How many nosocomial infections are there in Germany and how many deaths are caused by them?
It is difficult to determine an exact figure, as there is no obligation to report nosocomial infections. Some are also overlooked or wrongly considered “outpatient infections”. Very rarely are cases in which a “perfectly healthy” patient suddenly dies of a nosocomial infection.
In most cases, nosocomial infection is a complication and not the main cause of the patient’s death. In 2006, the Robert Koch Institute initiated several large studies to determine how many nosocomial infections there are each year. The results after counting and estimating showed the following data: A total of 400,000-600,000 nosocomial infections per year are assumed, of which 14,000 are due to MRSA.
About 10. 000-15. 000 patients died from nosocomial infections.
Scientists estimate the current figures to be higher, but these vague estimates are not reliable. For example, a study from 2016, in which the Robert Koch Institute was involved, shows an estimate of 90,000 deaths attributable to nosocomial infections. Depending on the criteria on which such a study is based, the numbers may be more or less high. However, it is important to note that the Robert Koch Institute made recommendations early on regarding the prevention of nosocomial infections as a consequence and that these recommendations are updated regularly
Which nosocomial infection is the most common?
The most common pathogens are Escherichia coli, Staphylococcus aureus, Clostridium difficile, Enterococcus faecalis and Enterococcus faecium. A study of the Robert Koch Institute in 2012 showed the following: The most common nosocomial diseases are (in descending order) wound infections (24.7%), urinary tract infections (22.4%) and pneumonia or respiratory tract infections (21.5%).
How can nosocomial infection be avoided?
In principle, nosocomial infections can be avoided by trying to cure or treat the disease that causes them as well as possible. Hygiene measures and a critical assessment of when which medical measures should be taken can shorten hospital stays and make nosocomial infections avoidable. In the case of nosocomial pneumonia (pneumonia), professional hand and device disinfection (e.g. of inhalation devices) should be carried out.
Inhalation of gastric juice, saliva or food should be prevented. This can be done by aspirating the secretion with special probes and timely intubation (i.e. insertion of a breathing tube) in case of swallowing difficulties. With the help of occupational and physiotherapy, training can also be provided to (re)learn how to swallow correctly or to facilitate coughing up from the lungs.
Nosocomial urinary tract infections can be avoided by not inserting an indwelling catheter. There are also special hygiene regulations regarding the insertion and changing of permanent catheters. The nursing staff should use closed urinary drainage systems with a reflux valve and a puncture-free collection system.
In case of a suspected urinary tract infection, a small urine sample can be taken cleanly in order to be able to initiate therapy at an early stage.A urine bag should always be positioned so that it is below the level of the bladder, so that the urine cannot simply flow back. At best, the drainage tube should also not lie in loops, so that urine cannot collect in the tube and promote the growth of bacteria. For patients who are to have a catheter for more than 3 days, an indwelling catheter is not an optimal solution.
A so-called suprapubic catheter, which leads directly through the abdominal wall into the bladder, would be better. Sometimes, however, in everyday hospital life it is not foreseeable whether a patient will need a catheter for longer than 3 days. Efforts are also made to discharge the patient without a catheter rather than to make him or her catheter dependent.
Therefore, unfortunately, too many permanent catheters are still being used in clinical routine. Wound hygiene plays an important role in nosocomial wound infections. Patients should not remove or change dressings themselves if wounds are still open (i.e. not scarred).
Strict rules and procedures apply when applying plasters and dressings. Nursing and medical staff learn these rules at an early stage and usually follow them in accordance with their duties. A far greater risk of poor wound healing is posed by risk factors such as old age and diseases such as diabetes mellitus.
A weakened immune system also plays an essential role here again. The affected part of the body (e.g. the leg) should be elevated and only be changed by trained personnel. Patients themselves can ensure that weeping dressings are changed immediately.
Wetness refers to excessive wound secretion. In the case of purulent inclusions, the pus should be able to drain through incisions. It is also possible to remove pus or excess wound secretion from the wound by applying a so-called lavage or drainage.
In this way, the process of wound healing can also be checked exactly, because the amount of fluid collected is recorded. Antiseptic solutions such as Octenisept should be used to irrigate and clean a wound. If there are signs of blood poisoning, antibiotic therapy can be used, which has an effect on the entire body system.
Furthermore, visitors and patients themselves can also contribute to improved hygiene measures by using the hand disinfection service, which is available at every hospital and ward entrance. Meanwhile, the toilets are also equipped with detailed instructions for correct hand disinfection. Some hospitals have also introduced a ban on shaking hands. A few hospitals have also started to control the changing of clothes by medical staff via laundry pickup and drop-off machines. There are also hospitals where doctors are no longer allowed to wear the coat-like gown, but wear short-sleeved kasaks.
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