Alexander Gropmann

Nosocomial infection and antibiotic use: a second national prevalence study in Germany.

BACKGROUND In 2011, seventeen years after the first national study on the prevalence of nosocomial infections and antibiotic use in German hospitals, a second national prevalence study was carried out according to the specifications of the European Centre for Disease Prevention and Control (ECDC). METHODS The ECDC protocol, containing uniform surveillance definitions and ascertainment methods, was implemented. The only infections counted were those that were active or under treatment with antibiotics on the day of the study. In addition to the representative sample required by the ECDC, which consisted of 46 hospitals, further hospitals participated on a voluntary basis. RESULTS Data on 41 539 patients in 132 hospitals were analyzed. The prevalence of infections that had arisen during the current hospital stay was 3.8% in the overall group and 3.4% in the representative sample of 9626 patients in 46 hospitals. The prevalence of all nosocomial infections, including those acquired before the current hospital stay and still present upon admission, was 5.1% in both the overall group and the representative sample. The prevalence of antibiotic use on the day of the study was 25.5% and 23.3% in the two groups, respectively. CONCLUSION The prevalence of nosocomial infection has not changed since 1994, but the prevalence of antibiotic use has increased. In interpreting these findings, one should bear in mind that confounders may have influenced them in different directions: The mean length of hospital stay is now shorter than in 1994, but the mean age of hospitalized patients is higher.

ICU ward design and nosocomial infection rates: a cross-sectional study in Germany

BACKGROUND There is increasing interest in the effects of hospital and ward design on multi-faceted infection control. Definitive evidence is rare and the state of knowledge about current ward design is lacking. OBJECTIVE To collect data on the current status of ward design for intensive care units (ICUs) and to analyse associations between particular design factors and nosocomial infection rates. METHODS In 2015, operational infrastructure data were collected via an online questionnaire from ICUs participating voluntarily in the German nosocomial infection surveillance system (KISS). A multi-variate analysis was subsequently undertaken with nosocomial infection rates from the KISS database from 2014 to 2015. FINDINGS In total, 534 ICUs submitted data about their operational infrastructure. Of these, 27.1% of beds were hosted in single-bed rooms with a median size of 18m2 (interquartile range 15-21m2), and 73.5% of all ICU beds had a hand rub dispenser nearby. The authors were able to match 266 ICUs in the multi-variate analysis. ICUs with openable windows in patient rooms were associated with lower device-associated lower respiratory tract infections [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.90]. ICUs with >40% two-bed rooms were associated with lower primary bloodstream infection rates (OR 0.66, 95% CI 0.51-0.86). CONCLUSION Only minor associations were found between design factors and ICU infection rates. Most were surrogates for other risk factors.

