Scientific publications

general infection prevention control

February 20, 2021
Comparison of the in vitro-efficacy of different mouthwash solutions targeting SARS-CoV-2 based on the European Standard EN 14476
K Steinhauer, TL Meister, D Todt, A Krawczyk, L Paßvogel, B Becker, D Paulmann, B Bischoff, S Pfaender, FHH Brill, E Steinmann

The outbreak of the SARS-Cov-2 pandemic is triggering a global health emergency alert. Until vaccination becomes available, a bundle of effective preventive measures is desperately needed. Recent research is indicating the relevance of aerosols in the spread of SARS-CoV-2. Thus, in this study commercially available antiseptic mouthwashes based on the actives chlorhexidine digluconate (CHX) and octenidine dihydrochloride (OCT) were investigated regarding their efficacy against SARS-CoV-2 using the European Standard 14476. Based on the requirement of EN 14476 in which reduction of at least four decimal logarithms (log10) of viral titer is requested to state efficacy, the OCT-based formulation was found to be effective within a contact time of only 15 sec against SARS-CoV-2. Based on this in vitro-data the OCT-mouthwash thus constitutes an interesting candidate for future clinical studies to prove its effectiveness in a potential prevention of SARS-CoV-2 transmission by aerosols.

February 20, 2021
Improved method for tuberculocidal and mycobactericidal activity testing of disinfectants based on the European Standard 14348
FHH Brill, J Lenz, C Lach, N Radischat, L Paßvogel, P Goroncy-Bermes, H Gabriel, J Steinmann, K Steinhauer

Safe measurements to prevent the transmission of (multi-drug-resistant) mycobacteria such as disinfection are essential in healthcare settings. In Europe chemical disinfectants are tested for their tuberculocidal and mycobactericidal efficacy by the internationally accepted test procedure described in EN 14348. However, especially for amine-based disinfectants, invalid results can occur by this procedure due to insufficient neutralization. In this multi-lab study the procedure described in EN 14348 was optimized by a combination of chemical neutralization and membrane filtration in order to obtain a valid and secure method especially for amine-based disinfectants.

August 24, 2020
In-vitro study on endotoxin release of gram-negative bacteria after contact with silver releasing compared to DACC coated wound dressings
TL Meister, Y Brüggemann, D Todt, C Conzelmann, JA Müller, R Groß, J Münch, A Krawczyk, J Steinmann, J Steinmann, S Pfaender, E Steinmann

The treatment of critically colonized or locally infected wounds with local antimicrobial agents is a standard of care. The destruction of especially gram-negative bacteria potentially increases the endotoxin level in the wound. This in-vitro study aims to answer the question of whether and to what extent endotoxin release caused by the destruction of gram-negative bacteria is influenced by different wound dressing. Silver ion releasing dressings were compared to wound dressings with hydrophobic effect coated with dialkyl carbamoyl chloride (DACC). In addition, the bactericidal efficacy was measured. The log10 reduction factors (RF) against Pseudomonas aeruginosa were between 0 and 0.9 for the hyprophobic Dressings and 8.7 for the silver releasing dressing. The bacterial endotoxin content of the agar located under the dressing after contamination with P. aeruginosa was >300 <3,000 IU/ml in the case of a cotton gauze (control), >3,000 <30,000 IU/ml for DACC coated distance grid, >30 <300 IU/ml in for the DACC coated foam dressing and >0.3 <3 IU/ml in the case of the silver ion releasing dressing. The content of bacterial endotoxins which could be extracted from the wound dressing after contact with P. aeruginosa was >30,000 <300,000 IU/ml for the control dressing, >30,000 <300,000 IU/ml in the case of Cutimed Sorbact, >3,000 <30,000 IU/ml for the DACC coated foam dressing and >3 <30 IU/ml for the silver-releasing dressing. According to these findings, the silver ion releasing dressing has a higher antibacterial effect than wound dressings coated with DACC and it also releases a significantly lower amount of bacterial endotoxins.

March 1, 2020
Potentially pathogenic bacteria isolated from diverse habitats in Spitsbergen, Svalbard
DC Mogrovejo‑Arias, FHH Brill, D Wagner

The Arctic ecosystem, a reservoir of genetic microbial diversity, represents a virtually unlimited source of microorganisms that could interact with human beings. Despite continuous exploration of Arctic habitats and description of their microbial communities, bacterial phenotypes commonly associated with pathogenicity, such as hemolytic activity, have rarely been reported. In this study, samples of snow, fresh and marine water, soil, and sediment from several habitats in the Arctic archipelago of Svalbard were collected during Summer, 2017. Bacterial isolates were obtained after incubation on oligotrophic media at different temperatures and their hemolytic potential was assessed on sheep blood agar plates. Partial (ɑ) or true (β) hemolysis was observed in 32 out of 78 bacterial species. Genes expressing cytolytic compounds, such as hemolysins, likely increase the general fitness of the producing microorganisms and confer a competitive advantage over the availability of nutrients in natural habitats. In environmental species, the nutrient-acquisition function of these compounds presumably precedes their function as toxins for mammalian erythrocytes. However, in the light of global warming, the presence of  hemolytic bacteria in Arctic environments highlights the possible risks associated with these microorganisms in the event of habitat melting/destruction, ecosystem transition, and re-colinization.

January 22, 2020
High Environmental Stability of Hepatitis B Virus and Inactivation Requirements for Chemical Biocides
B Watermann, A Thomsen, B Daehne, C Fürle

Hepatitis B virus (HBV) infection is considered a major public health problem worldwide, and a significant number of reports on nosocomial and occupational outbreaks have been reported. This systematic investigation of HBV stability and susceptibility to different antiseptics revealed that HBV infectivity was very stable, with a half-life of >22 days at 37°C. At 4°C, infectivity was barely reduced for up to 9 months. Different alcohols and commercially available hand antiseptics had a virucidal effect against HBV. We propose that very strict compliance with established hygienic guidelines should be mandatory to avoid and prevent HBV infections.

November 1, 2019
High tolerance of hepatitis B virus to thermal disinfection
A König, TT Than, D Todt, S Kew Yoon, J Steinmann, E Steinmann, M Windisch
Hepatitis B virus (HBV) is a severe global health burden, with approximately 2 billion infected individuals and more than 250 million carriers worldwide. Despite the availability of vaccines and therapeutics, chronic hepatitis B remains incurable. The virus is highly contagious and can circulate with 10^8 to 10^10 infectious particles in a patient’s blood. Because HBV has a very low minimal infectious dose of only 10 genomes, the transmission from only trace amounts of blood pose a serious risk for infection.

June 1, 2017
Study on the decononisation of urinary tract catheters applaying a practice-like in vitro test method
FHH Brill, S Pahl, JH Klock, H Gabriel, H Brill, J Hambach, C Jänicke, A Arndt

Introduction: Urinary infections are among the most common nosocomial infections, accounting for 23.2% of them. In 80% of cases, these infections are catheterassociated urinary tract infections (CAUTI). The pathogens attach themselves to the catheter walls within a biofilm. Long-term use of urinary catheters is therefore a risk factor for developing a CAUTI. Changing the catheters more frequently would remove the biofilm, but is unpleasant for the patient and timeconsuming for personnel. Regular rinsing of the catheter can be a useful way to remove the emerging biofilm, and to prevent the creation of biofilm in the first place and potential subsequent blockages of the catheter. However, this is not yet standard clinical practice.

Objectives: The influence of rinsing the catheters should be tested in vitro in order to examine its operating principle. Methods: In a practice-like in vitro test method the catheters were contaminated with Escherichia coli, Proteus mirabilis or methicillinresistant Staphylococcus aureus for 72 hours. Afterwards, the catheters were rinsed with 0.02% Polihexanide (PHMB), 0.9% NaCl or were not treated (positive control) and the viable cell count was determined. The biofilm mass was quantified in a staining assay. In addition, fluorescence microscopy assays were performed in a flow cell to visualize the vitality of the cells after rinsing with PHMB or NaCl.

