Research for infection protection

Multidrug-resistant pathogens – each year, more than 10 000 infections preventable through hygiene alone

“We run into danger that our antibiotics are not effective enough anymore. If we do not act now, mortality due to infections will soon be as high as before the introduction of antibiotics,” Prof. Dr. Uwe Frank, Senior Hospital Hygienist at Heidelberg University Hospital and Senior Physician at the Institute of Environmental Medicine and Hospital Hygiene, University Medical Centre Freiburg, Germany warned. Particularly multidrug-resistant Gram-negative pathogens may lead to infections that are not controllable, the hospital hygienist pointed out. Every year, between 30 000 and 35 000 patients in German clinics acquire infections caused by these dangerous bacteria.

More than 25 surgeries after MRSA infection

Hospital-acquired infections do not only affect older people or patients with an underlying disease. This is impressively shown by a case of a young police officer, which Dr. Andrej Trampuz, Senior Physician, Head of Infectiology and Septic Surgery at Charité Berlin, Germany described. After cruciate ligament plastic surgery, the patient acquired an MRSA infection and almost lost her leg. The young woman had to undergo more than 25 surgeries before her infection was combatted effectively at Charité Berlin by identifying the microorganisms and conducting a specific antibiotic therapy.

Hygiene potential not fully exploited

The largest immediate potential to prevent infections with MDR pathogens currently is the consistent implementation of hygiene measures. “On a conservative estimate, 30 per cent of all infections acquired in hospital could be prevented by hygiene alone. More recent studies even seem to indicate that much more infections could be prevented,” Dr. Henning Mallwitz, Head of the BODE SCIENCE CENTER reported. In Germany alone, at least 10 000 infections due to multidrug-resistant pathogens could be prevented every year.

Hand hygiene plays a key role in infection control. A potential that still is not fully exploited. Only last August, the Robert Koch-Institute published figures on the implementation of hand hygiene.

Accordingly, the average hand hygiene compliance rate is between 41 per cent and 55 per cent.

For patients it is especially critical, if hand hygiene is omitted before aseptic procedures, for example before placing catheters or changing a dressing, as they involve the risk of pathogens entering areas that are primarily sterile or not colonised with potentially pathogenic microorganisms and triggering severe infections from there.

On the basis of these risks of infection, the BODE SCIENCE CENTER examined important aseptic nursing activities along the patient journey from hospital admission to discharge, and then developed standardised operating procedures (SOPs) for the most common nursing activities, particularly focussing on all steps that involve a risk of infection. “Although we did not reinvent hygiene, we can considerably reduce the share of hygiene mistakes and increase patient protection,” Mallwitz explained.

Optimal workflows – improved patient protection

Recent studies show that optimised processes can considerably increase compliance with hygiene, especially with hand hygiene. For example, the introduction of the SOPs increased hand hygiene compliance from 65 per cent to 97 per cent with blood sampling and dressing change. Hygiene experts assume that infection rates can be reduced considerably, if compliance rates reach at least 80 per cent. Claudia Becker from St. Nikolaus-Stiftshospital GmbH showed in her speech how this works in daily practice. The infection control nurse manages the introduction of SOPs in her clinic. Only a few months after establishing the new processes for the aseptic dressing change, the compliance rate increased from 75 per cent to 88 per cent for all steps that involve the risk of infection. “This was of direct benefit to our patients as at the same time surgical site infections after the indicator surgery ‘colon’ reduced.”

*ECDC (European Centre for Disease Prevention and Control)

Lunchtime Symposium: “Pathogens resistant to antibiotics: New hygiene strategies along the patient journey”. Berlin, 17 November 2016, arranged by the BODE SCIENCE CENTER, Hamburg