Personal protective equipment, including masks, prevents COVID-19 infections and other viral respiratory diseases. Experts are currently warning of a high increase in influenza infections as well as respiratory syncytial viruses (RSV). FFP2 protective masks are also part of the RKI’s prevention concept for these infections.

The most important facts:

• Experts are currently warning of an increase in influenza, parainfluenza-3 and respiratory syncytial viruses (RSV).
• They see the reasons behind this being a reduced basic immunity level and the decline in compliance with hygiene measures.
• The parallel occurrence of SARS-CoV-2, RSV, and influenza can lead to huge pressures on health institutions.
• Transmissions and the risk of secondary bacterial pneumonia can be prevented through hygiene and PPE with FFP2 protective masks.

Experts from the Robert Koch Institute and the Clinical Virology Network (CVN) are warning of a significant increase in viral respiratory diseases. According to the CVN, which deals with the systematic recording of respiratory infections, the number of infections in Germany has almost doubled compared to pre-pandemic levels. Especially in the 0 to 4 year-old age group, infections are at a very high level. Two thirds of the cases compiled are RSV related. The virus occurs mainly in young children.

Reduced basic immunity

One of the reasons for the increase in infections is the lack of basic immunity in children over the last two seasons. The hygiene measures used to prevent COVID-19 have also prevented other viruses from spreading significantly. With the relaxation of the measures, the number of cases is increasing. At the same time, the viruses are coming into contact with children who have not yet formed a defense. The CVN experts attribute another reason for the worrying increase in viral respiratory diseases to lower compliance with hygiene measures.

Prevention thanks to basic hygiene and PPE

To prevent viral respiratory infections, basic hygiene and the proper wearing of respiratory protection are important measures. Compliance with prevention measures is urgently needed to mitigate the consequences of a parallel emergence of SARS-CoV-2, RSV and influenza viruses.

The Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention; KRINKO) at the Robert Koch Institute has provided the following recommendations for caring for and treating patients with respiratory diseases caused by the viruses that are prevalent throughout autumn/winter:

• Influenza A and B virus
  7 days after the onset of symptoms:
  Isolation room
  Disposable gloves
  Protective gown
  Face mask

Required disinfectant spectrum: Limited virucidal agent

• Respiratory syncytial virus
  During the duration of the symptoms:
  Isolation room
  Disposable gloves
  Protective gown
  Face mask

Required disinfectant spectrum: Limited virucidal agent

• Parainfluenza virus
  During the duration of the symptoms:
  Isolation room
  Disposable gloves
  Protective gown
  Face mask

Required disinfectant spectrum: Limited virucidal agent

• Human metapneumovirus
  During the duration of the symptoms:
  Isolation room
  Disposable gloves
  Protective gown
  Face mask

Required disinfectant spectrum: Limited virucidal agent

• Rhinovirus
  Disposable gloves

Required disinfectant spectrum: Virucidal agent

TIP

• A face mask must be tight fitting to provide adequate protection. The nosepiece should be pressed firmly against the nose; if necessary, the mask can be readjusted using the straps.
  
  
• When wearing personal protective equipment (PPE), there is a risk of contamination. Pathogens can then be passed on from the PPE to the employees’ hands. The majority of contamination risks occur while removing PPE. This is why the correct sequence must be observed when removing the PPE.

Download: How to properly remove personal protective equipment (PPE)

Sources:
Liang En Ian Wee et al. (2021). Unintended consequences of infection prevention and control measures during COVID-19 pandemic. American Journal of Infection Control.
Clinical Virology Network (CVN) (2021). Aktivität respiratorischer Viren. https://clinical-virology.net/de/charts/chart/ctype/count/network/resp/section/viruses. Letzter Zugriff am 28.10.21
Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (2015). Infektionsprävention im Rahmen der Pflege und Behandlung von Patienten mit übertragbaren Krankheiten.
Tomas et al. (2015). Contamination of Health Care Personnel During Removal of Personal Protective Equipment. JAMA Intern Med.

As a result of the COVID-19 pandemic, the WHO has called for surface hygiene to be carried out more frequently. Experts are again warning of a new risk of pandemic proportions: the global spread of multidrug-resistant pathogens. Intensifying surface disinfection would also be necessary here in light of poor compliance.

The most important facts:

• With the COVID-19 pandemic, surfaces potentially being a source of transmission also became a focus of preventative measures.
• Contaminated surfaces play a particularly important role in the transmission of multi-resistant bacteria.
• Only one third of the necessary surfaces in inpatient and outpatient health institutions are disinfected properly.
• After surface disinfection has been carried out, re-contamination with pathogens can reach the initial level again after just 1.5 to 2.5 hours.

In May 2020, the WHO called for surface hygiene to be carried out more frequently in health institutions to combat the COVID-19 pandemic. The role of inanimate surfaces in the transmission of SARS-CoV-2 has not yet been conclusively investigated. The WHO recommendations for intensifying surface hygiene are based on studies addressing other coronaviruses such as SARS-CoV and MERS-CoV. Contact surfaces have been identified as important sources of transmission for both coronavirus species.

Resistant germs on surfaces

With its recommendation, the WHO draws attention to surface hygiene as an important measure to prevent pathogen transmission. Inanimate surfaces have long been known as a source of transmission of pathogenic germs. In outbreak situations, contamination of the patient’s immediate surroundings is often detected. The main focus is on (resistant) pathogens such as C. difficile, MRSA, VRE, A. baumannii and noroviruses. Contaminated surfaces are significantly involved in the spread of gram-negative bacteria. For example, the risk of becoming infected with carbapenem-resistant A. baumannii increases 2.77-fold if the surrounding surfaces are contaminated.

Compliance with surface disinfection is lacking

Disinfecting the surfaces close to the patient can significantly reduce the risk of transmission of pathogens. Ideally, ready-to-use disinfectants or appropriately pre-soaked disposable wipes are suitable for this purpose. However, despite useful application solutions, compliance with surface hygiene is lacking according to studies: An investigation into the disinfection rate on surfaces with frequent hand and skin contact showed a rate of only 35 percent. At the same time, further studies show that the contamination of surfaces in intensive care units, e.g. with MRSA, quickly returns to the initial level after disinfection.

Conclusion:

Surface disinfection demands increased attention, and not just within the context of the COVID-19 pandemic. Surfaces in patient rooms with frequent hand and skin contact are, as of now, not disinfected to a sufficient level. To protect patients from dangerous germs such as gram-negative bacteria, surface disinfection in patient rooms must be intensified.

