S W Lemmen

University Hospital RWTH Aachen, Aachen, North Rhine-Westphalia, Germany

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Publications (81)149.73 Total impact

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    ABSTRACT: Clostridiumdifficile spores and multidrug-resistant (MDR) organisms, such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and MDR Acinetobacter baumannii, are important nosocomial pathogens that are difficult to eliminate from the hospital environment. We evaluated the efficacy of hydrogen peroxide vapor (HPV), a no-touch automated room decontamination system, for the inactivation of a range of pathogens dried onto hard nonporous and porous surfaces in an operating room (OR). Stainless steel and cotton carriers containing >4 log10 viable MRSA, VRE, or MDR A baumannii were placed at 4 locations in the OR along with 7 pouched 6 log10Geobacillus stearothermophilus spore biologic indicators (BIs). HPV was then used to decontaminate the OR. The experiment was repeated 3 times. HPV inactivated all spore BIs (>6 log10 reduction), and no MRSA, VRE, or MDR A baumannii were recovered from the stainless steel and cotton carriers (>4-5 log10 reduction, depending on the starting inoculum). HPV was equally effective at all carrier locations. We did not identify any difference in efficacy for microbes dried onto stainless steel or cotton surfaces, indicating that HPV may have a role in the decontamination of both porous and nonporous surfaces. HPV is an effective way to decontaminate clinical areas where contamination with bacterial spores and MDR organisms is suspected. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
    American Journal of Infection Control 01/2015; 43(1):82-5. DOI:10.1016/j.ajic.2014.10.007 · 2.33 Impact Factor
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    ABSTRACT: To assess the influence of signal colors on hand disinfectant dispenser activities, health care workers (HCWs) at a medical intensive care unit were analyzed for a total of 20 weeks with 8 weeks before and 12 weeks after exchange to signal color. No significant increase in hand rubs (HRs) per patient day (PD) was observed (about 40 HRs/PD); however, HCW-adjusted compliance showed a 6% increase with signal colored devices. Therefore, colored devices may help to improve hand hygiene compliance. Copyright
    American Journal of Infection Control 08/2014; 42(8):926–928. DOI:10.1016/j.ajic.2014.05.021 · 2.33 Impact Factor
  • Karl Lewalter, Sebastian Lemmen, Simone Scheithauer
    Intensivmedizin up2date 05/2014; 10(02):117-128. DOI:10.1055/s-0034-1365160
  • S Lemmen, S Scheithauer
    DMW - Deutsche Medizinische Wochenschrift 04/2014; 139(14):693-5. DOI:10.1055/s-0034-1369844 · 0.55 Impact Factor
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    ABSTRACT: The purpose of this report was to assess the safety and application of chlorhexidine (CHG)-containing dressings-shown to reduce central line infection rates markedly-for external ventricular drainages (EVDs) and lumbar drainages (LDs). Cerebrospinal fluid samples of patients receiving standard dressings and CHG-containing dressing (ten each) were analyzed by high-performance liquid chromatography for the presence of CHG. The application was evaluated. CHG was not detectable in all samples. The dressings' application for EVDs and LDs worked without problems. Thus, the use of CHG-containing dressings for EVDs and LDs seems to be safe. Further studies addressing their infection reduction potential are warranted.
    Infection 02/2014; 42(3). DOI:10.1007/s15010-014-0596-2 · 2.86 Impact Factor
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    ABSTRACT: OBJECTIVE: To compare the effect of two strategies (enhanced hand hygiene vs meticillin-resistant Staphylococcus aureus (MRSA) screening and decolonisation) alone and in combination on MRSA rates in surgical wards. DESIGN: Prospective, controlled, interventional cohort study, with 6-month baseline, 12-month intervention and 6-month washout phases. SETTING: 33 surgical wards of 10 hospitals in nine countries in Europe and Israel. PARTICIPANTS: All patients admitted to the enrolled wards for more than 24 h. INTERVENTIONS: The two strategies compared were (1) enhanced hand hygiene promotion and (2) universal MRSA screening with contact precautions and decolonisation (intranasal mupirocin and chlorhexidine bathing) of MRSA carriers. Four hospitals were assigned to each intervention and two hospitals combined both strategies, using targeted MRSA screening. OUTCOME MEASURES: Monthly rates of MRSA clinical cultures per 100 susceptible patients (primary outcome) and MRSA infections per 100 admissions (secondary outcome). Planned subgroup analysis for clean surgery wards was performed. RESULTS: After adjusting for clustering and potential confounders, neither strategy when used alone was associated with significant changes in MRSA rates. Combining both strategies was associated with a reduction in the rate of MRSA clinical cultures of 12% per month (adjusted incidence rate ratios (aIRR) 0.88, 95% CI 0.79 to 0.98). In clean surgery wards, strategy 2 (MRSA screening, contact precautions and decolonisation) was associated with decreasing rates of MRSA clinical cultures (15% monthly decrease, aIRR 0.85, 95% CI 0.74 to 0.97) and MRSA infections (17% monthly decrease, aIRR 0.83, 95% CI 0.69 to 0.99). CONCLUSIONS: In surgical wards with relatively low MRSA prevalence, a combination of enhanced standard and MRSA-specific infection control approaches was required to reduce MRSA rates. Implementation of single interventions was not effective, except in clean surgery wards where MRSA screening coupled with contact precautions and decolonisation was associated with significant reductions in MRSA clinical culture and infection rates.