Results: Rinsing the catheters with Polihexanid singnificantly reduced the cell count (p = 0.012). The reduction factor compared to "nontreatment" was 2.56 ± 0.67 log. In comparison to NaCl, rinsing with Polihexanide results in significantly lower cell counts (p = 0.034), higher reduction rates in biofilm mass and is able to kill off the cells at the surface of the biofilm.

Conclusion: Rinsing the catheters reduces colonization of catheters by microorganisms. Polihexanide-rinsing is more effective compared to rinsing with saline solution. A reduction in biomass of the biofilm was demonstrated both by fluorescence microscopy and via the in vitro-model. Further studies need to investigate wheter the presented results can be transferred into practice and actually lead to a reduction in urinary tract infections.

Disclosure of Interest
F. Brill Grant/Research support from: B. Braun Medical AG, S. Pahl: None Declared, J.-H. Klock Grant/Research support from: B. Braun Medical AG, H. Gabriel Grant/Research support from: B. Braun Medical AG, H. Brill Grant/Research support from: B. Braun Medical AG, J. Hambach Grant/Research support from: B. Braun Medical AG, C. Jänicke Grant/Research support from: B. Braun Medical AG, A. Arndt Employee of: B. Braun Medical AG

November 1, 2016
Wanderungsgeschwindigkeit von uropathogenen Erregern - Migration speed of uropathogens Determination in the ureteral splint in a practice-like in vitro model
H Braunwarth, FHH Brill, J Steinmann, D Hegeholz, W Droste

Bei den verschiedenen Urostomien wie dem Ileumconduit und der Ureterhautfistel besteht ein hohes Infektionsrisiko für die Nieren und das harnableitende System des Patienten. Deshalb ist das Vermeiden des Aufsteigens von Bakterien im künstlichen Abfluss (Splintkatheter) durch z. B. kontaminierten Harn wichtigstes Ziel der hygienischen Maßnahmen. Es sollte in vitro nachgewiesen werden, wie schnell klinisch relevante Prüfbakterien diese Splintkatheter besiedeln können.

Es wurde die Wanderungsgeschwindigkeit von Bakterien in einem handelsüblichen Splintkatheter in einem praxisnahen In-vitro-Modell untersucht. Hierzu wurde ein Vorratsgefäß mit Splintkathetern mit einem zweiten Vorratsgefäß verbunden, in dem eine Bakteriensuspension der Prüfbakterien Escherichia coli, Proteus mirabilis und Staphylococcus aureus in künstlichem Harn vorgelegt wurde. Die beiden Vorratsgefäße wurden bei 36 °C bis zu 72 h inkubiert. Die Keimzahl in den Splintkathetern wurde nach 24 h, 48 h und 72 h bestimmt, um die Besiedlungsstrecke nachzuweisen.

Die durchschnittliche Wanderungsgeschwindigkeit lag bei 0,63 cm/h für E. coli, 0,80 cm/h für S. aureus und 0,94 cm/h für P. mirabilis. Dies ergibt eine gemittelte Besiedlungsstrecke von 80 cm in ca. 3 Tagen.

Aus den Ergebnissen im In-vitro-Modell lässt sich eine hohe Wanderungsgeschwindigkeit der Bakterien ableiten. In vivo würde es bedeuten, dass innerhalb der üblichen Liegedauer der Splintkatheter beim Urostoma von 10–14 Tagen vollständig besiedelt wird.

Urostoma Splint Bakterien Hygiene Bakterienwanderung


A urostomy with an ileum conduit or a skin fistula leads to a high infection risk for the kidneys and the ureter of the patient. Therefore, the prevention of retrograde colonization of the artificial drain (splint) with e. g. contaminated urine is the most important objective of infection prevention measurements. We performed an in vitro experiment to determine the migration speed of clinically relevant bacteria in a commercially available splint catheter system.

The migration speed of bacteria in commonly used splint catheters was determined in a practice-like in vitro model. Two storage vessels were connected with splints. The second vessel contained a bacterial suspension of the test bacteria Escherichia coli, Proteus mirabilis, and Staphylococcus aureus in artificial urine. The two vessels were incubated at 36 °C for 24–72 h. The microbial count in the catheters was determined after each experiment to investigate the migration distance.

The average migration speed was 0.63 cm/h for E. coli, 0.80 cm/h for S. aureus, and 0.94 cm/h for P. aeruginosa. This results in a colonization distance of approximately 80 cm in 3 days.

If the system, e. g., the stoma pouch is contaminated, it can be expected that during the common application time of a splint of 10–14 days, the complete splint will be contaminated due to the high bacteria migration speed. Consequently there is a high infection risk for kidneys and ureters. A return stop feature in the stoma pouch should minimize this risk. However, it is of upmost importance to not applying the splint through the return stop to prevent any contact with potentially contaminated urine.

Urostomy Splint Bacteria Hygiene Bacteria migration speed

August 1, 2016
A new topical panthenol-containing emollient: Results from two randomized controlled studies assessing its skin moisturization and barrier restoration potential, and the effect on skin micro
H Stettler, P Kurka, N Lunau, C Manger, A Böhling, S Bielfeldt, KP Wilhelm, S Dähnhardt-Pfeiffer, D Dähnhardt, FHH Brill, H Lenz


Two randomized, intra-individual comparison studies were performed in healthy subjects to evaluate the skin moisturization and barrier restoration potential of a new topical panthenol-containing emollient (NTP-CE) (Study 1), and its effect on skin microflora (Study 2).


In Study 1 (N = 23), two skin areas, one challenged with 0.5% sodium dodecyl sulfate (SDS) solution and one unchallenged, were treated with NTP-CE for 3 weeks. Transepidermal water loss (TEWL), skin hydration, and intercellular lipid lamellae (ICLL) organization were measured at regular intervals during the study. In Study 2 (N = 20), quantitative bacterial cultures were obtained over 6 h from a skin area undergoing wash stress with 10% SDS with subsequent single application of NTP-CE.


In Study 1, mean AUC for TEWL reduction from baseline was more pronounced with NTP-CE compared with control (-168.36 vs. -123.38 g/m2/h, p = 0.023). NTP-CE use was also associated with statistically significant improvements in stratum corneum hydration and an increase in mean ICLL length from baseline (day 22: 120.61 vs. 35.85 nm/1000 nm2, p < 0.001). In Study 2, NTP-CE use had no negative impact on bacterial viability.


NTP-CE use has favorable and lasting effects on barrier function and repair as well as skin hydration without negatively influencing bacterial viability.


Emollient; microbiome; moisturization; panthenol; randomized controlled study; repair; skin; skin barrier; topical

October 1, 2013
Stability and transmission of hepatitis C virus in different anesthetics
P Behrendt, J Doerrbecker, N Riebesehl, C Wilhelm, S Ciesek, TJ Erichsen, J Steinmann, M Ott, MP Manns, T Pietschmann, E Steinmann

In May 2012, Branch-Elliman et al reported an outbreak of hepatitis C virus (HCV) infections due to contamination of multidose medication vials.1 The New York City Department of Health and Mental Hygiene was informed of a cluster of 4 patients treated at an outpatient gastroenterology center who developed acute HCV infection. A detailed investigation identified a total of 12 clinic-associated HCV transmissions within a period of 8 days, which were traced back to unsafe handling of multidose medication vials and possible reuse of contaminated needles during anesthetic procedures.

August 1, 2013
Thermostability of seven hepatitis C virus genotypes in vitro and in vivo.
J Doerrbecker, P Meuleman, J Kang, N. Riebesehl, C Wilhelm, M Friesland, S Pfaender, J Steinmann, T Pietschmann, E Steinmann

Hepatitis C virus (HCV) is transmitted primarily through percutaneous exposure to contaminated blood especially in healthcare settings and among people who inject drugs. The environmental stability of HCV has been extrapolated from studies with the bovine viral diarrhoea virus or was so far only addressed with HCV genotype 2a viruses. The aim of this study was to compare the environmental and thermostability of all so far known seven HCV genotypes in vitro and in vivo. Incubation experiments at room temperature revealed that all HCV genotypes showed similar environmental stabilities in suspension with viral infectivity detectable for up to 28 days. The risk of HCV infection may not accurately be reflected by determination of HCV RNA levels. However, viral stability and transmission risks assessed from in vitro experiments correlated with viral infectivity in transgenic mice containing human liver xenografts. A reduced viral stability for up to 2 days was observed at 37 °C with comparable decays for all HCV genotypes confirmed by thermodynamic analysis. These results demonstrate that different HCV genotypes possess comparable stability in the environment and that noninfectious particles after incubation in vitro do not cause infection in an HCV in vivo model. These findings are important for estimation of HCV cross-transmission in the environment and indicate that different HCV genotypes do not display an altered stability or resistance at certain temperatures.