Hygiene und Sicherheitskultur in deutschen Krankenhäusern

ZusammenfassungHintergrundNosokomiale Infektionen (NI) sind die häufigsten unerwünschten Ereignisse (UE) im Gesundheitswesen und ihre Prävention ein wichtiger Beitrag zur Patientensicherheit.FragestellungDie vorliegende Studie erfasst, in welchem Umfang hygienerelevante sicherheitskulturelle Aspekte in deutschen Krankenhäusern umgesetzt sind.MethodenAspekte der Sicherheitskultur wurden mit einem Onlinefragebogen erhoben. Die Auswertung erfolgte deskriptiv.Ergebnisse534 Krankenhäuser mit im Median 275 (IQR 157–453) Betten nahmen teil. Fast alle Krankenhäuser verfügten über Hygienerichtlinien (99,6 %), 82 % hatten Hygieneziele festgelegt: häufig hinsichtlich Händehygiene (93 %) und multiresistenten Erregern (72 %), seltener bezüglich Antibiotic Stewardship (48 %) oder Prävention spezifischer NI. Die Umsetzung von Präventionsmaßnahmen im Sinne einer „guten Praxis“ wurde in 23 % anerkannt oder belohnt. In 94 % der Krankenhäuser gab es die Möglichkeit zur Meldung von UEs. 68 % der Teilnehmer war bekannt, dass UEs im Jahr 2013 gemeldet wurden. Hierzu zählten auch niedrige Compliance bei der Händehygiene, Ausbrüche und Clostridium-difficile-assoziierte Infektionen. Die Verantwortung für die täglichen Belange der Prävention von NI wurde vorrangig dem Hygieneteam (94 %) und selten anderen Mitarbeitern (19 %) zugeschrieben.SchlussfolgerungSicherheitskulturelle Aspekte wie ein unterstützendes Arbeitsumfeld, eine Lern- und Fehlerkultur sowie das Formulieren und Kommunizieren von Hygienezielen sind noch nicht in vollem Umfang in deutschen Krankenhäusern umgesetzt. Infektionsprävention sollte stärker als bisher als ein von der Krankenhausleitung unterstützter und im Krankenhaus erkennbar kommunizierter Prozess in die täglichen Abläufe integriert werden.AbstractBackgroundHealthcare-associated infections (HAI) are the most frequent adverse events in the healthcare setting and their prevention is an important contribution to patient safety in hospitals.ObjectivesTo analyse to what extent safety cultural aspects with relevance to infection control are implemented in German hospitals.MethodsSafety cultural aspects of infection control were surveyed with an online questionnaire; data were analysed descriptively.ResultsData from 543 hospitals with a median of [IQR] 275 [157; 453] beds were analysed. Almost all hospitals (96.6 %) had internal guidelines for infection control (IC) in place; 82 % defined IC objectives, most often regarding hand hygiene (HH) (93 %) and multidrug resistant organisms (72 %) and less frequently for antibiotic stewardship (48 %) or prevention of specific HAI. In 94 % of hospitals, a reporting system for adverse events was in place, which was also used to report low compliance with HH, outbreaks and Clostridium difficile-associated infections. Members of the IC team were most often seen to hold daily responsibility for IC in the hospital, but rarely other hospital staff (94 versus 19 %).ConclusionsSafety cultural aspects are not fully implemented in German hospitals. IC should be more strongly implemented in healthcare workers’ daily routine and more visibly supported by hospital management.

Antimicrobial usage in German acute care hospitals: results of the third national point prevalence survey and comparison with previous national point prevalence surveys

Objectives Previous point prevalence surveys (PPSs) revealed the potential for improving antimicrobial usage (AU) in German acute care hospitals. Data from the 2016 German national PPS on healthcare-associated infections and AU were used to evaluate efforts in antimicrobial stewardship (AMS). Methods A national PPS in Germany was organized by the German National Reference Centre for Surveillance of Nosocomial Infections in 2016 as part of the European PPS initiated by the ECDC. The data were collected in May and June 2016. Results were compared with data from the PPS 2011. Results A total of 218 hospitals with 64 412 observed patients participated in the PPS 2016. The prevalence of patients with AU was 25.9% (95% CI 25.6%-26.3%). No significant increase or decrease in AU prevalence was revealed in the group of all participating hospitals. Prolonged surgical prophylaxis was found to be common (56.1% of all surgical prophylaxes on the prevalence day), but significantly less prevalent than in 2011 (P < 0.01). The most frequently administered antimicrobial groups were penicillins plus β-lactamase inhibitors (BLIs) (23.2%), second-generation cephalosporins (12.9%) and fluoroquinolones (11.3%). Significantly more penicillins plus BLIs and fewer second-generation cephalosporins and fluoroquinolones were used in 2016. Overall, an increase in the consumption of broad-spectrum antimicrobials was noted. For 68.7% of all administered antimicrobials, the indication was documented in the patient notes. Conclusions The current data reaffirm the points of improvement that previous data identified and reveal that recent efforts in AMS in German hospitals require further intensification.

