Axel Kramer

Universität Greifswald · Institute of Hygiene and Environmental Medicine

In healthcare settings, contaminated surfaces play an important role in the transmission of nosocomial pathogens potentially resulting in healthcare-associated infections (HAI). Pathogens can be transmitted directly from frequent hand-touch surfaces close to patients or indirectly by staff and visitors. HAI risk depends on exposure, extent of conta...

The consensus-based guideline “hand antisepsis and hand hygiene” for Germany has the following sections: Prevention of nosocomial infections by hygienic hand antisepsis, prevention of surgical site infections by surgical hand antisepsis, infection prevention in the community by hand antisepsis in epidemic or pandemic situations, hand washing, selec...

Background Health care workers (HCW) in Emergency Medical Services (EMS) frequently come into contact with carriers of methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) strains and may acquire and transmit them to patients. However, there is little data on MSSA and MRSA colonization of medic...

Background: For reusable devices and device components, effective reprocessing is essential to prevent nosocomial infections. Aim: The objective of the study was to evaluate manual cleaning as the first step of reprocessing reusable glass probes of a device for genera-tion of non-invasive physical plasma, in accordance with regulations. Methods: Tw...

Objectives: Oral mucositis caused by intensive cancer chemotherapy or radiotherapy frequently results in pronounced damage of the oral mucosa leading to painful oral hygiene. To support oral care, antimicrobial effective mouth rinses may be used. Thus, the efficacy of a hypochlorite-based mouth rinse (Granudacyn®), assumed to be highly biocompatib...

Chronic wound infection is highly associated with morbidity and endangers the patient's life. Therefore, wound care products must have a potent antimicrobial and biofilm-eradicating effect. In this work, the antimicrobial/antibiofilm activity of two low-concentrated chlorine-based and releasing solutions was investigated on a total of 78 strains of...

Oral mucositis is the most common and severe non-hematological complication associated with cancer radiotherapy, chemotherapy, or their combination. Treatment of oral mucositis focuses on pain management and the use of natural anti-inflammatory, sometimes weakly antiseptic mouth rinses in combination with optimal oral cavity hygiene. To prevent neg...

Hair follicles constitute important drug delivery targets for skin antisepsis since they contain ≈25% of the skin microbiome. Nanoparticles are known to penetrate deeply into hair follicles. By massaging the skin, the follicular penetration process is enhanced based on a ratchet effect. Subsequently, an intrafollicular drug release can be initiated...

The approval of ethanol by the Biocidal Products Regulation has been under evaluation since 2007 due to controversial opinions on the risk assessment. Because of this critical situation, 2022 a memorandum was published to verify whether the use of ethanol for hand antisepsis poses any hazard. On the basis of the memorandum a toxicological evaluatio...

The German Society of Hospital Hygiene develops guidelines, recommendations and standard operation procedures on a voluntary basis, published on the DGKH-website (https://www.krankenhaushygiene.de/). The original German version of this recommendation was published in April 2022 and has now been made available to the international professional publi...

A newly developed UVC LED source with an emission wavelength of 233 nm was proved on bactericidal efficacy and skin tolerability. The bactericidal efficacy was qualitatively analysed using blood agar test. Subsequently, quantitative analyses were performed on germ carrier tests using the MRSA strain DSM11822, the MSSA strain DSM799, S. epidermidis...

Aim Periprosthetic joint infections are a devastating complication after arthroplasty, leading to rejection of the prosthesis. The prevention of septic loosening may be possible by an antimicrobial coating of the implant surface. Poly (hexamethylene) biguanide hydrochloride [PHMB] seems to be a suitable antiseptic agent for this purpose since previ...

Zielsetzung von Antiseptic Stewardship (ASS) ist die Eindämmung der Selektion Antibiotika-resistenter Bakterien und Pilze durch Einsatz von Antiseptika anstatt von Antibiotika, sofern durch Antiseptika eine vergleichbare oder höhere Effektivität zu erwarten ist. Die Notwendigkeit für ASS ist gegeben, da topische Antibiotika zu den meistverschrieben...

Ein kurzer Blick in die Geschichte zeigt, dass bereits im alten Ägypten dem Problem entzündlicher Augenveränderungen und auch deren Behandlung besondere Beachtung gezollt wurde. Erste Berichte zur Behandlung von Wundverletzungen können bis ca. 2600 v. Chr. zurückdatiert werden. Später im sog. „Papyros Ebers“ (ca. 1500 v. Chr.) wurden bereits Behand...

The current pandemic caused by COVID-19 has underlined the importance of a joint effort and approach to ensure patient and health care worker safety in medical care throughout Europe. In addition, the recent flood disasters in Germany and other countries called for immediate joint action, in this case with regard to the prevention of water-borne in...