June 1, 2012
Hygienerisiken steriler Septen-Systeme für Infusionslösungen bei Mehrfachentnahme
FHH Brill, H Brill

Studiendesign: In einer hygienisch-mikrobiologischen Laborstudie wurde untersucht, ob Septen-Systeme von Infusionsflaschen mit einem alkoholischen Hautantiseptikum desinfizierbar sind und ob es diesbezüglich Unterschiede zwischen verschieden konstruierten Systemen gibt. Die Untersuchung sollte zeigen, welches hygienische Risiko bei der Wiederverwendung solcher Systeme entsteht, die herstellerseitig nur für den einmaligen Gebrauch vorgesehen sind.

Methodik: Jeweils 10 Septen-Systeme (Kabipac®, Ecoflac® plus, Sintetica-Bioren) wurden mit 2,5 x 108 KBE des Hautbakteriums Staphylococcus aureus und des Luftkeims Kucuria rhizophila kontaminiert. 9 Systeme wurden nach Antrocknung der Bakterien mit einem alkoholischen Hautantiseptikum wischdesinfiziert. 1 System diente als Wachstumskontrolle. Anschließend wurde die bakterielle Restbelastung mittels Tupferprobe bestimmt.

Ergebnisse: Nach der Desinfektion von Ecoflac® plus zeigten 7 von 9 Tupferproben kein Wachstum. Von einem Septen-System wurde ein Bakterium und von einem 37 KBE isoliert. Bei Kabipac® waren 7 Tupferproben keimfrei; in 2 Fällen wurden hohe Keimzahlen zurückgewonnen. Die Tupferabstriche des Septen-Systems von Sintetica-Bioren zeigten in 6 von 9 Fällen hohe Keimzahlen. 2 Tupferproben zeigten kein Wachstum.

Schlussfolgerungen: Grundsätzlich ist eine effektive Desinfektion von Infusionsflaschen-Septen-Systemen mit einem alkoholischen Hautantiseptikum möglich. Jedoch sind verschieden konstruierte Systeme, unterschiedlich leicht hygienisch aufzubereiten. Je einfacher das Desinfektionsmittel bei einer Wischdesinfektion die Oberflächen der Systeme erreicht, desto höher ist die Wirkung. Deshalb sind solche Systeme für den Einsatz in der Praxis zu bevorzugen, bei denen die Oberflächen einfach zu erreichen und die möglichst eben ausgeführt sind.

cleansing disinfection antiseptics preservation

December 15, 2020
Virucidal efficacy of glutaraldehyde for instrument disinfection
FHH Brill, B Becker, D Todt, E Steinmann, J Steinmann, D Paulmann, B Bischoff, J Steinmann

Aim: Glutaraldehyde (GDA) is an active ingredient in many instrument disinfectants and is effective against a broad spectrum of microorganisms. In the past, the virus-inactivating properties of these products were mainly claimed based on quantitative suspension tests with different test viruses. Recently, however, a European Norm EN 17111:2018 has been published which allows examination of instrument disinfec- tants in a surface carrier test, simulating practical conditions. Therefore, it is of interest to evaluate GDA for the ability to inactivate the viruses used in this European Norm as test viruses.

Methods: The virucidal efficacy of GDA as the active ingredient in instru- ment disinfectants was evaluated with 4 different test viruses in a method simulating practical conditions (EN 17111:2018).

Results: With a fixed exposure time of five minutes at 20°C, 100 ppm GDA were necessary to inactivate vaccinia virus, classifying it as a limited spectrum virucidal activity for precleaning products. For adenovirus, 125 ppm GDA were required, whereas for murine norovirus as a surro- gate for human norovirus, 4,000 ppm GDA were required for a significant reduction of viral titres. Both nonenveloped viruses must be tested to prove virucidal activity in EN 17111:2018. But even 4,000 ppm were not enough to yield a 4 log10 reduction of the murine parvovirus at 20°C. This virus is only required as a test virus using this method if tempera- tures ≥40°C are used.

Conclusion: GDA, as the active ingredient of many instrument disinfec- tants, shows virucidal efficacy at 20°C. The necessary concentrations are strongly dependent on the stability of the test viruses. Due to the high stability of murine norovirus, GDA levels of 4,000 ppm were required to inactivate this virus within the 5-minute exposure time.

January 3, 2019
Prüfmethode für die vergleichende Bewertung von Instrumentenreinigern zur manuellen Aufbereitung von chirurgischen Instrumenten auf der Basis von Fibrin
M Wehrl, U Rosenberg, FHH Brill, H Gabriel, A Kampe, W Michels, K Roth, L Schnieder, P Frey, J Köhnlein, O Riebe, A Hartung, R Bloß, G Kirmse, MT Linner, D Martini, M Tschoerner, U Weber, S Krüger, H Martiny, J Gebel
Gegenwärtig existieren weder in Deutschland noch international allgemein akzeptierte Methoden zur Überprüfung der Wirksamkeit von Reinigern für die Aufbereitung von Instrumenten. Die Anforderungen, die an eine adäquate Prüfmethode gestellt werden, sind:
i) Auswahl einer schwierig zu entfernenden praxisrelevanten Testanschmutzung,
ii) Definierte Aufbringung der Testanschmutzung auf eine relevante Oberfläche,
iii) Quantitative Elution von Restanschmutzungen sowie
iv) Festlegung eines repräsentativen Analyten (Leitsubstanz) und adäquater Methoden zur Quantifizierung des Analyten.
Die 2011 gegründete Arbeitsgruppe Reinigungsmitteltestung (AG RMT) der Deutschen Gesellschaft für Krankenhaushygiene e.V. (DGKH) erarbeitete und etablierte eine neue Prüfmethode zur vergleichenden Bewertung von Reinigern für die Instrumentenaufbereitung.
Im Folgenden wird eine auf einem Fibrinprüfkörper (F-PCD) basierende Methode vorgestellt, die es erlaubt, anhand der hochmolekularen und wasserunlöslichen Testanschmutzung Fibrin die Wirksamkeit verschiedener Reiniger in einem Tauchmodell (keine Mechanik) vergleichend zu untersuchen und verschiedene Instrumentenreiniger hinsichtlich ihrer Wirksamkeit zu unterscheiden. Die Besonderheit der Methode beruht auf dem Einsatz von wasserunlöslichem Fibrin als praxisrelevanter Testanschmutzung. Fibrin gilt als kritische, am schwierigsten zu entfernende Proteinanschmutzungskomponente chirurgischer Instrumente und konnte bislang mittels etablierter Elutions- und Proteinquantifizierungsmethoden nicht erfasst und bewertet werden. Durch die Entwicklung einer neuen Elutionsmethode kann die wasserunlösliche Fibrinanschmutzung der Prüfkörper in eine solubilisierte Form überführt und mittels etablierter Proteinquantifizierungsmethoden (OPA-, BCA-Methode) erfasst werden. Durch mehrere Ringversuche mit bis zu sechs beteiligten Laboren wurde die Reproduzierbarkeit und Vergleichbarkeit der Ergebnisse der neu entwickelten Methode überprüft und bestätigt. Die Arbeiten der AG RMT führten sowohl zur Entwicklung einer neuen Prüfmethode als auch zu einem umfangreich erweiterten Verständnis der vollumfänglichen Erfassung von Restproteingehalten auf aufbereiteten Medizinprodukten.

