Medicine It and hygiene
INVESTMENTS IN THE FIGHT AGAINST HOSPITAL INFECTIONS PAY OFF
Hospital-acquired infections have become a well-known problem worldwide.
Their number is rising and the mostly bacterial pathogens are increasingly characterized by high resistance to antibiotics.
The probability of contracting such a nosocomial infection in a German acute-care hospital is 5.7% to 6.3%.
Every year, 600,000 to 700,000 patients contract infections in hospital.
The treatment of such illnesses is becoming increasingly difficult and costly due to the increasing multi-resistance of pathogens.
In 1% of infected patients this leads to death, in 3-4% the nosocomial infection contributes significantly to the lethal outcome.
Any measure that reduces nosocomial infections is therefore a sensible investment, both for the benefit of the patient and for the hospital.
This is because the follow-up costs caused by infections are also enormous: with an average length of stay extended by 10 days, this means 6.4 to 7 million additional days of stay with costs of 300 million to almost 1 billion euros.
This is why strategies and tools for preventing infections are at the forefront of quality assurance measures in hospitals.
HIGH PRESENCE IN THE MEDIA
The phenomenon of multi-resistance can be seen in many groups of bacteria.
The term MRE (multi-resistant pathogens) includes such cryptic terms as ESBL (extended spectrum beta-lactamase)-producing species, MRPSAE (multi-resistant Pseudomonas aeruginosa), MRSP (multi-resistant Streptococcus pneumoniae), VRE (vancomycin-resistant enterococci) and the different variants of resistant Staphylococcus aureus (MRSA, caMRSA, VISA, GISA).
Methicillin-resistant Staphylococcus aureus (MRSA) in particular is a hot topic in hospitals and is frequently discussed in the media.
The search term MRSA already has over four million entries in the leading search engine Google®.
But MRSA is not the only risk.
THE MOST COMMON NOSOCOMIAL DISEASES:
- Urinary tract infections
- Respiratory tract infections
- post-operative wound infections
- Blood poisoning (sepsis)
- Infections of the gastrointestinal tract
Patients become infected particularly frequently during operations with large wounds.
This is because the pathogens have a particularly easy time there.
However, five percent of patients are also likely to become infected on admission to hospital.
The reason for the pathogens’ success is largely due to the excessive and often inappropriate administration of antibiotics in Germany over the past 20 years.
The result is the selection and generation of highly resistant species, which then spread easily due to disregarded or only fragmentarily established hygiene systems.
For a long time now, increasingly sensitive hygiene plans have been drawn up, cost-intensive room air purification systems installed and maintained, and structural measures taken to separate and seal off areas in order to contain high-risk germs.
And yet the number of infections continues to rise.
EXPENSIVE GUESTS IN HOSPITAL
Apart from the unnecessary suffering of people, there are other reasons that justify all efforts to prevent MRE contamination: Cost and image.
Today, hospitals advertise in quality reports that their POI rate is below the national average.
Many infections are reportable and are statistically recorded and published.
Furthermore, under the current DRG conditions, health insurance companies do not cover the costs incurred by the prolonged treatment and/or rehabilitation of infected and colonized patients.
Even for patients who are recovering well, these costs can quickly amount to around 10,000 euros.
THE VECTOR HAND
Even the inanimate environment is not free of microorganisms.
Surfaces in hospitals serve as depots for many bacteria, from which they are transferred to other areas by vectors.
Bacteria can survive on these surfaces for a long time.
Four weeks is not a problem for MRSA.
The most important vector is the human being and essentially his hand.
An “area” at which transmission is targeted can be a patient or another hospital employee, who can then also infect people.
This sets a cascade in motion that leads to a massive spread of the pathogens after a short time, resulting in increasing infection rates.
Such a scenario can be prevented by suitable disinfection measures for special surfaces and hands.
The chairman of the DGKH, Prof. Dr. Walter Popp, makes the following public accusation: “ Berlin: Every year, at least 20,000 patients in Germany die simply because staff do not wash their hands sufficiently.
Walter Popp, Chairman of the German Hospital Hygiene Association, has made this accusation against hospitals and the federal states as the responsible supervisory authorities. ” Source: Daily newspaper Rheinische Post from 14.03.2008 From this it can be deduced that all hand contact surfaces that cannot be easily disinfected 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 patients and staff.
MRSA has also been detected on computer keyboards.
Conventional computer keyboards in particular are a special feature.
Due to their design, they have many vertical and horizontal surfaces as well as inaccessible slots, which is accompanied by an extremely complicated situation when it comes to surface disinfection.
They are a special case among hand contact surfaces that are difficult to clean/disinfect.
Hygiene therefore requires that surfaces close to patients and surfaces with frequent hand contact in high-risk areas must be disinfectable, especially for IT components and systems.
It is not sufficient to regulate the contamination of the inanimate environment by the hands of nursing staff primarily in terms of organization or through consistent compliance with hand disinfection/hand hygiene.
Only the disinfection of contact surfaces, in this case the computer keyboard and input devices, can be successful.
HYGIENE AND IT SYSTEMS
It is not only computer keyboards and input devices such as PC mice that can pose a hygiene risk.
The systems and monitors are also hygienically relevant.
Conventional computers and monitors have fan systems in addition to gaps, cracks and open screw connections.
It has been shown that, in addition to dust, these also draw in microorganisms and accumulate inside the system.
Due to their special ability to survive for long periods on dry surfaces in a viable state, potent infectious agents can be enriched and released into the environment in large numbers.
If the environment is an operating theatre, an intensive care unit, an oncology ward or a sterilization department, this must be considered highly risky from an infectious disease perspective.
PC systems and monitors are therefore also classified as critical.
They must be easy to disinfect and should not be a “germ trap”.
This can be achieved by creating suitable surfaces and dispensing with fan systems.
FROM THE ROBERT KOCH INSTITUTE’S FAQ In the FAQ on the Robert Koch Institute’s website, we found a current note on the use of computers and keyboards in critical areas:
WHAT SHOULD BE CONSIDERED WHEN USING PERSONAL COMPUTERS (PC) AND NOTEBOOKS IN THE AREA OF PATIENT CARE IN HEALTHCARE FACILITIES?
Here are two quotes from the RKI 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 fans have not yet been published. ““ Conventional keyboards cannot usually be disinfected due to their complicated design.
Defects must be expected quickly.
Manufacturers have already taken action to offer smooth, liquid-tight surfaces with the possibility of disinfection.
It can therefore only be recommended that appliances with an appropriate design are purchased. “
