What are the most common HAIs in intensive care?

Intensive care is dominated by ventilator-associated pneumonia, central line-associated bloodstream infections and catheter-associated urinary tract infections. Long hospital stays and the use of invasive devices increase their incidence.

Which European standards must a disinfectant meet in the medical field?

A disinfectant suitable for the medical field must meet these standards: Hands – Hygienic handrub (without water): EN 13727 (bactericidal), EN 1500 (bactericidal on skin), EN 13624 (yeasticidal). Optional: EN 14348 (mycobactericidal), EN 14476 (virucidal).Hands – Hygienic handwash (with water): EN 13727 (bactericidal), EN 1499 (bactericidal on skin), EN 13624 (yeasticidal). Optional: EN 14348 (mycobactericidal), EN 14476 (virucidal). Hands – Surgical disinfection: EN 13727 (bactericidal), EN 12791 (effect on skin), EN 13624 (yeasticidal). Medical instruments (immersion): EN 13727 (bactericidal), EN 14561 (bactericidal on instruments), EN 13624 (yeasticidal), EN 14562 (yeasticidal on instruments). Optional: EN 14348/14563 (mycobactericidal), EN 14476/17111 (virucidal), EN 17126 (sporicidal). Surfaces – Spraying (without mechanical action): EN 13727 (bactericidal), EN 13624 (yeasticidal), EN 17387 (bactericidal/yeasticidal). Optional: EN 14348 (mycobactericidal), EN 14476/16777 (virucidal), EN 17126 (sporicidal). Surfaces – Wiping (with mechanical action): EN 13727 (bactericidal), EN 16615 (bactericidal/yeasticidal on surfaces), EN 13624 (yeasticidal). Optional: EN 14348 (mycobactericidal), EN 14476 (virucidal), EN 17126 (sporicidal). Airborne (room fogging): EN 17272 (bactericidal, yeasticidal, fungicidal, mycobactericidal, tuberculocidal, virucidal, sporicidal). Textiles (washing machine): EN 13727 (bactericidal), EN 16616 (bactericidal/yeasticidal in the machine), EN 13624 (yeasticidal), EN 14562 (yeasticidal on instruments). Optional: EN 14348/14563 (mycobactericidal), EN 14476/17111 (virucidal), EN 17126 (sporicidal). Surfaces – Spraying (without mechanical action): EN 13727 (bactericidal), EN 13624 (yeasticidal), EN 17387 (bactericidal/yeasticidal). Optional: EN 14348 (mycobactericidal), EN 14476/16777 (virucidal), EN 17126 (sporicidal). Surfaces – Wiping (with mechanical action): EN 13727 (bactericidal), EN 16615 (bactericidal/yeasticidal on surfaces), EN 13624 (yeasticidal). Optional: EN 14348 (mycobactericidal), EN 14476 (virucidal), EN 17126 (sporicidal). Airborne (room fogging): EN 17272 (bactericidal, yeasticidal, fungicidal, mycobactericidal, tuberculocidal, virucidal, sporicidal). Textiles (washing machine): EN 13727 (bactericidal), EN 16616 (bactericidal/yeasticidal in the machine), EN 13624 (yeasticidal). Optional: EN 14348 (mycobactericidal), EN 14476 (virucidal), EN 17126 (sporicidal). Water treatment (Legionella): EN 13623 (against Legionella).

How important is the disinfectant's contact time?

Contact time is critical because it is the minimum period needed for the product to reach its tested microbiological efficacy (according to European standards). If you shorten this interval or wipe the product off early: You drastically reduce the disinfectant's efficacy (microorganisms are not fully destroyed). You increase the risk of infection transmission in the medical setting. You encourage the emergence of disinfectant-resistant strains.

When is sterilisation mandatory?

Sterilisation is mandatory for critical instruments that enter sterile tissue or the vascular system. High-level disinfection does not replace sterilisation in these situations.

Preventing HAIs in high-risk wards: a practical guide

Prevention of healthcare-associated infections (HAIs): a practical strategy for high-risk wards

Healthcare-associated infections (HAIs) remain one of the most difficult challenges for high-risk wards: ICU, surgery, neonatology, oncology, or dialysis. Immunocompromised patients, the frequent use of invasive devices, and long hospital stays increase exposure to pathogens.

If you manage or coordinate such a ward, you need a clear, immediately applicable strategy that includes:

written and updated protocols;
biocidal products that are authorized and used correctly;
constant staff training;
monitoring and reporting according to legislation.

The legal framework in Romania is based on Ministry of Health Order no. 1101/2016 regarding the surveillance, prevention, and limitation of HAIs and Ministry of Health Order no. 1761/2021 regarding technical standards for cleaning, disinfection, and sterilization in healthcare units. Compliance with these is not optional, and failure to comply entails individual and institutional liability, according to Art. 8 of Order 1101/2016.

What are HAIs and why are certain wards more exposed

An HAI is any infection that occurs during medical care and was not present or incubating at the time of admission. In the ICU, ventilator-associated pneumonia (VAP) and central line-associated bloodstream infections (CLABSI) occur frequently. In surgery, surgical site infections predominate. In dialysis and oncology, vascular access-associated bacteremias are a constant problem.

