Hygiene for dishwashers in care facilities and childcare centres

When is hygiene given and what do I have to do for it?!

Again and again the question arises whether the dishes are hygienically clean or even disinfected at the end of a washing cycle with a dishwasher. Is there a difference at all and if so, does it play a role?

But first of all we should clarify the most important terms and their differences:

• Hygiene
• Disinfection
• Sterilization

Definition: Hygiene

The word hygiene gr. hygieia is derived from the adjective hygieinós ('beneficial to health'). Hygiene is the teaching of the prevention of diseases and the maintenance and consolidation of health (source: www.who.int).

A superordinate task is especially to prevent influences from the environment and to regularly check the health of people.

What is hygiene?

• The term hygiene refers to all measures that serve to prevent infections.
• Probably the best known and most widespread hygiene measure is hand washing with soap. By simply washing your hands with soap, the amount of germs can be reduced by up to 99%.
• In a test with influenza A viruses, it was proven that 20 seconds of hand washing with soap was sufficient to no longer detect an infectious influenza virus.
• Since in most cases (also due to improper implementation) washing usually only leads to a reduction of germs but has no germicidal effect, the next step is hygienic hand disinfection.
• In this case, special agents are additionally used, which usually contain alcohol as the main active ingredient to kill or reduce germs.

Definition: Disinfection

So we now come to the next term of disinfection. According to the German Pharmacopoeia (DAB), disinfection means "to put dead or living material into a state that it can no longer infect". One speaks of disinfection when the result of a test procedure proves a reduction of 1,000,000 germs to a maximum of 10 germs capable of reproduction.

What is disinfection?

• Disinfection is a measure in which the number of infectious agents is reduced to such an extent that transmission or infection is no longer possible.
• Attention: There is no 100% reduction of germs! However, the small remaining number of germs is no longer sufficient to infect someone.
• In disinfection, a rough distinction is made between two disinfection methods. The chemical and the physical disinfection.
• In the latter, disinfection is achieved by radiation, dry heat or moist heat.
• There are also different ways of achieving disinfection in rinsing technology. The two most common ones in dishwashing technology, which are also used in the HOBART care dishwasher, are the following methods:
• Thermal disinfection (moist heat) via the wash and rinse temperature
• Chemical disinfection through the use of detergents and/or additional chemical aids

Definition: Sterilisation

Sterilisation is a disinfection with higher demands. Out of one million germs capable of reproduction, a maximum of one single germ may be left over during sterilization.

In contrast to disinfection, the aim of the sterilization process is to kill or damage all microorganisms and spores.

A 100% sterility should be achieved.

But what is now necessary in the area of the residential group in a retirement and nursing home?

Due to a weakened immune system, older people are often more susceptible to infections.
In an environment such as the residential group, the residents usually eat together.
The question is therefore: How do you ensure that the dishes used are not only visually clean, but also hygienically clean?

Commercial dishwashers differ significantly from household dishwashers in several respects and are therefore very suitable for the disinfectant reprocessing of dishes and cutlery in homes.

An important point is e.g. the water temperature with which a commercial dishwasher washes and rinses. For example, DIN EN 17735 suggests that temperatures in the rinse cycle of 80 - 85°C are a good basis.

This is what makes a commercial dishwasher so important for hygiene:

• Very high rinse temperatures of over 80 °C in the standard range
• Thermal disinfection with 100 °C hot steam
• Use of highly effective commercial cleaners (liquid or solid)
• Monitoring, display and recording of temperatures

MRSA, the super resistant hospital germ - When is it killed?

MRSA stands for methicillin-resistant Staphylococcus aureus. These are bacteria from the species Staphylococcus aureus.
They occur on the skin of many healthy people, but do not necessarily lead to the outbreak of the disease as long as they do not enter the body. These bacteria can become resistant to the antibiotic methicillin and also to most other antibiotics, i.e. become insensitive, which is a great danger for young and especially elderly people, e.g. in old people's homes and nursing homes.

The germs can be transmitted from person to person via contaminated objects, but also from animal to person. It is questionable how and how many germs are transferred to the dishes of a sick patient. There are the following procedural measures in the event that a patient is infected with MRSA:
The dishes of a patient should be brought into the kitchen covered/labelled if possible. It is important that the dishes are brought directly into the kitchen, otherwise the germs could be spread further.

Clean the dishes of an MRSA patient in the dishwasher: Most guidelines for MRSA patients do not specify any special precautions for the dishes. It is usually sufficient to clean the dishes with a short or normal dishwasher programme.
Ideally, however, the dishes should be washed in the dishwasher at maximum temperature (thermal disinfection with 100 °C steam and A0 value=60).

At this temperature it is to be expected that MRSA bacteria are reduced. A spread of the bacteria is therefore impossible. (Source: http://www.mrsa-net.nl/de/)
 

AO=60 - What does this value say?

To demonstrate or measure the reduction of microorganisms in processes with moist heat (steam) the scale A0 is used.
This value determines the required temperatures and holding times.
The value A0 is therefore a physical parameter that stands for the reduction of microorganisms.

A0 value table

An A0 value of 60 means according to the formula

• 70 °C at 10 min. holding time
• 80 °C at 60 seconds hold time
• 90 °C at 6 seconds hold time
• and so on

The performance of the disinfection is measured by the area of action and the reduction factor by which the amount of germs is reduced. It is therefore dependent on:

• the level of the initial bacterial count
• the nature of the germs
• the intended use of the material to be disinfected

So-called thermologgers are used to check machine thermal disinfection processes, recording temperature and time during operation.

Good to know!

With the HOBART care dishwasher you are making the right choice. With the combination of chemical and thermal disinfection, with the short and standard programme with 85 °C hot water, you are on the safe side. If this is still not enough for you, you can improve the result with the thermal disinfection programme and 100 °C hot steam. This will disinfect the wash ware with an A0=60 value and thus achieve a corresponding disinfection performance.