Perceptions and attitudes regarding antibiotic resistance in Germany: a cross-sectoral survey amongst physicians, veterinarians, farmers and the general public

Background Drivers of antibiotic (AB) resistance (ABR) include outpatient treatment, hospital care and animal husbandry. During the first phase of the One Health project RAI (Responsible Antibiotic Use via Information and Communication) surveys were conducted in these sectors. Objectives To compare perceptions and attitudes towards ABR among general practitioners (GPs), hospital physicians, veterinarians, pig farmers and the general public. Methods Cross-sectional questions on AB use and ABR were integrated in group-specific surveys of GPs, hospital physicians, veterinarians, pig farmers and the German general population. Results A total of 1789 participants (340 GPs, 170 hospital physicians, 215 pig farmers, 60 veterinarians and 1004 members of the public) responded. Each group tended to identify drivers of ABR as being from outside its own area of activity. Guidelines were shown to be an important information source for AB therapy for all prescriber groups, but the frequency of routine use differed (39% of GPs, 65% of hospital physicians and 53% of veterinarians). Regarding further information sources, hospital physicians preferred smartphone apps and e-learning, GPs preferred non-sponsored training and veterinarians preferred multidisciplinary networks and e-learning. Farmers were predominantly satisfied with existing solutions. Farmers had three times better basic knowledge of ABR and knew twice as many people with MDR organism problems than the general public. They also received information on ABR more often from their veterinarians than patients did from their doctors. Conclusions This study reveals considerable differences in perceptions and attitudes to ABR among the groups investigated. The results can help to tailor future interventions. Furthermore, they promote mutual understanding and thus support the One Health approach.

Hygiene und Sicherheitskultur in deutschen Krankenhäusern@@@Infection control and safety culture in German hospitals

ZusammenfassungHintergrundNosokomiale Infektionen (NI) sind die häufigsten unerwünschten Ereignisse (UE) im Gesundheitswesen und ihre Prävention ein wichtiger Beitrag zur Patientensicherheit.FragestellungDie vorliegende Studie erfasst, in welchem Umfang hygienerelevante sicherheitskulturelle Aspekte in deutschen Krankenhäusern umgesetzt sind.MethodenAspekte der Sicherheitskultur wurden mit einem Onlinefragebogen erhoben. Die Auswertung erfolgte deskriptiv.Ergebnisse534 Krankenhäuser mit im Median 275 (IQR 157–453) Betten nahmen teil. Fast alle Krankenhäuser verfügten über Hygienerichtlinien (99,6 %), 82 % hatten Hygieneziele festgelegt: häufig hinsichtlich Händehygiene (93 %) und multiresistenten Erregern (72 %), seltener bezüglich Antibiotic Stewardship (48 %) oder Prävention spezifischer NI. Die Umsetzung von Präventionsmaßnahmen im Sinne einer „guten Praxis“ wurde in 23 % anerkannt oder belohnt. In 94 % der Krankenhäuser gab es die Möglichkeit zur Meldung von UEs. 68 % der Teilnehmer war bekannt, dass UEs im Jahr 2013 gemeldet wurden. Hierzu zählten auch niedrige Compliance bei der Händehygiene, Ausbrüche und Clostridium-difficile-assoziierte Infektionen. Die Verantwortung für die täglichen Belange der Prävention von NI wurde vorrangig dem Hygieneteam (94 %) und selten anderen Mitarbeitern (19 %) zugeschrieben.SchlussfolgerungSicherheitskulturelle Aspekte wie ein unterstützendes Arbeitsumfeld, eine Lern- und Fehlerkultur sowie das Formulieren und Kommunizieren von Hygienezielen sind noch nicht in vollem Umfang in deutschen Krankenhäusern umgesetzt. Infektionsprävention sollte stärker als bisher als ein von der Krankenhausleitung unterstützter und im Krankenhaus erkennbar kommunizierter Prozess in die täglichen Abläufe integriert werden.AbstractBackgroundHealthcare-associated infections (HAI) are the most frequent adverse events in the healthcare setting and their prevention is an important contribution to patient safety in hospitals.ObjectivesTo analyse to what extent safety cultural aspects with relevance to infection control are implemented in German hospitals.MethodsSafety cultural aspects of infection control were surveyed with an online questionnaire; data were analysed descriptively.ResultsData from 543 hospitals with a median of [IQR] 275 [157; 453] beds were analysed. Almost all hospitals (96.6 %) had internal guidelines for infection control (IC) in place; 82 % defined IC objectives, most often regarding hand hygiene (HH) (93 %) and multidrug resistant organisms (72 %) and less frequently for antibiotic stewardship (48 %) or prevention of specific HAI. In 94 % of hospitals, a reporting system for adverse events was in place, which was also used to report low compliance with HH, outbreaks and Clostridium difficile-associated infections. Members of the IC team were most often seen to hold daily responsibility for IC in the hospital, but rarely other hospital staff (94 versus 19 %).ConclusionsSafety cultural aspects are not fully implemented in German hospitals. IC should be more strongly implemented in healthcare workers’ daily routine and more visibly supported by hospital management.