The risk increases for several reasons:

repeated vascular access;
airway manipulation;
therapeutically induced immunosuppression;
colonization with multidrug-resistant bacteria.

In most cases, transmission occurs through direct or indirect contact via contaminated hands, surfaces, or equipment.

To significantly reduce biological risks, learn more about the importance of using quality disinfectants to protect the health of patients and medical staff!

7 practical steps for preventing HAIs in high-risk wards

Establish a strict hand hygiene protocol

Apply the 5 WHO moments without exception. Install dispensers at every point of care and ensure a constant supply of products from the range of professional disinfectants authorized for medical use. For hygienic and surgical hand and body cleaning and disinfection, you can use Klintensiv® PVP Iodine Soap 7.5% surgical soap.

Hand hygiene products must meet the following standards, depending on their use:

Hygienic handrub: standards EN 13727 (bactericidal activity in suspension), EN 1500 (hygienic handrub on skin), and EN 13624 (yeasticidal activity);
Hygienic handwash: EN 13727, EN 1499, and EN 13624;
Surgical hand disinfection: EN 13727, EN 12791, and EN 13624.

Conduct a monthly audit of consumption and provide feedback to the team. If you notice a decrease in product consumption, investigate the cause immediately.

Rigorous control of surface cleaning and disinfection

Always start with mechanical cleaning. Organic matter inactivates many active substances, especially chlorine-based or quaternary ammonium compounds.

The choice of product for surface and floor disinfection depends directly on the epidemiological risk level of the respective area (low, medium, or high). For medium-risk areas, a concentrated disinfectant detergent such as Deziamino can be used, which ensures both efficient cleaning and disinfection of hard surfaces. Regardless of the chosen product, strict adherence to the working concentration and contact time indicated by the manufacturer in the technical data sheet is mandatory.

For high-level disinfection, especially in terminal disinfection, choose dedicated products such as Klintensiv Dezicon – high-level concentrated disinfectant, with a broad spectrum, including sporicidal, in accordance with relevant EN standards. Use them strictly according to the manufacturer's instructions.

Correctly manage instruments and invasive medical devices

Every catheter or tube represents an entry point for microorganisms. Use checklists when inserting central venous catheters. Ensure skin antisepsis with an authorized product and let it dry completely before puncture.

Evaluate the necessity of the device daily. If it is no longer indicated, remove it immediately. Reducing the duration of use directly decreases the incidence of device-associated infections.

Perform screening and proper isolation

In high-risk wards, screening for MRSA or carbapenemase-producing enterobacteria helps in the early identification of carriers. Isolate or cohort patients according to internal procedures.

Apply contact precautions: gown, gloves, dedicated personal protective equipment. Do not move equipment between wards without intermediate disinfection.

Monitor and report constantly

Calculate the incidence density per 1000 device-days for CLABSI, CAUTI, or VAP. Analyze the data quarterly and establish corrective measures.

If you identify two or more cases linked temporally and spatially, trigger the outbreak investigation procedure. Intensify disinfection, verify adherence to contact times, and re-evaluate functional circuits.

Apply antimicrobial stewardship

Antibiotic prescription must follow culture and antibiogram results. De-escalate treatment from broad-spectrum to targeted as soon as you have microbiological data.

Collaboration between the physician, pharmacist, and microbiologist reduces selection pressure and limits the emergence of resistant strains.

Invest in staff training

Organize regular training sessions. Include practical demonstrations on the correct dilution of disinfectants, the use of PPE, and medical waste management.

New staff must be trained before entering the ward. Lack of training leads to dosage errors, incompatible mixtures, or insufficient contact times.

Disinfection versus sterilization: practical differences

Disinfection is the procedure of destroying most pathogenic or non-pathogenic microorganisms on any surface, including skin, using physical and/or chemical agents. Sterilization is the operation through which a 10⁻⁶ (1/1,000,000) logarithmic reduction of microorganisms, including bacterial spores, is achieved.

Critical surgical instruments must be sterilized using validated methods (pressurized steam, ethylene oxide, plasma). If you need technical details, consult the material on what sterilization is and the main processes through which pathogens can be completely eliminated.

Do not substitute sterilization with high-level disinfection for critical devices. This error directly increases the risk of postoperative infections. For heat-sensitive medical instruments (which cannot withstand high temperatures in an autoclave), use exclusively cold chemical sterilization by complete immersion. This procedure mandatorily involves preliminary cleaning, medium-level disinfection, and, after sterilization, a final rinse with sterile water.

Frequent mistakes that increase the risk of HAIs

Keeping gloves on between two patients nullifies protection. Wiping a surface immediately after applying a biocide shortens the contact time and compromises effectiveness.

Diluting "by eye" alters the active concentration. A solution that is too diluted does not destroy microorganisms; one that is too concentrated can damage surfaces and increase the risk of chemical exposure for staff.

Invest in clear protocols, authorized products, and continuous training. Periodically review procedures and adjust them based on collected data. If you want to optimize your unit's disinfection plan, analyze the available professional range and choose the right solutions for your ward's risk level.