TIP: When it comes to surface disinfection, frequently touched surfaces in hospitals are often overlooked. Graphical representations of the individual rooms and the correct sequence for disinfection help to increase compliance.

 

Sources:
World Health Organization (2020). Cleaning and disinfection of environmental surfaces in the context of COVID-19. Interim guidance
Interim guidance 15 May 2020Klöcker U. (2015) Reinigung und Desinfektion im Krankenhaus. HYSIST, Düsseldorf
Kampf G. (2013). Flächendesinfektion. Krankenhaushygiene up2date
Hubert HA et al. (2012). Intrinsic bacterial burden associated with intensive care unit hospital beds: Effects of disinfection on population recovery and mitigation of potential infection risk. American Journal of Infection Control

COVID-19 has increased the willingness of employees to practice hand hygiene in health institutions. Much remains to be done to ensure that this trend continues and also results in falling infection rates, even after we’ve moved past COVID-19.

The most important facts:

• The increase in hand hygiene compliance at the start of the pandemic was a temporary phenomenon. The high compliance rates dropped again over time.
• The highest rates are recorded AFTER contact with a patient and are mainly driven by the desire to protect oneself rather than to protect patients.
• Gloves and long-sleeved clothing are important barriers to achieving good hand hygiene.
• Intervention programs to intensify hand hygiene are more efficient and sustainable than the threat of COVID-19.

100% hand hygiene compliance. What experts around the world hardly think possible has become reality at the National University Hospital in Singapore: Influenced by COVID-19, the staff’s willingness to disinfect their hands, which was already very good at 85%, rose to 100%. The largest hospital in the country, with 1,800 beds, evaluated the data both by measuring how much disinfectant was used and also by directly observing all “5 Moments for Hand Hygiene.” Several studies report increased hand disinfection rates among hospital staff in the early stage of the pandemic.

From a standard procedure to a daily habit?

Could hand hygiene, a standard procedure, have become a daily habit that people do without thinking thanks to the COVID-19 pandemic? According to the studies, the picture is rather mixed. In some studies, hand hygiene increased significantly at the start of the pandemic, but then decreased again and often even settled at a rather low level. It’s also worth comparing the moments when hand disinfection is carried out. From September 2019 to November 2020, Huang et. al investigated hand hygiene compliance in an infectious disease ward with 25 single rooms using an electronic monitoring system with a sensor. Time points for observing compliance were when entering the room, when providing care at the patient’s bedside and when leaving the room.

Patient protection was not the main focus

The authors found that the rate of hand hygiene upon entering the room, interpreted as the “before patient contact” moment, decreased over time. Compliance when leaving the room, interpreted as the “after patient contact” moment, increased by 13.73% during the first wave of COVID-19, decreased by 9.87% during the post-lockdown period, and then increased again by 2.82% during the second wave of the pandemic. The authors believe that the most important factor in the increase in hand hygiene was the employees’ desire to protect themselves from infections. Marie Stangerup’s team found out that the compliance rate is falling again despite the fact that the pandemic has not been declared over: A research team from Denmark conducted an observational study on a surgical ward between January 2019 and December 2020. One phase of the study consisted of an intervention program with employee meetings and presentations and discussions of anonymous hand hygiene compliance data. The analyses showed that hand hygiene compliance was at 58% during the intervention program that was run prior to the pandemic but dropped to 34% during the pandemic.

Conclusion:

Interventions and feedback remain indispensable tools to ensure that improvements in hand hygiene do not drop again. Employees quickly fall back into old routines as soon as intervention programs are stopped. On top of this, to ensure a high level of hand hygiene compliance, the management teams must remain committed to the issue of hand hygiene.

TIP: To achieve good hand hygiene, the basic conditions must also be right: Studies show that there is still room for improvement when it comes to placing dispensers at the point of care.

Checklists: Proper placement of dispensers at the point of care

1.) Dispenser placement in the OR

2.) Dispenser placement in the ER

3.) Dispenser placement in ICU

4.) Dispenser placement in General Wards

Sources:
Huang F et al. (2021) Journal of Hospital Infection 111: 27.-34
Moore LD et al. (2021) American Journal of Infection Control 49: 30−33
Stangerup M et al. (2021American Journal of Infection Control 49: 1118-1122
Thomas BW et al. (2009). JAOA; 109 (5): 263-267
Azim S et al. (2016). American Journal of Infection Control; 44 (7):772-776

Measures implemented to protect against the coronavirus in hospitals also reduce other nosocomial agents. One study shows that MRSA rates can even be halved.

Surveillance data from the largest hospital in Singapore, with 1,800 beds, show that infection protection measures implemented to prevent COVID-19 can also prevent other nosocomial infections.

The most important findings at a glance:

• High compliance rates in hand hygiene, upping surface hygiene and handling personal protective equipment correctly significantly reduce MRSA and catheter-associated bloodstream infections in particular.
   
• This study shows that compulsory social distancing and mask-wearing reduces nosocomial viral respiratory infections, which are responsible for severe courses of illness and intensive care.
   
• Other multidrug-resistant agents such as carbapenemase-forming/carbapenem-resistant Enterobacteriaceae and Clostridioides difficile can be kept stable despite high levels caused by the pandemic.

Success formula: Surveillance and reinforced infection control

We are not yet certain if upping our infection protection measures in the context of the coronavirus pandemic also reduces other hospital infections. This is due to a particular lack of comparative data before and during the pandemic. Now we have new evidence to suggest the coronavirus measures have a positive influence in reducing other hospital germs, provided by data from the largest hospital in Singapore. The 1,800-bed clinic established stringent infection protection measures from February to August 2020. The hospital maintained surveillance of important hospital agents and infections during this period.