October 1, 2018
Sterilization procedures for CO2 incubators
L. Knegendorf, H Brill, J Steinmann, S Pahl, E Steinmann, FHH Brill

Cell culture methods are utilized ubiquitously in science and pharmaceutical and biotech industries. Sterility is one crucial factor for maintenance of cells and creation of valid data from experiments. As cells are usually cultured in CO2 incubators, those are one bottleneck in terms of sterility in a cell culture lab. This review gives an overview on the different sterilization procedures for CO2 incubators on the market with emphasize to considerations from a practical point of view. It compares sterilization by dry heat, steam, gas and ultraviolet radiation in terms of validity and practicability in accordance with international standards and regulations and transfers literature consensus about these methods to CO2 incubators. As conclusion, the authors give recommendations for a sterile working environment in line with good cell culture practice.

June 1, 2018
Bestimmung des Restproteingehalts von manuell aufbereiteten dentalen Übertragungsinstrumenten. Verfahren zur Eliminierung von Matrixeffekten
A Kampe, M Wehrl, A Pfannmüller, FHH Brill

Ein elementarer Bestandteil der validierten Aufbereitung dentaler Übertragungsinstrumente ist die periodische Kontrolle des Aufbereitungserfolges durch eine Restproteinbestimmung mittels der OPA-Methode. Matrixeffekte zwischen Rückständen der zur manuellen Aufbereitung eingesetzten Chemikalien und dem OPA-Reagenz können die Proteinquantifizierung beeinflussen und zu massiv falsch-positiven Ergebnissen führen. Die vorliegende Arbeit zeigt erstmals eine neuartige Methode zur Eliminierung dieser Matrixeffekte. Durch Zugabe einer Zelltrümmersuspension zum OPA-Messansatz konnte eine Eliminierung der Matrixeffekte um 74 – 100 % erreicht werden.

December 1, 2017
Prüfung und Deklaration der Wirksamkeit von Desinfektionsmitteln gegen Viren zur Anwendung im human-medizinischen Bereich
I Schwebke, M Eggers, J Gebel, B Geisel, D Glebe, I Rapp, J Steinmann, HF Rabenau

Stellungnahme des Arbeitskreises Viruzidie beim Robert Koch-Institut (RKI), des Fachausschusses Virusdesinfektion der Deutschen Vereinigung zur Bekämpfung der Viruskrankheiten (DVV) e. V. und der
Gesellschaft für Virologie (GfV) e. V. sowie der Desinfektionsmittelkommission des Verbundes für Angewandte Hygiene (VAH) e. V.

November 1, 2017
Virucidal efficacy of peracetic acid for instrument disinfection
B Becker, FHH Brill, D Todt, E Steinmann, J Lenz, D Paulmann, B Bischoff, J Steinmann

Background: Various peracetic-acid (PAA)-based products for processing flexible endoscopes on the market are often based on a two-component system including a cleaning step before the addition of PAA as disinfectant. The peracetic acid concentrations in these formulations from different manufacturers are ranging from 400 to 1500 ppm (part per million). These products are used at temperatures between 20 °C and 37 °C. Since information on the virus-inactivating properties of peracetic acid at different concentrations and temperature is missing, it was the aim of the study to evaluate peracetic acid solutions against test viruses using the quantitative suspension test, EN 14476. In addition, further studies were performed with the recently established European pre norm (prEN 17111:2017) describing a carrier assay for simulating practical conditions using frosted glass.

Methods: In the first step of examination, different PAA solutions between 400 and 1500 ppm were tested at 20 °C, 25 °C, and 35 °C with three test viruses (adenovirus, murine norovirus and poliovirus) necessary for creating a virucidal action according to the European Norm, EN 14476. A second step for simulating practical conditions based on prEN 17111:2017 followed by spreading a test virus together with soil load onto a glass carrier which was immerged into a peracetic acid solution. A fixed exposure time of five minutes was used in all experiments.

Results: In the quantitative suspension test 1500 ppm PAA solution was needed at 35 °C for five minutes for the inactivation of poliovirus, whereas only 400 ppm at 20 °C for adeno- and murine norovirus were necessary. In the carrier assay 400 ppm peracetic acid at 20 °C were sufficient for adenovirus inactivation, whereas 600 ppm PAA were needed at 25 °C and 35 °C and 1000 ppm at 20 °C for murine norovirus. A PAA solution with 1000 ppm at 35 °C was required for complete inactivation of poliovirus. However, a dramatically decrease of titer after the drying and immerging could be observed. In consequence, a four log reduction of poliovirus titer could not be achieved in the carrier test.

Conclusion: In summary, 1500 ppm PAA at 35 °C was necessary for a virucidal action in the quantitative suspension test. After passing the requirements of the suspension test, additional examinations with adeno- and murine norovirus on glass carriers based on prEN 17111:2017 will not additionally contribute to the final claim of an instrument disinfectant for virucidal efficacy. This is due to the great stability of poliovirus in the preceded quantitative suspension test and the fact that poliovirus could not serve as test virus in the following carrier assay.

Keywords: Peracetic acid, Virucidal efficacy, Instrument disinfection

February 1, 2017
Virucidal activity of WHO-recommended formulations against enveloped viruses including Zika, Ebola and emerging Coronaviruses
A Siddharta, S Pfaender, Na Jane Vielle, R Dijkman, M Friesland, B Becker, J Yang, M Engelmann, D Todt, MP Windisch, FHH Brill, J Steinmann, J Steinmann, S Becker, MP Alves, T Pietschmann, M Eickmann, V Thiel, E Steinmann

The World Health Organization (WHO) published two alcohol-based formulations to be used in healthcare settings and outbreak-associated infections, but inactivation efficacies of these products have not been determined against (re-) emerging viruses. In this study, we evaluated the virucidal activity of these WHO products in a comparative analysis. Zika virus (ZIKV), Ebola virus (EBOV), Severe Acute Respiratory Syndrome coronavirus (SARS-CoV), Middle East Respiratory Syndrome coronavirus (MERS-CoV) as (re-) emerging viral pathogens and other enveloped viruses could be efficiently inactivated by both WHO formulations implicating their use in healthcare systems and viral outbreak situations.

January 1, 2017
Virucidal efficacy of a sonicated hydrogen peroxide system (trophon® EPR) following European and German test methods
B Becker, B Bischoff, FHH Brill, E Steinmann, J Steinmann

Aim: The virucidal efficacy of an automated ultrasound probe disinfector (trophon® EPR) was evaluated in a three step procedure according to European and German test methods. This system uses sonicated hydrogen peroxide mist (35%) at elevated temperature (50°C) in a closed chamber with control of all parameters within a 7 minute cycle.

Methods: In the first step of examination, the peroxide solution was tested in a quantitative suspension assay according to the Guideline of Deutsche Vereinigung zur Bekämpfung der Viruskrankheiten (DVV) e.V. and Robert Koch-Institute (RKI) and in parallel with the European Norm EN 14476 with all test viruses creating a virucidal claim.

In the second step, the virucidal efficacy of the hydrogen peroxide solution was evaluated in a hard surface carrier test according to the Guideline of DVV with adenovirus, murine norovirus and parvovirus simulating practical conditions.

Finally, the efficacy was evaluated by the automated system using stainless steel carriers inoculated with test virus and positioned at different levels inside the chamber.

Results: A ≥4 log10 reduction of virus titre was demonstrated with all methods including carrier tests with murine norovirus, adenovirus, and parvovirus using the automated device.

Conclusion: The automated device is able to inactivate test viruses of German and European norms and can therefore claim efficacy against human pathogenic enveloped and non-enveloped viruses. This includes human papillomaviruses which form part of the complete virucidal claim.

Keywords: disinfection, ultrasound probes, virucidal efficacy, trophon® EPR, human papillomaviruses


Zielsetzung: Die viruziden Eigenschaften der maschinellen Aufbereitung von vaginalen Ultraschallsonden (trophon® EPR) wurden in einem dreistufigen Prozess untersucht. Das System basiert auf der Vernebelung einer speziellen Peroxidlösung (35%) in einer geschlossenen Kammer bei erhöhter Temperatur (50°C) und einer Einwirkzeit von 7 min unter Kontrolle aller Parameter.

