1 Enteritis during mountaineering above the snow line – how to practice prophylaxis? (preliminary results) Robert Adamek (1), Beate Kraft (2), Michael Pietsch (2) and Hans-Volkhart Ulmer (1) 1) Institute of sports science, Johannes Gutenberg- Universität, Mainz, Germany 2) Department of hygiene, Universitätsklinikum Mainz ___________________________________________________________ Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009 4th international Symposium: “High altitude influence on human performance: science and praxis” – Bohinjska Bela (Slovenia) Sept. 8-13, 2009
Transcript
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Enteritis during mountaineering above the snow line
– how to practice prophylaxis?(preliminary results)
Robert Adamek (1), Beate Kraft (2), Michael Pietsch (2) and Hans-Volkhart Ulmer (1)
1) Institute of sports science, Johannes Gutenberg-Universität, Mainz, Germany
2) Department of hygiene, Universitätsklinikum Mainz
___________________________________________________________Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009
4th international Symposium: “High altitude influence on human performance: science and praxis” – Bohinjska Bela (Slovenia) Sept. 8-13, 2009
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INTRODUCTION
ZOCHOLL (2008) described, that diarrhea by infection with faecal bacteria under difficult hygienic conditions above the snow-line is a typical problem in mountaineering
Faeces contain many pathogenic and non pathogenic microorganisms, –> enteritis
Introduction, aim, methods, results, discussion, final conclusions
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Introduction
Enteritis –>diarrhea:
Loss of water and electrolytes, negative for physical and psychic performance capacity
Introduction, aim, methods, results, discussion, final conclusions
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Mountaineering in high altitudes:
No WC,
only „SC“ („snow closet“)
with an alternative: Clean mountain can
Introduction, aim, methods, results, discussion, final conclusions
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„SC“ (snow closet)
using the „clean
mountain can“ in the Mt McKinley
region
Foto: M. Tannheimer
Introduction, aim, methods, results, discussion, final conclusions
Hier Foto
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Introduction, aim, methods, results, discussion, final conclusions
„Clean mountain can“:Rigorous reglementation of use
with supervision after return
Only in the Mt McKinley-region (Alaska)
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Process of infection by faeces during mountaineering in high altitudes above the snow line:
1) Defaecation only possible in snow (better in the clean mountain can)
2) Snow used for melting water
3) Melting water: Potential of infection with pathogenic microorganisms, if not disinfected, risk of diarrhea
Introduction, aim, methods, results, discussion, final conclusions
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To prevent infection with pathogenic microorganisms from faeces, usually snow water is boiled or disinfected chemically or physically (filter) as prophylaxis against enteritis
Introduction, aim, methods, results, discussion, final conclusions
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For boiling gas is used – problem of additional weight for transportation
Chemical disinfection – less weight for transportation, but needs effecting time
Physical disinfektion – also weight of filter-systems for transportation
Introduction, aim, methods, results, discussion, final conclusions
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PIETSCH (2008) – specialist of hygiene – argued, however:
The risk of infection by the own hands could be more important than the risk of infection by melted snow
Therefore disinfection of the hands would be very important
Introduction, aim, methods, results, discussion, final conclusions
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Introduction, aim, methods, results, discussion, final conclusions
AIMS
1) Check – melted snow and – gloves
Basal consideration: Coliform bacteria etc. are an indicator
for faecal contamination and so for the risk of enteritis
2) Check practicability of hand disinfection in high altitude
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METHODS
Bacteriological check for faecal bacteria (usual bacteriological procedure similar as for drinking water) of
1. melted snow from the Muztagh Ata region (Kunlun-mountains – brought by B. HONKA):
4 steps between 4400 and 6800 m, 25 snow specimens, each August 2008
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Introduction, aim, methods, results, discussion, final conclusions
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Bacteriological check
2. of melted snow for comparison: 3 specimens from Kleinwalsertal (touristic region with many restaurants, cottages etc, 1500 m), Jan. 2009, snow ca. 1 week old
3. of a pair of gloves, used 14 days before during mountaineering
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Introduction, aim, methods, results, discussion, final conclusions
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Test of typical hand-disinfection with alcohol tampons during mountaineering above the snow line (Kleinwalsertal, Jan 2009, environmental temperature ca. – 10 until 0 °C, ca. 2000 m, no storm)
___________________________________________________________Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009
Introduction, aim, methods, results, discussion, final conclusions
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Introduction, aim, methods, results, discussion, final conclusions
RESULTS (preliminary)
In 21 of 100 Kunlun specimens coliform bac- teria or escherischia coli were found, the higher, the lesser:
Table: Frequency of coliform bacteria or e. coli
Hight (m) 4400 5400 6200 6800
Frequency 44 % 20 % 16% 4 %
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Introduction, aim, methods, results, discussion, final conclusions
In the other 3 specimens from the Kleinwalsertal (touristic region):
No faecal bacteria
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Introduction, aim, methods, results, discussion, final conclusions
– Also in all fingers of one pair of gloves faecal bacteria (enterococcus faecalis) were found
– The use of typical alcohol tampons under mountaineering conditions was very difficult or not practicable, due to cold and wind, e.g. coordination problems by cold fingers and additional cooling effect of the alcohol. Needed time: ca. 1 – 1½ min
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DISCUSSION
Methodical mistake in taking off the snow probes etc?
