6 January

    Hygiene is teamwork.

    The fight against post-operative wound infections.


    Post-operative wound infections are one of the most common types of hospital-acquired infection, accounting for 22.4% of cases.

    Hospital-acquired infections represent a constantly worsening problem for the health sector. In Germany alone, between 400,000 and 600,000 cases of these types of infection are recorded each year. Frequent causes included invasive investigations or treatments, such as the use of NG tubes, vascular or urinary catheters, or artificial respiration. Surgery, however, also represents a frequent gateway for pathogens to invade the human body. Post-operative wound infections are one of the most common types of hospital-acquired infection, accounting for 22.4% of cases. This fact was adopted by the commission for hospital hygiene and infection prevention (KRINKO) of the Robert Koch Institute in April 2018 as a basis for updating their recommendations for the prevention of post-operative wound infections (also known as surgical site infections, or SSIs).

    For a long time, broad-spectrum antibiotics were used as a preventive measure. The consequences of this are well-known: increased rates of pathogens developing resistance, with antibiotics frequently no longer being effective. And so now the field of wound antiseptics is experiencing a renaissance, especially due to wound antiseptics such as PHMB being proven well-tolerated in patients, as well as being easy-to-use, and having a bactericidal (rather than bacteriostatic) mode of action. Pathogens do not develop resistance against these new weapons. It is no wonder then that they are now being used in applications beyond post-operative wound care, such as during the surgery itself.

    It is vital to overcome silo mentality, and to implement measures across different departments.

    However, if we want to effectively prevent infections, we cannot stop there. Whether it’s our own personal behaviour, patient-oriented safety measures, or operational/technical preventive measures: there is an interplay between different factors which come together to contribute to effective protection against infection. For this reason, it is also important to overcome silo mentalities, to promote communication between different stakeholders and to set down consistent, interdepartmental measures.

    Dr. Roland Knieler, Managing Director of Knieler & Team, has also made a case for this:

    “A company will never be able to develop the best solution by working alone, just as we wouldn’t expect a hygienist or user to. The best opportunities for improving the protection of patients and users in the future can be found in intensive collaboration between all the different players involved, with broad exchange and an unbiased approach to the different challenges which arise.”

    To promote and further develop exchange between different disciplines: this is the objective which Lohmann & Rauscher has set for itself. In an expert panel discussion at the Slavkov u Brna production location, we were met not only by Dr. Knieler, however: other in attendance included Prof. Axel Kramer from the Institute of Hygiene and Environmental Medicine of the Greifswald University Hospital; Tina Leeb, Department Head for R&D, specialising in microbiology at L&R; and Dipl.-Ing. Thomas Menitz, L&R’s COO. Together they discussed how post-operative wound infections can best be avoided, and which factors play a decisive role.

    Whilst increasing resistance of pathogens to antibiotics continues to play a role, a lack of hygiene measures is also responsible for the high levels of SSIs which are still being seen. For this reason, both convenience and compliance of hand/surface disinfection need to be increased through innovations in the field.

    “In the field of surface disinfection, the biggest breakthrough has been a transition to ready-to-use systems, such as wipe dispenser systems which contain pre-treated wipes which do not require any preparation by staff. This innovation has brought high levels of safety”,

    Dr. Knieler explained. Dr. Kramer has also been grappling with issues in compliance. In order to make improvements, he recommends: combining particularly important measures into one single package of measures, providing training in these, and to supervise compliance by using checklist-based self-monitoring.

    “In this process, it is important for the package of surgical care measures to be evidence-based and highly effective, as well as easy to implement and monitor over time”,

    he added.

    The importance of interdisciplinary collaborations was also highlighted on multiple occasions. This is an approach which Thomas Menitz has also backed:

    “Our product portfolio makes a significant contribution to reducing infections. Our ways of thinking and acting in relation to hygiene and hygiene measures also have to change over the long term.”

    Tina Leeb also sees exchange and cooperation as fundamental. These principles are also reflected in the work of her team:

    “I find it truly amazing to have an interdisciplinary team available all on one site, meaning that we can all see the bigger picture.”

    There was a strong consensus that the system has to be considered as one whole in order to improve hygiene, and consequently improve patient safety.

    Ready-to-use products have brought high levels of safety.

    L&R in Slavkov u Brna, Czech Republic

    • Approx. 700 employees working across 28,400 m2
    • Production, logistics, distribution, administration, quality assurance, chemical and physical laboratories - all under one roof
    • Production of: Gazin dressing materials, orthopaedic devices, Debrisoft, and individual [3]products such as Kitpack and Setpack
    • Since 2014, on-site sterilisation units in operation, with 3 chambers covering 3,130 m2
      • Each year, 25,000 paletts of products are sterilised
      • Sterilisation is a key process in order to ensure the quality of the medical devices.
        This process eliminates living microorganisms, as well as their dormant variants (e.g. spores), from medical devices.
      • Ethylene oxide (EO) is used for sterilisation: the most widely-used and reliable method in the medical device sector.
        No other process can guarantee the product quality, and in turn, patient safety, without the product itself being modified in the process.