Methode: Im ersten Schritt wurde die Peroxidlösung in einem quantitativen Suspensionsversuch gemäß der Leitlinie der Deutschen Gesellschaft zur Bekämpfung von Viruskrankheiten e.V. (DVV) und des Robert Koch-Institutes und parallel gemäß der Europäischen Norm EN 14476 mit allen Prüfviren für eine viruzide Auslobung untersucht.

Im zweiten Schritt folgte ein Keimträgerversuch entsprechend der DVV-Leitlinie mit murinem Noro-, Adeno- und Parvovirus, um eine Viruzidie „high level“ zu zeigen.

Abschließend wurde die Wirksamkeit der maschinellen Aufbereitung mit den Viren der DVV-Leitlinie auf viruskontaminierten Edelstahlträgern überprüft.

Ergebnisse: Eine ≥4 log10 Reduktion des Virustiters konnte mit allen Methoden einschließlich der maschinellen Aufbereitung mit murinem Noro-, Adeno- und Parvovirus erreicht werden.

Schlussfolgerung: Die maschinelle Aufbereitung ist in der Lage, die Prüfviren der Deutschen und Europäischen Normen zu inaktivieren und erzielt damit den Anspruch, alle humanpathogenen behüllten und unbehüllten Viren einschließlich der humanen Papillomaviren zu inaktivieren, die Teil dieses resultierenden Claims einer kompletten Viruzidie sind.

Schlüsselwörter: Desinfektion, Ultraschallsonden, viruzide Wirksamkeit, trophon® EPR System, humane Papillomaviren

October 1, 2016
Hygienemotivation in Großküchen | Behr's Jahrbuch für die Gemeinschaftsgastronomie : Themen, Trends, Termine 2017
FHH Brill, S Pahl, J Praski, M Wodrich

Hygienemotivation in Großküchen
- Einleitung
- Rationale Einschätzung der Situation vieler Unternehmen
- Einflussfaktoren auf die Mitarbeiter-Compliance
- Leizsätze der Hygienemotivation

February 1, 2016
Hygienemotivation in der Lebensmittelproduktion: Der Schlüssel zu höchster Qualität
FHH Brill, S Pahl, J Praski, M Wodrich

Die Herstellung von Lebensmitteln unterliegt einer Vielzahl von Regularien im Rahmen des Lebensmittelrechts und der Lebensmittelkontrolle, deren oberstes Ziel der Gesundheitsschutz der Verbraucher ist.

September 1, 2015
Alcohol hand rub or soap and water for removal of norovirus from hands – the debate continues
J Steinmann, B Becker, B Bischoff, E Steinmann

Tuladhar et al. described a comparison between a propanol-based hand rub (Sterillium; BODE Chemie GmbH, Hamburg, Germany) and a hand soap (Unicura Hand soap; Colgate Palmolive, Weest, The Netherlands) for efficacy against murine norovirus (MNV) as a surrogate for human norovirus in a finger pad model. They reported that MNV infectivity reduction by washing hands with soap and water was significantly higher (P = 0.004) than treating hands with the rub. No residual virus was detected after handwashing in contrast to treatment with Sterillium.

June 1, 2015
Residual Antiseptic Efficacy of Octenidine dihydrochloride versus Chlorhexidine gluconate in Alcoholic Solutions
FHH Brill, N Radischat, P Goroncy-Bermes, J Siebert

Introduction: Skin antisepsis is an important measure to prevent postoperative infections. It is known that wound infections infringe the well-being of the patient and prolongs the rehabilitation significantly. At the same time additional costs will be caused in the health care system. Alcohol-based solutions containing the active ingredients chlorhexidine
gluconate [CHX] or octenidine dihydrochloride [OCT] have a residual antimicrobial effect on skin. This may re-sult in a better preventative outcome than alcohol alone.
Objectives: The aim of the presented study was to compare the immediate and long-term efficacy of CHX and OCT.
Methods: We performed a study on the skin on the arm of 20 healthy volunteers in a cross-over design based on DGHM standard method 13 and measured the colony forming units (cfu) of the resident skin flora after the application of the products according to Williamson and Kligman (1965). The cfu were determined directly after the application and after 24 h on 5 consecutive study days. The calculated log reduction factors were statistically evaluated with the student’s t-test.
Results: Both solutions showed as expected a significant any quick reduction of the resisdent skin flora and a long-term effect over 24 h. For OCT a statistically significant superior long-term effect after four applications was determined (lg reduction: (2.21 vs. 1.37; p = 0.004).
Conclusion: The presented data show that alcoholic solutions with octenidin dihydrochloride and chlorhexidine gluconate show a comparable efficacy on the resident skin flora. Alcohol-based preparations with the additional active octenidin dihydrochloride are a valid alternative for skin antisepics to the world-wide broadly used CHX-based products.

December 1, 2014
Mechanisms of viral inactivation methods against hepatitis C virus
S Pfaender, J Brinkmann, D Todt, N Riebesehl, J Steinmann, J Steinmann, T Pietschmann, E Steinmann

Virus inactivation by chemical disinfectants is an important instrument for infection control in medical settings, but the mechanisms involved are poorly understood. In this study, we systematically investigated the effects of several antiviral treatments on hepatitis C virus (HCV) particles as model for enveloped viruses. Studies were performed with authentic cell culture derived viruses and influence of chemical disinfectants, heat and UV treatment on HCV was analyzed by determination of infectious particles in a limiting dilution assay, quantitative RT-PCR, core ELISA and proteolytic protection assay. All different inactivation methods resulted in a loss of HCV infectivity by targeting different parts of the virus particle. Alcohols like ethanol and 2-propanol did not affect the viral RNA genome integrity, but disrupted the viral envelope membrane in a capsid protection assay. Heat and UV treatment of HCV particles resulted in direct damage of the viral genome as transfection of viral particle associated RNA into permissive cells did not initiate RNA replication. Additionally, heat incubation at 80°C disrupted the HCV envelope rendering the viral capsid susceptible to proteolytic digest. This study demonstrated the molecular processes of viral inactivation of an enveloped virus and should facilitate the development of effective disinfection strategies in infection control not only against HCV but also against other enveloped viruses.

microbiological test methods

December 1, 2020
Determination of legionella in routine examinations between 2012 and 2016 after amendments of the drinking water ordinance
M Kummerfeld, H Gabriel, S Pahl, E. Steinmann, D. Todt, J. Kunzmann, M. Kunzmann, J. Steinmann, FHH Brill

Legionella are a globally distributed aquatic bacterial genus. Since Legionella was first included in the Drinking Water Ordinance in 2011, there have been several amendments to date. In this study, test results ac- cording to Drinking Water Ordinance (TrinkwV) on Legionella of a North Ger- man drinking water test center from 2012 and 2016 were evaluated and pre- sented anonymously. The aim of the study was to investigate to what extent the amendment to the Drinking Water Ordinance has contributed to reducing the risk of contamination by Legionella.

January 23, 2020
Biofilm formation displays intrinsic offensive and defensive features of Bacillus cereus
J Caro-Astorga, E Frenzel, JR Perkins, A Álvarez-Mena, A de Vicente, JAG Ranea, OP Kuipers, D Romero

Biofilm formation is a strategy of many bacterial species to adapt to a variety of stresses and has become a part of infections, contaminations, or beneficial interactions. In this study, we demonstrate that profound physiological changes permit Bacillus cereus to switch from a floating to a sessile lifestyle, to undergo further maturation of the biofilm and to differentiate into the offensive or defensive features. We report that floating and biofilm cells are populations that differentiate metabolically, with members of each subpopulation developing different branches of certain metabolic pathways. Secondly, biofilm populations rearrange nucleotides, sugars, amino acids, and energy metabolism. Thirdly, this metabolic rearrangement coexists with: the synthesis of the extracellular matrix, sporulation, reinforcement of the cell wall, activation of the ROS detoxification machinery and production of secondary metabolites. This strategy contributes to defend biofilm cells from competitors. However, floating cells maintain a fermentative metabolic status that ensures a higher aggressiveness against hosts, evidenced by the production of toxins. The maintenance of the two distinct subpopulations is an effective strategy to face different environmental conditions found in the life styles of B. cereus.

