You are here: MEDICA Portal. MEDICA Magazine. Topic of the Month. Volume archives. Our Topics in 2011. September 2011: Hospital Hygiene. Medical Errors.
Medical Science and Technology against hospital-acquired Infections
© panthermedia.net / Monkeybusi-
But why is it that despite the knowledge on the causes of infection, to some extent severe infections continue to occur in patients and staff? Is it a lack of hygiene awareness and incorrectly and improperly sterilized equipment? Doctor Klaus-Dieter Zastrow, spokesman of the German Society for Hospital Hygiene, at least does not want to accept the latter: “The fewest infections are spread by poorly prepared or sterilized medical devices, since the medical instrument cleaning and disinfection process – at least as far as Germany is concerned – is very well standardized.“
Even though all patients with open wounds – this meaning especially patients that require surgery – are exposed to higher risks of infection since they present a better “contact surface” for microorganisms, especially in the operating room and for surgical instruments, special attention is given to sterilization. And in any case, only those instruments can be reprocessed that have been appropriately labeled by the manufacturers. “There is a clear guideline on the type of conditions under which instruments may be reprocessed again. That is to say, if a company reprocesses properly according to the manufacturer’s instructions, there are no problems. For example, in there it is stipulated that the product has to be devoid of blood, organic matter, there can be no particles or pyrogens etc. These are requirements we also request from every new product. This means that those who adhere to the guidelines produce a medical instrument that is absolutely equivalent to a new one“.
Human beings are the biggest source of error
So if technology takes care of sterilized instruments – always assuming it is being used correctly, then where are the hygienic weak points at a hospital? The hygiene expert comments: “Infections such as for instance MRSA are spread by medical staff. There are mistakes being made during medical care and hygiene awareness is often lacking“. He says that oftentimes hand sanitation is not or poorly done, sterile gloves are not being changed even though non-sterile areas have been touched or while placing a catheter the patient’s lower arm was accidentally brushed – and all this can lead to infection. For all his constructive criticism however, Dr. Zastrow also understands the situation for the medical staff: “The difficulties of course are majorly complex, for instance due to staffing issues. On the one hand staff is being cut, but on the other hand they are being told: You have to deliver the same performance. That’s not doable. Even though adhering to hygiene regulations essentially doesn’t take up much time, if you are pressed for time though, you won’t do as good of a job. One example for this is the reuse of needles, if the first stab wasn’t successful. Technically, the physician would have to immediately unpack a new needle, since now there is a skin punch in the used needle. But what do you do if there is no clean needle readily available? Then he uses the one he has a second time, since he isn’t going to quickly get a new needle if he is supposed to accomplish double or triple the amount of work at the same time.
In the hectic everyday life, it can happen quickly: you have already put on the gloves to change a wound dressing and the patient suddenly wants to exchange a quick handshake. Even if it seems rude, please don’t do it - unless you are willing to put on new, sterile gloves afterwards to avoid possible infections; © panthermedia.net / Lasse Kristensen
So if there are not going to be any changes in staff numbers at the hospitals, ways and means have to be found to make the working processes for employees as simple and safe as possible. This also includes easy handling of existing sterilization devices. These processes cannot “eat away“ additional time. That’s why new research projects like the “SteriHealth“ project, a collaboration of six Fraunhofer institutes, are counting on a mix of new sterilization technology and simplified service process.
A sterile product in just a few steps
One of the scientists involved in this project is Doctor Axel Wibbertmann from the Fraunhofer Institute for Toxicology and Experimental Medicine. He and his team are doing research on a device that sterilizes an instrument or a device in a one step system, to where it can be removed from the device completely packaged and is immediately storable. So this is about the development of a device as well as corresponding packaging and constant safety control. But couldn’t that also be achieved with already existing methods? Wibbertmann doesn’t think so: “There are many systems out on the market, but the problem is that the previous methods, for instance for new products such as cell therapeutics, for all intents and purposes kill the systems. That is to say, if you treat cell therapeutics with heat or hard gamma-rays, the cell lines will die off. That’s why we plan a low-energy ray-based system. This means, electrons are being accelerated and also have a great effect, but the radiation as such is not strong and a lot that so far was not able to be treated with radiation can then be treated with it.“ But where does the new packaging come into play? “The main principle will be that if at the hospital you would like to sterilize surgical instruments for instance, you place them in our newly developed packaging. Closed up, it then is placed into the sterilization apparatus where the surgical instruments are being irradiated through the packaging for about five to ten seconds. After the irradiation you can then remove the readily packaged and now sterile product. The advantage is that you no longer have to touch and repackage the surgical instruments after sterilization, but can already directly store them instead.“
In doing so, one step of the previous sterilization process would thus be eliminated – the removal and packaging of sterilized equipment. A transfer of microorganisms to the product by “human hand” would thus be prevented. What’s more, the packaging is meant to also receive a diamond, which together with a reading device can provide information on whether a product is still sterile in the packaging or not. Needless to say, for all the technology and application one weighty argument will tip the scales on whether in the end the device and packaging will be adopted: cost and complexity. Since sterilization is meant to be possible to do on-site, meaning at the hospitals, medical practices or nursing homes, staff needs to be appropriately educated. This way though, each day multiple sterilization processes can be performed which is beneficial for the users. But for now the project is still at its beginning stage. Wibbertmann: “In May 2011 the SteriHealth project was launched, its running time is three years. The first experiments with regard to irradiation are already running and right now we are choosing the packaging. The germ selection for the test is also in progress. Which germs for instance are relevant in a clinic? Those we need to test. We anticipate having first results by the end of this year. Initially the plan is to develop a demo unit for objects sized up to 20 centimeters. Of course you can later adapt it to the wishes of the end-consumer. So if and how this new system is going to develop and what advantages it will actually have compared to traditional methods can only be seen in a few months. The fact of the matter is that the market for medical devices is highly competitive and time and time again interesting ideas and new developments can be seen. Which of them remain is also decided by the end-consumer. Yet it would be very desirable if with all of the technical development, human beings who use this technology are not lost sight of – the health personnel in hospitals and medical practices. The best technology isn’t worth much if the staff is so overworked, to where dangerous mistakes continue to slip in.
(Translated by Elena O'Meara)