The following nosocomial agents were monitored, among others:

• Respiratory viral infections caused by agents such as human metapneumovirus (HMPV), respiratory syncytial virus (RSV), rhinovirus A/B/C, influenza virus A/B, human parainfluenza virus (HPIV), human coronavirus (hCoV)
   
• Methicillin-resistant Staphylococcus aureus (MRSA)
   
• Carbapenemase-forming, carbapenem-resistant Enterobacteriaceae (CP/CRE)
   
• Clostridioides difficile
   
• Device-associated infections (urinary tract infections, bloodstream infections, ventilator-associated pneumonia)

 

Multi-stage infection control program

With the occurrence of the first SARS-CoV-2 case in January 2020, the Singapore hospital established a multi-level prevention strategy:

• Isolation of patients with symptoms of respiratory disease and a minimum social distance of 1.5 m between beds
   
• Universal compulsory mask-wearing for personnel, initially ordinary face masks, later FFP2 masks
   
• Upping the surface disinfection in the environment surrounding the patient to 3 x daily
   
• Surveillance of surface disinfection with fluorescent markers
   
• Intensifying hand hygiene
   
• Personal protective equipment (gowns, gloves) for health workers; and cleaning staff including training on how to properly wear it

 

Positive effects for patient safety

• Viral respiratory diseases

The greatest positive effect was seen in the decrease in nosocomial viral respiratory infections. The incidence decreased from 9.69 cases per 10,000 patient stay-overs before the infection control program was introduced to 0.83 cases per 10,000 patient stay-overs. Viral respiratory diseases are often an underestimated cause of severe hospital-acquired pneumonia that eventually requires intensive care.

• MRSA

The MRSA rate also developed in a positive way. Before the pandemic, it was 11.7 cases per 10,000 patient stay-overs, compared to 6.4 cases per 10,000 patient stay-overs during the pandemic. Nosocomial bacteraemia caused by MRSA decreased from 0.36 cases per 10,000 patient stay-overs to 0.11 cases per 10,000 patient stay-overs.

• Catheter-associated bloodstream infections

For catheter-associated bloodstream infections, the authors of the study recorded a decrease from 0.83 cases per 1,000 days a catheter was used (95 incidents, 113,466 days a catheter was used) to 0.20 incidents per 1,000 days a catheter was used.

• CP-CRE and other nosocomial agents

Despite the interruptions to the daily running of the clinic caused by the pandemic, CP-CRE and C. difficile rates remained stable. The authors assume that upping alcohol-based hand disinfection was not successful to the same extent with C. difficile as it was with MRSA, since hands must be washed as well as sanitized. For CP-CRE, it’s mainly hospital sinks and drains that serve as reservoirs. Surface hygiene during the COVID-19 pandemic focused in particular on frequent disinfection of the environment surrounding the patient as well as frequently touched surfaces. A less frequent usage of sanitary areas could have led to CP-CRE persisting in sinks and drains.

Despite these limitations, the positive effects of the coronavirus prevention measures should not be underestimated and should not be taken for granted: for example, during the first SARS outbreak in 2003, there was an increase of MRSA in a Hong Kong hospital intensive care unit that cared for SARS patients. Resistant agents increased from 3.53% in the pre-SARS period to 25.30% during the SARS period and then decreased again to 2.21% in the post-SARS period. The rate of ventilator-associated pneumonia was also high at 36.5 episodes per 1,000 days on a ventilator.

 

Sources:

1. Liang En Ian Wee et al. Unintended consequences of infection prevention and control measures during COVID-19 pandemic. American Journal of Infection Control 2021; 49:469−477. 
https://www.ajicjournal.org/article/S0196-6553(20)30963-9/pdf
 (Letzter Zugriff 13.06.2021).

2. Yap FHY et al. Increase in Methicillin-Resistant Staphylococcus aureus Acquisition Rate and Change in Pathogen Pattern Associated with an Outbreak of Severe Acute Respiratory Syndrome. Clinical Infectious Diseases 2004; 39:511–6.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204093/ 
(Letzter Zugriff 13.06.2021).

Regularly opening windows or an efficient ventilation system can significantly reduce airborne coronaviruses in hospitals and other facilities, according to the experts.

So-called aerosols are one of the main transmission routes of COVID-19. The solid or liquid particles in the air that we exhale provide the viruses with a convenient “means of transport”. These particles remain in the air for a long time and can spread throughout the entire room in a matter of minutes. At the same time, just the heat emitted by the human body is sufficient to keep the virus-containing particles suspended in the air.

Ventilation concepts to reduce the viral load

The “Aerosols Expert Group” carried out an investigation into which ventilation methods can reduce the concentration of coronaviruses in, for example, patient rooms and waiting areas. This group of scientists includes the Deputy Chair of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute (RKI), Prof. Dr. med. Heike von Baum.

In practice, it is not possible to actually measure the viral load in the air in a room. However, one way to track the virus-carrying aerosols is by measuring the air quality by means of the CO₂ concentration. Although the amount of carbon dioxide emitted does not provide a specific measure of the number of virus particles, a low CO₂ content is nevertheless indicative of a smaller aerosol load.

The expert panel of engineers, scientists and physicians recommends indoor air quality with a CO₂ concentration of less than 800 parts per million (> 800 ppm). According to the scientists, this technical guide value is currently the best means of assessing the amount of aerosols in a room.

The CO₂ level, and therefore the viral load, in the air can be reduced by:

• Opening windows
• Ventilation and air conditioning (VAC) systems
• Air purifiers (in addition)

This is how the experts of the Aerosols Working Group evaluate the various ventilation concepts:

5 facts about ventilation by opening windows 

1. Tilted windows only have a limited ventilation effect.
    
2. The required air flow can only be achieved by pulse ventilation (windows wide open for short periods) or cross-ventilation with windows/doors on opposite sides of the room.
    
3. Low outside temperatures reduce the ventilation time required. Example: a 20 m² room with an open window takes 3 minutes to ventilate at outside temperatures between 0°C and -10°C. At 15°C, it would take twice as long.
    
4. This type of natural ventilation is not appropriate everywhere, as it can cause a major temperature drop in the room, which affects the well-being of the occupants. Windows fitted with security restrictors are another factor.
    
5. If there are several people infected with SARS-CoV-2 in the room, ventilation has only a limited effect.

 

5 facts about ventilation and air conditioning systems (VAC)

1. VAC systems use fans to draw in outside air, then filter it and adjust its temperature before blowing the conditioned incoming air through openings into the room.
    
2. If the openings are placed appropriately, a large-volume, room-wide air flow is created, regardless of the outdoor temperature.
    
3. Aerosols are also removed from the room with the extracted air.
    
4. VAC units should be operated without recirculation and should be equipped with filters.
    
5. So-called HEPA (High Efficiency Particulate Air) filters with an efficiency of >99.95% or >99.995% are recommended. These have a H13 or H14 (outdated) rating, as well as classes ISO 35 H or ISO 45 H.

 

5 facts about air purifiers

1. Air purifiers have a fan that draws in the indoor air, passes it through filters and returns it to the room as purified air.
   