February 5, 2019
Praxisnahe Prüfverfahren zum Nachweis viruzider Eigenschaften von Desinfektionsmitteln
J Steinmann, D Paulmann, S Pahl, FHH Brill

Desinfektionsmittel, die im Krankenhaus und in der ärztlichen Praxis zum Einsatz kommen sollen, müssen abhängig vom Anwendungsgebiet neben einer bakteriziden und levuroziden Wirksamkeit, auch gegen alle oder bestimmte Viren als Infektionserreger wirksam sein. Relevante virale Infektionserreger stellen beispielsweise Noroviren, Influenza A-Viren oder Herpes simplex-Viren dar. Doch erst vor einigen Jahren wurde intensiv damit begonnen, praxisnahe Prüfungen zur Viruswirksamkeit zu entwickeln. Aktuell wird weiterhin die Mehrzahl der viruziden Wirksamkeitsauslobungen lediglich auf Basis von Suspensionsversuchen getroffen, was den tatsächlichen Anwendungsfall der Produkte jedoch nur unzureichend nachstellt. Im Folgenden wird der Stand der Entwicklung praxisnaher Tests in der Virologie zusammengefasst.

March 1, 2016
Der 4-Felder-Test – ein ­geeignetes Verfahren zur Prüfung von Viruzidie?
J Steinmann

Die Auslobung der Viruzidie von Tüchern zur Flächendesinfektion basiert momentan ausschließlich auf einem Suspensionsversuch und einem Carrierversuch ohne Mechanik. Für die Bakterien und Pilze existiert bereits ein praxisnaher Test mit Mechanik (4-Felder-Test), der in der Virusprüfung bislang noch nicht vorhanden ist. Ziel muss es daher sein, auch für Viren diesen 4-Felder-Test zu entwickeln. Insbesondere müssen die Prüfviren für diese praxisnahe Methode noch ausgewählt werden, wobei darauf zu achten ist, dass diese das gesamte Spektrum der relevanten Erreger nosokomialer Infektionen abdecken. Erste Untersuchungen zeigen, dass eine solche praxisnahe Prüfmethode für Tücher auch mit Viren entwickelt werden kann, um dann eine entsprechende Viruzidie der Tücher ausloben zu können.

March 1, 2015
Is polyhexamethylene-guanidine hydrochloride (PHMGH) sporicidal? A critical review
FHH Brill, H Gabriel

No Abstract

January 1, 2014
Evaluation of a virucidal quantitative carrier test for surface disinfectants.
HF Rabenau, J Steinmann, I Rapp, I Schwebke, M Eggers

Surface disinfectants are part of broader preventive strategies preventing the transmission of bacteria, fungi and viruses in medical institutions. To evaluate their virucidal efficacy, these products must be tested with appropriate model viruses with different physico-chemical properties under conditions representing practical application in hospitals.

The aim of this study was to evaluate a quantitative carrier assay. Furthermore, different putative model viruses like adenovirus type 5 (AdV-5) and different animal parvoviruses were evaluated with respect to their tenacity and practicability in laboratory handling. To evaluate the robustness of the method, some of the viruses were tested in parallel in different laboratories in a multi-center study. Different biocides, which are common active ingredients of surface disinfectants, were used in the test. After drying on stainless steel discs as the carrier, model viruses were exposed to different concentrations of three alcohols, peracetic acid (PAA) or glutaraldehyde (GDA), with a fixed exposure time of 5 minutes. Residual virus was determined after treatment by endpoint titration.

All parvoviruses exhibited a similar stability with respect to GDA, while AdV-5 was more susceptible. For PAA, the porcine parvovirus was more sensitive than the other parvoviruses, and again, AdV-5 presented a higher susceptibility than the parvoviruses. All parvoviruses were resistant to alcohols, while AdV-5 was only stable when treated with 2-propanol. The analysis of the results of the multi-center study showed a high reproducibility of this test system.

In conclusion, two viruses with different physico-chemical properties can be recommended as appropriate model viruses for the evaluation of the virucidal efficacy of surface disinfectants: AdV-5, which has a high clinical impact, and murine parvovirus (MVM) with the highest practicability among the parvoviruses tested.

March 1, 2012
Der Einfluss der Viskosität von künstlichem Harn auf die Durchflussgeschwindigkeit in Kathetern
H Braunwarth, FHH.Brill, D Hegeholz, P Hammerer

Urologe 2012 51:403-408
DOI 10.1007/s00120-012-2807-8
Online publiziert: 15. Februar 2012
© Springer-Verlag 2012

antimicrobial wound management

October 1, 2018
Control of Cleaning of Dental Transfer Instruments: Challenge of Chemical Residues
A Kampe, FHH Brill, A Pfannmüller, M Wehrl

Chemical residues of detergents and disinfectants after the manual preparation of dental transfer instruments pose a particular challenge in the control of the cleaning success. This periodic control is an elementary part of the validated treatment and is carried out by determining the residual protein content by OPA method. Matrix effects between chemical residues and the OPA reagent can affect protein quantification and lead to massive false-positive results. The present work shows a novel method for eliminating these matrix effects. By adding a cell debris suspension to the OPA measurement approach, an elimination of the matrix effects by 74 - 100% could be achieved.

May 1, 2018
Decolonization potential of 0.02% polyhexanide irrigation solution in urethral catheters under practice-like in vitro conditions
FHH Brill, H Gabriel, H Brill, JH Klock, J Steinmann, A Arndt

Long-term use of indwelling urethral catheters is associated with high risk of urinary tract infection (UTI) and blockage, which may in turn cause significant morbidity and reduce the life of the catheter. A 0.02% polyhexanide irrigation solution has been developed for routine mechanical rinsing together with bacterial decolonization of suprapubic and indwelling urethral catheters.

Using a practice-like in vitro assay and standard silicon catheters, artificially contaminated with clinically relevant bacteria, experiments were carried out to evaluate the bacterial decolonization potential of polyhexanide vs. 1) no intervention (standard approach) and 2) irrigation with a saline (NaCl 0.9%) solution. Swabbing and irrigation was used to extract the bacteria.

Irrigation with polyhexanide reduced the microbial population vs. the control catheters by a factor of 1.64 log10 (swab extraction) and by a factor of 2.56 log10 (membrane filtration). The difference in mean microbial counts between the two groups (0.90) was statistically significant in favor of polyhexanide when the liquid extraction method was used (p = 0.034). The difference between the two groups using the swab extraction method did not reach statistical significance.

The saline and polyhexanide solutions are able to reduce bacterial load of catheters, which shows a combined mechanical and antimicrobial effect. Further research is required to evaluate the long-term tolerability and efficacy of polyhexanide in clinical practice.

July 1, 2017
Biofilme in chronischen Wunden: Entstehung und klinische Relevanz für die Wundheilung
FHH Brill, M Wodrich, S Pahl

Biofilme (wörtlich = lebende dünne Schicht) sind Lebensgemeinschaften unterschiedlicher Mikroorganismen. Diese sezernieren extrazelluläre polymere Substanzen (vorwiegend Zuckermoleküle), die die dreidimensionale Matrix des Biofilms bilden (3). Sofern ausreichend Nährstoffe, Wasser sowie eine Grenzfläche vorhanden sind, bilden sich Biofilme. Chronische Wunden erfüllen durch ihr feucht-warmes Milieu, einem ausreichenden Nährstoffangebot sowie dem Wundgrund als Grenzfläche gute Voraussetzungen für die Biofilmbildung. Deshalb sind in circa 60 % der chronischen Wunden Biofilmstrukturen nachweisbar (5). Der Wundgrund ist jedoch keine ideale Grenzfläche, da er zum Beispiel Exsudat sezerniert sowie durch Muskel- und Hautkontraktionen in Bewegung ist. Daher bilden sich im Vergleich zu festen Grenzflächen wie Kunststoffen in Wunden üblicherweise keine besonders schwer zu entfernenden Biofilme.