– The expedition leader HONKA was precisely instructed about the procedure (also the coauthor Adamek) , – they used professional equipment for analyses of drinking-water– the bacteriolical analyses were performed in a professional lab
So we are shure: no methodical mistakes
Introduction, aim, methods, results, discussion, final conclusions
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Incidence of other pathogenic microorganism?
We only looked on coliform bacteria, e. scherischia coli and enterococcus faecalis as indicator for faecal contamination
Introduction, aim, methods, results, discussion, final conclusions
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Check of melted snow:
The exemplary results show already, that a relevant part of the melted snow (Kunlun) was contaminated with faecal bacteria
The amount/ml is irrelevant: Coliform bacteria indicate faecal contamination
and so the risk of enteritis
To prevent infection (enteritis) by melted water it should be disinfected further on
Introduction, aim, methods, results, discussion, final conclusions
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In the touristic region Kleinwalsertal with many people and many WC in restaurants, cottages etc. the contamination of snow with faeces would be a rarity
Even, if we had only 3 specimens, this exemplary finding underlines the importance of defaecation during mountaineering in high altitudes
Introduction, aim, methods, results, discussion, final conclusions
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In 6800 m water boils at 77 °C.
Sufficient? Boiling with bubbles at least 1 min is sufficient until 8.900 m Küpper et al., 2008), but needs lot of gas
Alternative for high altitudes:
Disinfection of melted snow : chemically or physically with micropore filters
Introduction, aim, methods, results, discussion, final conclusions
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Check of one pair of gloves:
Infection by gloves – until today not discussed:
A possible relevant problem, too, even if only one pair of gloves could be tested
In contrast to coli-bacteria enterococus faecalis (e. f.) can survive in dry environment
e. f. not effects enteritis, e. f. low pathogenetic potential,but e. f. indicates also faecal contamination inside of
the gloves with other potential pathogenic mikroorganisms
Introduction, aim, methods, results, discussion, final conclusions
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If the gloves are contaminated,
the hands are contaminated, too.
But which consequence?
Introduction, aim, methods, results, discussion, final conclusions
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Hand-disinfection with alcohol tampons:
Even under mild climatic conditions for mountainee-ring (ca. 2000 m, environmental temperature ca. – 10 until 0 °C, no storm) classical hand disinfektion was hardly or not practicable
Recommendation:Perhaps it could be possible after special training
inside of a tent, at least after every defaecation
Introduction, aim, methods, results, discussion, final conclusions
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Prevention of infection by own hands:
Avoid infection of the food with the own hands by handling all food carefully.
Introduction, aim, methods, results, discussion, final conclusions
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Introduction, aim, methods, results, discussion, final conclusions
FINAL CONCLUSIONS
Process of infection by faeces during mountaineering in high altitudes above the snow line:
Defaecation only possible in snow, (mountain clean can: not realistic world wide)
Snow is used for melted water
Melted water: risk of infection, if not disinfected
Own hands: Also
Pay attention to risk of infection by faecal microorganisms
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But all these recommendations need time, and so prevention of enteritis by melted snow is a question of risk balance.
The higher the used snow, the lesser the risk
The knowledge about the ways of infection may help for the risk balance
Introduction, aim, methods, results, discussion, final conclusions
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Literature
1) Küpper, T.E.A.H., Schöffl, V. and Milledge, J. S.: Water disinfection in the mountains – state of the art recommendation paper of the Union Internationale des Associations d'Alpinisme Medical Commission