   
2. These portable devices can reduce or keep the viral load low over time.
   
   
3. But even air purifiers are not a substitute for the “hands, face, space” + ventilation rule. If two people come together in a room without wearing masks and social distancing, they will be exposed to aerosols even if an air purifier is used.
   
   
4. The device must be large enough and suitably equipped. The decisive factor is the clean air delivery rate (CADR) rather than the filtering efficiency.
   
   
5. Limiting factors for their use are power consumption, noise emission and maintenance costs.

 

Proper ventilation of patient rooms during the coronavirus pandemic at 20 m²

Download graphic

Proper ventilation of patient rooms during the coronavirus pandemic at 40 m²

Download graphic

 

Sources:

Dittler A et al. (12/2020). Stellungnahme: Aerosole&SARS CoV2 – Entstehung, Infektiosität, Ausbreitung & Minderung luftgetragener, virenhaltiger Teilchen in der Atemluft. (Letzter Zugriff 02.02.2021) https://www.baden-wuerttemberg.de/fileadmin/redaktion/m-mwk/intern/dateien/Anlagen_PM/20201204_Stellungnahme_Aerosole_SARS_CoV2.pdf

Positionspapier der Gesellschaft für Aerosolforschung zum Verständnis der Rolle von Aerosolpartikeln beim SARS-CoV-2 Infektionsgeschehen vom 07.12.2020. Letzter Zugriff 02.02.2021. https://www.tropos.de/aktuelles/pressemitteilungen/positionspapier-der-gaef-zum-verstaendnis-der-rolle-von-aerosolpartikeln-bei-covid-19

A recent study review indicates that SARS-CoV-2 can remain infectious on glass, e.g. mobile phone and tablet displays, for up to 28 days at 20°C. This means that there is a significant risk of transmission of the viruses to the hands of staff and from there to other surfaces or persons.

EThe risk of SARS-CoV-2 transmission comes principally from aerosols. Studies have shown that the viruses can remain infectious in tiny droplet particles for longer than 3 hours. The role of surfaces contaminated with SARS-CoV-2 in the spread of the virus is not yet fully understood, but there are many documented cases of cross-contamination with other viruses. The transmission rate of noroviruses from contaminated surfaces to the hands, for example, is put at 40% in one study [1]. Surfaces with frequent skin and hand contact, such as touchscreens of smartphones, buttons for operating vending machines or elevators, as well as surfaces in the proximity of patients, are often found to be contaminated with viruses and bacteria.

Risks from smartphones underestimated

Current studies by Ridell et al. on the survivability of SARS-CoV-2 on glass and plastic show that the viruses remained infectious for up to 28 days at 20°C [2]. Displays of digital devices thus pose a potential transmission risk. However, the risk of infection from mobile devices is underestimated by health workers. Only about 8% of doctors who use their smartphones frequently disinfect them regularly.

Therefore, it is essential that electronic devices are not neglected in the daily disinfection of surfaces in the proximity of patients.

As an element of patient care, these surfaces should be wipe-disinfected at least once a day with a suitable surface disinfectant:

Work surfaces	Treatment couches	Bed frames	Monitors	Displays	Keyboards	Control panels

Winter viruses and how they differ

In addition to SARS-CoV-2, other highly infectious viruses such as noroviruses and influenza viruses must also be increasingly expected in the winter months. While SARS-CoV-2 and influenza viruses, as enveloped viruses, are easily inactivated using disinfectants with “limited spectrum virucidal activity”, noroviruses require disinfection with products in the “limited virucidal activity PLUS” category. You can find out more about the differences between the viruses in our infographic “Viruses in comparison”.

Download infografic [PDF]

Sources:

1. Kampf G. Flächendesinfektion. Krankenhaushygiene up2date 8; 2013. DOI http://dx.doi.org/10.1055/s-0033-1359050
2. Riddell, S., Goldie, S., Hill, A. et al. The effect of temperature on persistence of SARS-CoV-2 on common surfaces. Virology Journal 17, 145 (2020).

Preparations for the first phase of the COVID-19 vaccination campaign via vaccination centers and mobile vaccination teams are in full swing. The vaccination process takes about an hour per person, according to estimates by organizers such as the Technisches Hilfswerk. A large part of that time is spent on registration and the necessary documentation plus the 30-minute waiting period under medical supervision. The actual vaccination requires systematic hygiene measures, especially for high-risk patients. Our chart shows what is important to remember.

Vaccinations such as the influenza or COVID-19 shot are aseptic procedures. Before, during and after vaccination, care must be taken to sterilize the skin at the spot where the vaccine is injected so as to prevent transfer or penetration of harmful germs into the body. Preventing such transfer of germs is particularly important in the planned first phase of COVID-19 vaccination, since the people first in line for vaccination will belong to the vulnerable risk groups.

The hygiene steps that need to be observed in connection with COVID-19 vaccination are shown in an easy-to-follow chart.

Download the chart

 

Sources::

Impfung gegen COVID-19: Erst Zentren – dann Praxen. Dtsch Arztebl 2020; 117(50): A-2449 / B-2065

Anforderungen an die Hygiene bei Punktionen und Injektionen. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut (RKI). Bundesgesundheitsbl 2011 · 54:1135–1144.

In order to prevent the spread of SARS-CoV-2, nursing staff must frequently disinfect their hands and in cases of presumed or actual contact with COVID-19, they must consistently wear respirator masks, goggles or visors. A study of 542 nurses in Hubei, China investigated the effect of preventive measures on skin health.

Work-related skin conditions are widespread among health professionals. Between 20 and 30 percent of all people working in patient and elderly care develop hand eczema [1]. The main cause of this is so-called 'wet work'. Wearing gloves for long periods of time and frequent contact with water and soap compromises the natural skin barrier and leads to skin damage on the hands. During this period of coronavirus, skin conditions seem to be increasing. It is not just the hands that are affected, but also parts of the face such as the bridge of the nose, cheeks and forehead.

The bridge of the nose is affected particularly often

A study at a tertiary care hospital in Hubei, China with over 500 nurses [2] came to the conclusion that wearing different respirator masks also left marks on the nurses' skin. According to a questionnaire evaluation, 97% of those asked, who were treating COVID-19 patients, had skin problems. The most common symptoms were a feeling of tightness, dryness, flaky skin and redness. Nearly 70% complained of damage to the skin on the bridge of their nose due to wearing a FFP2 mask. The number of nurses who observed damage to the skin on the bridge of their nose increased considerably when the FFP2 mask was worn for longer than 6 hours, rising to 81.1%.