Mikroorganismen leben vorzugsweise in einem Biofilm, weil sie (6):
- vor Austrocknung und Scherkräften geschützt sind,
- eine bis zu 1000-fach geringere Sensibilität gegenüber antimikrobiellen Wirkstoffen ausbilden können,
- eine verbesserte Nährstoffversorgung haben,
- neue ökologische Mikronischen vorfinden zum Beispiel sauerstoffreiche und -arme Bereiche.

In der klinischen Praxis kann ein Biofilm in der Regel nur durch erfahrene Kliniker diagnostiziert werden. Biofilme stellen sich als schleimige Beläge dar. Grundsätzlich gilt, dass sie wie andere Wundbeläge die Wundheilung stören können, da sie eine chronisch-entzündlichen Reaktion stimulieren (4). Daher ist im Rahmen des Wundmanagements eine Entfernung von Biofilmen anzustreben. Hierfür gibt es verschiedene Möglichkeiten, wobei der Goldstandard die mechanische Entfernung ist. Dies ist in Wunden meist optimal möglich, da sie gut zugänglich sind. Dabei sind Maßnahmen, die zur Entfernung von „Wundbelägen“ wirksam sind, auch für Biofilme effektiv:
- Spülen mit Kochsalz-, Ringer-Lösung oder sterilem Wasser,
- Spülen mit tensidhaltigen, antimikrobiellen Wundspüllösungen,
- mechanisches Wischen in der Regel in Kombination mit einer der genannten Lösungen,
- „scharfe“ chirurgische Maßnahmen oder zum Beispiel Ultraschall-Debridement.
Optimal ist es, Biofilmen und Wundbelägen vorzubeugen durch:
- Spülen mit Kochsalz-, Ringer-Lösung oder sterilem Wasser,
- Spülen mit tensidhaltigen, antimikrobiellen Wundspüllösungen,
- mechanisches Wischen in der Regel in Kombination mit einer der genannten Lösungen.

Die Besonderheit bei der Prävention von Biofilmen ist, dass ein antimikrobieller Wirkstoff in der Wunde der Bildung von Biofilmen vorbeugen kann. Damit kann auch das Risiko für eine Wundinfektion vermindert werden, welches grundsätzlich bei vorhandenem Biofilm aufgrund der hohen Anzahl von Mikroorganismen hoch ist.
Abbildung 1 verdeutlicht, wie der antiseptische Wirkstoff Polyhexanid (PHMB) auf einen Biofilm wirkt (2). Die rot dargestellten toten Zellen zeigen, dass ausschließlich die oberen Schichten des Biofilms erreicht werden, daher kommt der Biofilmprävention eine besondere Bedeutung bei. Hierbei gilt, dass alle Maßnahmen, die zum mikro-biologischen Wundmanagement hilfreich sind, auch gegen Biofilme funktionieren. Abb. 1: Fluoreszenzmikroskopische Aufnahme zur Wirkung von 0,9 % Kochsalzlösung (oben) bzw. 0,02 % Polyhexanid (unten) auf einen künstlichen Biofilm. Durch Polyhexanid werden die Zellen an der Oberfläche des Biofilms abgetötet (grün = lebende Zellen, rot = tote Zellen).

Zusammenfassend kann festgehalten werden, dass die Reinigung und Infektionsprävention chronischer Wunden essentiell ist. Moderne Reinigung und Infektionspräven¬tion beinhaltet und beherrscht damit die Herausforderung Biofilm. Da Biofilme in chronischen Wunden nicht zu verhindern sind, ist ein erfolgreicher Wundmanager ein Biofilmmanager.

1. Brill F, Koca A, Böttrich JG. Behandlung von Wunden mit Prontosan-Wundspüllösung zur Entfernung von Biofilmen und anderen Wundbelägen. Hospitalis 2007;77(7/8):230-231.
2. Eberlein T, Fendler H, Hoffmann M. Ulcus cruris venosum – Prontosan-Lösung oder Standardbehandlung? Die Schwester Der Pfleger 2006;45(9/06):2-4.
3. Flemming HC, Wingender J. Biofilme – die bevorzugte Lebensform der Bakterien. Biologie in unserer Zeit 2001;31(3):169-179.
4. Flemming HC, Wingender J. Was Biofilme zusammenhält. Chemie in unserer Zeit 2002;36(1):30-42.
5. James GA, Swogger E, Wolcott R, et al. Biofilms in chronic wounds. Wound Repair Regen 2008;16(1):37-44.
6. Phillips PL, Wolcott RD, Fletcher J et al. Biofilms Made Easy. Wounds International 2010;1(3).

March 1, 2017
Effect of antiseptic irrigation on infection rates of traumatic soft tissue wounds: a longitudinal cohort study
B Roth, R Neuenschwander, FHH Brill, F Wurmitzer, C Wegner, O Assadian, A Kramer

Acute traumatic wounds are contaminated with bacteria and therefore an infection risk. Antiseptic wound irrigation before surgical intervention is routinely performed for contaminated wounds. However, a broad variety of different irrigation solutions are in use. The aim of this retrospective, non-randomised, controlled longitudinal cohort study was to assess the preventive effect of four different irrigation solutions before surgical treatment, on wound infection in traumatic soft tissue wounds.

Over a period of three decades, the prophylactic application of wound irrigation was studied in patients with contaminated traumatic wounds requiring surgical treatment, with or without primary wound closure. The main outcome measure was development of wound infection. From 1974-1983, either 0.04 % polihexanide (PHMB), 1 % povidone-iodine (PVP-I), 4 % hydrogen peroxide, or undiluted Ringer's solution were concurrently in use. From 1984-1996, only 0.04 % PHMB or 1 % PVP-I were applied. From 1997, 0.04 % PHMB was used until the end of the study period in 2005.

The combined rate for superficial and deep wound infection was 1.7 % in the 0.04 % PHMB group (n=3264), 4.8 % in the 1 % PVP-I group (n=2552), 5.9 % in the Ringer's group (n=645), and 11.7 % in the 4 % hydrogen peroxide group (n=643). Compared with all other treatment arms, PHMB showed the highest efficacy in preventing infection in traumatic soft tissue wounds (p<0.001). However, compared with PVP-I, the difference was only significant for superficial infections.

The large patient numbers in this study demonstrated a robust superiority of 0.04 % PHMB to prevent infection in traumatic soft tissue wounds. These retrospective results may further provide important information as the basis for power calculations for the urgently needed prospective clinical trials in the evolving field of wound antisepsis.

PHMB; antiseptics; hydrogen peroxide; polihexanide; povidone-iodine; traumatic soft tissue wounds; wound infection; wound irrigation

December 1, 2016
Letter to the Editor: According the article "Cytokine Expression in Human Osteoblasts After Antiseptic Treatment: A Comparative Study between Polyhexanide and Chlorhexidine" by Röhner E. et
T Eberlein, C Wiegand, FHH Brill

April 1, 2015
In-vitro study on endotoxin release of gram-negative bacteria after contact with silver releasing compared to DACC coated wound dressings
H Braunwarth, D Becher, FHH Brill

The treatment of critically colonized or locally infected wounds with local antimicrobial agents is a standard of care. The destruction of especially gram-negative bacteria potentially increases the endotoxin level in the wound. This in-vitro study aims to answer the question of whether and to what extent endotoxin release caused by the destruction of gram-negative bacteria is influenced by different wound dressing. Silver ion releasing dressings were compared to wound dressings with hydrophobic effect coated with dialkyl carbamoyl chloride (DACC). In addition, the bactericidal efficacy was measured. The log10 reduction factors (RF) against Pseudomonas aeruginosa were between 0 and 0.9 for the hyprophobic Dressings and 8.7 for the silver releasing dressing. The bacterial endotoxin content of the agar located under the dressing after contamination with P. aeruginosa was >300 <3,000 IU/ml in the case of a cotton gauze (control), >3,000 <30,000 IU/ml for DACC coated distance grid, >30 <300 IU/ml in for the DACC coated foam dressing and >0.3 <3 IU/ml in the case of the silver ion releasing dressing. The content of bacterial endotoxins which could be extracted from the wound dressing after contact with P. aeruginosa was >30,000 <300,000 IU/ml for the control dressing, >30,000 <300,000 IU/ml in the case of Cutimed Sorbact, >3,000 <30,000 IU/ml for the DACC coated foam dressing and >3 <30 IU/ml for the silver-releasing dressing. According to these findings, the silver ion releasing dressing has a higher antibacterial effect than wound dressings coated with DACC and it also releases a significantly lower amount of bacterial endotoxins.

