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NUMBER OF HOSPITAL INFECTIONS RISING

IT PAYS TO INVEST IN THE FIGHT AGAINST HOSPITAL INFECTIONS

Infections acquired in hospital have become a globally recognized problem. The incidence of such infections is rising, and the bacteria that cause most of them are becoming increasingly resistant to antibiotics.

The probability of contracting such a nosocomial disease in a German acute care hospital is 5.7% to 6.3%. 

This means that 600,000 to 700,000 patients succumb to infections caught in hospital every year. As the organisms that cause these infections are increasingly developing multiple resistance to antibiotics, treatment is becoming increasingly difficult and complex.
 

This causes death in 1% of patients, while the nosocomial infection contributes significantly to lethal outcomes in 3-4 % of cases. 

Every measure that helps reduce nosocomial disease is therefore a meaningful investment in both the hospital and the patient’s well-being.
Even the follow-up costs caused by infections are enormous:
For an average 10-day extension, this translates into 6.4 to 7 million additional days of stay costing between €300 million and nearly €1 billion.

That is why strategies and tools for the prevention of infections rank first in quality assurance measures in the hospital.

HIGH PROFILE ALSO IN THE MEDIA

The phenomenon of multiple drug resistance is found in many groups of bacteria. The term MRE (multidrug-resistant pathogens) includes such cryptic names as ESBL (extended spectrum beta-lactamase) -forming species, MRPSAE (multidrug-resistant Pseudomonas aeruginosa), MRSP (multidrug-resistant Streptococcus pneumoniae), VRE (vancomycin-resistant enterococci) and the different variants of the resistant Staphylococcus aureus (MRSA, caMRSA, VISA, GISA).

Methicillin-resistent staphylococcus aureus (MRSA) is a particularly important topic in hospitals and is also the subject of frequent discussion in the media. In the leading search engine Google®, a search using the term MRSA already returns more than four million results. However, MRSA is not the only risk.

THE MOST COMMON NOSOCOMIAL DISEASES:

  • Urinary tract infections
  • Respiratory infections
  • Post-operative wound infections
  • Blood poisoning (sepsis)
  • Gastrointestinal infections


Patients are particularly likely to succumb to infection if they are left with large wounds after surgery. Because it's also a cakewalk for the pathogens here. What's more, five percent of people are also likely to become infected when they're admitted to hospital.

The reason for the pathogen's success lies largely in the excessive and often inappropriate administration of antibiotics in Germany over the past 20 years.

The result is selection and generation of highly resistant species, which then spread easily due to neglected or fragmented sanitation systems. For a long time now, increasingly sensitive hygiene plans have been drawn up, cost-intensive room air cleaning systems installed and maintained, and structural measures taken to separate and isolate the germs in order to contain them. And yet, the number of infections continues to increase.

EXPENSIVE HOSPITAL VISITORS

Apart from unnecessary human suffering, there are other reasons why every effort should be made to avoid MDRO contamination: cost and image.

Today, clinics advertise in quality reports that their POI rate is below the national average. Many infections are notifiable; these are recorded statistically and the results published. 

Furthermore, under the current DRG conditions, the health insurances don't cover the costs of prolonged treatment and/or rehabilitation of infected and colonised patients.

Even with patients who recover well, they can quickly reach around 10,000 euros.

THE VECTOR HAND

http://www.reinmedical.com/typo3temp/pics/9314e6e90d.png

Microorganisms are also rife in inanimate environments. Hospital surfaces serve as a depot for many bacteria, from where they are transmitted to other areas by vectors.

Bacteria can survive on these surfaces for a long time. Four weeks are no problem for MRSA.


The most important vector is humans and in this respect their hands. An "area" targeted by the transmission can be a patient or another hospital employee who can also infect people.

In this way, a cascade is set in motion which, after a short time, leads to a massive spread of the pathogens with the result of increasing infection rates. A scenario of this kind can be prevented by appropriate disinfection measures on special surfaces and hands intended just for this purpose.