Wearing time of less than 6 hours recommended

Over half of the study participants complained of skin irritation on their forehead caused by wearing a protective visor. The number of people affected increased by 10% when the protective visors were worn for longer than 6 hours. Only gloves did not show any difference between the extent of the skin irritation and the duration of wear: even after 6 hours, the skin irritation caused by gloves was not significantly worse than after a shorter duration of wear, but it was at an overall high level of 76%.

Preventing skin damage

Hand hygiene was named as the cause of the skin irritation by 60% of the nurses who availed of up to 10 opportunities for hand hygiene. More than 10 hand hygiene opportunities led to skin irritation in almost 80% of the nurses. The study did not mention which products were used for hand hygiene. For the prevention of skin irritation on the bridge of the nose, the authors refer to another study that had positive results through the preventive use of hydrocolloid dressings.

Conclusion:

Barrier nursing with respirator masks, protective visors (if applicable) and consistent hand hygiene is essential to prevent the transmission of SARS-CoV-2 when caring for COVID-19 patients. If possible, the nursing staff should not wear the masks for longer than 6 hours. The protective effect of FFP2 masks lasts for a maximum of 8 hours. This duration of wear for FFP2 masks should only be fully utilized in case of a shortage of masks and in emergency situations.

The Robert Koch Institute [3] and the AKTION Saubere Hände [4] recommend focusing in particular on the skin compatibility of hand disinfectants. This is usually the case with comprehensively examined products, e.g. by means of VAH certification. However, on the basis of the general according to the Federal Institute for Occupational Safety and Health (Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, BAuA), not all hand disinfectants have sufficient care properties and thus sufficient skin compatibility.

Sources:

1. Skudlik C, Dulon M, Wendeler D, John SM, Nienhaus A.
Hand Eczema in Geriatric Nurses in Germany – Prevalence and Risk Factors.
Contact Dermatitis, accepted 22. Oct. 2008

2. Juan Tao. Skin damage among health care workers managing coronavirus disease-2019. Research Letter. J AM ACAD DERMATOL, Mai 2020, Volume 82, No. 5.

3. Robert Koch-Institut. Händehygiene in Einrichtungen des Gesund­heits­wesens (2016). www.rki.de. (Letzter Zugriff 21.07.2020)

4. Wissenschaftlicher Beirat der AKTION Saubere Hände. Positionspapier Verträglichkeit von Händedesinfektionsmitteln. November 2010. Letzter Zugriff 21.07.2020)

COVID-19 patients have an increased risk of contracting bacterial co-infections. Triggers of this may include oral bacteria that accumulate in the oral cavity. They can spread from there to other areas of the body and cause infections. Older people are particularly vulnerable. In order to guard against this, it is important to practice thorough oral hygiene.

Viral respiratory tract infections make patients more susceptible to bacterial co-infections. [1] The co-infections in turn lead to increased disease severity and mortality. A Chinese study demonstrates that during the coronavirus pandemic, 50% of deceased COVID-19 patients had concurrent, secondary bacterial infections. [2] Another Chinese study identified both bacterial and fungal co-infections. [3]

Oral bacteria as triggers of co-infections

The development of co-infections in COVID-19 patients is promoted by oral bacteria that spread throughout the body. Analyses of genomic material from patients with SARS-CoV-2 showed high values of cariogenic and periodontal pathogenic bacteria. This confirms the view that there is a link between the oral microbiome and COVID-19 complications. [4]

In addition, there is evidence that periodontal pathogenic bacteria are involved in the onset and development of respiratory diseases associated with COVID 19. Moreover, these bacteria are associated with chronic-inflammatory systemic diseases including type 2 diabetes, hypertension and cardiovascular diseases. These diseases are therefore often comorbidities, which increase the risk of severe complications and death in cases of COVID-19. [4]

Oral hygiene is particularly important for the elderly

In contrast, other studies demonstrate that the clinical outcomes considerably improve and the mortality decreases for patients suffering from pneumonia when they implement improved oral hygiene. [5] One in ten pneumonia-related deaths among elderly care home residents aged 65 years and older are deemed avoidable thanks to improved oral hygiene. [6]

Conclusion: These connections illustrate just how important thorough oral hygiene is for infection prevention. Good oral hygiene is particularly vital for older patients and residents in nursing facilities in order to reduce the germs in the oral cavity and to prevent the spread of oral bacteria to other parts of the body.

Sources:

1. Cox M J et al. Co-infections: potentially lethal and unexplored in COVID-19, Correspondence.
www.thelancet.com/microbe Vol 1 May 2020.

2. Zhou F. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054–62.

3. Chen N et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507–13.

4. Patel J / Sampson V The role of oral bacteria in COVID 19, Correspondence. www.thelancet.com/microbe Vol 1 July 2020.

5. Manger D et al. Evidence summary: the relationship between oral health and pulmonary disease. Br Dent J 2017; 222: 527–33.

6. Sjögren P et al. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc 2008; 56: 2124–30.

Droplets, contact surfaces or aerosols? Not all transmission routes of SARS-CoV-2 have yet been clarified. The good news is: For disinfecting COVID-19 single rooms, products with the “limited virucidal” efficacy spectrum and the RKI procedure remain the first choice.

Like other coronaviruses, SARS-CoV-2 viruses can survive anywhere between a few hours and several days. Apart from droplet infection and direct transmission via contaminated hands, indirect contact transmission via viruses on inanimate surfaces also plays a role. Mathematical and animal models and intervention studies on SARS-CoV and MERS-CoV even suggest that the transmission of the viruses via contact surfaces is an important route.

This brings surface disinfection to the fore as an important prevention measure. Especially in the single rooms for COVID-19 patients, regular surface disinfection must be ensured.

Recommendations from the Robert Koch Institute for surface disinfection:

• Disinfect surfaces close to the patient and surfaces with frequent hand contact such as door handles, bedside table, sanitary cubicle by wiping – if necessary, disinfection should be extended.
• Frequency: daily or targeted in case of contamination

Recommendations from the Robert Koch Institute for products for surface disinfection:

Surface disinfectants should at least have a proven efficacy in the area of the “limited virucidal” agent (effective against enveloped viruses). Products with extended effectiveness against viruses such as “limited virucidal PLUS" or “virucidal” can also be used.

In this context, the RKI refers to the VAH list or the list of disinfectants and disinfection procedures tested and approved by the RKI (RKI list).