Infection control and safety culture in German hospitals

ZusammenfassungHintergrundNosokomiale Infektionen (NI) sind die häufigsten unerwünschten Ereignisse (UE) im Gesundheitswesen und ihre Prävention ein wichtiger Beitrag zur Patientensicherheit.FragestellungDie vorliegende Studie erfasst, in welchem Umfang hygienerelevante sicherheitskulturelle Aspekte in deutschen Krankenhäusern umgesetzt sind.MethodenAspekte der Sicherheitskultur wurden mit einem Onlinefragebogen erhoben. Die Auswertung erfolgte deskriptiv.Ergebnisse534 Krankenhäuser mit im Median 275 (IQR 157–453) Betten nahmen teil. Fast alle Krankenhäuser verfügten über Hygienerichtlinien (99,6 %), 82 % hatten Hygieneziele festgelegt: häufig hinsichtlich Händehygiene (93 %) und multiresistenten Erregern (72 %), seltener bezüglich Antibiotic Stewardship (48 %) oder Prävention spezifischer NI. Die Umsetzung von Präventionsmaßnahmen im Sinne einer „guten Praxis“ wurde in 23 % anerkannt oder belohnt. In 94 % der Krankenhäuser gab es die Möglichkeit zur Meldung von UEs. 68 % der Teilnehmer war bekannt, dass UEs im Jahr 2013 gemeldet wurden. Hierzu zählten auch niedrige Compliance bei der Händehygiene, Ausbrüche und Clostridium-difficile-assoziierte Infektionen. Die Verantwortung für die täglichen Belange der Prävention von NI wurde vorrangig dem Hygieneteam (94 %) und selten anderen Mitarbeitern (19 %) zugeschrieben.SchlussfolgerungSicherheitskulturelle Aspekte wie ein unterstützendes Arbeitsumfeld, eine Lern- und Fehlerkultur sowie das Formulieren und Kommunizieren von Hygienezielen sind noch nicht in vollem Umfang in deutschen Krankenhäusern umgesetzt. Infektionsprävention sollte stärker als bisher als ein von der Krankenhausleitung unterstützter und im Krankenhaus erkennbar kommunizierter Prozess in die täglichen Abläufe integriert werden.AbstractBackgroundHealthcare-associated infections (HAI) are the most frequent adverse events in the healthcare setting and their prevention is an important contribution to patient safety in hospitals.ObjectivesTo analyse to what extent safety cultural aspects with relevance to infection control are implemented in German hospitals.MethodsSafety cultural aspects of infection control were surveyed with an online questionnaire; data were analysed descriptively.ResultsData from 543 hospitals with a median of [IQR] 275 [157; 453] beds were analysed. Almost all hospitals (96.6 %) had internal guidelines for infection control (IC) in place; 82 % defined IC objectives, most often regarding hand hygiene (HH) (93 %) and multidrug resistant organisms (72 %) and less frequently for antibiotic stewardship (48 %) or prevention of specific HAI. In 94 % of hospitals, a reporting system for adverse events was in place, which was also used to report low compliance with HH, outbreaks and Clostridium difficile-associated infections. Members of the IC team were most often seen to hold daily responsibility for IC in the hospital, but rarely other hospital staff (94 versus 19 %).ConclusionsSafety cultural aspects are not fully implemented in German hospitals. IC should be more strongly implemented in healthcare workers’ daily routine and more visibly supported by hospital management.