Director of the DGKH, Prof. Dr. Walter Popp, publicly made the following reproach on this point:

Berlin: At least 20,000 patients in Germany die every year simply because the staff did not wash their hands properly. Walter Popp, member of the Executive Board of Deutsche Krankenhaushygiene, has raised this issue against the hospitals and the federal states as the competent supervisory authorities. 
Source: Rheinische Post (daily newspaper) of March 14, 2008

This suggests that all hand contact surfaces that are not well disinfectable contribute to cross-contamination.

MRSA AND IT

It is known that MRSA can be detected in the inanimate environment (e.g. on hand contact surfaces) of the patient and the staff.

MRSA has also been found on computer keyboards.
Conventional computer keyboards pose a particular challenge.

Due to their construction, they have many vertical and horizontal surfaces as well as inaccessible slots, which is make things extremely complicated when it comes to surface disinfection. They represent a special case among the hand contact surfaces that are difficult to clean/disinfect.

In terms of hygiene, areas close to patients and areas with frequent hand contact must be disinfectable, especially for IT components and systems.

It's not enough to regulate the contamination of the inanimate environment by the hands of the nursing staff primarily in an organizational way, or by consistent adherence to hand disinfection/hand hygiene.

Only the disinfection of the contact surfaces, in this case of computer keyboards and
input devices, can ensure success.

HYGIENE AND IT SYSTEMS

Peripheral devices such as computer keyboards and mice are not the only components that can become a hygiene risk. The hygiene of systems and monitors is also important. 

Conventional computers and monitors have fan systems in addition to gaps, cracks, and open fittings. It has been demonstrated that, in addition to dust, these also suck in microorganisms and accumulate them inside the system.

Due to the special ability to survive long periods on dry surfaces, potent pathogens can be enriched and released into the environment in large numbers

If the environment is an operating theater, an intensive care unit, an oncology ward, or even a sterilization department, this must be regarded as highly risky from an infection point of view

Therefore, PC systems and monitors are also classified as critical. They must be easily disinfectable and should not be "germ catapults". This can be achieved by producing suitable surfaces and dispensing with ventilation systems.

FROM THE FAQ OF THE ROBERT KOCH INSTITUTE

In the FAQ of the website of the Robert Koch Institute we found a current hint for the use of computers and keyboards in critical areas:

WHAT SHOULD BE CONSIDERED WHEN USING PERSONAL COMPUTERS (PC) AND NOTEBOOKS FOR PATIENT CARE IN HEALTH CARE FACILITIES?

Here are two quotations from the RKI’s FAQ:

» From this it can be concluded that the use of hardware without fans (blowers) is recommended in critical areas (operating theaters, intensive care units). This is the rational deduction from the above considerations. Studies or other observations on nosocomial infections caused by such blowers have not yet been published«

» 
Conventional keyboards are usually not disinfectable because of their complicated structure. There is a high risk of defects. Manufacturers have already taken action to offer smooth, liquid-tight surfaces with the possibility of disinfection. Therefore, it can only be recommended that you purchase devices with a corresponding design. 

 

Inline image

Handabklatsch
​​​​nach Desinfektion (L),
Kolonizahl ohne Desinfektion (R)

So wird eine Kaskade in Gang gebracht, die nach kurzer Zeit zu einer massiven Ausbreitung der Erreger führt, mit dem Ergebnis zunehmender Infektionsraten. Verhindert werden kann ein solches Szenario durch geeignete Desinfektionsmaßnahmen von dazu vorgesehenen Spezialoberflächen und Händen.

Der Vorstand des DGKH, Prof. Dr. Walter Popp, erhebt dazu öffentlich folgenden Vorwurf:

» Berlin: Jährlich sterben mindestens 20.000 
Patienten in Deutschland nur deshalb, weil sich das Personal nicht ausreichend die Hände wäscht. Diesen Vorwurf hat Walter Popp, Vorstand bei der Deutschen Krankenhaushygiene, gegen die Hospitäler und die Bundesländer als zuständige Aufsicht erhoben.
 « 
Quelle: Tageszeitung Rheinische Post vom 14.03.2008

Daraus lässt sich ableiten, dass alle Handkontaktflächen, die nicht gut desinfizierbar sind, zur Kreuzkontamination beitragen.