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Source:
Otter JA et al. Transmission of SARS and MERS Coronaviruses and Influenza Virus in Healthcare Settings: The Possible Role of Dry Surface Contamination. J Hosp Infect, 92 (3), 235-50 Mar 2016

With its new interim guidance regarding surface hygiene in connection with COVID-19, the World Health Organization (WHO) wants to “reduce any role that contaminated surfaces may play in the transmission of SARS-CoV-2”. Surfaces in rooms where a patient with a suspected or confirmed COVID-19 infection is present must, according to the experts, be cleaned and disinfected several times. In this regard, the sequence of cleaning or disinfection is also important.

The role that surfaces which have been contaminated with SARS-Cov-2 play in the transmission of the novel pulmonary disease is not yet fully understood. Previous studies that investigated the survival of the novel coronaviruses were based on experimental studies and laboratory experiments. Now, studies on the real contamination of surfaces in Chinese COVID-19 hospitals and laboratories prove that frequently touched surfaces in particular pose a transmission risk.

Increased frequency of cleaning

With this in mind, the World Health Organization (WHO) has published new interim guidance on surface cleaning and disinfection in connection with COVID-19. Surfaces in facilities associated with the care of suspected or confirmed COVID-19 patients should be cleaned or disinfected up to three times daily. In the guidance published, the WHO goes beyond the daily wipe disinfection recommended by the Robert Koch Institute (RKI).

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PDF Download graphics for individual areas

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Source

World Health Organization (WHO). Cleaning and disinfection of environmental surfaces in the context of COVID-19. Interim guidance
15 May 2020

At the moment, routine operations are gradually being carried out again – even the outpatient departments are filling up more and more. The German Society for General and Visceral Surgery (DGAV e.V.) has given recommendations on how to prevent so-called “nosocomial infection clusters”. Ward modules help to manage the different groups of patients.

With courses of infection that come in waves and different infection frequencies in the general population – as long as there is no vaccine available, COVID-19 patients are part of everyday hospital life. Healthcare facilities will have to live and work with the risk of nosocomial spread of SARS-CoV-2 in the near future. The German Society for General and Visceral Surgery (DGAV e.V.) has issued recommendations that summarize how infections can be prevented as far as possible during the gradual return to standard care.

Ward management during the COVID-19 pandemic

The new normal – working with the coronavirus: Clinics must prepare to treat patients who have different issues or who are not affected by COVID-19 at all – and at the same time keep an eye out for the risk of a nosocomial coronavirus outbreak. Even a single cluster of patients within a hospital can paralyze an entire clinic.

At organizational level, the DGAV experts are suggesting different ward modules for caring for different groups of patients. Depending on the size of the clinic, these can be organized as separate units or as isolation areas within a specialist department. The different units correspond to the groups of patients affected by other issues or not affected by COVID-19: In addition to the isolation area for COVID-19 patients, having wards for COVID-19 positive patients, but also for COVID-19 asymptomatic patients (i.e. those patients who come into hospital treatment due to other indications) are useful. In addition, wards for patients without COVID-19 will have to be managed. The concept reflects the diversity of patient care during the coronavirus pandemic and, at the same time, makes it possible to provide risk-adapted infection protection.

Ward modules or units in specialist departments:

• The holding area
  New admissions wait for their swab results in the admission unit for inpatients. The patients and all employees shall wear face masks. If the swab is negative, the patients can be admitted by the respective specialist units.
• The suspected COVID-19 ward
  Here the patients are cared for exclusively under consideration of the barrier care.
• Ward for patients who test positive for COVID-19
  Isolation ward with barrier care. Depending on the leading clinical symptoms, the isolation ward can be further divided into subareas:
  - internal (COVID-19 patients) or e.g.
  - surgical department (patients who are also COVID-19 positive)
• Patients without COVID-19
• Intensive care unit/intermediate care
  - COVID-19 isolation
  - COVID-19 negative area
  

Furthermore, the professional association recommends that occupancy should not be based on the number of beds available. Rather, the possible capacity of surgical and interventional units (e.g. endoscopy, catheter laboratory, radiology) should be taken as a basis. The number of patients admitted daily is adjusted to the daily capacities. If a renewed increase of COVID-19 patients is noted, this should be included in the overall occupancy planning.

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Source:
German Society for General and Visceral Surgery (DGAV e.V.) COVID-19 recommendations. Friday, April 24, 2020. https://www.awmf.org Last accessed on 05/14/2020

In order to eliminate gaps in supply chains for hand sanitizers and surface disinfectants, the Federal Institute for Occupational Safety and Health (BAuA) issued a general decree which has been updated several times. This authorizes pharmacies and companies in the pharmaceutical and chemical industry to manufacture biocide products that can be used as hand sanitizers and surface disinfectants. Specialist for hygiene and environmental medicine, Prof. Dr. Günter Kampf, explains what healthcare facilities should keep in mind.

What exactly is the reasoning for the general decrees issued by the Federal Institute for Occupational Safety and Health (BAuA) for the approval of biocidal products for hand sanitizers and surface disinfectants?

Prof. Dr. Günter Kampf: As the competent authority for biocidal products, the BAuA issued a general decree on March 4th 2020 regarding the approval of biocidal products for hygienic hand disinfection, which has been updated three times since it was first issued. The latest version is dated April 9th 2020. Additionally, a general decree on the approval of certain biocidal products for surface disinfection was issued on April 2nd 2020. These general decrees significantly expand the circle of manufacturers of disinfectants for hand sanitizers and surface disinfectants. These products may only be placed on the market for a maximum of 180 days as the biocidal products do not fulfill the conditions laid down in Regulation 528/2012 for granting an approval in the typical way.

Is this also the reason why you recommend that healthcare facilities use approved products from the well-known disinfectant manufacturers wherever possible?

Yes, because the antimicrobial effectiveness of approved, commercially available products for hand sanitizers and surface disinfectants has been extensively tested. Many of these products have been certified by the VAH and the skin compatibility or material compatibility is usually well documented.

How do we know how effective these products are against SARS-CoV-2?

Hand sanitizers and surface disinfectants that have a proven efficacy against enveloped viruses and therefore fulfill the “limited virucidal” efficacy spectrum are to be regarded as generally effective against coronaviruses including SARS-CoV-2.

Recipes for hygienic hand disinfection approved according to the BAuA are also effective against coronaviruses. And yet despite this, you critically evaluate these biocide products for healthcare facilities, why?

