Role of disinfection in the Infection Prevention Multibarrier System

The role of disinfection in infection prevention has been analyzed over the past 50 years both in the form of benefit-risk evaluations as well as in an epidemiological sense. This has served as the basis for not only national and international guidelines and recommendations, but has also created the legal and normative framework for regulation of infection control (and hence of disinfection) in numerous and acts and ordinances. Likewise, today the efficacy of disinfection measures, user safety and environmental compatibility in line with the state of the art are assured. Compliance as regards the conductance of disinfection measures has increased accordingly. The user is able to select and correctly employ the disinfectant most suited to the intended disinfection procedure. The quality of the apparatus used has vastly improved since the coming into force of the German Medical Devices Act (MPG). And finally the preconditions for conductance of disinfection have become so matter of fact that it is easy to forget just what progress has been made here. This applies e.g. to the facilities now available for hand hygiene, for decontamination of instruments, laundry and bedpans with washer-disinfectors as well as for surface disinfection and drinking water disinfection. But it is the human being who continues to pose the greatest risk. Risk awareness does not always result in proper action being taken: it is hard to really grasp something that one cannot experience. As such, hand disinfection is often dispensed with, and without any sense of having done something wrong, the debate about the evidence of the usefulness of floor disinfection continues, and often medical practitioners fail to resort to exclusive automated decontamination of medical devices because of the costs incurred. Hospitals, nursing homes and rehabilitation establishments are obliged to set up a quality management system, and to continue developing this. This calls for a quality assurance system regulating organizational procedures, responsibilities, workflow patterns for the entire domain of infection control within the hospital or medical practitioner's premises and outcome evaluation (microbiological monitoring, surveillance of nosocomial infections). An indispensable component of primary prevention is assurance of structural and process quality. In turn, disinfection is indispensable for assurance of process quality.