gms | German Medical Science

Complying with these measures allows the use of anaesthesia breathing systems for a period of up to 7 days based on the latest state of knowledge, provided that the system continues to meet functional requirements such as air tightness IB and if stated by the manufacturer in the instructions for use. Can I bring my own food and drink?

GMS Hygiene and Infection Control

The BSF shall be changed after each patient. The anaesthesia breathing system may be used for a period of up to 7 days provided that the functional requirements of the system remain unchanged and the manufacturer states this in the instructions for use.

The breathing system and the manual ventilation bag are changed immediately after the respective anaesthesia if the following situation has occurred or it is suspected to have occurred: Notifiable infectious disease involving the risk of transmission via the breathing system and the manual bag, e.

In case of visible contamination e. Observing of the appropriate hand disinfection is very important. All surfaces of the anaesthesia equipment exposed to hand contact must be disinfected after each case. Wilkes, Cardiff, UK served as an external advisor. Members of the working group: The respective evidence of the recommendations is made clear by means of categorisation in accordance with the directive of the Commission for hospital hygiene and infection prevention state of April , published by the Robert Koch-Institut Berlin.

The categories are as follows:. The recommendations are based on well-designed experimental or epidemiological studies, IB: The recommendations are considered to be effective by experts and by virtue of a consensus resolution by the working group, and they are based on well-founded indications as to their effectiveness. A classification is also possible even if there have not been any studies yet. The recommendations are based partly on indicative clinical or epidemiological studies, partly on comprehensible theoretical explanations or studies.

No recommendation or unresolved issue: Measures supported with insufficient evidence about their efficiency or without consensus on this. Due to frequent patient changes at the anaesthesia workstation, anaesthesia ventilation is characterised by the risk of cross-contamination and subsequent infection.

As the entire complex of prevention measures regarding nosocomial pneumonia is concerned [1] both in the CDC Guidelines [2] and in the recommendations by the commission for hospital hygiene and infection prevention at the Robert-Koch-Institute RKI , the present recommendations are limited to the evaluation of the literature published in the meantime on the application of breathing system filters BSF as an alternative to the change of the anaesthesia breathing system after each patient, and on the hygienic reprocessing of the breathing gas cond uctin g systems of the anaesthesia ventilator.

The requirements for BSF and their potential applications are derived from this objective of filter use. Further prevention measures are only emphasized if they can be considered as a prerequisite for the safe use of BSF without changing the anaesthesia breathing system.

The use of suitable BSF between tracheal tube and anaesthetic system and the adherence to appropriate disinfection measures at all contact points of the anaesthetic equipment represent, if used together, a safe and cost-effective alternative to the use of a new or individually cleaned breathing system and to the reprocessing of the breathing gas conducting parts of the anaesthesia ventilator after each patient IB , and they contribute to the process optimisation.

Operating time according to manufacturer's instructions must be followed IV. The BSF can be used during patient transport and for subsequent ventilation in intensive care. For the duration of use of the BSF for subsequent ventilation without rebreathing, e.

If post operative ventilation takes longer, an appropriate breathing gas humidification must be ensured, e. The breathing system and the manual ventilation bag are changed immediately after the respective anaesthesia if the following situation has occurred or it is suspected to have occurred:.

Respective patients should be operated — if possible — at the end of the operation list; the breathing system and the manual bag are changed after that.

Complying with these measures allows the use of anaesthesia breathing systems for a period of up to 7 days based on the latest state of knowledge, provided that the system continues to meet functional requirements such as air tightness IB and if stated by the manufacturer in the instructions for use.

Moreover, the recommendations for preventing nosocomial pneumonia shall apply in full [2]. Otherwise, if a BSF is used it is unnecessary to sanitize the interior of the device breathing circle system ; exception: Pathogens can be released directly from the patient to the environment or transmitted via the staff. After use on the patient, all breathing gas conducting parts of the anaesthetic system can therefore be contaminated with pathogens, with the greatest levels of contamination being detectable close to the patient [10] , [11] , [12] , [13].

The risk of viral transmission is considered to be comparatively low [1] , [2]. In the era of insufficient processing of breathing gas conducting parts of the anaesthetic system, particularly of the tracheal tubes and of the anaesthesia breathing system, infections or outbreaks due to contaminated systems were reported sporadically [12] , [18] , [19] , [20] , [21].

This contamination can be minimised with BSF. Pathogen-rich or potentially pathogen-containing bodily fluids such as saliva, blood, sputum etc. This may be enhanced by patient positioning, increased secretion production and blood release due to illness as well as errors and trauma during intubation.

Furthermore, CO 2 -absorption in the rebreathing anaesthesia ventilation system leads to the release of humidity, which condenses over the course of the operation.

Approximately 15—20 ml water per hour accumulate in an unheated breathing system [24] ; which, depending on the fresh gas flow, may remain in the system where it gathers primarily in the lower bends of the breathing systems.