For the majority of biocidal products for hygienic hand disinfection mentioned in the general decree, there is no or only a small amount public evidence of efficacy in the form of expert opinions, even if the active substances themselves are mostly well investigated by the manufacturers or in the scientific literature. Based on published data, half of the 8 biocidal products for hygienic hand disinfection from the general decree issued by the Federal Institute for Occupational Safety and Health do not have sufficiently strong bactericidal and levurocidal efficacy within 30 seconds. Three of the formulations must even be applied with 2 x 3 ml over 2 x 30 seconds, which is twice the application time and twice the application volume if you compare it to the majority of commercially available products. On top of this, four of the alcohol-water mixtures from the general decree do not include skin care substances.

What consequences do these shortcomings in the formulations have for the practice with regards to the care of patients?

If these alcohol-water mixtures are frequently used, it is to be expected that employees will suffer from skin irritation. If their skin is irritated, it is less likely that employees will continue to comply with hand hygiene recommendations. This will then increase the patient’s risk of nosocomial infection. Clinics continue to treat critically ill patients whose greatest risk of infection is still bacteria and yeast fungi, and increasingly also multi-resistant bacteria. To prevent the transmission of these germs, employees sanitize their hands up to 60 times per shift. For hand sanitizers to provide reliable antimicrobial effectiveness within 30 seconds as well as having good skin compatibility are of the utmost importance for patient care. In the latest version of the general decree, the biocidal products described above with a lower efficacy within 30 s are therefore only recommended for use outside patient care.

According to the general decree from the Federal Institute for Occupational Safety and Health, four biocidal products should also be considered for hand disinfection in the care of patients in the event of a shortage?

These are two alcohol-water mixtures as well as the modified WHO formulations originally developed by the World Health Organization for countries with limited economic resources to locally manufacture products for the care of patients.

What do you think about biocidal products that are manufactured in accordance with the general decrees from the Federal Institute for Occupational Safety and Health (BAuA) for approval as surface disinfectants?

Biocide products that are temporarily approved by the Federal Institute for Occupational Safety and Health for surface disinfection are based on 80% v/v ethanol, 0.5% w/w sodium hypochlorite or 2.5% w/w chloramine T.

According to the general decree, ethanol can only be used on areas of up to 2 m2 and should be effective over a period of 15 minutes. Therefore, this biocidal product is only suitable for small areas. The manufacturer must also ensure that the ethanol does not contain hazardous impurities. Sodium hypochlorite should only be used against enveloped viruses and should only be applied to non-polluted dry surfaces for 30 minutes.

Aqueous chloramine T solution must also not contain any hazardous impurities and should be effective for over 2 hours. This all means that the practicability and application safety of these three temporarily approved biocidal products must still be critically questioned for routine use on surfaces in the care of patients.

Prof. Dr. Kampf, thank you for speaking with us.

In light of the Coronavirus pandemic, nursing staff in particular are required to carefully observe hygiene rules. The hotspots set up in healthcare facilities for hand hygiene during a working day that are vital in preventing infection can be found in a brief summary in our diagram on 05/05.

PDF download info diagramm

On this year’s International Hand Hygiene Day, the World Health Organization (WHO) is celebrating the contribution of nurses and midwives. The WHO reminds us that “clean and safe care” begins with the nursing staff. Policy makers should increase nurse staffing levels and provide more support to ensure infection control and improve quality of care.

Half of all healthcare workers worldwide are nurses and midwives. Both professions play a key role in protecting against infection and will be the focus of this year's WHO hand hygiene campaign on May 5th.

To recognize the achievements and responsibilities of nurses, the WHO has dedicated both the International Day of Hand Hygiene and the year 2020 to nurses and midwives.

With this decision, the 72nd World Health Assembly simultaneously celebrates the 200th birthday of Florence Nightingale. The British nurse reformed nursing care and was among the first to recognize that nurses could harm patients by spreading infections.

High-quality, safe care begins with nurses, but it also requires the extensive support of society as a whole. This is why the WHO is again addressing different tasks to different groups in society this year:

WHO 2020 Calls to Action:

• Nurses: “Clean and safe care starts with you.”

• Midwives “Your hands make all the difference for mothers and babies.”

• Policy makers: “Increase nurse staffing levels to prevent infections and improve quality of care. Create the means to empower nurses and midwives in their tasks”.

• Managers for hygiene and infection control: “Support nurses and midwives in providing hygienic care.”

• Patients and families: “Safer care for you, with you.”

International Hand Hygiene Day and COVID-19

Especially during the current Coronavirus pandemic, nurses and other healthcare workers deserve special recognition and appreciation, as the World Health Organization emphasizes: They are the heroes who stand on the frontline to save the lives of patients with COVID-19.

Nursing staff have a special responsibility in the current pandemic. Here, the WHO mentions correct hand hygiene, physical distancing and disinfecting surfaces as the most important measures in containing the Coronavirus pandemic.

Nursing staff need protection too

In order for nurses to be able to perform as well as possible in their important role in infection control, they must be protected themselves. Studies show the stresses to which nurses are exposed:

• Contradictory or inconsistent work instructions instead of targeted interprofessional cooperation

• Postponement of tasks: mainly taking over non-nursing activities

• Interprofessional tensions

• Lack of social support from colleagues and superiors (often in large institutions)

• Confronting death, illness and suffering

• Working extremely long hours

• Emotional and psychological strain and stress

On the other hand, the increase in personnel capacities and a more diverse mix of personnel and qualifications, also known as skill-mix teams, has a positive effect.

This means that there is an increase in:

• The quality of care

• Job satisfaction

The following is reduced:

• Adverse events in patients who are hospitalized, including nosocomial infections such as catheter-associated urinary tract infections, bloodstream infections and ventilator-associated pneumonia.

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Sources:
World Health Organization (WHO): Save lives: Clean Your Hands. „Nurses an Midwifes Clean care is in Your Hands. Adovocacy Slides. 5 May 2020. https://www.who.int/infection-prevention/campaigns/clean-hands/advocacy-slides-2020_long-version.pdf?ua=1 Last accessed May 2nd 2020

Gill CJ, Gill G. Nightingale in Scutari: her legacy reexamined. Clin Infect Dis. 2005; 40:1799-805 Allegranzi B et al. Infection prevention: laying an essential foundation for quality universal health coverage. Lancet Global Health 2019. 7(6):e698–e700. doi:10.1016/S2214-109X(19)30174-3

Klaus Jacobs / Adelheid Kuhlmey / Stefan Greß / Jürgen Klauber / Antje Schwinger (Hrsg.) Pflege-Report 2016 „Die Pflegenden im Fokus“. Schattauer (Stuttgart) 2016

If it becomes absolutely necessary to transport a COVID-19 patient within a hospital or care facility, special protective measures must be considered.

