Anforderungen an die Hygiene bei der medizinischen Versorgung von immunsupprimierten Patienten

Koch-Institut, Kommission für Krankenhaushygiene und Infektionsprävention (Krinko) beim Robert

doi:10.1007/s00103-010-1028-9

Cited by 94 publications

(21 citation statements)

References 366 publications

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“…Infection-control measures in the haematological and oncologic setting are heterogeneous and contentious, particularly about transmission of fungi. The Robert Koch-Institute in Germany published recommendations on hygiene requirements for the medical care of immunocompromised patients [ 3 ]. However, most recommendations are based on expert opinion rather than actual published evidence.…”

Section: Resultsmentioning

confidence: 99%

Primary prophylaxis of invasive fungal infections in patients with haematological malignancies: 2017 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO)

et al. 2017

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Immunocompromised patients are at high risk of invasive fungal infections (IFI), in particular those with haematological malignancies undergoing remission-induction chemotherapy for acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS) and recipients of allogeneic haematopoietic stem cell transplants (HSCT). Despite the development of new treatment options in the past decades, IFI remains a concern due to substantial morbidity and mortality in these patient populations. In addition, the increasing use of new immune modulating drugs in cancer therapy has opened an entirely new spectrum of at risk periods. Since the last edition of antifungal prophylaxis recommendations of the German Society for Haematology and Medical Oncology in 2014, seven clinical trials regarding antifungal prophylaxis in patients with haematological malignancies have been published, comprising 1227 patients. This update assesses the impact of this additional evidence and effective revisions. Our key recommendations are the following: prophylaxis should be performed with posaconazole delayed release tablets during remission induction chemotherapy for AML and MDS (AI). Posaconazole iv can be used when the oral route is contraindicated or not feasible. Intravenous liposomal amphotericin B did not significantly decrease IFI rates in acute lymphoblastic leukaemia (ALL) patients during induction chemotherapy, and there is poor evidence to recommend it for prophylaxis in these patients (CI). Despite substantial risk of IFI, we cannot provide a stronger recommendation for these patients. There is poor evidence regarding voriconazole prophylaxis in patients with neutropenia (CII). Therapeutic drug monitoring TDM should be performed within 2 to 5 days of initiating voriconazole prophylaxis and should be repeated in case of suspicious adverse events or of dose changes of interacting drugs (BIItu). General TDM during posaconazole prophylaxis is not recommended (CIItu), but may be helpful in cases of clinical failure such as breakthrough IFI for verification of compliance or absorption.Electronic supplementary materialThe online version of this article (10.1007/s00277-017-3196-2) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Primary prophylaxis of invasive fungal infections in patients with haematological malignancies: 2017 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO)

et al. 2017

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“…For example, the HACCP concept has already been successfully adapted for water safety in hospitals, helping to prevent water-associated infections [ 20 ], [ 21 ]. Actually, many clinical pathways and hygienic directives use the principles of the proposed modified HACCP but without specifically addressing this [ 12 ], [ 22 ], [ 23 ]. Seeing these successful and well accepted measures from a new perspective could not only help to understand why some interventions work and others not, but also help to improve the concepts in general and overcome certain controversies in infection prevention.…”

Section: Discussionmentioning

confidence: 99%

Can the Hazard Assessment and Critical Control Points (HACCP) system be used to design process-based hygiene concepts?