During anaesthesia, pathogen-containing saliva, tracheal secretion and, eventually, blood may gather thus posing a risk of aspiration. During mechanical ventilation both inspiration and expiration gases pass through the junction between tracheal tube and anaesthesia breathing system. Consequently this is the suitable interface at which the application of BSF can effectively block the transport of microbial and particulate contamination within the breathing gas conducting components of the breathing system in each direction of flow.

BSF are designed to prevent the passage of air borne and liquid borne pathogens in both directions, without increasing the air flow resistance and dead space to non physiological levels, and to contribute to the breathing gas humidification. BSF are designed for the retention of aerosols from the ventilation gases. The filter medium is constructed as a three-dimensional depth filter. Clinically relevant characteristics of BSF are dead space and gas flow resistance, which are defined in accordance with ISO [7].

Additional heat and moisture exchanging components may be integrated in the filter housing to improve breathing gas humidification; this combination is called a Heat and Moisture Exchanging Filter HME-F. Breathing systems are nowadays used for up to 7 days on the same anaesthesia ventilator [25]. Modern CO 2 -absorbers can be used until the soda lime is completely exhausted. It is therefore not unlikely that large amounts of liquid will gather in the breathing system, where exhaled bacteria may even proliferate; viruses do not have this capability.

In order to evaluate the suitability of BSF therefore both air-borne and liquid-borne transport processes must be considered. Aerosols are a suspension of liquid or solid particles in a gas. Their typically polydisperse distribution may extend over a wide range of sizes. Liquid particles are usually spherical; their diameter is determ ine d by the surface tension of the liquid and the partial vapour pressure in the environment.

Due to evaporation or condensation of the fluid, the size of liquid particles is variable; a droplet may also contain different numbers of microorganisms.

Solid particles can take very different irregular shapes. Filtration of aerosols is based on the interaction of different mechanisms [26] if the diameter of the particle is sufficiently large, the particle may be retained close to the surface of the filter medium already direct interception.

Due to their mass, smaller particles cannot always follow the changes of direction in the carrier gas surrounding the filter fibres.

During their passage through the filter medium they are adsorbed deeper inside the filter medium inertial impaction. Even smaller particles, e. This increases their virtual diameter, which in turn brings them into contact with the filter medium, where they are adsorbed as well diffusion filtration. These mechanisms characterise the so-called mechanical filters. In suitable filter materials the filtration performance can be additionally increased by applying electrical charge, which attracts and binds particles with opposite charge electret filters.

The spatial effect of these charges allows, at a similar air-borne retention performance, a more open structure of these filter media in comparison with mechanical filters. School and university students: Upon presentation of a student ID, school and university students under 27 years of age receive a discount on KD panoramic cruises and scheduled services, in accordance with the current timetable. On Tuesdays and Thursdays, two cyclists may travel for the price of one on all scheduled services on the Rhine one-way journey, excludes surcharges.

This offer does not apply to partner carriers. Valid for 2 adults and 2 children up to 16 years of age: For all discounts, discount cards, etc.: Only one discount may be applied at once. The discounts listed above do not apply to evening cruises, cruises with special programmes, cruises for firework events, cruises with food and drink included and party cruises.

No additional discounts are granted on already reduced fares e. KD vouchers purchased from KD agents or the KD head office are valid until the end of the third year after the voucher was purchased. You can find the date of purchase on the voucher. Vouchers may not be extended beyond the expiry date or exchanged for cash. If the value of the voucher exceeds the amount due, the KD ticket agent will issue a new voucher for the difference. Vouchers may also be redeemed for food and drink on board KD ships, but only to the full amount.

No new vouchers can be issued for the difference on board KD ships. The difference will not be paid out in cash either. Vouchers are not valid on the ships of KD partner carriers. KD online vouchers purchased from the KD web shop are valid until the end of the third year after the voucher was purchased.

You can find the expiry date on the voucher. KD online vouchers can only be redeemed online at www. They only apply to KD's own offerings e. If the amount due exceeds the value of the voucher, the difference may be paid using a different approved payment method or another voucher. Transaction fees may apply. If the value of the voucher exceeds the amount due, the amount remaining on the KD online voucher will remain valid under the same voucher code until the expiry date and can be redeemed in another booking at www.

No new KD voucher is issued for the remaining amount. Remaining credit cannot be exchanged for cash. Upon request, we would be happy to provide you with a list of all the main allergens and additives in our food. Please speak to the service staff on board. You are not obliged to purchase food and drink on board.

Food or drink you have brought with you may not be consumed in the dining area, only on the deck. You may not bring any alcoholic beverages on board.

For party and event cruises, and cruises with food and drink included in the fare, no food or drink may be brought on bord. We cannot guarantee you a certain seat or table. However, we will do our best to make sure that groups can sit together.

