environment Dirk Bockmühl Hygiene at home Gerd had rather spent more money in toilet cleaning agents Home hygiene the consumers view Hygiene ID: 934322
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Slide1
Hygiene in the non-clinical environment
Dirk
Bockmühl
Slide2Hygiene at home?Gerd had rather
spent more money
in toilet cleaning
agents…
Slide3Home hygiene: the consumer’s view Hygiene threats are mostly found outside
my home
According
to
a GfK
survey
for
the
„Apotheken-Umschau“
2006
Slide4Notifiable infections in Germany (2008)Source: RKI
Slide5Household-associated infectionsKrause et al.:
Emerg Inf Dis 13(10) (2007)
Slide6The key message
The domestic environment is one of the most important sources for infectious diseases
These infections are predominately food-borne
Slide7The risk of infection at home
7
Risk
Source: IFH
Slide8Risk
Source: IFH
The
risk
of
infection
at
home
Slide9Decontamination of food contact surfaces
Slide10The
dishwasher
: a
risk
?
Slide11Slide12Dishwashers host black
yeasts
Slide13Zalar et al. (2011)Dishwashers host
black yeasts
Slide14?But is there a risk of infection?
Slide15Estimation of infection riskPathogenic microbes?Routes of infection
?Exposition?Risk
factors?
Slide16Groups of higher risk: YOPIs
Young
Old
Pregnant
Immunocompromised
Slide17Antibacterial 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
Slide18The „killer“ spongeEnriquez et al. Dairy Food Environ. Sanitation. 17:20-24.
10
2
– 10
7
microbial
cells
per
gramm
SEM-photograph: A.
Hinnemann
, Rhine-Waal University
of
Applied Sciences
Slide19How to sanitize a kitchen spongeSharma et al. Food Control 20 (2009) 310–313
Slide20The dishwasher kills…
Slide21The dishwasher kills…
…bacteria!
Thus it is an important means
to ensure decontamination of food-contact
surfaces
Slide22The risk of infection at home
Risk
Source: IFH
Slide23The washing machine as source
of germs
Slide24Will we all die now?
Slide25Infections and laundering
Fungal infections(Athlete‘s foot
, Candida)Viral infections
(Noroviruses)
Slide26Inactivation of Norovirus via launderingLemm et al. Tenside, Surfactants, Detergents (submitted)
Detection of viral RNA on fecally
contaminated textiles
Slide27Challenge: low temperaturesT [°C]%
Medium washing
temperature
Textiles washed at ≥60°C
Survey on
german
h
ouseholds
S
ource: IKW
Sustainability
Report 2010
Slide28Wearing
Drying
Washing
Storage
Hygiene in the wash- and use-cycle
Slide29Input
of microorganisms
Reduction
of microorganisms
Wearing
Drying
Washing
Storage
Hygiene in the wash- and use-cycle
Slide30Input
of
microorganisms
Reduction
of
microorganisms
Wearing
Drying
Washing
Storage
s
kin
f
lora
e
xcretions
b
iofilms
c
ross
c
ontami
-nation
f
ungal
s
pores
d
ust
d
ehydration
temperature
c
hemistry
m
echanics
temp
.
d
ehydration
Hygiene in the wash- and use-cycle
Slide31Challenges
Slide32Challenges
Wich
microbes?Quantity?
Slide33Challenges
Machine
impact?
Slide34Challenges
Impact of
drying and ironing?
Slide35cfu/cm2After
dryingAfter laundering
After use
What happens when
you
wash
your
towels
?
Blümke
et al.
, EDC
conference
2011
Slide36cfu/cm2After
dryingAfter laundering
After use
What happens when
you
wash
your
towels
?
Blümke
et al.
, EDC
conference
2011
Slide37cfu/cm2After
dryingAfter laundering
After use
What happens when
you
wash
your
towels
?
Blümke
et al.
, EDC
conference
2011
Slide38The 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
Slide39Another real-life study…
Analysis
of
Laundry
in
Nursery
Homes
Slide40Analysis of Laundry in Nursery Homes
c
fu / 100 cm2
Before laundering
After
laundering
A
fter
drying
Survey on 16
nursery
homes
in
the
district
of
Kleve
Bertelmann
et al.
, DGHM
conference
2012
Slide41Individual reduction factorsNursery home #
Log reduction (before/after laundering
)Bertelmann et al., DGHM
conference 2012
Slide42Impact factors on laundry hygiene
Bertelmann et al., DGHM conference
2012
Slide43Impact factors on laundry hygiene
Bertelmann et al., DGHM conference
2012
Slide44Impact factors on laundry hygiene
Bertelmann et al., DGHM conference
2012
Slide45Impact factors on laundry hygiene
Bertelmann et al., DGHM conference
2012
Slide46Impact factors on laundry hygieneBertelmann et al., DGHM conference
2012
Slide47Analysis of Laundry in Nursery Homes cfu
/ 100 cm2Before
launderingAfter laundering
After drying
Very
low
counts
after
tumble
drying
Bertelmann
et al.
, DGHM
conference
2012
Slide48Do hygiene rinsers help?
Hygiene
+
Source: Forum Waschen
Slide49Do hygiene rinsers help?
Claim: Kill 99,9(99)%
of
germs
Substantiated
via
suspension
tests
Source: Forum Waschen
Slide50Efficacy in the washing machine?
Additional detergency effect
Textile effect
Different germsetc.
Slide51Powder detergent with hygiene rinserLucassen et al.
, Tenside, Surfactants, Detergents (2013)
Slide52Akimitsu et al.: Antimicrob Agents Chemother 1999;43:3042-3
Cross resistance between
antibiotics and biocides
Slide53Cross-
resistance
Lambert: Journal
of Applied Microbiology 2004, 97, 699–711
Slide54Lambert et al.: Journal of Applied Microbiology 2001, 91, 972±984Resistance profile vs. origin
TSI: Total
Susceptibility IndexAnzahl
Klinische Isolate
# Isolates
Clinical Isolates
Slide55Clinical isolates are more resistance in generalAntibiotic resistance is predominately found in clinical
isolatesClinical environment
fosters resistance
Lambert et al.: Journal of Applied Microbiology 2001, 91: 972-984
Does
biocide
use
enhance
antibiotic
resistance
?
Slide56Biocides at home?
Slide57Biocides at home?
Hygiene rinsers:only
for special cases
Slide58Biocides at home?
Hygiene rinsers:only
for special cases
http://londoncleaning-services.co.uk
Detergents
with
activated
oxygen
bleach
ensure
sufficient
hygiene
Slide59Are we too clean? The hygiene hypothesisStrachan (1989): 20th century rise in allergic diseases is related to lower incidence of infection in early childhood
Slide60Hygiene hypothesis: the consumer‘s view
„
We need some bacteria
to train our immune system“„
Too
clean
is
harmful
“
Slide61Hygiene hypothesis: the consumer‘s view
Slide62Hygiene 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.
Slide63Old friends hypothesis (Graham Rook)Microorganisms that were once abundant (but aren‘t
any more) trained our immune
system to be more tolerant:
LactobacilliSaprophytic MycobacteriaParasitic
worms
Slide64Are we too clean? Cleaning does most probably not increase the risk for
allergy and asthma
Slide65Are 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
infection
s
Slide66Targeted Hygiene
Risk
Source: IFH
Slide67ThanksBritta Brands, Angelina Eckert, Marlitt Honisch, Davina Lemm, Ralf Lucassen,
Nadine Merettig, Ramona Steiner
Slide68Thank you