Einsatz und Effektivität wieder verwendbarer endständiger Wasserfilter nach einer Standzeit von bis zu 8 Wochen in einer onkologischen Transplantationseinheit

Zielsetzung: Die Bereitstellung von Wasser mit Trinkwasserqualität ohne Gehalt an Trinkwasserpathogenen ist für immunsupprimierte Patienten von entscheidendem Einfluss auf die Mortalität und Letalität. Deshalb wurde in einer prospektiven Studie die Effizienz eines neu entwickelten aufbereitbaren Point-of-use Filters (Germlyser®, Aquafree GmbH, Hamburg) geprüft. Methode: Die Studie umfasste 4 Versuchsserien. In Versuchsserie 1 wurden die Filter nach einer Filterstandzeit von 7 d manuell, in Versuchsserie 2 maschinell in einem RDG aufbereitet. Nach der Aufbereitung wurden die Filter auf Leckage geprüft und in sterilen Behältern zwischengelagert. In Versuchsserie 3 wurde die Standzeit der Filter auf bzw. 4 Wochen verlängert und analog wie in Versuchsserie 2 aufbereitet. Versuchsserie 4 unterschied sich von Versuchsserie 3 durch den Einsatz eines im Gehäuse veränderten Filters und die auf 8 Wochen verlängerte Standzeit. Insgesamt wurden 12 Zapfeinrichtungen und 6 Brauseköpfe beprobt. In Versuchsserie 2 wurden 78 Proben von 6 Zapfeinrichtungen aus den Badezimmern der Patientenzimmer gezogen. Die Proben wurden jeweils direkt vor dem Filterwechsel gewonnen. Während Versuchsserie 1 mit wöchentlichem Filterwechsel über 3 Wochen durchgeführt wurde, beinhaltete Versuchsserie 2 13 Probennahmen mit jeweils wöchentlichem Filterwechsel im Verlauf von 7 Wochen, danach monatlich über 6 Monate. In Versuchsserie 3 wurden die Proben bei monatlichem Filterwechsel wöchentlich über 3 Monate gesammelt und in Versuchsserie 4 bei Filterwechsel nach 2 Monaten nach 2, 4 und 8 Wochen. Zur Probennahme wurde die erste auslaufende Wasserportion ohne vorheriges Abflammen des Wasserauslasses in einem sterilen Probennahmegefäß aufgefangen. Untersucht wurde auf Gesamtkoloniezahl bei 22 und 36 °C, coliforme Bakterien, P. aeruginosa, Fäkalstreptokokken, Legionella spp. und Schimmelpilze entsprechend Anlage 1 Nr. 5 der TrinkwV (1990), DIN EN 12780, der Empfehlung des Umweltbundesamts (2000) sowie gemäß Daeschlein et al. (2008). Ergebnisse: Während die manuelle Aufbereitung zur Verkeimung der Filter führte, gewährleistete die maschinelle Aufbereitung die sichere Dekontamination der Filter. Das gefilterte Wasser erfüllte die Anforderungen der Deutschen TrinkwV ebenso wie der die WHO Leitlinie, d. h. kein Nachweis von Wasserpathogenen und Koloniezahl or = 500 cfu/ml). As no reprocessed filter exhibited 100% filter efficacy in the final quality control after each reprocessing, these contaminations could be explained by retrograde contamination during use. CONCLUSION: As a consequence of the study, the manufacturer recommends changing filters after 4 weeks in high risk areas and after 8 weeks in moderate infectious risk areas, together with routine weekly alcohol-based surface disinfection and additionally in case of visible contamination. The filter efficacy of the 3 filters types did not differ significantly regarding total bacterial counts. Manual reprocessing proved to be insufficient. Using a validated reprocessing in a washer/disinfector with alkaline, acid treatment and thermic disinfection, the filters were effectively reprocessable and now provide tap water meeting the German drinking water regulations as well as the WHO guidelines, including absence of pathogens

Individualized Target Fortification of Breast Milk: Optimizing Macronutrient Content Using Different Fortifiers and Approaches

Background: Native breast milk composition displays significant inter- and intra-individual variation which persists after standard fortification with fixed doses and challenges target fortification. This study aims to analyze the macronutrient composition of different commercially available fortifiers and the effect of different fortification strategies on nutritional intake of preterm infants. Methods: In 103 preterm infants, native breast milk samples were collected from 24-h feeding batches (n = 3,338) and fat, protein and carbohydrate contents were analyzed. Nutrient content was compared for breast milk that had undergone either (i) standard fortification, (ii) targeted fortification, (iii) selective batching according to breast milk composition, or (iv) partial lyophilization. For (i) eight commercially available standard fortifiers were tested. Targeted fortification (ii) involved the addition of single component modulars of either protein, fat or carbohydrates to standard fortified breast milk. Using a mathematical growth model, the combined effect of protein, fat and carbohydrate intake on growth was assessed. The best composition of standard fortifiers as the initial step for target fortification was explored assuming three clinical scenarios for milk analysis. Results: Macronutrient content was highly variable between native breast milk samples, and this variation was still present after standard fortification, however at elevated macronutrient levels. Standard fortification, breast milk batching, as well as partial lyophilization of human milk resulted in deficient and imbalanced enteral intakes in a significant proportion of infants. Target fortification reduced this variation in a, respectively, higher percentage of samples. The effect size was dependent on the number of measurements per week. The optimum composition of standard fortifiers was dependent on the clinical scenario (measurement frequency) for target fortification. Conclusions: To provide precise and accurate intakes of macronutrients, breast milk should be target fortified. Standard fortified breast milk can result in excess above recommended intakes of some macronutrients which limits the efficiency of target fortification. Standard fortifiers with improved composition are needed for target fortification