For event cruises with food and drink included in the fare, specific seats are reserved for you. These will be shown to you when you embark. Separate lounges can be reserved on scheduled services and panoramic cruises, depending on the ship operated and the group size.

If you are interested, please contact the KD Service Centre, info at k-d. If you are interested in a customised setting for your business or private event on the water, please contact the KD Charter Team, charter k-d.

Cake, flower and decoration packages can be ordered on request, depending on availability, at an extra cost. Please contact the KD head office. On board, we explain the most important sights along the route in German and English additional language options: Unfortunately, playing music and singing are not allowed on board, for the comfort and consideration of all passengers and so that passengers may listen to the explanations of the landscape in various languages. There is no dress code, but guests may be refused entry if they are wearing inappropriate clothing.

A fee of 3. Service dogs or guide dogs may travel free of charge further information can be found in the section on Passengers with Limited Mobility. Dogs on board must be kept on a lead and, if necessary, muzzled. Children have a great time on board the KD fleet.

On many KD ships, children's play facilities make KD cruises a wonderful experience for the little ones.

Slides, see-saws and different types of swing are among the standard equipment on many ships. On the other ships in the KD fleet, we also recommend you use the toilet facilities to change babies' nappies.

There are no designated breastfeeding facilities. Pushchairs and wheelchairs may be taken on board free of charge depending on the respective facilities. The crew will allocate space for storing such vehicles. We offer special cruises for children and families, such as the Fairytale Cruise to Zons and the on-board Pirate Party. The other event cruises are not suitable for children. Depending on the number of passengers and type of ship, bicycles may be transported for a fee of 2.

Tandems, luggage trailers, child bike trailers, dog trailers, pushchairs and wheelchairs may be taken on board free of charge depending on the respective facilities. The crew will allocate space for storing such vehicles and bicycles. It is not possible to take bicycles on our partner carriers. Segways are not permitted on board as a mode of transport. The passenger is responsible for securing their Segway on board.

There is no luggage office on board or at the wharf, therefore large baggage cannot be transported max. The passenger is responsible for transporting their luggage and other items brought on board to and from the ship.

The carrier accepts no liability for luggage and other items brought on board. Severely disabled passengers pay the standard price school and university students under 27 years of age and persons over 60 years of age receive a discount on KD panoramic cruises and scheduled services in accordance with the current timetable. Segways are not permitted on board to be used for leisure or as a mode of transport.

Passengers should aim to be at the wharf approx. One week before departure, we publish our ship movements list in German Schiffsbewegungsliste, or SBL , which tells you which ship is operating. There may be deviations from the timetable due to high or low water levels, a high volume of passengers and other traffic obstructions resulting from breakdowns or malfunctions which are not the fault of KD and for which KD is not obliged to offer a replacement service.

KD does not accept liability for any missed connections. Passengers are permitted to break their journey as many times as they wish after gaining prior written confirmation from the crew.

Passengers who would like to break their journey at intermediate stations must inform the crew of their intention at least 10 minutes prior to the ship's arrival. We will inform passengers of last-minute cancellations on the KD website. If the trip is cancelled by KD, the legitimate ticket holder will receive a refund of the ticket price upon presentation of the ticket at the office where it was purchased.

In order to avoid delays in the schedule, ships cannot wait for individual passengers. In the event of a late arrival, please go to the KD ticket office on site and take a later departure, if possible. Please contact the nearest KD agent or the KD head office to receive information from a member of staff. At that time, two companies existed: Due to various economic factors, it was not possible for both companies to sustainably coexist and so, on 9 June , the joint venture "Kölnische und Düsseldorfer Gesellschaft für Rhein-Dampfschiffahrt" was founded.

During KD's long history, the route network was constantly adapted and today the ships do not sail between Dusseldorf and Cologne, partly because the scenery along this route is less attractive and also because the journey would take 5 hours to sail upriver and 3 hours downriver. We accept credit cards Visa or Mastercard , Paypal and Sofortüberweisung a direct payment service.

Depending on the journey, you may choose between print-at-home and posted tickets. Posted tickets will be sent to you via post. Print-at-home tickets will be sent to you via e-mail. A good-quality printout of this ticket in DIN A4 format must be presented to staff upon embarking the ship.

Failing this, or if the ticket is illegible, a fee will be charged for a replacement ticket. In addition to an advance booking charge and service charge per ticket, an order fee may be charged. The amount of any potential charges and fees will be indicated during the booking process. In the event that the buyer requests tickets, admission tickets or gift vouchers to be sent via post instead of print-at-home , the buyer does so at their own risk.

The total price of the order includes statutory VAT and is due for full payment, including all fees, immediately upon conclusion of the contract. You may change your booking up to one day prior to the departure date, provided that the desired alternative journey costs the same price or less.

In this case, we can change your reservation as per your request. You will receive any difference in price in the form of an online voucher. Please contact us in writing with your re-booking request. A re-booking fee will not be charged. It is not possible to book an alternative journey that costs more than your original booking.