According to the Robert Koch Institute, the same recommendations apply when transporting a COVID-19 patient within a hospital or care facility. In accordance with this, several important points must be observed before, during and after the transport of a person suffering from COVID-19.

Prior to transport

• Firstly, it should be checked whether it is absolutely necessary to transport the COVID-19 patient within the hospital or care home.
• If it is absolutely necessary, the target area must be informed accordingly in advance.
• Sick people should be transported individually.
• If the state of health of the sick person allows, they should wear a face mask.
• Staff should wear personal protective equipment, including protective gowns, disposable gloves, at least an FFP2 mask and protective goggles during transport.

During transport

• In hospitals, contact with other patients and visitors should be avoided. In care homes, it’s also important not to come into contact with other residents and visitors.

After transport

• Immediately after the necessary measures have been taken in the target area, all contact surfaces as well as the means of transport must be thoroughly disinfected by wiping them down with a surface disinfectant with a proven at least limited virucidal agent.

Sources:
Robert Koch Institute, recommendations from the Robert Koch Institute on hygiene measures in the treatment and care of patients with a SARS-CoV-2 infection, as of: 04/24/2020. https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Hygiene.html#h

Robert Koch-Institute, prevention and management of COVID-19 in care homes and nursing homes and facilities for people with disabilities, recommendations for care homes and nursing homes and facilities for people with disabilities and for the public health service, as of: 04/24/2020. https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Alten_Pflegeeinrichtung_Empfehlung.pdf?__blob=publicationFile

Personal protective equipment (PPE) is a central component of occupational safety, especially during this coronavirus period. In order that PPE reliably fulfill its protective function, it is important to apply the individual components correctly, step by step.

The primary purpose of PPE is to protect employees from direct contact with potential pathogens. It’s particularly important to put the gown on before the gloves so that the gloves can be pulled up over the cuffs.

Instructions:

Using personal protective equipment (PPE) correctly

Download PDF Instructions sheet

The current Coronavirus pandemic caused by severe acute respiratory syndrome, known as Coronavirus 2 (SARS-CoV-2), shows remarkable transmissibility. According to the current situation, four transmission routes are known or highly probable. Our overview diagram shows where the risks of each transmission route lie.

Download PDF info graphic

We are continuing to hear of supply bottlenecks for face masks and FFP2 masks. With the number of COVID-19 cases on the rise, the demand for respiratory masks will continue to grow in the future. One way to use face masks and FFP2 masks and yet still conserve resources is to make use of the maximum wearing time.

Maximize wearing time – Reduce respiratory mask use

According to experts, face masks can be used up to a maximum of 4 hours. Their protective effect remains intact during this period.

According to experts, FFP2 masks can be used for up to 8 hours. Their protective effect remains intact during this period.

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Download PDF info diagram on wearing time of respiratory masks

The correct use of protective equipment is essential for personnel protection. Many employees find it particularly difficult to remove. Our explanatory video and instructions show how to avoid contamination.

The primary purpose of personal protective equipment (PPE) is to protect employees from direct contact with potential pathogens. A study investigated how safely the personnel were able to handle protective equipment using a fluorescent solution. The researches observed the following:

• The majority of contamination risks occurred while removing PPE. Over half of the individuals tested contaminated themselves after taking off their gloves.
• After taking off their protective suit, about 38% of the study participants found the fluorescent substance on their bodies.

Training staff on how to correctly remove the protective equipment has reduced the risk of contamination from 60% to 19%. What was most helpful to the employees was step-by-step instructions.

Simple instructions according to CDC

There are many recommendations for correctly disposing of PPE. Our instructions on “How to properly dispose of personal protective equipment (PPE)” and our explanatory video are based on a simple variant of the Center for Disease Control and Prevention. The step-by-step procedure allows for a pragmatic but at the same time safe approach – to offer simple solutions, especially during the Coronavirus pandemic.

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Instructions on how to dispose of personal protective equipment (PPE) correctly

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Download PDF instructions sheet

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Sources:
Tomas et al. Contamination of Health Care Personnel During Removal of Personal Protective Equip- ment. JAMA Intern Med. Published online October 12, 2015.
Centers for Disease Control and Prevention. How to safely remove personal protective equipment (PPE). Example2. https://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf Letzter Zugriff 05.03.2020.

The supply gaps for respiratory masks are huge. Reprocessing has been permitted since April 1st. The procedure recommended by the German government classifies material standards and relies on personalization to ensure the protective function.

Respiratory masks that disappear by the container without a trace, or are glued from coffee filters or produced using a 3D printer at home: Necessity is the mother of invention, but can sometimes be considered a crime. With the reprocessing of medical face masks being approved on April 1st, the German government wants to create a quick interim solution until sufficient new respiratory masks become available on the world market. Aim of the reprocessing procedure: To reuse a sufficient number of masks without reducing their protective function.

Indeed, face masks are also in short supply. However, when directly caring for COVID-19 patients, FFP2 and FFP3 masks are in particularly high demand.

The recommendations for the decontamination of FFP2 and FFP3 class respiratory masks:

Thermal Decontamination:

• For decontaminating FFP2 and FFP3 respiratory masks, the recommendation is for thermal disinfection at 65°C to 70°C over a period of 30 minutes.
• Inactivation through heat can be carried out in drying ovens.

Bewertung der Materialbeständigkeit:

1. High probability that the contour will remain and the material will not change:

• Masks with CE marking
• Masks approved by the Central Office of the Federal States for Safety Technology (ZLS)

2. Masks that have to be subjected to a quick test for temperature resistance at 70°C before reprocessing:

• Masks that are marketable in the USA, Canada, Australia or Japan

3. Masks that have to be subjected to a test for temperature resistance at 70°C over 24 hours before reprocessing:

• Incoming non CE-marked masks

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Download PDF checklist

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Source:
Federal Ministry of Health. Use of protective masks in healthcare facilities. Paper from the crisis team with the involvement of the Robert Koch Institute (RKI), the Federal Institute for Drugs and Medical Devices (BfArM) and IFA. 03/31/2020.