    BMJ Open 09/2013; 3(9). DOI:10.1136/bmjopen-2013-00312 · 2.06 Impact Factor
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    ABSTRACT: OBJECTIVE: To compare the effect of two strategies (enhanced hand hygiene vs meticillin-resistant Staphylococcus aureus (MRSA) screening and decolonisation) alone and in combination on MRSA rates in surgical wards. DESIGN: Prospective, controlled, interventional cohort study, with 6-month baseline, 12-month intervention and 6-month washout phases. SETTING: 33 surgical wards of 10 hospitals in nine countries in Europe and Israel. PARTICIPANTS: All patients admitted to the enrolled wards for more than 24 h. INTERVENTIONS: The two strategies compared were (1) enhanced hand hygiene promotion and (2) universal MRSA screening with contact precautions and decolonisation (intranasal mupirocin and chlorhexidine bathing) of MRSA carriers. Four hospitals were assigned to each intervention and two hospitals combined both strategies, using targeted MRSA screening. OUTCOME MEASURES: Monthly rates of MRSA clinical cultures per 100 susceptible patients (primary outcome) and MRSA infections per 100 admissions (secondary outcome). Planned subgroup analysis for clean surgery wards was performed. RESULTS: After adjusting for clustering and potential confounders, neither strategy when used alone was associated with significant changes in MRSA rates. Combining both strategies was associated with a reduction in the rate of MRSA clinical cultures of 12% per month (adjusted incidence rate ratios (aIRR) 0.88, 95% CI 0.79 to 0.98). In clean surgery wards, strategy 2 (MRSA screening, contact precautions and decolonisation) was associated with decreasing rates of MRSA clinical cultures (15% monthly decrease, aIRR 0.85, 95% CI 0.74 to 0.97) and MRSA infections (17% monthly decrease, aIRR 0.83, 95% CI 0.69 to 0.99). CONCLUSIONS: In surgical wards with relatively low MRSA prevalence, a combination of enhanced standard and MRSA-specific infection control approaches was required to reduce MRSA rates. Implementation of single interventions was not effective, except in clean surgery wards where MRSA screening coupled with contact precautions and decolonisation was associated with significant reductions in MRSA clinical culture and infection rates. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT00685867.
    BMJ Open 09/2013; 3(9-9):e003126. DOI:10.1136/bmjopen-2013-003126 · 2.06 Impact Factor
  • Sebastian Lemmen, Karl Lewalter
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    ABSTRACT: Surgical site infections are the most common nosocomial infections. Strategies to prevent these infections are crucial. Evidence based measures like hand hygiene, treatment of nasal carriage of S. aureus, surveillance, prophylactic application of antibiotics or hair removal with electric clippers are listed in national and international guidelines. Beside these measures several myths and traditions like the application of antibiotic prophylaxis for several days or hygienic rituals in a septic operating theatre still exist. These measures are not helpful and should not be used any more. It is helpful to include effective measures in a bundle, the compliance with the bundle should be monitored regularly. Only the consequent implementation of evidence based and effective measures can help to prevent surgical site infections.