June 1, 2014
Antimicrobial efficacy of modern wound dressings: Oligodynamic bactericidal versus hydrophobic adsorption effect
H Braunwarth, FHH Brill

Locally infected wounds and wounds colonised with multidrug-resistant bacteria are commonly treated with local antimicrobial agents. Recently, wound dressings have been introduced into clinical practice that reduces bacteria by adsorbing bacteria on the dressing surface by a hydrophobic effect. Our aim was to investigate, whether this hydrophobic effect is only present in dressings coated with dialkyl carbamoyl chloride (DACC) or also in other modern wound dressings.
To determine the hydrophobicity of the dressing surface contact angle measurements were performed. In addition, for selected wound dressings, the bacteria eliminating effect of the wound dressings for Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa were measured.
31 of the 34 wound dressings presented with a hydrophobic surface. The reduction factor (RF) of one wound dressing without coating was 1.6 for MRSA and RF 2.1 for P. aeruginosa. One with a DACC coated dressing showed a RF of 0.7 (MRSA) and 1.2 (P. aeruginosa). The RF of a wound dressing that releases silver ions was 6.1 for MRSA and 7.5 for P. aeruginosa respectively.
The results show that both uncoated and with DACC coated wound dressings can have hydrophobic surfaces. These hydrophobic dressings are able to adsorb bacteria onto their surface and consequently remove them from the wound. However, the RF for wound dressings that release silver ions is significantly higher.
Depending on the degree of contamination, these results can have an effect on the clinical decision to choose certain products. We assume that for e.g. infected or critically colonised wounds, wound dressings with a hydrophobic effect may not be sufficient to significantly improve the microbiological wound condition. However, this assumption has to be verified in clinical studies.

antifouling and biocorrosion

August 1, 2018
Volle Fahrt voraus! - Dynamische Prüfung
B Daehne, B Watermann, C Fürle


March 1, 2018
Putting anti-fouling coatings to the test
B Daehne, BT Watermann, C Fürle

Self-cleaning coatings offer ship owners critical protection against fouling and the issues this can cause. However, the mandatory tests for these coatings do not represent real-life conditions for the intended use. A novel circular test bench, that was developed in the R&D project “FoulProtect” funded by the Federal Ministry for Economic Affairs and Energy (FKZ: 03SX370E), uses a dynamic method to obtain accurate information, for example, on the minimum speeds required to activate self-cleaning effects and prevent fouling.

September 1, 2017
Antifouling biocides in German coastal & inland waters – How reliable are exposure prognoses of EU-scenario models for marinas?
B Watermann, D Daehne, C Fürle, A Thomsen

Reliable data regarding the amounts of leisure boasts and number of berths in marinas are needed for the EU biocidal products regulation of antifouling products. Since for Germany such data are lacking, a national survey was initiated by the German Federal Environmental Agency. The survey counted 206279 leisure boats, of which 71% is located in freshwater, 26% in brackish water, and 3% in salt water. High densities of boats were found at the western Baltic Sea, Lower Elbe, Mecklenburg Lake District, and Lake Constance. Antifouling concentrations were measured in selected marinas. MAMPEC was used to predict antifouling concentrations, and results the compared to measured concentrations.

August 1, 2015
Sicherung der Verlässlichkeit der Antifouling- Expositionsschätzung im Rahmen des EU-Biozid- Zulassungsverfahrens auf Basis der aktuellen Situation in deutschen Binnengewässern für die Verwe
B Watermann, D Daehne, C Fürle, A Thomsen

Um modellbasierte Prognosen von Antifouling-Wirkstoffeinträgen durch Sportboote durchzuführen, müssen im Rahmen der EU-Biozidproduktzulassung belastbare Daten zum Bestand von Sportbooten und Häfen mit ihren Liegeplätzen vorliegen. Für Deutschland waren solche repräsentativen Daten nicht verfügbar. Das Umweltbundesamt förderte eine Studie, um den Bestand an Liegeplätzen für Sportboote in Marinas und kleineren Häfen im Binnen- und Küstenbereich zu erfassen. Die bundesweite Bestandsaufnahme der Liegeplätze ergab eine Gesamtanzahl von 206.279, von denen sich 146.425 (71 %) im Süßwasser, 54.079 (26,2 %) im Brackwasser (Salinität <18%) und 5.775 (2,8 %) im Salzwasser befanden. Die Charakteristika und Formen der Sportboothäfen im Süßwasser waren sehr heterogen und entsprachen nicht dem klassischen Schema von offenen und geschlossenen Häfen. Die Anzahl der Boote an den Liegeplätzen variierte sehr stark in Abhängigkeit vom Revier und der Sportbootsaison. Als Gebiete mit hohen Liegeplatzzahlen erwiesen sich die Ostseeküste, die Unterelbe ab Hamburg, die Mecklenburger Seenplatte, die Gewässer in und um Berlin und der Bodensee mit weiteren Voralpenseen. In einem weiteren Arbeitsschritt wurden in 50 repräsentativen Sportboothäfen Wasserproben gezogen und auf die aktuell erlaubten Antifoulingbiozide und deren Abbauprodukte analysiert, um das Vorkommen von Antifoulingbioziden in der Wasserphase von Sportboothäfen im Küsten- und Binnenbereich zu dokumentieren. Im dritten Schritt wurden die gemessenen Konzentrationen mit denen verglichen, die mittels der Computermodellierung mit MAMPEC errechnet wurden. Es stellte sich heraus, dass das MAMPEC-Modell im Gegensatz zu Küstenhäfen für Süßwasserhäfen nur bedingt zuverlässig ist.

January 1, 2015
Antifouling: die unendliche Geschichte
B Watermann

Bestandsaufnahme und wie sieht der Bewuchsschutz für die Sportbootfahrt auf Binnenseen und Küstengewässern in Zukunft aus?
Von Dr. Burkard Watermann. Die Diskussion um Antifoulinganstriche hatte begonnen, nachdem durch Untersuchungen in den 70er Jahren bekannt wurde, dass ein Austernsterben im Becken von Arcachon an der französischen Atlantikküste auf die Antifoulingfarbe der sich damals stark vergrößernden Freizeitflotte zurückzuführen war. Damals begann die Suche nach Alternativen. Segelverbände und Farbenindustrie waren sich schnell einig: Gerade in den für Flora und Fauna so wichtigen Flachwasserzonen, in denen sich die Sportboothäfen befinden, sollte die Natur so wenig wie möglich belastet werden. Zumal schnell deutlich wurde, dass auch der Mensch, der am Ende der Nahrungskette steht, von den giftigen Stoffen betroffen werden kann.
In den vergangenen Jahren ist viel geschehen. Die Industrie musste und muss in den Antifoulingfarben auf immer mehr wirksame Biozide verzichten. Durch die Umsetzung der EU-Biozid-Verordnung, die für Deutschland zum ersten Mal ein Zulassungsverfahren für technische Biozide vorsieht, besteht eine gewisse Unsicherheit darüber, welche Antifouling-Biozide in Deutschland in Zukunft noch erlaubt sein werden. Alle sogenannten „Altbiozide“, die in den vergangenen Jahrzehnten im Gebrauch waren und für die kein Neuantrag auf Zulassung gestellt wurde, sind seit 2008 verboten. Hierzu gehören Diuron, Chlorthalonil und 30 andere Biozide.