 7 Risk Source: IFH

8 Risk Source: IFH The risk of infection at home

9 Decontamination of food contact surfaces

10 The dishwasher: a risk?

11

12 Dishwashers host black yeasts

13 Zalar et al. (2011) Dishwashers host black yeasts

14 ? But is there a risk of infection?

15 Estimation of infection risk 1.Pathogenic microbes? 2.Routes of infection? 3.Exposition? 4.Risk factors?

16 Groups of higher risk: YOPIs YoungOld PregnantImmunocompromised

17 Antibacterial effect of hand dishwashing Mattick et al.: Int J Food Microbiol 85 (2003) 213– 226 Soaking time [min] Temperature [°C] Water Water + Detergent Time needed to reduce 99,9% of Salmonella

18 The „killer“ sponge Enriquez et al. Dairy Food Environ. Sanitation. 17: – 10 7 microbial cells per gramm SEM-photograph: A. Hinnemann, Rhine-Waal University of Applied Sciences

19 How to sanitize a kitchen sponge Sharma et al. Food Control 20 (2009) 310–313

20 The dishwasher kills…

21 …bacteria! Thus it is an important means to ensure decontamination of food- contact surfaces

22 The risk of infection at home Risk Source: IFH

23 The washing machine as source of germs

24 Will we all die now?

25 Infections and laundering Fungal infections (Athlete‘s foot, Candida) Viral infections (Noroviruses)

26 Inactivation of Norovirus via laundering Lemm et al. Tenside, Surfactants, Detergents (submitted) Detection of viral RNA on fecally contaminated textiles

27 Challenge: low temperatures T [°C] % Medium washing temperature Textiles washed at ≥60°C Survey on german households Source: IKW Sustainability Report 2010

28 Wearing Drying Washing Storage Hygiene in the wash- and use-cycle

29 Input of microorganisms Reduction of microorganisms Wearing Drying Washing Storage Hygiene in the wash- and use-cycle

30 Input of microorganisms Reduction of microorganisms Wearing Drying Washing Storage skin flora excretions biofilms cross contami- nation fungal spores dust dehydration temperature chemistry mechanics temp. dehydration Hygiene in the wash- and use-cycle

31 Challenges

32 Wich microbes? Quantity?

33 Challenges Machine impact?

34 Challenges Impact of drying and ironing?

35 cfu/cm 2 After drying After laundering After use What happens when you wash your towels? Blümke et al., EDC conference 2011

36 cfu/cm 2 After drying After laundering After use What happens when you wash your towels? Blümke et al., EDC conference 2011

37 cfu/cm 2 After drying After laundering After use What happens when you wash your towels? Blümke et al., EDC conference 2011

38 The washing machine as a reservoir for germs Microbial colonisation of the rinsing chamber is independent of the chosen temperature Contamination after the main wash cycle

39 Another real-life study… Analysis of Laundry in Nursery Homes

40 cfu / 100 cm 2 Before laundering After laundering After drying Survey on 16 nursery homes in the district of Kleve Bertelmann et al., DGHM conference 2012

41 Individual reduction factors Nursery home # Log reduction (before/after laundering) Bertelmann et al., DGHM conference 2012

42 Impact factors on laundry hygiene Bertelmann et al., DGHM conference 2012

43 Impact factors on laundry hygiene Bertelmann et al., DGHM conference 2012

44 Impact factors on laundry hygiene Bertelmann et al., DGHM conference 2012

45 Impact factors on laundry hygiene Bertelmann et al., DGHM conference 2012

46 Impact factors on laundry hygiene Bertelmann et al., DGHM conference 2012

47 Analysis of Laundry in Nursery Homes cfu / 100 cm 2 Before laundering After laundering After drying Very low counts after tumble drying Bertelmann et al., DGHM conference 2012

48 Do hygiene rinsers help? Source: Forum Waschen

49 Do hygiene rinsers help? Claim: Kill 99,9(99)% of germs Substantiated via suspension tests Claim: Kill 99,9(99)% of germs Substantiated via suspension tests Source: Forum Waschen

50 Efficacy in the washing machine? Additional detergency effect Textile effect Different germs etc.

51 Powder detergent with hygiene rinser Lucassen et al., Tenside, Surfactants, Detergents (2013)

52 Akimitsu et al.: Antimicrob Agents Chemother 1999;43: Cross resistance between antibiotics and biocides

53 Cross-resistance Lambert: Journal of Applied Microbiology 2004, 97, 699–711

54 Lambert et al.: Journal of Applied Microbiology 2001, 91, 972±984 Resistance profile vs. origin TSI: Total Susceptibility Index Anzahl Klinische Isolate # Isolates Clinical Isolates

55  Clinical isolates are more resistance in general  Antibiotic resistance is predominately found in clinical isolates  Clinical environment fosters resistance Lambert et al.: Journal of Applied Microbiology 2001, 91: Does biocide use enhance antibiotic resistance?

56 Biocides at home?

57 Hygiene rinsers: only for special cases

58 Biocides at home? Hygiene rinsers: only for special cases Detergents with activated oxygen bleach ensure sufficient hygiene

59 Are we too clean? The hygiene hypothesis Strachan (1989): 20th century rise in allergic diseases is related to lower incidence of infection in early childhood

60 Hygiene hypothesis: the consumer‘s view „We need some bacteria to train our immune system“ „Too clean is harmful“

61 Hygiene hypothesis: the consumer‘s view

62 Hygiene hypothesis: the scientific view Taken from: Smith et al.: The Hygiene Hypothesis and its implications for home hygiene, lifestyle and public health, IFH review 2012; based on: Rook G Clin Exper Immunol 2010; 160:70-79.

63 Old friends hypothesis (Graham Rook) Microorganisms that were once abundant (but aren‘t any more) trained our immune system to be more tolerant: -Lactobacilli -Saprophytic Mycobacteria -Parasitic worms

64 Are we too clean? Cleaning does most probably not increase the risk for allergy and asthma

65 Are we too clean? Cleaning does most probably not increase the risk for allergy and asthma The targeted use of cleaning and antimicrobial products may help to reduce the risk for household-associated infections

66 Targeted Hygiene Risk Source: IFH

67 Thanks Britta Brands, Angelina Eckert, Marlitt Honisch, Davina Lemm, Ralf Lucassen, Nadine Merettig, Ramona Steiner

68 Thank you


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