    ains · Anästhesiologie · Intensivmedizin 09/2013; 48(9):518-23. DOI:10.1055/s-0033-1355230 · 0.34 Impact Factor
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    ABSTRACT: The reduction of central venous line (CVL)-associated bloodstream infections (CLABSIs) is generally advocated. However, despite implementing infection prevention recommendations, CLABSI rates remain high at some institutions. Therefore, a chlorhexidine-containing dressing should be assessed for its potential for infection reduction, adverse events (AEs) and practicability. The number of CVLs, CVL days, CLABSIs and CLABSI rates with regard to the kind of dressing (standard vs. chlorhexidine-containing) were documented from November 2010 to may 2012 (1,298 patients with 12,220 CVL days) at two intensive care units (ICUs) and compared to historical controls. The practicability and safety of the chlorhexidine-containing dressing and reasons for not using this dressing were assessed. Forty CLABSIs occurred in 34 patients, resulting in a significantly lower overall CLABSI rate in patients with the chlorhexidine-containing dressing [1.51/1,000 CVL days; confidence interval (CI): 0.75-2.70] compared to patients with the standard dressing (5.87/1,000 CVL days; CI: 3.93-8.43; p < 0.0001). The CLABSI rate in historical controls receiving the standard dressing was 6.2/1,000 CVL days. The main reason for not using chlorhexidine-containing dressing was bleeding at the insertion site. AEs occurred in five patients and represented self-healing skin macerations (3 cases) and superficial skin necrosis (2 cases). In case of high CLABSI rates despite the implementation of standard recommendations, our findings suggest that a chlorhexidine-containing dressing safely decreases CLABSI rates.
    Infection 08/2013; 42(1). DOI:10.1007/s15010-013-0519-7 · 2.86 Impact Factor
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    ABSTRACT: The emergency department (ED) represents an environment with a high density of invasive, and thus, infection-prone procedures. The two primary goals of this study were (1) to define the number of hand-rubs needed for an individual patient care at the ED and (2) to optimize hand hygiene (HH) compliance without increasing workload. Prospective tri-phase (6-week observation phases interrupted by two 6-week interventions) before after study to determine opportunities for and compliance with HH (WHO definition). Standard operating procedures (SOPs) were optimized for invasive procedures during two predefined intervention periods (phases I and II) to improve workflow practices and thus compliance with HH. 378 patient cases were evaluated with 5674 opportunities for hand rubs (HR) and 1664 HR performed. Compliance significantly increased from 21% (545/2603) to 29% (467/1607), and finally 45% (652/1464; all p<0.001) in phases 1, 2, and 3, respectively. The number of HR needed for one patient care significantly decreased from 22 to 13 for the non-surgical and from 13 to 7 for the surgical patients (both p<0.001) due to improved workflow practices after implementing SOPs. In parallel, the number of HR performed increased from 3 to 5 for non-surgical (p<0.001) and from 2 to 3 for surgical patients (p=0.317). Avoidable opportunities as well as glove usage instead of HR significantly decreased by 70% and 73%, respectively. Our study provides the first detailed data on HH in an ED setting. Importantly, HH compliance improved significantly without increasing workload.
    BMC Infectious Diseases 08/2013; 13(1):367. DOI:10.1186/1471-2334-13-367 · 2.56 Impact Factor
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    ABSTRACT: Here we investigated a cluster of eight newly Methicillin-resistant Staphylococcus aureus (MRSA)-colonized neonates at an ICU, and present data on molecular strain characterization as well as the source identification process in which we analyze the impact of MRSA-colonized HCWs. Molecular strain characterization revealed a unique pattern which was identified as spa-type t 127 - an extremely rare strain type in Germany. Environmental sampling and screening of parents of colonized neonates proved negative. However, staff screening identified one healthcare worker (HCW; 1/134) belonging to a group of recently employed Romanian HCWs who was colonized with the spa 127 strain. Subsequent screening also detected MRSA in 9/51 Romanian HCWs (18%) and 7/9 (14% of all) isolates showed the same molecular pattern as the index case (spa/PFGE type). All carriers were successfully decolonized, after which no new patient cases occurred. As a result, we have now implemented a universal screening programme of all new employees as part of our infection control management strategy. MRSA-colonized HCWs can act as a source for in hospital transmission. Since HCWs from high endemic countries are particular prone to being colonized, they may pose a risk to patients.