Background: Vibrio spp. are aquatic bacteria that prefer warm seawater with moderate salinity. In humans, they can cause gastroenteritis, wound infections, and ear infections. During the summers of 2018 and 2019, unprecedented high sea surface temperatures were recorded in the German Baltic Sea. Aim: We aimed to describe the clinical course and mi...

The loss of skin integrity is inevitable in life. Wound healing is a necessary sequence of events to reconstitute the body’s integrity against potentially harmful environmental agents and restore homeostasis. Attempts to improve cutaneous wound healing are therefore as old as humanity itself. Furthermore, nowadays, targeting defective wound healing...

Unlike the native surface of the implant material (Ti6Al4V), oxidation with H2O2 leads to increased binding of the effective antimicrobial agent poly(hexamethylene) biguanide [PHMB]. However, treating with NaOH instead results in an even higher PHMB mass coverage. After oxidation with H2O2, strong differences in the PHMB adsorption capability betwe...

Multiresistant pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) cause serious postoperative infections. A skin tolerant far-UVC (< 240 nm) irradiation system for their inactivation is presented here. It uses UVC LEDs in combination with a spectral filter and provides a peak wavelength of 233 nm, with a full width at half maximum...

Methicillin-resistant Staphylococcus aureus (MRSA) can colonize dental patients and students, however, studies on the prevalence of MRSA and methicillin-susceptible S. aureus (MSSA) among dental health care workers (DHCW) including use of personal protective equipment (PPE) are scarce. We conducted an observational study (StaphDent study) to (I) de...

Hair follicles (HFs) are important drug delivery targets for the therapy of miscellaneous skin diseases and for skin antisepsis. Furthermore, HFs significantly contribute to drug delivery of topically applied substances. Nanoparticulate systems are excellently suited for follicular drug delivery as they entail the opportunity of directed drug trans...

Aim An outbreak of the extensively drug-resistant (XDR) K. pneumoniae strain ST307 in a cluster of North-German hospitals gave rise to the assumption that the epidemiological success of the strain could be based on an increased tolerance to biocides. Methods The tolerance of the outbreak strain was compared to epidemiologically unrelated clinical...

Abstract Background Cutibacterium acnes is part of the anaerobic skin microbiome and resides in deeper skin layers. The organism is an agent of surgical site infections (SSI) in shoulder surgery. We hypothesized that prolonged skin preparation with an agent that penetrates deeply into the skin would be beneficial. Thus, we compared two classes of a...

Chemical disinfection is an indispensable means of preventing infection. This holds true for healthcare settings, but also for all other settings where transmission of pathogens poses a potential health risk to humans and/or animals. Research on how to ensure effectiveness of disinfectants and the process of disinfection, as well as on when, how an...

Objective Local wound infections are a major challenge for patients and health professionals. Various diagnostic and therapeutic options are available. However, a generally accepted standard is still lacking in Europe. The aim was to develop an easy-to-use clinical score for the early detection of local wound infections, as a basis for decision-mak...

Background Antibiotic-resistant Klebsiella pneumoniae are a major cause of hospital- and community-acquired infections, including sepsis, liver abscess, and pneumonia, driven mainly by the emergence of successful high-risk clonal lineages. The K. pneumoniae sequence type (ST) 307 lineage has appeared in several different parts of the world after fi...

Objective Medical professionals have a key role in active patient involvement in infection control and prevention (ICP). ICP of hospital-associated infections is critical for patient safety and requires targeted integration of patients and their relatives. The possibilities of proper involvement are identified, tested and realized in the innovative...

Background/aim: The antiproliferative effects of cold atmospheric plasma (CAP) make it a promising application option in oncology. The aim of the present study was to examine whether short-term CAP treatment leads to an initial partial elimination of the treated cells or to long-term impairement and inhibition of cell growth. Materials and method...

Background Cutibacterium acnes is part of the anaerobic skin microbiome and resides in deeper skin layers. The organism is an agent of surgical site infections (SSI) in shoulder surgery and is difficult to target with skin antisepsis. We hypothesized that prolonged preparation with an agent that penetrates more deeply into the skin is more effectiv...

The COVID-19 crisis profoundly disguised the vulnerability of human societies and health care systems in the situation of a pandemic. In many instances, it became evident that the quick and safe reduction of viral load and spread is the foremost principle in the successful management of such a pandemic. However, it became also clear that many of th...

The generation of cold physical plasma at atmospheric pressure (cold atmospheric plasma: CAP) generates different reactive molecular species as well as radiation in the ultraviolet (UV) range. The therapy of tumor diseases has proven to be a new promising area of application for CAP treatment. With regard to the routine use of CAP in cancer therapy...