 

MRSA und IT

Es ist bekannt, dass sich MRSA in der unbelebten Umgebung (z.B. auf Handkontaktflächen) des Patienten und des Personals nachweisen lassen.

Auch auf Computertastaturen wurde MRSA nachgewiesen. Gerade herkömmliche Computertastaturen stellen eine Besonderheit dar.

Durch ihre Konstruktion weisen sie viele vertikale und horizontale Flächen sowie nicht erreichbare Schlitze auf, was einhergeht mit einer äußerst komplizierten Situation, wenn es um die Flächendesinfektion geht. Sie stellen einen Sonderfall unter den schwierig zu reinigenden/desinfizierenden Handkontaktflächen dar.

Seitens der Hygiene gilt daher die Forderung, dass in Risikobereichen patientennahe Flächen und Flächen mit häufigem Handkontakt desinfizierbar sein müssen, besonders für IT-Komponenten und -Systeme.

Es genügt nicht, die Kontamination der unbelebten Umgebung durch die Hände des Pflegepersonals primär organisatorisch, bzw. durch konsequente Einhaltung der Händedesinfektion/Händehygiene zu regeln.

Nur die ebenfalls vorgenommene Desinfektion der Kontaktflächen, hier von Computertastatur und Eingabegeräten, verspricht Erfolg.

 

Hygiene und IT-Systeme

Nicht allein Computertastaturen und Eingabegeräte wie PC-Mäuse können zum Hygienerisiko werden. Auch die Systeme und Monitore sind hygienisch relevant. 

Herkömmliche Computer und Monitore weisen neben Spalten, Ritzen und offenen Verschraubungen Lüftersysteme auf. Es konnte gezeigt werden, dass diese neben Staub auch Mikroorganismen ansaugen und im Inneren des Systems akkumulieren.

Durch die besondere Fähigkeit, oft lange Zeiten auf trockenen Oberflächen keimfähig zu überleben, können so potente Infektionserreger angereichert und in großer Keimzahl in die Umgebung freigesetzt werden. 

Handelt es sich bei der Umgebung um einen Operationssaal, eine Intensivstation, eine onkologische Station, oder auch eine Sterilisationsabteilung, muss dies als infektiologisch höchst riskant eingeschätzt werden. 

Daher werden auch PC-Systeme und Monitore als kritisch eingestuft. Sie müssen leicht desinfizierbar sein und sollen keine „Keimschleudern“ darstellen. Erreichbar ist dies durch Schaffung geeigneter Oberflächen und den Verzicht auf Lüftersysteme.

 

Aus dem FAQ des Robert Koch Instituts

Im FAQ der Internetpräsenz des Robert Koch Instituts fanden wir einen aktuellen Hinweis zum Einsatz von Computern und Tastaturen in kritischen Bereichen:

Was ist beim Einsatz von Personal Computern (Pc) und Notebooks im Bereich der Patientenversorgung in Einrichtungen des Gesundheitswesens zu Berücksichtigen?

Hier zwei Zitate aus dem FAQ des RKI:

» Daraus kann gefolgert werden, dass der Einsatz von Hardware ohne Lüfter (Gebläse) in kritischen Bereichen (OP, Intensivstation) zu empfehlen ist. Dies ist die rationale Ableitung aus den o. g. Überlegungen. Studien oder andere Beobachtungen zu nosokomialen Infektionen durch solche Gebläse wurden bisher nicht veröffentlicht. «

» Herkömmliche Tastaturen sind ob ihres komplizierten Aufbaus in der Regel nicht zu desinfizieren. Es muss rasch mit Defekten gerechnet werden. Um dort glatte, flüssigkeitsdichte Flächen mit der Möglichkeit der Desinfektion anzubieten, sind Hersteller bereits tätig geworden. Es kann also hier nur empfohlen werden, Geräte mit einer entsprechenden Konstruktion anzuschaffen. «