    International journal of hygiene and environmental health 07/2013; 217(2-3). DOI:10.1016/j.ijheh.2013.07.006 · 3.28 Impact Factor
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    06/2013; 2(1). DOI:10.1186/2047-2994-2-S1-P110
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    ABSTRACT: BACKGROUND: The anesthesia working area represents an environment with a high density of invasive and, thus, infection-prone procedures. The 2 primary goals of this study were (1) to perform a precise analysis of anesthesia-related hand hygiene (HH) procedures and (2) to optimize HH compliance. METHODS: We conducted a prospective, triphase before/after study to determine opportunities for and compliance with hand disinfection (World Health Organization definition) in an anesthesia working area. Standard operating procedures were optimized for invasive procedures during 2 predefined intervention periods to improve work flow practices. RESULTS: Seven hundred fifty anesthesia procedures were evaluated with 12,142 indications for HH. Compliance significantly increased from 10% (465/4,636) to 30% (1,202/4,029) and finally to 55% (1,881/3,477; all P < .001) in phases I, II, and III, respectively. We identified a significant increase in the number of hand rubs performed during 1 anesthesia procedure (2 to 8, respectively; P < .001) in parallel with a significant decrease in number of opportunities needing a hand rub (24 to 14, respectively; P < .0001) because of improved work flow practices. Notably, the greatest improvement was seen before aseptic tasks (8% to 55%, respectively). CONCLUSION: Our study provides the first detailed data on anesthesia-related and indication-specific HH. Importantly, HH compliance improved significantly without a noticeable increasing workload.
    American journal of infection control 05/2013; 41(11). DOI:10.1016/j.ajic.2013.02.004 · 2.33 Impact Factor
  • Krankenhaushygiene up2date 03/2013; 08(01):25-38. DOI:10.1055/s-0032-1326392
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    ABSTRACT: In a previous observational intervention study, we achieved a more than 100 % increase in overall hand hygiene (HH) compliance in the hemodialysis setting by increasing the number of hand rubs (HR) performed and concomitantly optimizing HH standard operating procedures (SOPs). SOPs were mainly aimed at reducing the number of avoidable opportunities due to a less than perfect workflow. However, the long-term sustainability of this successful intervention was not evaluated. The present study was carried out to evaluate the long-term effects of our previous successful intervention. We conducted a follow-up observational study 1 year after the first intervention study in the same hemodialysis unit to assess the sustainability. No HH-related interventions were performed in the 1 year between studies. The main outcome was HH compliance, and the secondary outcome was opportunities per hemodialysis procedure. A total of 1,574 opportunities for HH and 871 hand rubs (HR) were observed during the follow-up observational study. Overall, compliance was 55 %, which was significantly than that at the end of the first study (62 %; p < 0.0001), but significantly higher than that at the start and mid-term phases of the first study (37 and 49 %, p < 0.0001). Both the decrease in HH opportunities and the increase in HR were sustained over the course of this observational study. The number of avoidable opportunities in the present study was similar to that at the end of the previous study. Thus, in 320 opportunities (20 %), gloves were worn instead of HR performed, representing 46 % of all missed HR. Despite a decrease in HH compliance compared to the last postintervention period, a multifaceted intervention focusing on standardization and workflow optimization resulted in a sustained improvement in HH. We therefore propose that standardization of the hemodialysis workflow aimed at improving HH is a promising avenue for improving the quality of patient care and outcome.
    Infection 02/2013; 41(3). DOI:10.1007/s15010-013-0424-0 · 2.86 Impact Factor
  • S. Scheithauer, S.W. Lemmen
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    ABSTRACT: Hand hygiene is considered to be the pillar of infection control and prevention. Despite national and international recommendations on hand hygiene, compliance remains low. Basic requirements allowing adequate hand hygiene compliance, in theory at least, are well known. Why then is it so hard to achieve acceptable compliance despite sufficient access to hand disinfectant dispensers, repeated training, and participation in national campaigns? Could it be that hand hygiene is regarded as too laborious, and changes to the established work-flow are needed to increase compliance? Some practicable examples are presented and pitfalls in defining compliance are discussed. Ownership for compliance must come from within clinical teams, and not solely driven from the infection control team. Support from the hospital management is essential. Ideally, the concepts presented allow a simple and efficient implementation of hand hygiene as part of the clinical work-flow to achieve an increase in compliance in the longer term.