Hygienic safety of reusable tap water filters (Germlyser^®) with an operating time of 4 or 8 weeks in a haematological oncology transplantation unit

Abstract Background Microbial safe tap water is crucial for the safety of immunosuppressed patients. Methods To evaluate the suitability of new, reusable point-of-use filters (Germlyser®, Aquafree GmbH, Hamburg, Germany), three variations of a reusable filter with the same filter principle but with different outlets (with and without silver) and inner surface coating of the filter encasements (with and without nano-crystalline silver) were tested. The filter efficacy was monitored over 1, 4 and 8 weeks operating time in a haematological oncology transplantation unit equipped with 18 water outlets (12 taps, 6 showers). Results The filtered water fulfilled the requirements of absence of pathogens over time. From 348 samples, 8 samples (2.3%) exceeded 100 cfu/ml (no sample ≥ 500 cfu/ml). As no reprocessed filter exhibited 100% filter efficacy in the final quality control after each reprocessing, these contaminations could be explained by retrograde contamination during use. Conclusion As a consequence of the study, the manufacturer recommends changing filters after 4 weeks in high risk areas and after 8 weeks in moderate infectious risk areas, together with routine weekly alcohol-based surface disinfection and additionally in case of visible contamination. The filter efficacy of the 3 filters types did not differ significantly regarding total bacterial counts. Manual reprocessing proved to be insufficient. Using a validated reprocessing in a washer/disinfector with alkaline, acid treatment and thermic disinfection, the filters were effectively reprocessable and now provide tap water meeting the German drinking water regulations as well as the WHO guidelines, including absence of pathogens.</p

Longitudinal stability of the filter efficacy for total bacteria counts in trial 2 (22°C, 31 weeks, 6 tap filters)

<p><b>Copyright information:</b></p><p>Taken from "Hygienic safety of reusable tap water filters (Germlyser) with an operating time of 4 or 8 weeks in a haematological oncology transplantation unit"</p><p>http://www.biomedcentral.com/1471-2334/7/45</p><p>BMC Infectious Diseases 2007;7():45-45.</p><p>Published online 23 May 2007</p><p>PMCID:PMC1892024.</p><p></p

CompactLight Design Study

International audienceH2020 CompactLight Project aims at designing the next generation of compact hard X-Rays Free-Electron Lasers, relying on very high accelerating gradients and on novel undulator concepts. CompactLight intends to design a compact Hard X-ray FEL facility based on very high-gradient acceleration in the X band of frequencies, on a very bright photo injector, and on short-period/superconductive undulators to enable smaller electron beam energy. If compared to existing facilities, the proposed facility will benefit from a lower electron beam energy, due to the enhanced undulators performance, be significantly more compact, as a consequence both of the lower energy and of the high-gradient X-band structures, have lower electrical power demand and a smaller footprint. CompactLight is a consortium of 24 institutes (21 European + 3 extra Europeans), gathering the world-leading experts both in the domains of X-band acceleration and undulator design

CompactLight design study

The H2020 CompactLight Project aims at designing the next generation of compact X-rays Free-Electron Lasers, relying on very high gradient accelerating structures (X-band, 12 GHz), the most advanced concepts for high brightness electron photo injectors, and innovative compact short-period undulators. Compared to existing facilities, the proposed facility will benefit from a lower electron beam energy, due to the enhanced undulators performance, and will be significantly more compact, with a smaller footprint, as a consequence of the lower energy and the high-gradient X-band structures. In addition, the whole infrastructure will also have a lower electrical power demand as well as lower construction and running costs

Status of the CompactLight Design Study

International audienceCompactLight (XLS) is an International Collaboration of 24 partners and 5 third parties, funded by the European Union through the Horizon 2020 Research and Innovation Programme. The main goal of the project, which started in January 2018 with a duration of 36 months, is the design of an hard X-ray FEL facility beyond today’s state of the art, using the latest concepts for bright electron photo-injectors, high-gradient accelerating structures, and innovative short-period undulators. The specifications of the facility and the parameters of the future FEL are driven by the demands of potential users and the associated science cases. In this paper we will give an overview on the ongoing activities and the major results achieved until now