As a result of the coronavirus disease pandemic, commercial hand hygiene products have become scarce and World Health Organization (WHO) alcohol-based hand rub formulations containing ethanol or isopropanol are being produced for hospitals worldwide. Neither WHO formulation meets European Norm 12791, the basis for approval as a surgical hand prepar...

Background: Physical plasma is a mixture of reactive particles and electromagnetic radiation. Due to the antimicrobial, immunomodulatory, anti-inflammatory, wound-healing promoting, and antineoplastic effects of body tempered physical plasma under atmospheric pressure (cold atmospheric plasma: CAP), CAP therapy is increasingly becoming the focus o...

Immobilized polycationic substances on biomaterial surfaces kill adhering bacteria upon contact and are considered a promising non-antibiotic alternative. Unfortunately, there is no generally accepted in vitro method for quantitatively evaluating the antibacterial efficacy of contact-active non-leachable antimicrobial surfaces. Moreover, guidelines...

Osteosarcoma (OS) is the most common tumor of the musculoskeletal system. Recently, cold atmospheric plasma (CAP) has been regarded as a promising anti-oncogenic therapy. Previous experimental studies have demonstrated that CAP treatment results in significant growth inhibition of human sarcoma and is able to induce apoptosis. However, due to devic...

From June to October 2019, 17 patients (six infected, 11 colonised) with an extensively drug-resistant (XDR) Klebsiella pneumoniae strain were notified from four Western Pomerania medical facilities. The XDR K. pneumoniae produced carbapenemases NDM-1 and OXA-48, and was only susceptible to chloramphenicol, tigecycline and cefiderocol. Synergistic...

Background: The prevention of nosocomial infections requires participation from the patients themselves. In the past, however, patients have been apprehensive to point out hygiene-relevant behaviour to the personnel.In the project AHOI, the possibilities of active patient involvement in infection prevention are identified, tested and realized. The...

Antimicrobial coating of implant material with poly(hexamethylene biguanide) hydrochloride (PHMB) may be an eligible method for preventing implant‐associated infections. In the present study, an antibacterial effective amount of PHMB is adsorbed on the surface of titanium alloy after simple chemical pretreatment. Either oxidation with 5% H2O2 for 2...

Aim: Since the introduction of surgical gloves, one of the main challenges has been to improve donning and wearability. For the wearer, the formation of "glove juice" is problematic. To improve gliding properties for donning the gloves and absorbing sweat, in 1963 Bio-sorb® cream: sterile powder cream (Johnson & Johnson Medical, Gargrave, Skipton,...

Background: Cutibacterium acnes is part of the anaerobic skin microbiome and resides in deeper skin layers. The organism is an important agent of surgical site infections (SSI), particularly in shoulder surgery, and is difficult to target with skin antisepsis. We hypothesized that prolonged preparation with an agent that penetrates deeper into the...

Background: Prompted by an outbreak of vancomycin-resistant enterococci (VRE) in a medical facility, this study examined a pneumatic tube transport system (PTS) as a potential transmission channel. Method: Samples from receiving station and entry-racks were gathered via smear technique. Then sponges used for PTS decontamination were soaked with...

Background: A previous study among neonatal intensive care unit (NICU) nurses showed that the antibacterial efficacy of alcohol-based handrubs (ABHR) can be achieved in 15 s instead of 30 s with a significant increase in the frequency of hand antisepsis. This study aimed to examine 15-s vs 30-s antisepsis performance by measuring microbial load on...

While endoprothetic interventions become more and more routine, complications as periprothetic infections increase. These infections by mainly Staphylococcus epidermidis and Staphylococcus aureus, often lead to a rejection of the prosthesis and a need for replacement. This so called septic loosening could be prevented by antimicrobial coatings of i...

The colonization of implant surfaces by pathogenic bacteria forms the basis for periprosthetic infections possibly in septic loosening. The most commonly detected pathogens associated with implant infections are S.epidermidis and S.aureus. By forming a slimy biofilm, these microorganisms can protect themselves from environmental changes, the patien...

Background: Device-related infections in orthopaedic and trauma surgery are a devastating complication with substantial impact on morbidity and mortality. Systemic suppressive antibiotic treatment is regarded an integral part of any surgical protocol intended to eradicate the infection. The optimal duration of antimicrobial treatment, however, rema...

Objective: Due to classification of the agent polihexanide (PHMB) in category 2 'may cause cancer' by the Committee for Risk Assessment of the European Chemicals Agency in 2011, the users of wound antiseptics may be highly confused. In 2017, this statement was updated, defining PHMB up to 0.1% as a preservative safe in all cosmetic products. In th...