    The Journal of hospital infection 02/2013; 83:S17–S22. DOI:10.1016/S0195-6701(13)60005-5 · 2.78 Impact Factor
  • S.W. Lemmen
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    ABSTRACT: Für die Vermeidung von Wundinfektionen stehen verschiedene Maßnahmen zur Verfügung. Die Teilnahme an einem Infektionssurveillanceprogramm, wie z. B. dem Krankenhaus-Infektions-Surveillance-System (KISS), ist gesetzlich verbindlich gefordert, hier steht ein spezielles Modul für die Erfassung postoperativer Wundinfektionen zur Verfügung. Patienteneigene Faktoren, wie z. B. Immunsuppression, Alkoholabusus, Nikotingebrauch oder Adipositas lassen sich meist nur in geringem Maße beeinflussen. Zu den präoperativen Maßnahmen gehören u. a. eine optimale Blutzuckereinstellung, Ausgleich einer Anämie oder einer Mangelernährung und die Behandlung von Infektionen bei elektiven Eingriffen. Auch eine Keimlastreduktion durch desinfizierende Körperwaschungen, Vermeidung einer scharfen Haarrasur, die Durchführung einer adäquaten Antibiotikaprophylaxe und eine korrekt durchgeführte chirurgische Hände- und Hautdesinfektion des Operationssitus stellen wichtige Maßnahmen dar. Intraoperativ sind ein Auskühlen des Patienten zu vermeiden und auf die strikte Einhaltung der Asepsis zu achten. Postoperative Maßnahmen umfassen eine sachgerechte Wundversorgung sowie ein zügiges Entfernen von Wunddrainagen.
    Arthroskopie 01/2013; 26(4). DOI:10.1007/s00142-013-0772-x
  • Karl Lewalter, Sebastian Lemmen, Simone Scheithauer
    Krankenhaushygiene up2date 12/2012; 07(04):275-289. DOI:10.1055/s-0032-1325954
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    ABSTRACT: BACKGROUND: Surveillance for central line (CL)-associated bloodstream infections (CLABSIs) is generally advocated. However, the standard definition of this surveillance does not take into account the number of CLs in place and thus the possibility of increased infection risk with multiple CLs in place simultaneously. In this study, we tested the hypothesis that simultaneous placement of more than 1 CL is associated with an increased CLABSI rate. METHODS: The number of CLs, CL-days, and CLABSIs and CLABSI rates with regard to the number of CLs in place simultaneously was documented in 2 intensive care units between 2001 and 2011. Standard CLABSI rates, as well as the rates for 1 CL and multiple CLs in place, were calculated. RESULTS: The average CLABSI rate was significantly lower in patients with 1 CL in place compared with those with more than 1 CL in place (3.69 per 1,000 CL-days vs 13.09/1,000 CL-days; incidence rate ratio [IRR], 3.63; 95% confidence interval [CI], 2.61-5.05). Importantly, all differences from the standard rate (5.94/1,000 CL-days) were significant (1 CL vs standard: IRR, 0.61; 95% CI, 0.51-0.74; more than 1 CL vs standard: IRR, 2.23; 95% CI, 1.87-2.65; both P < .0001). CONCLUSIONS: Our data show that the number of CLs in place had a strong influence on CLABSI rates. Thus, we advocate stratifying patients by the number of CLs in place to take this increased risk of infection into account during surveillance.
    American journal of infection control 08/2012; 41(2). DOI:10.1016/j.ajic.2012.02.034 · 2.33 Impact Factor
  • S Lemmen, K Lewalter
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    ABSTRACT: Fever is common in patients in intensive care units. Sources of fever can be infectious or non-infectious. The most common sources of infectious fever include ventilator-associated pneumonia, intravascular catheter-related infections, infection with Clostridium difficile or sinusitis. Typical examples of non-infectious fever include thromboembolic events, myocardial infarction, autoimmune disease, withdrawal symptoms or a drug-fever. Every new onset of fever prompts diagnostic decisions, treatment with antipyretics should be discussed critically.
    DMW - Deutsche Medizinische Wochenschrift 05/2012; 137(21):1123-5. DOI:10.1055/s-0032-1304941 · 0.55 Impact Factor

Publication Stats

590 Citations
149.73 Total Impact Points

Institutions

  • 2000–2015
    • University Hospital RWTH Aachen
      • Department of Neurology
      Aachen, North Rhine-Westphalia, Germany
  • 2001–2013
    • RWTH Aachen University
      • • Central Unit of Hospital Hygiene and Infectious Diseases
      • • Institut für Medizinische Mikrobiologie
      Aachen, North Rhine-Westphalia, Germany
  • 2010
    • Universitätsklinikum Freiburg
      • Department of Environmental Health Sciences
      Freiburg, Lower Saxony, Germany