Hübner

Fleßa²,

Haak³

et al. 2011

GMS Krankenhaushygiene Interdisziplinär; 6(1):Doc24; ISSN 1863-5245

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“…In general, both quantitative and qualitative determinations of the mould species can be dispensed with in the case of visible mould infestation. Instead, identifying the cause of infestation is far more important, followed by the elimination of infestation and its primary causes.Mould exposure can generally lead to mucous membrane irritation (MMI), odour effects and mood disorders.Specific clinical pictures seen in mould exposure are pertinent to allergies and fungal infections (mycosis).It is the physician’s duty to objectify suspected links between indoor moisture damage/mould and gastrointestinal or renal disease, reproductive disorders, teratogenicity or cancer.Risk groups warranting particular protection include:individuals on immunosuppression according to the classification of the German Commission for Hospital Hygiene and Infection Prevention ( Kommission für Krankenhaushygiene und Infektionsprävention , KRINKO) at the Robert Koch-Institute (RKI) [11],individuals with cystic fibrosis (mucoviscidosis),individuals with bronchial asthma. The risk for developing asthma (“allergic march”) is increased in:patients with allergic rhinoconjunctivitis,patients with allergic rhinosinusitis,atopic patients. It is likely that all moulds are capable of causing sensitization and allergies. Their allergenic potential is considered lower compared with other environmental allergens [12, 13].…”

Section: Core Messages Of the Awmf Mould Guidelinementioning

confidence: 99%

Abridged version of the AWMF guideline for the medical clinical diagnostics of indoor mould exposure

et al. 2017

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This article is an abridged version of the AWMF mould guideline “Medical clinical diagnostics of indoor mould exposure” presented in April 2016 by the German Society of Hygiene, Environmental Medicine and Preventive Medicine (Gesellschaft für Hygiene, Umweltmedizin und Präventivmedizin, GHUP), in collaboration with the above-mentioned scientific medical societies, German and Austrian societies, medical associations and experts. Indoor mould growth is a potential health risk, even if a quantitative and/or causal relationship between the occurrence of individual mould species and health problems has yet to be established. Apart from allergic bronchopulmonary aspergillosis (ABPA) and mould-caused mycoses, only sufficient evidence for an association between moisture/mould damage and the following health effects has been established: allergic respiratory disease, asthma (manifestation, progression and exacerbation), allergic rhinitis, hypersensitivity pneumonitis (extrinsic allergic alveolitis), and increased likelihood of respiratory infections/bronchitis. In this context the sensitizing potential of moulds is obviously low compared to other environmental allergens. Recent studies show a comparatively low sensitizing prevalence of 3–10% in the general population across Europe. Limited or suspected evidence for an association exist with respect to mucous membrane irritation and atopic eczema (manifestation, progression and exacerbation). Inadequate or insufficient evidence for an association exist for chronic obstructive pulmonary disease, acute idiopathic pulmonary hemorrhage in children, rheumatism/arthritis, sarcoidosis and cancer. The risk of infection posed by moulds regularly occurring indoors is low for healthy persons; most species are in risk group 1 and a few in risk group 2 (Aspergillus fumigatus, A. flavus) of the German Biological Agents Act (Biostoffverordnung). Only moulds that are potentially able to form toxins can be triggers of toxic reactions. Whether or not toxin formation occurs in individual cases is determined by environmental and growth conditions, above all the substrate. In the case of indoor moisture/mould damage, everyone can be affected by odour effects and/or mood disorders. However, this is not a health hazard. Predisposing factors for odour effects can include genetic and hormonal influences, imprinting, context and adaptation effects. Predisposing factors for mood disorders may include environmental concerns, anxiety, condition, and attribution, as well as various diseases. Risk groups to be protected particularly with regard to an infection risk are persons on immunosuppression according to the classification of the German Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention, KRINKO) at the Robert Koch- Institute (RKI) and persons with cystic fibrosis (mucoviscidosis); with regard to an allergic risk, persons with cystic fibrosis (mucoviscidosis) and patients with bronchial asthma should be protected.The rational diagnos...

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Anforderungen an die Hygiene bei der medizinischen Versorgung von immunsupprimierten Patienten

Cited by 94 publications

References 366 publications

Primary prophylaxis of invasive fungal infections in patients with haematological malignancies: 2017 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO)

Primary prophylaxis of invasive fungal infections in patients with haematological malignancies: 2017 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO)

Can the Hazard Assessment and Critical Control Points (HACCP) system be used to design process-based hygiene concepts?

Abridged version of the AWMF guideline for the medical clinical diagnostics of indoor mould exposure

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