The inhibition of microbial growth is the first step toward avoiding the formation of biofilms. Therefore, this study aimed to compare the microbiostatic activity of cold atmospheric pressure plasma (CAP) with three commonly used antiseptic agents to find an alternative to or supplementary concept for antiseptic treatment. The efficacy of two CAP g...

Background/aim: In prostate cancer (PC), the formation of new blood vessels is stimulated by hypoxic conditions, androgens, and a number of molecular factors including microRNAs. MicroRNA-1 (miR-1) has been characterized in some tumor entities as anti-angiogenic, but this has not yet been investigated in PC. Materials and methods: PC cells stabl...

BACKGROUND/AIM: Therapeutic options for osteosarcoma (OS) are still limited. Cold atmospheric plasma (CAP) leads to inhibition of tumor growth and metastasis, but underlying mechanisms are not fully understood. The aim of this study was to investigate CAP-induced changes in cytokine expression in OS cells. MATERIALS AND METHODS: OS cell lines (U2...

Purpose Infections, in particular with multidrug-resistant organisms, are a burden for inpatient and outpatient care and the whole community. The pathogens “roam” with patients and their relatives, forming an epidemiological bridge between different care facilities. Patients could play an important role in infection control, given that they are pro...

The use of atmospheric low‐temperature plasma (AP) on chronic wounds and its effect on microbial bioburden in open wounds has not been explored with a systematic review and meta‐analysis. PRISMA guidelines were followed and PubMed, Embase, CENTRAL, and CINAHL databases searched for randomised controlled trials (RCTs), which compared AP with no AP f...

Hintergrund: Ziel von AHOI (Aktivierung der PatientInnen, Pflegebedürftigen und Pflegenden für eine hygienebewusste Partizipation an der Infektionsprävention) ist es, PatientInnen, Pflegebedürftige und Angehörige aktiv in den Infektionsschutz mit der Zielsetzung des besseren Selbstschutzes, mehr Bewegungsfreiheit der PatientInnen und Entlastung vo...

Aim: To describe the indication and technique of microbiological wound investigation in treating infected or colonised wounds with or without multi-drug resistant microorganisms (MDROs). The clinical symptoms and criteria of locally or systemically infected wounds are summarized and described. Method: An interdisciplinary consensus of microbiologic...

Background: Peritoneal lavage is often used for peritonitis, however, the volume and type of lavage fluid varies. Saline or Ringer's solution are used most often and lavage is performed until the fluid is clear. However, at present there is no irrigation fluid for peritoneal lavage with residual antiseptic activity. Because the combination of aque...

Objective: At present, the shortest recommended application time of alcoholic handrubs is an application interval of 30 seconds. However, application times shorter than 30 seconds are regularly practiced. Therefore, the aim of this study was to investigate whether a 15-second application time achieves a comparable wettability of hands to a 30-seco...

The enzymatic system in saliva, consisting of salivary peroxidase (SPO), hydrogen peroxide (H2O2), and thiocyanate (SCN−), produces hypothiocyanite (OSCN−) as a high effective antibacterial compound. OSCN− is of great importance for the natural non-specific antibacterial resistance in the oral cavity. However, no analytical method currently exists...

Promising cold physical plasma sources have been developed in the field of plasma medicine. An important prerequisite to their clinical use is lack of genotoxic effects in cells. During optimization of one or even different plasma sources for a specific application, large numbers of samples need to be analyzed. There are soft and easy-to-assess mar...

Background Ovarian cancer (OC) is a gynecologic tumor with poor prognosis. Despite radical cytoreductive surgery and platinum-based adjuvant systemic treatment, OC relapses in the majority of the cases. Several studies have suggested profound antitumor activity of cold atmospheric plasma (CAP). CAP is an ionized gas that mainly mediates its effects...

With Cold Atmospheric Plasma (CAP), chronic wounds in pets, which cannot be controlled by conventional therapy methods, can be healed without side effects. For several cases of wound disorders, e.g. in cases of suture dehiscence, impressive therapeutic results have been achieved by CAP.

Cold atmospheric plasma (CAP) operates at temperatures between 36 and 52°C. It is a highly efficient tool in a number of hygiene and biomedical applications. CAP is effective against microorganisms and viruses. Development of microbial resistance has not been observed yet and is not expected. As opposed to some chemical disinfectants and sterilizat...

Background/aim: Ovarian cancer (OC) is a gynecologic tumor with poor prognosis. Despite radical cytoreductive surgery and platinum-based adjuvant systemic treatment, OC will relapse in the majority of the cases. Thus, cold atmospheric plasma (CAP), a highly reactive physical state bearing diverse biological activities being suited for anticancer t...